Category Archives: Out of Pocket Expenses

What it’s like to be a nurse after 6 months of COVID-19 response

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Contact Tracing, Coronavirus, Coronavirus Treatment, Crisis, Crisis Management, Deferred Healthcare, Economic Crisis, Elective Procedures, Elective Surgery, Employee Protections, Employer-Based Health Insurance, Essential Health Benefits, Essential Workers, Evidence-Based Care, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Expert, Expert Opinion, Front Lines, Health Insurance Coverage Adequacy, Healthcare Providers, Infection Control, Infection Control Plan, Infectious Virus, Labor Union, Mortality, National Strategy, Nurses, Nurses Union, Out of Pocket Expenses, Pandemic, Personal Protective Equipment (PPE), Preexisting Conditions, Primary Care, Public Health, Public Safety, Quarantine, Scientists, Social Determinants of Health, Social Distancing, Supply Chain, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Ventilators, Worker Protection, Worker Rights, World Health Organization (WHO) • Leave a comment

https://www.healthcaredive.com/news/what-its-like-to-be-a-nurse-6-months-coronavirus/581709/

Those on the front lines of the fight against the novel coronavirus worry about keeping themselves, their families and their patients safe.

That’s especially true for nurses seeking the reprieve of their hospitals returning to normal operations sometime this year. Many in the South and West are now treating ICUs full of COVID-19 patients they hoped would never arrive in their states, largely spared from spring’s first wave.

And like many other essential workers, those in healthcare are falling ill and dying from COVID-19. The total number of nurses stricken by the virus is still unclear, though the Centers for Disease Control and Prevention has reported 106,180 cases and 552 deaths among healthcare workers. That’s almost certainly an undercount.

National Nurses United, the country’s largest nurses union, told Healthcare Dive it has counted 165 nurse deaths from COVID-19 and an additional 1,060 healthcare worker deaths.

Safety concerns have ignited union activity among healthcare workers during the pandemic, and also given them an opportunity to punctuate labor issues that aren’t new, like nurse-patient ratios, adequate pay and racial equality.

At the same time, the hospitals they work for are facing some of their worst years yet financially, after months of delayed elective procedures and depleted volumes that analysts predict will continue through the year. Many have instituted furloughs and layoffs or other workforce reduction measures.

Healthcare Dive had in-depth conversations with three nurses to get a clearer picture of how they’re faring amid the once-in-a-century pandemic. Here’s what they said.

Elizabeth Lalasz, registered nurse, John H. Stroger Hospital in Chicago

Elizabeth Lalasz has worked at John H. Stroger Hospital in Chicago for the past 10 years. Her hospital is a safety net facility, catering to those who are “Black, Latinx, the homeless, inmates,” Lalasz told Healthcare Dive. “People who don’t actually receive the kind of healthcare they should in this country.”

Data from the CDC show racial and ethnic minority groups are at increased risk of getting COVID-19 or experiencing severe illness, regardless of age, due to long-standing systemic health and social inequities.

CDC data reveal that Black people are five times more likely to contract the virus than white people.

This spring Lalasz treated inmates from the Cook County Jail, an epicenter in the city and also the country. “That population gradually decreased, and then we just had COVID patients, many of them Latinx families,” she said.

Once Chicago’s curve began to flatten and the hospital could take non-COVID patients, those coming in for treatment were desperately sick. They’d been delaying care for non-COVID conditions, worried a trip to the hospital could risk infection.

A Kaiser Family Foundation poll conducted in May found that 48% of Americans said they or a family member had skipped or delayed medical care because of the pandemic. And 11% said the person’s condition worsened as a result of the delayed care.

When patients do come into Lalasz’s hospital, many have “chest pain, then they also have diabetes, asthma, hypertension and obesity, it just adds up,” she said.

“So now we’re also treating people who’ve been delaying care. But after the recent southern state surges, the hospital census started going down again,” she said.

Amy Arlund, registered nurse, Kaiser Permanente Medical Center in Fresno, California:

Amy Arlund works the night shift at Kaiser Fresno as an ICU nurse, which she’s done for the past two decades.

She’s also on the hospital’s infection control committee, where for years she’s fought to control the spread of clostridium difficile colitis, or C. diff., in her facility. The highly infectious disease can live on surfaces outside the body for months or sometimes years.

The measures Arlund developed to control C. diff served as her litmus test, as “the top, most stringent protocols we could adhere to,” when coronavirus patients arrived at her hospital, she told Healthcare Dive.

But when COVID-19 cases surged in northern states this spring, “it’s like all those really strict isolation protocols that prior to COVID showing up would be disciplinable offenses were gone,” Arlund said.

Widespread personal protective equipment shortages at the start of the pandemic led the CDC and the Occupational Safety and Health Administration to change their longstanding guidance on when to use N95 respirator masks, which have long been the industry standard when dealing with novel infectious diseases.

The CDC also issued guidance for N95 respirator reuse, an entirely new concept to nurses like Arlund who say those changes go against everything they learned in school.

“I think the biggest change is we always relied on science, and we have always relied heavily on infection control protocols to guide our practice,” Arlund said. “Now infection control is out of control, we can no longer rely on the information and resources we always have.”

The CDC says experts are still learning how the coronavirus spreads, though person-to-person transmission is most common, while the World Health Organization recently acknowledged that it wouldn’t rule out airborne transmission of the virus.

In Arlund’s ICU, she’s taken care of dozens of COVID positive patients and patients ruled out for coronavirus, she said. After a first wave in the beginning of April, cases dropped, but are now rising again.

Other changing guidance weighing heavily on nurses is how to effectively treat coronavirus patients.

“Are we doing remdesivir this week or are we going back to the hydroxychloroquine, or giving them convalescent plasma?”Arlund said. “Next week I’m going to be giving them some kind of lavender enema, who knows.”

Erik Andrews, registered nurse, Riverside Community Hospital in Riverside, California:

Erik Andrews, a rapid response nurse at Riverside Community Hospital in California, has treated coronavirus patients since the pandemic started earlier this year. He likens ventilating them to diffusing a bomb.

“These types of procedures generate a lot of aerosols, you have to do everything in perfectly stepwise fashion, otherwise you’re going to endanger yourself and endanger your colleagues,” Andrews, who’s been at Riverside for the past 13 years, told Healthcare Dive.

He and about 600 other nurses at the hospital went on strike for 10 days this summer after a staffing agreement between the hospital and its owner, HCA Healthcare, and SEIU Local 121RN, the union representing RCH nurses, ended without a renewal.

The nurses said it would lead to too few nurses treating too many patients during a pandemic. Insufficient PPE and recycling of single-use PPE were also putting nurses and patients at risk, the union said, and another reason for the strike.

But rapidly changing guidance around PPE use and generally inconsistent information from public officials are now making the nurses at his hospital feel apathetic.

“Unfortunately I feel like in the past few weeks it’s gotten to the point where you have to remind people about putting on their respirator instead of face mask, so people haven’t gotten lax, but definitely kind of become desensitized compared to when we first started,” Andrews said.

With two children at home, Andrews slept in a trailer in his driveway for 12 weeks when he first started treating coronavirus patients. The trailer is still there, just in case, but after testing negative twice he felt he couldn’t spend any more time away from his family.

He still worries though, especially about his coworkers’ families. Some coworkers he’s known for over a decade, including one staff member who died from COVID-19 related complications.

“It’s people you know and you know that their families worry about them every day,” he said. “So to know that they’ve had to deal with that loss is pretty horrifying, and to know that could happen to my family too.”

 

 

 

One question still dogs Administration: Why not try harder to solve the coronavirus crisis?

Posted on by • Posted in 2020 Election Issues, Accountability, Blame, Centers for Disease Control & Prevention (CDC), Clinical Testing, Competency, Contact Tracing, Coronavirus, Crisis, Crisis Management, Data, Data Analytics, Data Integrity, Data Interpretation, Data Ownership, Economic Crisis, Economic Recovery, Employer-Based Health Insurance, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, Expert, Expert Opinion, False Hope, False Narrative, Health Insurance Coverage Adequacy, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Job, Job Loss, Job Market, Job Search, Job Security, Judgement, Leadership Decentralized, Mislead, Misleading, Mistake, Mistrust, Mixed Message, Mortality, National Strategy, Out of Control, Out of Pocket Expenses, Pandemic, Preexisting Conditions, Public Health, Public Safety, Public Trust, Quarantine, Scapegoat, School Reopening, Scientists, Social Distancing, Trust, Truth, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Wishful Thinking • Leave a comment

https://www.washingtonpost.com/politics/trump-not-solve-coronavirus-crisis/2020/07/26/7fca9a92-cdb0-11ea-91f1-28aca4d833a0_story.html?utm_source=ActiveCampaign&utm_medium=email&utm_content=Republicans+Roll+Out+%241+Trillion+Coronavirus+Relief+Plan&utm_campaign=TFT+Newsletter+07272020

Questions to ask students in class to help them deal with the ...

Both President Trump’s advisers and operatives laboring to defeat him increasingly agree on one thing: The best way for him to regain his political footing is to wrest control of the novel coronavirus.

In the six months since the deadly contagion was first reported in the United States, Trump has demanded the economy reopen and children return to school, all while scrambling to salvage his reelection campaign.

But allies and opponents agree he has failed at the one task that could help him achieve all his goals — confronting the pandemic with a clear strategy and consistent leadership.

Trump’s shortcomings have perplexed even some of his most loyal allies, who increasingly have wondered why the president has not at least pantomimed a sense of command over the crisis or conveyed compassion for the millions of Americans hurt by it.

People close to Trump, many speaking on the condition of anonymity to share candid discussions and impressions, say the president’s inability to wholly address the crisis is due to his almost pathological unwillingness to admit error; a positive feedback loop of overly rosy assessments and data from advisers and Fox News; and a penchant for magical thinking that prevented him from fully engaging with the pandemic.

In recent weeks, with more than 145,000 Americans now dead from the virus, the White House has attempted to overhaul — or at least rejigger — its approach. The administration has revived news briefings led by Trump and presented the president with projections showing how the virus is now decimating Republican states full of his voters. Officials have also set up a separate, smaller coronavirus working group led by Deborah Birx, the White House coronavirus response coordinator, along with Trump son-in-law and senior adviser Jared Kushner.

For many, however, the question is why Trump did not adjust sooner, realizing that the path to nearly all his goals — from an economic recovery to an electoral victory in November — runs directly through a healthy nation in control of the virus.

“The irony is that if he’d just performed with minimal competence and just mouthed words about national unity, he actually could be in a pretty strong position right now, where the economy is reopening, where jobs are coming back,” said Ben Rhodes, a deputy national security adviser to former president Barack Obama. “And he just could not do it.”

Many public health experts agree.

“The best thing that we can do to set our economy up for success and rebounding from the last few months is making sure our outbreak is in a good place,” said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. “People are not going to feel comfortable returning to activities in the community — even if it’s allowed from a policy perspective — if they don’t feel the outbreak is under control.”

Some aides and outside advisers have tried to stress to Trump and others in his orbit that before he could move on to reopening the economy and getting the country back to work — and life — he needed to grapple with the reality of the virus.

But until recently, the president was largely unreceptive to that message, they said, not fully grasping the magnitude of the pandemic — and overly preoccupied with his own sense of grievance, beginning many conversations casting himself as the blameless victim of the crisis.

In the past couple of weeks, senior advisers began presenting Trump with maps and data showing spikes in coronavirus cases among “our people” in Republican states, a senior administration official said. They also shared projections predicting that virus surges could soon hit politically important states in the Midwest — including Michigan, Minnesota and Wisconsin, the official said.

This new approach seemed to resonate, as he hewed closely to pre-scripted remarks in a trio of coronavirus briefings last week.

“This could have been stopped. It could have been stopped quickly and easily. But for some reason, it wasn’t, and we’ll figure out what that reason was,” Trump said Thursday, seeming to simultaneously acknowledge his predicament while trying to assign blame elsewhere.

In addition to Birx and Kushner, the new coronavirus group guiding Trump includes Kushner advisers Adam Boehler and Brad Smith, according to two administration officials. Marc Short, chief of staff to Vice President Pence, also attends, along with Alyssa Farah, the White House director of strategic communications, and Stephen Miller, Trump’s senior policy adviser.

The working group’s goal is to meet every day, for no more than 30 minutes. It views its mission as half focused on the government’s response to the pandemic and half focused on the White House’s public message, the officials said.

White House spokeswoman Sarah Matthews defended the president’s handling of the crisis, saying he acted “early and decisively.”

“The president has also led an historic, whole-of-America coronavirus response — resulting in 100,000 ventilators procured, sourcing critical PPE for our front-line heroes, and a robust testing regime resulting in more than double the number of tests than any other country in the world,” Matthews said in an email statement. “His message has been consistent and his strong leadership will continue as we safely reopen the economy, expedite vaccine and therapeutics developments, and continue to see an encouraging decline in the U.S. mortality rate.”

For some, however, the additional effort is too little and far too late.

“This is a situation where if Trump did his job and put in the work to combat the health crisis, it would solve the economic crisis, and it’s an instance where the correct governing move is also the correct political move, and Trump is doing the opposite,” said Josh Schwerin, a senior strategist for Priorities USA, a super PAC supporting former vice president Joe Biden, the presumptive Democratic nominee.

Other anti-Trump operatives agree, saying he could make up lost ground and make his race with Biden far more competitive with a simple course correction.

“He’s staring in the mirror at night: That’s who can fix his political problem,” said John Weaver, one of the Republican strategists leading the Lincoln Project, a group known for its anti-Trump ads.

One of Trump’s biggest obstacles is his refusal to take responsibility and admit error.

In mid-March, as many of the nation’s businesses were shuttering early in the pandemic, Trump proclaimed in the Rose Garden, “I don’t take responsibility at all.” Those six words have neatly summed up Trump’s approach not only to the pandemic, but also to many of the other crises he has faced during his presidency.

“His operating style is to double- and triple-down on positions and to never, ever admit he’s wrong about anything,” said Anthony Scaramucci, a longtime Trump associate who briefly served as White House communications director and is now a critic of the president. “His 50-year track record is to bulldog through whatever he’s doing, whether it’s Atlantic City, which was a failure, or the Plaza Hotel, which was a failure, or Eastern Airlines, which was a failure. He can never just say, ‘I got it wrong and let’s try over again.’ ”

Another self-imposed hurdle for Trump has been his reliance on a positive feedback loop. Rather than sit for briefings by infectious-disease director Anthony S. Fauci and other medical experts, the president consumes much of his information about the virus from Fox News and other conservative media sources, where his on-air boosters put a positive spin on developments.

Consider one example from last week. About 6:15 a.m. that Tuesday on “Fox & Friends,” co-host Steve Doocy told viewers, “There is a lot of good news out there regarding the development of vaccines and therapeutics.” The president appears to have been watching because, 16 minutes later, he tweeted from his iPhone, “Tremendous progress being made on Vaccines and Therapeutics!!!”

It is not just pro-Trump media figures feeding Trump positive information. White House staffers have long made upbeat assessments and projections in an effort to satisfy the president. This, in turn, makes Trump further distrustful of the presentations of scientists and reports in the mainstream news media, according to his advisers and other people familiar with the president’s approach.

This dynamic was on display during an in-depth interview with “Fox News Sunday” anchor Chris Wallace that aired July 19. After the president claimed the United States had one of the lowest coronavirus mortality rates in the world, Wallace interjected to fact-check him: “It’s not true, sir.”

Agitated by Wallace’s persistence, Trump turned off-camera to call for White House press secretary Kayleigh McEnany. “Can you please get me the mortality rates?” he asked. Turning to Wallace, he said, “Kayleigh’s right here. I heard we have one of the lowest, maybe the lowest mortality rate anywhere in the world.”

Trump, relying on cherry-picked White House data, insisted that the United States was “number one low mortality fatality rates.”

Fox then interrupted the taped interview to air a voice-over from Wallace explaining that the White House chart showed Italy and Spain doing worse than the United States but countries like Brazil and South Korea doing better — and other countries that are doing better, including Russia, were not included on the White House chart. By contrast, worldwide data compiled by Johns Hopkins University shows the U.S. mortality rate is far from the lowest.

Trump is also predisposed to magical thinking — an unerring belief, at an almost elemental level, that he can will his goals into existence, through sheer force of personality, according to outside advisers and former White House officials.

The trait is one he shares with his late father and family patriarch, Fred Trump. In her best-selling memoir, “Too Much and Never Enough,” the president’s niece, Mary L. Trump, writes that Fred Trump was instantly taken by the “shallow message of self-sufficiency” he encountered in Norman Vincent Peale’s 1952 bestseller, “The Power of Positive Thinking.”

Some close to the president say that when Trump claims, as he did twice last week, that the virus will simply “disappear,” there is a part of him that actually believes the assessment, making him more reluctant to take the practical steps required to combat the pandemic.

Until recently, Trump also refused to fully engage with the magnitude of the crisis. After appointing Pence head of the coronavirus task force, the president gradually stopped attending task force briefings and was lulled into a false sense of assurance that the group had the virus under control, according to one person familiar with the dynamic.

Trump also maintained such a sense of grievance — about how the virus was personally hurting him, his presidency and his reelection prospects — that aides recount spending valuable time listening to his gripes, rather than focusing on crafting a national strategy to fight the pandemic.

Nonetheless, some White House aides insist the president has always been focused on aggressively responding to the virus. And some advisers are still optimistic that if Trump — who trails Biden in national polls — can sustain at least a modicum of self-discipline and demonstrate real focus on the pandemic, he can still prevail on Election Day.

Others are less certain, including critics who say Trump squandered an obvious solution — good governance and leadership — as the simplest means of achieving his other goals.

“There is quite a high likelihood where people look back and think between February and April was when Trump burned down his own presidency, and he can’t recover from it,” Rhodes said. “The decisions he made then ensured he’d be in his endless cycle of covid spikes and economic disruption because he couldn’t exhibit any medium- or long-term thinking.”

 

 

 

Pandemic Proves Why Leaders Must Protect Americans From Junk Insurance Plans

Posted on by • Posted in 2020 Election Issues, Chronic Care Management, Chronic Conditions, Chronic Diseases, Consumer Advocacy, Consumer Protection, Coronavirus, Dept of Health and Human Services (HHS), Employer-Based Health Insurance, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Policy, Job, Job Loss, Job Market, Job Search, Job Security, Out of Pocket Expenses, Pandemic, Preexisting Conditions, Short Term Health Insurance, Skinny Health Plans, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://morningconsult.com/opinions/pandemic-proves-why-leaders-must-protect-americans-from-junk-insurance-plans/?utm_source=ActiveCampaign&utm_medium=email&utm_content=Republicans+Roll+Out+%241+Trillion+Coronavirus+Relief+Plan&utm_campaign=TFT+Newsletter+07272020

Cartoon – Short Term Health Insurance | HENRY KOTULA

The coronavirus pandemic hit the nation hard and fast, infecting Americans from coast to coast, overwhelming health care systems and wreaking havoc on the economy. Those with pre-existing conditions – like diabetes and cardiovascular disease – are more vulnerable to the deadly virus. Americans have higher rates of these chronic conditions than other countries, in part because so many people live without health insurance or have shoddy coverage. This has become increasingly worse over the last four years as underlying health coverage has shrunken for the virus’s hardest hit victims: Black Americans, Native Americans and people of color.

Of the hundreds of thousands of Americans now recovering from COVID-19, many will undoubtedly have new chronic conditions, like lasting lung damage. This will be on top of the pre-existing conditions many who were predisposed to coronavirus already had. Record job losses in the wake of the pandemic have resulted in the loss of employer-sponsored coverage for more than 5 million Americans who are now on the hunt for new, affordable health insurance plans.

This presents the perfect storm for junk insurance plans – short-term limited duration insurance plans – that allow discrimination based on pre-existing conditions, expose consumers to financial risk and provide inadequate coverage. STLDIs are more dangerous now than ever in our new COVID-19 reality. Let’s be clear: These junk insurance plans – touted by the Trump administration and supported through taxpayer dollars – are not the answer. It is time for our leaders to put back the limitations on how long they can be used.

As their name suggests, short-term limited duration plans are meant to be used temporarily to bridge short-term gaps in coverage that arise from a job loss or other extenuating circumstance. However, new federal rules under the Trump administration have allowed the coverage period of STLDI plans to expand from six to 12 months. The administration has also promoted these plans to states as being eligible for federal subsidies, meaning our tax dollars help pay for them. President Donald Trump himself has touted these plans for being more affordable than Obamacare, but that is because they lack the same protections and do not meet minimum essential coverage standards under the law.

That is what makes these plans so dangerous. Though they tend to be less expensive than Affordable Care Act plans, they leave consumers vulnerable to unanticipated out-of-pocket costs by offering bare-bones coverage. Unlike ACA plans, STLDI plans can exclude coverage for pre-existing conditions, do not cover the cost of prescription drugs, have annual or lifetime maximums on covered services, and are not required to cover preventive services like cancer screenings or maternity care.

The lower price tag may lure consumers suffering financially during the pandemic, but they are high risk for those who do not fully understand what they are buying. Without carefully reading the fine print, many may not know before purchasing that STLDI plans are exempt from ACA rules as well as regulations for insurers recently passed in the Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act. We have already seen the pandemic exacerbate existing health inequalities in America, and now these plans expose consumers, especially low-income individuals and those with chronic conditions, to more discrimination and financial ruin.

The Department of Health and Human Services has already acknowledged that these plans fall short. In fact, the government is having to cover the cost of COVID-19 testing for people with STLDI plans, classifying them as “uninsured.” Yet, they will not cover the cost of COVID-19 treatment, meaning those with STLDI plans could face bills in the thousands of dollars, considering the average cost to treat a hospitalized coronavirus patient is $30,000.

Consumers for Quality Care, a coalition of advocates and former policy makers which provides a voice for patients in the health care debate, recently sent a letter to HHS Secretary Alex Azar and Centers for Medicare & Medicaid Services Administrator Seema Verma asking that they protect consumers from these dangerous plans.

This pandemic has laid bare how dangerously unprepared America’s health care system is for a large-scale public health crisis. People needed high-quality insurance coverage before coronavirus hit, and they will need it long after the pandemic subsides. Let this be a lesson to the Trump administration – it is time to stop backing junk insurance plans and remove them from the open market. If our leaders fail to act, the lives and financial well-being of millions of Americans are at stake.

 

 

 

 

Administration’s talking health care again, with 2020 in mind

Posted on by • Posted in 2020 Election Issues, ACA, Economic Crisis, Economic Recovery, Employer-Based Health Insurance, Essential Health Benefits, Executive Orders, False Narrative, Health Insurance Coverage Adequacy, Health Policy, Health System, High Drug Prices, Hospital, Hospital Industry, Individual Mandate, Job, Job Loss, Job Market, Job Search, Job Security, Mixed Message, Opioid Epidemic, Out of Pocket Expenses, Preexisting Conditions, Price Transparency, Public Option, Short Term Health Insurance, Skinny Health Plans, Telemedicine, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

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Tell us: How has Trump handled healthcare in his first 100 days ...

Polls show voters say Joe Biden would handle the issue better. And Trump is running short on options to make concrete changes before November.

President Donald Trump is suddenly talking about health care again.

He signed several executive orders on drug pricing on Friday. He vowed to unveil some new health plan by the end of next week, although he hasn’t provided specifics or an explanation of how he’ll do it. His aides are touting a speech in which Trump will lay out his health care vision. White House counselor to the president Kellyanne Conway has been calling Trump “the health care president.”

Yet it’s unlikely to amount to much in terms of policy ahead of the election. There’s almost no chance Congress will enact any legislation on the issue before November and policy specialists say the executive orders in question will make changes only at the margins — if they make any changes at all. Trump has also previously vowed to roll out a grand health care plan without following through.

That leaves Trump with mostly rhetorical options — even if he insists otherwise — cognizant that voters consistently rank health care as a top priority and say Joe Biden, Trump’s presumptive 2020 rival, would handle the issue better than the president. Meanwhile, Trump is running for reelection having not replaced Obamacare or presented an alternative — all while urging the Supreme Court to overturn the decade-old health law. And millions of Americans are currently losing their health insurance as the coronavirus-gripped economy sputters.

“I think politically, the main objective will be to have something he can call a plan, but it will be smaller than a plan. Just something that he can talk about,” said Drew Altman, president and CEO of the Kaiser Family Foundation, a nonpartisan health policy organization. “But it’s almost inconceivable that anything can be delivered legislatively before the election.”

Trump has long stumped on his pledges to kill Obamacare, the law his predecessor implemented that expanded Americans’ access to health insurance, set baseline standards for coverage, introduced penalties for not having insurance and guaranteed coverage for preexisting conditions. But conservatives say the law introduced too many mandates and drove up costs.

But after winning election in 2016, Trump failed to overturn the law in Congress — or even offer an agreed upon alternative to the law — despite holding the majority in both chambers on Capitol Hill. Democrats then retook the House in the 2018 midterms, essentially ending any chances the law, formally known as the Affordable Care Act, would be repealed.

Even some conservatives said the ongoing failure to present a concrete replacement plan is helping the Democrats politically.

Republicans, said Joe Antos, a health expert at the conservative American Enterprise Institute, “spent basically 2010 to today arguing that the ACA is no good. After 10 years, clearly there are some problems with starting all over again. I haven’t detected very strong interest, at least among elected officials, in revisiting that.”

But the coronavirus pandemic has added pressure to address health care costs, and Trump has lagged behind Biden on his handling of the issue in polls. Fifty seven percent of registered voters recently polled by Quinnipiac said Biden would do a better job on health care than Trump, while only 35 percent approved of Trump’s handling of health care as president. And on the issue of affordability, a CNBC poll found 55 percent of battleground voters favored Biden and the Democrats, compared with 45 percent who preferred Trump and the Republicans.

“At this point, there are two huge issues, jobs and the economy, and health care, i.e., the coronavirus. If anything that’s simply been magnified,” said David Winston, a Republican pollster and strategist. “Given the fact that it’s one of the top issues, it’s not like there’s a choice but to talk about it. If candidates aren’t making statements and proposing solutions around that, it’s a requirement. Both candidates have to address it.”

Biden has campaigned on expanding Obamacare while also promising to implement a “public option” similar to Medicare, which is government-run health insurance for seniors. On drug pricing, he and Trump embrace some of the same ideas, like allowing the safe importation of drugs from other countries where they are cheaper. Biden also supports direct Medicare negotiation of drug prices, a Democratic priority that Trump supported during the 2016 campaign before reversing course.

“Donald Trump has spent his entire presidency working to take health care away from tens of millions of Americans and gut coverage for preexisting conditions,” said Andrew Bates, a Biden campaign spokesman. “If the Trump campaign wants to continue their pattern of highlighting the worst possible contrasts for Donald Trump, we certainly won’t stop them.”

The Trump administration insists it can point to several health care victories during Trump’s term.

Trump frequently notes the removal of the penalty for Americans who do not purchase insurance as a major victory, falsely claiming it is equivalent to overturning Obamacare.

Trump also signed an executive order last year to fight kidney disease to encourage home dialysis and increase the amount of kidney transplants, and he expanded telehealth medicine during the pandemic.

More recently, the U.S. Court of Appeals for the District of Columbia upheld a Trump administration rule expanding the availability of short-term health plans, which Trump has touted as an alternative to Obamacare but Democrats deride as “junk.” The plans are typically cheaper than Obamacare coverage because they don’t provide the same level of benefits or consumer protections for preexisting conditions.

A federal judge in June similarly upheld another Trump administration rule requiring hospitals to disclose the prices they have negotiated with insurers. Price transparency in the health care system has long been a significant issue, with Americans rarely having clarity over how much their treatments will cost ahead of time. Trump called the win “bigger than health care itself,” in an apparent reference to Obamacare. It’s unclear whether transparency will force down health care prices, and hospitals opposing the rule have appealed the judge’s decision.

And on Friday at the White House, Trump held an event to sign four executive orders aimed at slashing drug pricing. The move aimed to tackle a largely unfulfilled signature campaign promise — that he would stop pharmaceutical companies from “getting away with murder.”

“We are ending the sellouts, betrayals and broken promises from Washington,” Trump said Friday.“You have a lot of broken promises from Washington.”

But the orders appeared largely symbolic for now, as they were not immediately enforceable, contained notable caveats and may not be completed before the election anyway. For instance, an order requiring drugmakers to pass along any discounts directly to seniors requires the health secretary to confirm the plan won’t result in higher premiums or drive up federal spending. But the White House had shelved that plan last summer over worries the move might hike seniors’ Medicare premiums ahead of the election and cost taxpayers $180 billion over the next decade.

Conway disputed that Trump had not made progress on issues like drug pricing.

“President Trump is directing the development of therapeutics and vaccines, has delivered lower prescription drug costs, increased transparency in pricing for consumers and is committed to covering preexisting conditions and offering higher quality health care with lower costs and more choices,” she said.

Yet a number of Trump’s other health care initiatives have faced hurdles — especially amid the coronavirus pandemic.

The opioid crisis, which the president had touted as a top priority and campaigned on in 2016, is getting worse. Drug overdose deaths hit a record high in 2019 and federal and state data shows they are skyrocketing in 2020.

“The overdose epidemic will not take a back seat simply because Covid-19 has hit us hard, and that needs to be reflected in policy,” said Andrew Kessler, founder and principal of Slingshot Solutions, a behavioral health consulting firm.

The president’s plan to end HIV by 2030 has similarly receded during the pandemic. And Trump’s proposal on improving kidney care — an issue that affects roughly 15 percent of American adults — is still in its early stages and will not be finalized until next year.

 

 

 

Diabetes highlights two Americas: One where COVID is easily beaten, the other where it’s often devastating

Posted on by • Posted in Access & Quality of Healthcare, Chronic Care Management, Chronic Conditions, Chronic Diseases, Coronavirus, Coronavirus Long-Term Complications, Coronavirus Treatment, Diabetes, Essential Health Benefits, Essential Workers, Evidence-Based Care, Health Insurance Coverage Adequacy, Mortality, Out of Pocket Expenses, Pandemic, Preexisting Conditions, Primary Care, Social Determinants of Health, Underinsured, Unemployment, Unemployment Insurance, Uninsured, Vulnerable Populations • Leave a comment

https://www.usatoday.com/story/news/health/2020/07/27/diabetes-and-covid-two-americas-health-problems/5445836002/?utm_source=Sailthru&utm_medium=email&utm_campaign=Issue:%202020-07-27%20Healthcare%20Dive%20%5Bissue:28706%5D&utm_term=Healthcare%20Dive

What You Need to Know about Diabetes and the Coronavirus | diaTribe

Dr. Anne Peters splits her mostly virtual workweek between a diabetes clinic on the west side of Los Angeles and one on the east side of the sprawling city. 

Three days a week she treats people whose diabetes is well-controlled. They have insurance, so they can afford the newest medications and blood monitoring devices. They can exercise and eat well.  Those generally more affluent West L.A. patients who have gotten COVID-19 have developed mild to moderate symptoms – feeling miserable, she said – but treatable, with close follow-up at home.

“By all rights they should do much worse, and yet most don’t even go to the hospital,” said Peters, director of the USC Clinical Diabetes Programs.

On the other two days of her workweek, it’s a different story.

In East L.A., many patients didn’t have insurance even before the pandemic. Now, with widespread layoffs, even fewer do. They live in “food deserts,” lacking a car or gas money to reach a grocery store stocked with fresh fruits and vegetables. They can’t stay home, because they’re essential workers in grocery stores, health care facilities and delivery services. And they live in multi-generational homes, so even if older people stay put, they are likely to be infected by a younger relative who can’t.

They tend to get COVID-19 more often and do worse if they get sick, with more symptoms and a higher likelihood of ending up in the hospital or dying, said Peters, also a member of the leadership council of Beyond Type 1, a diabetes research and advocacy organization. 

“It doesn’t mean my East Side patients are all doomed,” she emphasized.

But it does suggest COVID-19 has an unequal impact, striking people who are poor and already in ill health far harder than healthier, better off people on the other side of town.

Tracey Brown has known that for years.

“What the COVID-19 pandemic has done is shined a very bright light on this existing and pervasive problem,” said Brown, CEO of the American Diabetes Association. Along with about 32 million others – roughly 1 in 10 Americans – Brown has diabetes herself.

“We’re in 2020, and every 5 minutes, someone is losing a limb” to diabetes, she said. “Every 10 minutes, somebody is having kidney failure.”

Americans with diabetes and related health conditions are 12 times more likely to die of COVID-19 than those without such conditions, she said. Roughly 90% of Americans who die of COVID-19 have diabetes or other underlying conditions. And people of color are over-represented among the very sick and the dead.

Diabetes and COVID: Coronavirus highlights America's health problems

Diabetes increases COVID risk

The data is clear: People with diabetes are at increased risk of having a bad case of COVID-19, and diabetics with poorly controlled blood sugar are at even higher risk, said Liam Smeeth, dean of the faculty of epidemiology and population health at the London School of Hygiene and Tropical Medicine. He and his colleagues combed data on 17 million people in the U.K. to come to their conclusions.

Diabetes often comes paired with other health problems – obesity and high blood pressure, for instance. Add smoking, Smeeth said, and “for someone with diabetes in particular, those can really mount up.”

People with diabetes are more vulnerable to many types infections, Peters said, because their white blood cells don’t work as well when blood sugar levels are high. 

“In a test tube, you can see the infection-fighting cells working less well if the sugars are higher,” she said.

Peters recently saw a patient whose diabetes was triggered by COVID-19, a finding supported by one recent study.

Going into the hospital with any viral illness can trigger a spike in blood sugar, whether someone has diabetes or not. Some medications used to treat serious cases of COVID-19 can “shoot your sugars up,” Peters said.

In patients who catch COVID-19 but aren’t hospitalized, Peters said, she often has to reduce their insulin to compensate for the fact that they aren’t eating as much.

Low income seems to be a risk factor for a bad case of COVID-19, even independent of age, weight, blood pressure and blood sugar levels, Smeeth said. “We see strong links with poverty.”

Some of that is driven by occupational risks, with poorer people unable to work from home or avoid high-risk jobs. Some is related to housing conditions and crowding into apartments to save money. And some, may be related to underlying health conditions.

But the connection, he said, is unmistakable.

Peters recently watched a longtime friend lose her husband. Age 60 and diabetic, he was laid off due to COVID, which cost him his health insurance. He developed a foot ulcer that he couldn’t afford to treat. He ignored it until he couldn’t stand anymore and then went to the hospital.

After surgery, he was released to a rehabilitation facility where he contracted COVID. He was transferred back to the hospital, where he died four days later.

“He died, not because of COVID and not because of diabetes, but because he didn’t have access to health care when he needed it to prevent that whole process from happening,” Peters said, adding that he couldn’t see his family in his final days and died alone. “It just breaks your heart.”

Taking action on diabetes– personally and nationally

Now is a great time to improve diabetes control, Peters added. With many restaurants and most bars closed, people can have more control over what they eat. No commuting leaves more time for exercise.

That’s what David Miller has managed to do. Miller, 65, of Austin, Texas, said he has stepped up his exercise routine, walking for 40 minutes four mornings a week at a nearby high school track. It’s cool enough at that hour, and the track’s not crowded, said Miller, an insurance agent, who has been able to work from home during the pandemic. “That’s more consistent exercise than I’ve ever done.”

His blood sugar is still not where he wants it to be, he said, but his new fitness routine has helped him lose a little weight and bring his blood sugar under better control. Eating less remains a challenge. “I’m one of those middle-aged guys who’s gotten into the habit of eating for two,” he said. “That can be a hard habit to shake.”

Miller said he isn’t too worried about getting COVID-19.

“I’ve tried to limit my exposure within reason,” he said, noting that he wears a mask when he can in public. “I honestly don’t feel particularly more vulnerable than anybody else.”

Smeeth, the British epidemiologist, said even though they’re at higher risk for bad outcomes, people with diabetes should know that they’re not helpless. 

“The traditional public health messages – don’t be overweight, give up smoking, keep active  – are still valid for COVID,” he said. Plus, people with diabetes should prioritize getting a flu vaccine this fall, he said, to avoid compounding their risk.

(For more practical recommendations for those living with diabetes during the pandemic, go to coronavirusdiabetes.org.)

In Los Angeles, Peters said, the county has made access to diabetes medication much easier for people with low incomes. They can now get three months of medication, instead of only one. “We refill everybody’s medicine that we can to make sure people have the tools,” she said, adding that diabetes advocates are also doing what they can to help people get health insurance.

Controlling blood sugar will help everyone, not just those with diabetes, Peters said. Someone hospitalized with uncontrolled blood sugar takes up a bed that could otherwise be used for a COVID-19 patient. 

Brown, of the American Diabetes Association, has been advocating for those measures on a national level, as well as ramping up testing in low-income communities. Right now, most testing centers are in wealthier neighborhoods, she said, and many are drive-thrus, assuming that everyone who needs testing has a car.

Her organization is also lobbying for continuity of health insurance coverage if someone with diabetes loses their job, as well as legislation to remove co-pays for diabetes medication.

“The last thing we want to have happen is that during this economically challenged time, people start rationing or skipping their doses of insulin or other prescription drugs,” Brown said. That leads to unmanaged diabetes and complications like ulcers and amputations. “Diabetes is one of those diseases where you can control it. You shouldn’t have to suffer and you shouldn’t have to die.”

 

 

Increasing unemployment alters national payer mix

Posted on by • Posted in 2020 Election Issues, ACA, Bad Debt Expense, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Economy Reopening, Employee Benefits, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employee Protections, Employer-Based Health Insurance, Health Insurance Coverage Adequacy, Health System, Hospital, Hospital Industry, Job, Job Loss, Job Market, Job Search, Job Security, Medicaid, Medicaid Expansion, Out of Pocket Expenses, Pandemic, Payor Mix, Rev Cycle Management, Revenue Cycle, Uncompensated Care, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://mailchi.mp/9075526b5806/the-weekly-gist-july-24-2020?e=d1e747d2d8

 

One in every five workers is now collecting unemployment benefits as the country struggles to get the COVID-19 outbreak under control. A recent Families USA study estimates a quarter of the 21.9M workers that were furloughed or laid off between February and May lost their health insurance. And the payer mix will continue to change as the pandemic wears on.

The graphic below highlights a study from consultancy Oliver Wyman, looking at the impact of rising unemployment (at 15, 20 and 30 percent) on insurance coverage. With each five to ten percent rise in unemployment, the commercially insured population decreases by three to five percent. Those who lose employer-sponsored insurance either remain uninsured, buy coverage on the Obamacare marketplaces, or qualify for Medicaid.

Surprisingly, Washington State and California are reporting little to no enrollment growth in Medicaid programs thus far. Experts point to lack of outreach and consumer awareness as key contributors to the slow growth—but Medicaid enrollment will likely begin to rise quickly in coming months as temporary furloughs convert to more permanent layoffs.

The right side of the graphic spotlights the growing number of uninsured individuals in those states with the highest uninsured rates. The previous record for the largest increase in uninsured adults was between 2008 and 2009, when nearly 4M lost coverage. The current pandemic-driven increase has crushed that record by 39 percent.

On average, states are seeing uninsured populations increase by two percent, with some as high as five percent. And the two states with the highest uninsured rates, Florida and Texas, are also dealing with the largest surge in COVID-19 cases and deaths. The ranks of the uninsured will continue to climb as states reimpose shutdowns, government assistance ends, and layoffs grow.

 

 

U.S. Coronavirus Pandemic Status: It’s about to get a lot worse

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy Reopening, Employee Benefits, Employee Furlough, Employee Layoffs, Employee Pay Cuts, Employee Protections, Employer-Based Health Insurance, False Hope, False Narrative, Health Insurance Coverage Adequacy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Infection Control, Infection Control Plan, Infectious Virus, Job, Job Loss, Job Market, Job Search, Job Security, Leadership Decentralized, Mortality, National Strategy, Out of Pocket Expenses, Pandemic, Pandemic Fatigue, Paycheck Protection Program, Preexisting Conditions, Public Health, Public Safety, Quarantine, Social Distancing, Uncertainty, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://www.axios.com/coronavirus-pain-getting-worse-cd329f4c-9962-4f40-b401-7a7ac1a393cf.html

The pain of the coronavirus is about to get a lot worse - Axios

For months now, American workers, families and small businesses have been saying they can’t keep up their socially distanced lives for much longer. We’ve now arrived at “much longer” — and the pandemic isn’t going away anytime soon.

The big picture: The relief policies and stopgap measures that we cobbled together to get us through the toughest weeks worked for a while, but they’re starting to crumble just as cases are spiking in the majority of states.

Next week, the extra $600 per week in expanded unemployment benefits will expire. And there’s no indication that Congress has reached a consensus on extending this assistance or providing anything in its place.

  • But nearly half of the U.S. population is still jobless, and millions will remain jobless for the foreseeable future. There are 14 million more unemployed people than there are jobs, per the Economic Policy Institute.
  • Nearly a third of Americans missed a housing payment in July — and that was with the additional $600. Plus, most Americans have already spent the stimulus checks they received at the beginning of the pandemic.
  • “We should be very concerned about what’s going to happen in August and beyond” — starting with a spike in evictions, Mathieu Despard, who leads the Social Policy Institute at the Washington University in St. Louis, tells Axios.

Expect more furloughs and layoffs as more small businesses are pushed off the pandemic cliff.

  • By economists’ estimates, more than 100,000 small businesses have permanently closed since the pandemic began.
  • For those that are hanging on, loans from the Paycheck Protection Program (PPP) have not been enough, and the back and forth between re-opening and then closing again as states deal with new case waves has been devastating. In fact, rates of closure have started increasing, the New York Times reports, citing Yelp data.
  • The big firms aren’t immune either. Just last week, behemoths like United Airlines, Wells Fargo, Walgreens and Levi’s either cut jobs or told workers their jobs were at risk, Axios’ Dion Rabouin writes.

And the question of whether schools will reopen looms.

  • Since schools sent kids home in March, and most summer camps didn’t open their doors for the summer, working parents have been dealing with a child care crisis — attempting to do their jobs, care for their kids and homeschool all at once — and hoping that the stress will be temporary.
  • The situation is more dire for low-income families with kids who rely on school lunches or for single parents who are juggling work and parenting without any help.
  • Now the public heath crisis hasn’t abated, and school districts are running out of time to figure out what the fall will look like. Some, starting with Los Angeles, have already decided to go online.

The bottom line: “It’s the uncertainty that is anxiety-inducing,” says Despard. “If you give people a time horizon and say, ‘Look you have to get through these next 8 weeks of extreme shutdown,’ they’ll do it. Now it’s like, ‘How much longer?'”

 

 

 

 

 

Cartoon – Coronavirus Sign of the Times

Posted on by • Posted in Cartoon, Clinical Diagnosis, Clinical Testing, Coronavirus, Diagnosis, Health Insurance Coverage Adequacy, High Deductible Health Plans, Mortality, Office Visit, Out of Pocket Expenses, Pandemic, Physician, Rev Cycle Management, Revenue Cycle, Sign of the Times, Today • Leave a comment

Cartoon – It remains to be seen which will get you first | HENRY ...

Texas has the highest uninsured rate in the U.S., with 29 percent of adults uninsured as of May

Posted on by • Posted in 2020 Election Issues, ACA, Chronic Care Management, Chronic Conditions, Chronic Diseases, Deferred Healthcare, Employer-Based Health Insurance, Essential Health Benefits, Health Insurance Coverage Adequacy, Health Policy, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Medicaid, Medicaid Expansion, Medicare, Out of Pocket Expenses, Preexisting Conditions, Uncompensated Care, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://www.beckershospitalreview.com/rankings-and-ratings/states-ranked-by-uninsured-rates.html?utm_medium=email

COVID-19 Health: Rate of Uninsured Americans by City - Self

Texas has the highest uninsured rate in the U.S., with 29 percent of adults uninsured as of May, according to a report from Families USA. 

The report compared uninsured rates in 2018 to rates in May 2020 using data from the U.S. Bureau of Labor Statistics and the Urban Institute. Every state saw an increase in the number of uninsured, and the total number of uninsured in the U.S. climbed 21 percent.

The increase was due in part to layoffs tied to the COVID-19 pandemic in recent months. Nearly 5.4 million Americans lost health insurance coverage from February to May of this year due to job losses, according to the report.

Below is the total percentage of all uninsured adults in each state and the District of Columbia as of May. 

Texas: 29 percent

Florida: 25 percent

Oklahoma: 24 percent

Georgia: 23 percent

Mississippi: 22 percent

Nevada: 21 percent

North Carolina: 20 percent

South Carolina: 20 percent

Alabama: 19 percent

Tennessee: 19 percent

Idaho: 18 percent

Alaska: 17 percent

Arizona: 17 percent

Missouri: 17 percent

Wyoming: 17 percent

New Mexico: 16 percent

South Dakota: 16 percent

Arkansas: 15 percent

Kansas: 15 percent

Louisiana: 14 percent

Virginia: 14 percent

California: 13 percent

Colorado: 13 percent

Illinois: 13 percent

Indiana: 13 percent

Maine: 13 percent

Montana: 13 percent

New Jersey: 13 percent

Oregon: 13 percent

Utah: 13 percent

Michigan: 12 percent

Nebraska: 12 percent

Washington: 12 percent

West Virginia: 12 percent

Delaware: 11 percent

Maryland: 11 percent

New Hampshire: 11 percent

North Dakota: 11 percent

Ohio: 11 percent

Connecticut: 10 percent

Hawaii: 10 percent

Kentucky: 10 percent

New York: 10 percent

Pennsylvania: 10 percent

Wisconsin: 10 percent

Iowa: 9 percent

Rhode Island: 9 percent

Massachusetts: 8 percent

Minnesota: 8 percent

Vermont: 7 percent

District of Columbia: 6 percent

 

 

What happens if Covid-19 symptoms don’t go away? Doctors are trying to figure it out.

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Clinical Trials, Contact Tracing, Coronavirus, Coronavirus Long-Term Complications, Coronavirus Treatment, Deconditioning, Delirium, Essential Businesses, Essential Workers, Evidence-Based Care, Health Insurance Coverage Adequacy, Health Policy, Health System, Hospital, Hospital Industry, Infection Control, Infection Control Plan, Infectious Virus, Intensive Care (ICU), Lingering Symptoms, Long-Term Consequences, Mortality, Out of Pocket Expenses, Pandemic, Post-Covid Care, Preexisting Conditions, Public Health, Public Safety, Quarantine, Scientists, Social Distancing, Underinsured, Uninsured • Leave a comment

https://www.vox.com/2020/7/14/21324201/covid-19-long-term-effects-symptoms-treatment

Covid-19 long-term effects: People with persistent symptoms ...

People with long-term Covid-19 complications are meanwhile struggling to get care.

In late March, when Covid-19 was first surging, Jake Suett, a doctor of anesthesiology and intensive care medicine with the National Health Service in Norfolk, England, had seen plenty of patients with the disease — and intubated a few of them.

Then one day, he started to feel unwell, tired, with a sore throat. He pushed through it, continuing to work for five days until he developed a dry cough and fever. “Eventually, I got to the point where I was gasping for air literally doing nothing, lying on my bed.”

At the hospital, his chest X-rays and oxygen levels were normal — except he was gasping for air. After he was sent home, he continued to experience trouble breathing and developed severe cardiac-type chest pain.

Because of a shortage of Covid-19 tests, Suett wasn’t immediately tested; when he was able to get a test, 24 days after he got sick, it came back negative. PCR tests, which are most commonly used, can only detect acute infections, and because of testing shortages, not everyone has been able to get a test when they need one.

It’s now been 14 weeks since Suett’s presumed infection and he still has symptoms, including trouble concentrating, known as brain fog. (One recent study in Spain found that a majority of 841 hospitalized Covid-19 patients had neurological symptoms, including headaches and seizures.) “I don’t know what my future holds anymore,” Suett says.

Some doctors have dismissed some of his ongoing symptoms. One doctor suggested his intense breathing difficulties might be related to anxiety. “I found that really surprising,” Suett says. “As a doctor, I wanted to tell people, ‘Maybe we’re missing something here.’” He’s concerned not just for himself, but that many Covid-19 survivors with long-term symptoms aren’t being acknowledged or treated.

Suett says that even if the proportion of people who don’t eventually fully recover is small, there’s still a significant population who will need long-term care — and they’re having trouble getting it. “It’s a huge, unreported problem, and it’s crazy no one is shouting this from rooftops.”

In the US, a number of specialized centers are popping up at hospitals to help treat — and study — ongoing Covid-19 symptoms. The most successful draw on existing post-ICU protocols and a wide range of experts, from pulmonologists to psychiatrists. Yet even as care improves, patients are also running into familiar challenges in finding treatment: accessing and being able to pay for it.

What’s causing these long-term symptoms?

Scientists are still learning about the many ways the virus that causes Covid-19 impacts the body — both during initial infection and as symptoms persist.

One of the researchers studying them is Michael Peluso, a clinical fellow in infectious diseases at the University of California San Francisco, who is currently enrolling Covid-19 patients in San Francisco in a two-year study to study the disease’s long-term effects. The goal is to better understand what symptoms people are developing, how long they last, and eventually, the mechanisms that cause them. This could help scientists answer questions like how antibodies and immune cells called T-cells respond to the virus, and how different individuals might have different immune responses, leading to longer or shorter recovery times.

At the beginning of the Covid-19 pandemic, “the assumption was that people would get better, and then it was over,” Peluso says. “But we know from lots of other viral infections that there is almost always a subset of people who experience longer-term consequences.” He explains these can be due to damage to the body during the initial illness, the result of lingering viral infection, or because of complex immunological responses that occur after the initial disease.

“People sick enough to be hospitalized are likely to experience prolonged recovery, but with Covid-19, we’re seeing tremendous variability,” he says. It’s not necessarily just the sickest patients who experience long-term symptoms, but often people who weren’t even initially hospitalized.

That’s why long-term studies of large numbers of Covid-19 patients are so important, Peluso says. Once researchers can find what might be causing long-term symptoms, they can start targeting treatments to help people feel better. “I hope that a few months from now, we’ll have a sense if there is a biological target for managing some of these long-term symptoms.”

Lekshmi Santhosh, a physician lead and founder of the new post-Covid OPTIMAL Clinic at UCSF, says many of her patients are reporting the same kinds of problems. “The majority of patients have either persistent shortness of breath and/or fatigue for weeks to months,” she says.

Additionally, Timothy Henrich, a virologist and viral immunologist at UCSF who is also a principal investigator in the study, says that getting better at managing the initial illness may also help. “More effective acute treatments may also help reduce severity and duration of post-infectious symptoms.”

In the meantime, doctors can already help patients by treating some of their lingering symptoms. But the first step, Peluso explains, is not dismissing them. “It is important that patients know — and that doctors send the message — that they can help manage these symptoms, even if they are incompletely understood,” he says. “It sounds like many people may not be being told that.”

Long-term symptoms, long-term consequences

Even though we have a lot to learn about the specific damage Covid-19 can cause, doctors already know quite a bit about recovery from other viruses: namely, how complex and challenging a task long-term recovery from any serious infection can be for many patients.

Generally, it’s common for patients who have been hospitalized, intubated, or ventilated — as is common with severe Covid-19 — to have a long recovery. Being bed-bound can cause muscle weakness, known as deconditioning, which can result in prolonged shortness of breath. After a severe illness, many people also experience anxiety, depression, and PTSD.

A stay in the ICU not uncommonly leads to delirium, a serious mental disorder sometimes resulting in confused thinking, hallucinations, and reduced awareness of surroundings. But Covid-19 has created a “delirium factory,” says Santhosh at UCSF. This is because the illness has meant long hospital stays, interactions only with staff in full PPE, and the absence of family or other visitors.

Theodore Iwashyna, an ICU physician-scientist at the University of Michigan and VA Ann Arbor, is involved with the CAIRO Network, a group of 40 post-intensive care clinics on four continents. In general, after patients are discharged from ICUs, he says, “about half of people have some substantial new disability, and half will never get back to work. Maybe a third of people will have some degree of cognitive impairment. And a third have emotional problems.” And it’s common for them to have difficulty getting care for their ongoing symptoms after being discharged.

In working with Covid-19 patients, says Santhosh, she tells patients, “We believe you … and we are going to work on the mind and body together.”

Yet it’s currently impossible to predict who will have long-lasting symptoms from Covid-19. “People who are older and frailer with more comorbidities are more likely to have longer physical recovery. However, I’ve seen a lot of young people be really, really sick,” Santhosh says. “They will have a long tail of recovery too.”

Who can access care?

At the new OPTIMAL Clinic at UCSF, doctors are seeing patients who were hospitalized for Covid-19 at the UCSF health system, as well as taking referrals of other patients with persistent pulmonary symptoms. For ongoing cough and chest tightness, the clinic is providing inhalers, as well as pulmonary rehabilitation, including gradual aerobic exercise with oxygen monitoring. They’re also connecting patients with mental health resources.

“Normalizing those symptoms, as well as plugging people into mental health care, is really critical,” says Santhosh, who is also the physician lead and founder of the clinic. “I want people to know this is real. It’s not ‘in their heads.’”

Neeta Thakur, a pulmonary specialist at Zuckerberg San Francisco General Hospital and Trauma Center who has been providing care for Covid-19 patients in the ICU, just opened a similar outpatient clinic for post-Covid care. Thakur has also arranged a multidisciplinary approach, including occupational and physical therapy, as well as expedited referrals to neurology colleagues for rehabilitation for the muscles and nerves that can often be compressed when patients are prone for long periods in the ICU. But she’s most concerned by the cognitive impairments she’s seeing, especially as she’s dealing with a lot of younger patients.

These California centers join new post-Covid-19 clinics in major cities across the country, including Mount Sinai in New York and National Jewish Health Hospital in Denver. As more and more hospitals begin to focus on post-Covid care, Iwashyna suggests patients try to seek treatment where they were hospitalized, if possible, because of the difficulty in transferring sufficient medical records.

Santosh recommends that patients with persistent symptoms call their closest hospital, or nearest academic medical center’s pulmonary division, and ask if they can participate in any clinical trials. Many of the new clinics are enrolling patients in studies to try to better understand the long-term consequences of the disease. Fortunately, treatment associated with research is often free, and sometimes also offers financial incentives to participants.

But otherwise, one of the biggest challenges in post-Covid-19 treatment is — like so much of American health care — being able to pay for it.

Outside of clinical trials, cost can be a barrier to treatment. It can be tricky to get insurance to cover long-term care, Iwashyna notes. After being discharged from an ICU, he says, “Recovery depends on [patients’] social support, and how broke they are afterward.” Many struggle to cover the costs of treatment. “Our patient population is all underinsured,” says Thakur, noting that her hospital works with patients to try to help cover costs.

Lasting health impacts can also affect a person’s ability to go back to work. In Iwashyna’s experience, many patients quickly run through their guaranteed 12 weeks of leave under the Family Medical and Leave Act, which isn’t required to be paid. Eve Leckie, a 39-year-old ICU nurse in New Hampshire, came down with Covid-19 on March 15. Since then, Leckie has experienced symptom relapses and still can’t even get a drink of water without help.

“I’m typing this to you from my bed, because I’m too short of breath today to get out,” they say. “This could disable me for the rest of my life, and I have no idea how much that would cost, or at what point I will lose my insurance, since it’s dependent on my employment, and I’m incapable of working.” Leckie was the sole wage earner for their five children, and was facing eviction when their partner “essentially rescued us,” allowing them to move in.

These long-term burdens are not being felt equally. At Thakur’s hospital in San Francisco, “The population [admitted] here is younger and Latinx, a disparity which reflects who gets exposed,” she says. She worries that during the pandemic, “social and structural determinants of health will just widen disparities across the board.” People of color have been disproportionately affected by the virus, in part because they are less likely to be able to work from home.

Black people are also more likely to be hospitalized if they get Covid-19, both because of higher rates of preexisting conditions — which are the result of structural inequality — and because of lack of access to health care.

“If you are more likely to be exposed because of your job, and likely to seek care later because of fear of cost, or needing to work, you’re more likely to have severe disease,” Thakur says. “As a result, you’re more likely to have long-term consequences. Depending on what that looks like, your ability to work and economic opportunities will be hindered. It’s a very striking example of how social determinants of health can really impact someone over their lifetime.”

If policies don’t support people with persistent symptoms in getting the care they need, ongoing Covid-19 challenges will deepen what’s already a clear crisis of inequality.

Iwashyna explains that a lot of extended treatment for Covid-19 patients is “going to be about interactions with health care systems that are not well-designed. The correctable problems often involve helping people navigate a horribly fragmented health care system.

“We can fix that, but we’re not going to fix that tomorrow. These patients need help now.”