‘Really difficult nut to crack’: MedPAC torn over telehealth regs post-COVID-19

https://www.healthcaredive.com/news/really-difficult-nut-to-crack-medpac-torn-over-telehealth-regs-post-covi/593466/

Dive Brief:

  • Members of an influential congressional advisory committee on Medicare are torn on how best to regulate telehealth after the COVID-19 public health emergency, hinting at the difficulty Washington faces as it looks to impose guardrails on virtual care without restricting its use after the pandemic ends.
  • During a Thursday virtual meeting, the Medicare Payment Advisory Commission expressed its support of telehealth broadly, but many members noted snowballing use of the new modality could create more fraud and abuse in the system down the line.
  • Key questions of how much Medicare reimburses for telehealth visits and what type of visits are paid for won’t be easily answered, MedPAC commissioners noted. “This is a really, really difficult nut to crack,” Michael Chernew, MedPAC chairman and a healthcare policy professor at Harvard Medical School, said.

Dive Insight:

Virtual care has kept much of the industry running during the coronavirus pandemic, allowing patients to receive needed care at home. Much of this was possible due to the declaration of a public health emergency early 2020, allowing Medicare to reimburse for a greater swath of telehealth services and nixing other restrictions on virtual care.

However, much of that freedom is only in place for the duration of the public health emergency, leaving regulators and legislators scrambling to figure which new flexibilities they should codify, and which perhaps are best left in the past along with COVID-19.

It’s a tricky debate as Washington looks to strike a balance between keeping access open and costs low.

In a Thursday meeting, MedPAC debated a handful of policy proposals to try and navigate this tightrope. Analysts floated ideas like making some expansions permanent for all fee-for-service clinicians; covering certain telehealth services for all beneficiaries that can be received in their homes; and covering telehealth services if they meet CMS’ criteria for an allowable service.

But many MedPAC members were wary of making any concrete near-term policy changes, suggesting instead the industry should be allowed to test drive new telehealth regulations after COVID-19 without baking them in permanently. 

I don’t think what we’ve done with the pandemic can be considered pilot testing. I think a lot of this is likely to go forward no matter what we do because the gate has been opened, and it’s going to be really hard to close it,” Marjorie Ginsburg, founder of the Center for Healthcare Decisions, said. But “I see this just exploding into more fraud and abuse than we can even begin imagining.”

Paul Ginsburg, health policy chair at the Brookings Institution, suggested a two-year pilot of any changes after the public health emergency ends.

However, it would be “regressive” to roll back all the gains virtual care has made over the past year, according to Jonathan Perlin, CMO of health system HCA.

“These technologies are such a part of the environment that at this point, I fear [it] would be anachronistic not to accept that reality,” Perlin said.

Among other questions, commissioners were split on how much Medicare should pay for telehealth after the pandemic ends. 

That parity debate is perhaps the biggest question mark hanging over the future of the industry. Detractors argue virtual care services involve lower practice costs, as remote physicians not in an office don’t need to shell out for supplies and staff. Paying at parity could distort prices, and cause fee-for-service physicians to prioritize delivering telehealth services over in-person ones, some commissioners warned.

Other MedPAC members pointed out a lower payment rate could stifle technological innovation at a pivotal time for the healthcare industry.

MedPAC analysts suggested paying lower rates for virtual care services than in-person ones, and paying less for audio-only services than video.

Commissioners agreed audio-only services should be allowed, but that a lower rate was fair. Commissioner Dana Gelb Safran, SVP at Well Health, suggested CMS should consider outlining certain services where video must be used out of clinical necessity.

Previously, telehealth services needed a video component to be reimbursed. Proponents argue expanded access to audio-only services will improve care access, especially for low-income populations that might not have the broadband access or technology to facilitate a video visit.

Another major concern for commissioners is how permanently expanding telehealth access would affect direct-to-consumer telehealth giants like Teladoc and Amwell. If all telehealth services delivered at home are covered, that could allow the private companies to “really take over the industry,” Larry Casalino, health policy chief in the Weill Cornell Department of Healthcare Policy and Research, said.

Because of the lower back-end costs for virtual care than in-office services, paying vendors the same rate as in-office physicians could drive a lot of brick-and-mortar doctors out of business, commissioners warned.

Biden ramps up vaccine distribution to 200 million doses by the end of summer

https://www.healthcarefinancenews.com/news/biden-ramps-vaccine-distribution-200-million-doses-end-summer

Biden administration to buy 200 million more doses of Covid vaccine -  POLITICO

The death toll from the pandemic is projected to climb to 500,000 by the end of  February.

President Joe Biden yesterday announced he is ramping up COVID-19 vaccine distribution to have 200 million doses delivered by the end of the summer.

This is an additional 100 million doses Biden set as his goal for his first 100 days in office.

In remarks yesterday, Biden directed COVID-19 Response Coordinator Jeff Zeints to work with the Department of Health and Human Services to increase the nation’s total supply. 

“And we believe that we’ll soon be able to confirm the purchase of an additional 100 million doses for each of the two FDA-authorized vaccines: Pfizer and Moderna,” Biden said. “That’s 100 million more doses of Pfizer and 100 million more doses of Moderna — 200 million more doses than the federal government had previously secured. Not in hand yet, but ordered. We expect these additional 200 million doses to be delivered this summer.”

After review of the current vaccine supply from manufacturing plants, the federal government believes it can increase overall weekly vaccination distribution to states, tribes, and territories from 8.6 million doses to a minimum of 10 million doses, starting next week.  

But the pandemic is expected to get worse before it gets better, Biden said, with experts predicting the death toll as likely to top 500,000 by the end of  February.

But the brutal truth is: It’s going to take months before we can get the majority of Americans vaccinated. Months. In the next few months, masks — not vaccines — are the best defense against COVID-19,” he said.

WHY THIS MATTERS

The increases in the total vaccine order in the United States from 400 million ordered to 600 million doses will be enough vaccine to fully vaccinate 300 Americans by the end of the summer or the beginning of fall, Biden said.  

“It’ll be enough to fully vaccinate 300 [million] Americans to beat this pandemic — 300 million Americans,” he said. “And this is an aggregate plan that doesn’t leave anything on the table or anything to chance, as we’ve seen happen in the past year.”

Biden’s team said they found the vaccine program to be in worse shape than they thought it would be and that they were starting from scratch.

“But it’s also no secret that we have recently discovered, in the final days of the transition — and it wasn’t until the final days we got the kind of cooperation we needed — that once we arrived, the vaccine program is in worse shape than we anticipated or expected,” Biden said. 

Governors have been guessing at what they’ll receive for vaccine shipments, the president said.

The federal  government is working with the private industry to ramp up production of vaccine and protective equipment such as syringes, needles, gloves, swabs and masks. The team has already identified suppliers and is working with them to move the plan forward.

Also, the Federal Emergency Management Agency is being directed to to stand up the first federally-supported community vaccination centers and to make  vaccines available to thousands of local pharmacies beginning in early February.

THE LARGER TREND

Last week, Biden signed a declaration to begin reimbursing states 100% for the use of their National Guard to help the COVID-19 relief effort, both in getting sites set up and in using some of their personnel to administer the vaccines. 

Biden has also said he wants to expand testing, which will help reopen schools and businesses.

He has formalized the Health Equity Task Force to ensure that the most vulnerable populations have access to vaccines. 

He is also pushing for a $1.9 trillion relief package.

My Parents Will Be Vaccinated Long Before Me. Can They Come Visit?

Can I Visit People Who Are Vaccinated During COVID-19? | Time

Welcome to COVID Questions, TIME’s advice column. We’re trying to make living through the pandemic a little easier, with expert-backed answers to your toughest coronavirus-related dilemmas. While we can’t and don’t offer medical advice—those questions should go to your doctor—we hope this column will help you sort through this stressful and confusing time. Got a question? Write to us at covidquestions@time.com.

Today, E.B. in New York asks:

My parents and in-laws will hopefully be vaccinated soon. My husband and toddler and I don’t expect to be vaccinated for quite some time. How should we think about whether it’s safe to spend time together in a mixed-vaccinated group? Could they get on a plane and fly to visit with us unmasked and indoors? Or is there enough risk that we should wait until we are all vaccinated (which may be a very long time especially with children in the mix)? Or split the difference and take some precautions?

To state the obvious, we are in a strange limbo state right now. The vaccines we’ve eagerly awaited for almost a year are here, and yet…nothing about our daily lives has really changed. Unfortunately, that’s going to be the case for a bit longer.

“The end is in sight,” says Dr. Colleen Kelley, a vaccine researcher and associate professor of infectious diseases at the Emory University School of Medicine in Georgia. “I just don’t know that it’s right now.”

Your loved ones getting vaccinated is unequivocally a step forward, Kelley says. It would certainly be safer to visit with your parents or in-laws after they’ve gotten both vaccine doses, but the safest plan is to wait until you and your husband are also vaccinated, she says.

The two coronavirus vaccines currently authorized for use in the U.S.—those made by Pfizer-BioNTech and Moderna—are both extremely effective at preventing people from getting sick with COVID-19. That’s a huge benefit on its own, especially for people at high risk of severe illness, such as elderly adults and people with underlying medical conditions.

But the outstanding question is whether COVID-19 vaccines also stop people from getting asymptomatically infected with the virusEarly evidence suggests both shots offer at least some protection against asymptomatic infection, and many experts are optimistic about their chances of stopping transmission, but the data are still coming together.

If the shots turn out not to stop asymptomatic infections entirely, even your vaccinated parents could feasibly get your family sick if they picked something up while traveling to see you. Or, if you happened to be exposed to the virus, your parents could potentially carry it and pass it to others. And, while the authorized COVID-19 vaccines are very effective, there is always a tiny chance of them failing, leaving your parents at risk of illness.

These are all worst-case scenarios, of course. But given the uncertainty and the extent to which COVID-19 is still spreading in the U.S., Kelley says you should wait a little while longer to visit with your parents and in-laws. If that’s not possible, you should take the same precautions you’ve been hearing about for a year: quarantining beforehand, and ideally staying outdoors and masked when possible.

Here’s the good news, though. Once you and your husband are fully vaccinated (along with more of the general population), Kelley says you can feel much better about spending time with other vaccinated people indoors and unmasked—even if your toddler isn’t yet vaccinated.

As you suggest, it may be a while before kids younger than 16 are eligible for COVID-19 vaccination, since pharmaceutical companies haven’t yet finished testing their shots on younger children. But “if the toddler is the only one who’s not vaccinated, I would say that’s a pretty darn safe scenario,” Kelley says.

Luckily, young kids rarely get seriously ill with COVID-19, so once all the adults in the room are fully protected, Kelley says you can feel pretty comfortable with your parents or in-laws coming for a visit.

“We’re not going to get to a zero-risk situation,” Kelley says, “but we are going to get to places that are safer and safer.”

Michael Dowling: No one said it would be easy

Five suggestions for technology companies, venture capitalists | Northwell  Health

Hardly one month into 2021, the pressing priorities facing healthcare leaders are abundantly clear. 

First, we will be living in a world preoccupied by COVID-19 and vaccination for many months to come. Remember: this is a marathon, not a sprint. And the stark reality is that the vaccination rollout will continue well into the summer, if not longer, while at the same time we continue to care for hundreds of thousands of Americans sickened by the virus. Despite the challenges we face now and in the coming months in treating the disease and vaccinating a U.S. population of 330 million, none of us should doubt that we will prevail. Despite the federal government’s missteps over the past year in managing and responding to this unprecedented public health crisis, historians will recognize the critical role of the nation’s healthcare community in enabling us to conquer this once-in-a-generation pandemic.

While there has been an overwhelming public demand for the vaccine during the past couple of weeks, there remains some skepticism within the communities we serve, including some of the most-vulnerable populations, so healthcare leaders will find themselves spending time and energy communicating the safety and efficacy of vaccines to those who may be hesitant. This is a good thing. It is our responsibility to share facts, further public education and influence public policy. COVID-19 has enhanced public trust in healthcare professionals, and we can maintain that trust if we keep our focus on the right things — namely, how we improve the health of our communities.

And as healthcare leaders diligently balance this work, we also have a great opportunity to reimagine what our hospitals and health systems can be as we emerge from the most trying year of our professional lifetimes. How do you want your hospital or system organized? What kind of structural changes are needed to achieve the desired results? What do you really want to focus on? Amid the pressing priorities and urgent decision-making needed to survive, it is easy to overlook the great reimagination period in front of us. The key is to forget what we were like before COVID-19 and reflect upon what we want to be after.

These changes won’t occur overnight. We’ll need patience, but here are my thoughts on five key questions we need to answer to get the right results.

1. How do you enhance productivity and become more efficient? Throughout 2021, most systems will be in recovery mode from COVID’s financial bruises. Hospitals saw double-digit declines in inpatient and outpatient volumes in 2020, and total losses for hospitals and health systems nationwide were estimated to total at least $323 billion. While federal relief offset some of our losses, most of us still took a major financial hit. As we move forward, we must reorganize to operate as efficiently as possible. Does reorganization sound daunting? If so, remember the amount of reorganization we mustered to work effectively in the early days of the pandemic. When faced with no alternative, healthcare moved heaven and earth to fulfill its mission. Crises bring with them great clarity. It’s up to leaders to keep that clarity as this tragic, exhausting and frustrating crisis gradually fades.

2. How do you accelerate digital care? COVID-19 changed our relationship with technology, personally and professionally. Look at what we accomplished and how connected we remain. We were reminded of how high-quality healthcare can go unhindered by distance, commutes and travel constraints with the right technology and telehealth programs in place. Health system leaders must decide how much of their business can be accommodated through virtual care so their organizations can best offer convenience while increasing access. Oftentimes, these conversations don’t get far before confronting doubts about reimbursement. Remember, policy change must happen before reimbursement catches up. If you wait for reimbursement before implementing progressive telehealth initiatives, you’ll fall behind. 

3. How will your organization confront healthcare inequities? In 2020, I pledged that Northwell would redouble its efforts and remain a leader in diversity and inclusion. I am taking this commitment further this year and, with the strength of our diverse workforce, will address healthcare inequities in our surrounding communities head-on. This requires new partnerships, operational changes and renewed commitments from our workforce. We need to look upstream and strengthen our reach into communities that have disparate access to healthcare, education and resources. We must push harder to transcend language barriers, and we need our physicians and medical professionals of color reinforcing key healthcare messages to the diverse communities we serve. COVID-19’s devastating effect on communities of color laid bare long-standing healthcare inequalities. They are no longer an ugly backdrop of American healthcare, but the central plot point that we can change. If more equitable healthcare is not a top priority, you may want to reconsider your mission. We need leaders whose vision, commitment and courage match this moment and the unmistakable challenge in front of us. 

4. How will you accommodate the growing portion of your workforce that will be remote? Ten to 15 percent of Northwell’s workforce will continue to work remotely this year. In the past, some managers may have correlated remote work and teams with a decline in productivity. The past year defied that assumption. Leaders now face decisions about what groups can function remotely, what groups must return on-site, and how those who continue to work from afar are overseen and managed. These decisions will affect your organizations’ culture, communications, real estate strategy and more. 

5. How do you vigorously hold onto your cultural values amid all of this change? This will remain a test through 2021 and beyond. Culture is the personality of your organization. Like many health systems and hospitals, much of Northwell’s culture of connectedness, awareness, respect and empathy was built through face-to-face interaction and relationships where we continually reinforced the organization’s mission, vision and values. With so many employees now working remotely, how can we continue to bring out the best in all of our people? We will work to answer that question every day. The work you put in to restore, strengthen and revitalize your culture this year will go a long way toward cementing how your employees, patients and community come to see your organization for years to come. Don’t underestimate the power of these seemingly simple decisions.

While we’ve been through hell and back over the past year, I’m convinced that the healthcare community can continue to strengthen the public trust and admiration we’ve built during this pandemic. However, as we slowly round the corner on COVID-19, our future success will hinge on what we as healthcare organizations do now to confront the questions above and others head-on. It won’t be quick or easy and progress will be a jagged line. Let’s resist the temptation to return to what healthcare was and instead work toward building what healthcare can be. After the crisis of a lifetime, here’s our opportunity of a lifetime. We can all be part of it. 

Biden to reopen ACA insurance marketplaces as pandemic has cost millions of Americans their coverage

President Biden is scheduled to take executive actions as early as Thursday to reopen federal marketplaces selling Affordable Care Act health plans and to lower recent barriers to joining Medicaid.

The orders will be Biden’s first steps since taking office to help Americans gain health insurance, a prominent campaign goal that has assumed escalating significance as the pandemic has dramatized the need for affordable health care — and deprived millions of Americans coverage as they have lost jobs in the economic fallout.

Under one order, HealthCare.gov, the online insurance marketplace for Americans who cannot get affordable coverage through their jobs, will swiftly reopen for at least a few months, according to several individuals inside and outside the administration familiar with the plans. Ordinarily, signing up for such coverage is tightly restricted outside a six-week period late each year.

Another part of Biden’s scheduled actions, the individuals said, is intended to reverse Trump-era changes to Medicaid that critics say damaged Americans’ access to the safety-net insurance. It is unclear whether Biden’s order will undo a Trump-era rule allowing states to impose work requirements, or simply direct federal health officials to review rules to make sure they expand coverage to the program that insures about 70 million low-income people in the United States.

The actions are part of a series of rapid executive orders the president is issuing in his initial days in office to demonstrate he intends to steer the machinery of government in a direction far different from that of his predecessor.

Biden has been saying for many months that helping people get insurance is a crucial federal responsibility. Yet until the actions planned for this week, he has not yet focused on this broader objective, shining a spotlight instead on trying to expand vaccinations and other federal responses to the pandemic.

The most ambitious parts of Biden’s campaign health-care platform would require Congress to provide consent and money. Those include creating a government insurance option alongside the ACA health plans sold by private insurers, and helping poor residents afford ACA coverage if they live in about a dozen states that have not expanded their Medicaid programs under the decade-old health law.

A White House spokesman declined to discuss the plans. Two HHS officials, speaking on the condition of anonymity about an event the White House has not announced, said Monday they were anticipating that the event would be held on Thursday.

According to a document obtained by The Washington Post, the president also intends to sign an order rescinding the so-called Mexico City rule, which compels nonprofits in other countries that receive federal family planning aid to promise not to perform or encourage abortions. Biden advisers last week previewed an end to this rule, which for decades has reappeared when Republicans occupied the White House and vanished under Democratic presidents.

The document also says Biden will disavow a multinational antiabortion declaration that the Trump administration signed three months ago.

The actions to expand insurance through the ACA and Medicaid come as the Supreme Court is considering two cases that could shape the outcome. One case is an effort to overturn rulings by lower federal courts, which have held that state rules, requiring some residents to work or prepare for jobs to qualify for Medicaid, are illegal. The other case involves an attempt to overturn the entire ACA.

According to the individuals inside and outside the administration, the order to reopen the federal insurance marketplaces will be framed in the context of the pandemic, essentially saying that anyone eligible for ACA coverage who has been harmed by the coronavirus will be allowed to sign up.

“This is absolutely in the covid age and the recession caused by covid,” said a health-care policy leader who has been in discussions with the administration. “There is financial displacement we need to address,” said this person, who spoke on the condition of anonymity to describe plans the White House has not announced.

The reopening of HealthCare.gov will be accompanied by an infusion of federal support to draw attention to the opportunity through advertising and other outreach efforts. This, too, reverses the Trump administration’s stance that supporting such outreach was wasteful. During its first two years, it slashed money for advertising and for community groups known as navigators that helped people enroll.

It is not clear whether restoring outreach will be part of Biden’s order or will be done more quietly within federal health-care agencies.

Federal rules already allow people to qualify for a special enrollment period to buy ACA health plans if their circumstances change in important ways, including losing a job. But such exceptions require people to seek permission individually, and many are unaware they can do so. Trump health officials also tightened the rules for qualifying for special enrollment.

In contrast, Biden is expected to open enrollment without anyone needing to seek permission, said Eliot Fishman, senior director of health policy for Families USA, a consumer health-advocacy group.

In the early days of the pandemic, the health insurance industry and congressional Democrats urged the Trump administration to reopen HealthCare.gov, the online federal ACA enrollment system on which three dozen states rely, to give more people the opportunity to sign up. At the end of March, Trump health officials decided against that.

During the most recent enrollment period, ending the middle of last month, nearly 8.3 million people signed up for health plans in the states using HealthCare.gov. The figure is about the same as the previous year, even though it includes two fewer states, which began operating their own marketplaces.

Leaders of groups helping with enrollment around the country said they were approached for help this last time by many people who had lost jobs or income because of the pandemic.

The order involving Medicaid is designed to alter course on experiments — known as “waivers” — that allow states to get federal permission to run their Medicaid programs in nontraditional ways. The work requirements, blocked so far by federal courts, are one of those experiments. Another was an announcement a year ago by Seema Verma, the Trump administration’s administrator of the Centers for Medicare and Medicaid Services, that states could apply for a fundamental change to the program, favored by conservatives, that would cap its funding, rather than operating as an entitlement program with federal money rising and falling with the number of people covered.

“You could think about it as announcing a war against the war on Medicaid,” said Katherine Hempstead, a senior policy adviser at the Robert Wood Johnson Foundation.

Dan Mendelson, founder of Avalere Health, a consulting firm, said Biden’s initial steps to broaden insurance match his campaign position that the United States does not need to switch to a system of single-payer insurance favored by more liberal Democrats.

The orders the president will sign “are going to do it through the existing programs,” Mendelson said.

100 million doses in 100 days: How Biden’s coronavirus vaccine push compares with those of other countries

https://www.washingtonpost.com/world/2021/01/23/international-comparison-biden-coronavirus-vaccine-plan/

A key part of President Biden’s new coronavirus strategy is a push to administer 100 million doses in 100 days, or a lofty sounding 1 million immunizations a day.

That goal, part of a comprehensive national plan launched this week, has raised questions about how quickly the United States can, and should aim to, deliver vaccines to its population.

The strategy document calls the 1 million shots per day pace “aggressive,” an effort that will “take every American doing their part.” But critics have pointed out that it does not constitute a major leap from the current rate, which has already neared or even surpassed the target. Many wonder why the country cannot move more swiftly.

It remains possible that the United States could pick up its pace as vaccine supply increases and logistics improve. But in international context 1 million doses a day does not seem slow.

Though differences in population, logistical capacity and data transparency, along with different levels of vaccine vetting and effectiveness between vaccine types, make it hard to compare vaccination campaigns across countries, the United States is near the top of the pack, behind some of the fastest countries to vaccinate, including Israel and Britain, but ahead of most of the rest of the world.

The biggest factor shaping the rate of vaccination is global supply.

Though the development and emergency approval of coronavirus vaccines has unfolded at an unprecedented pace, drug companies are scrambling to make enough doses to meet demand. As some countries receive a high number of doses from among the limited total produced, others must wait their turn.

So far, a small number of relatively rich countries, including the United States, have snapped up the initial supply, relegating low- and middle-income countries to the back of the line — possibly for years. Some projections suggest poor countries will not have enough doses until 2023 or 2024.

Rich countries are set to fare better. The European Commission aims to vaccinate 70 percent of the adult population of the European Union by the summer, though details of that plan are not yet clear.

Anthony S. Fauci, adviser to President Biden and director of the National Institute of Allergy and Infectious Diseases, said this week that the United States could potentially reach “herd immunity” by fall 2021.

Will other large countries move faster than the United States?

Possibly, but it is hard to say.

Questions about manufacturing capacity, the potential approval of additional vaccines and the impact of the new U.K. variant make predictions tough. However, India offers an interesting point of comparison.

On Jan. 16, India launched a plan to vaccinate 300 million people by August.

The roughly 200 day push to deliver 600 million doses is more ambitious than the U.S. plan. However, India’s population is more than three times larger than that of the United States.

China promised to vaccinate some 50 million people against the coronavirus before the Lunar New Year holiday next month — a seemingly rapid pace. But a report in a news outlet controlled by the ruling Communist Party said the country had administered 15 million doses by Jan. 20.

There are also questions about whether Chinese-made vaccines are as effective as the Moderna, Pfizer and AstraZeneca formulations used elsewhere.

Days after Brazilian officials announced that a vaccine made by Chinese company Sinovac was 78 percent effective protecting against moderate and severe covid-19 cases, for instance, they were forced to clarify that the shot’s efficacy rate among all cases was only 50.4 percent.

Ultimately, the biggest difference between the U.S. vaccination push and the Chinese effort is need.

Though there are doubts about China’s figures, the country reports just above 4,600 coronavirus deaths to date — comparable to the 4,409 U.S. deaths on Inauguration Day alone.

Today’s Special At Grendel’s Den In Harvard Square: A Coronavirus Test For Your Server

Grendel's owner Kari Kuelzer swabs her nose for a pooled coronavirus test for the restaurant's staff.  (Robin Lubbock/WBUR)

In the old days, pre-pandemic, the line in the brick-walled basement bar of Grendel’s Den would have consisted of young customers waiting to have their ID cards checked.

These days, says owner Kari Kuelzer, it’s made up of staff members getting checked for the coronavirus.

On a recent pre-opening early afternoon, a half dozen staffers assembled amid the twinkling lights and unoccupied tables, and Kuelzer handed out testing swabs.

“This is our test kit,” she explained, opening a clear plastic bag. “It’s a vial and then 10 swabs. They self-swab. And then it goes in the vial. And off I go to Kendall Square.”

Grendel’s Den, a classic Harvard Square hangout for more than 50 years, has just become the site of a coronavirus experiment: Twice a week, the restaurant will gather nose samples from up to 10 staffers, combine them and take them for processing to the company CIC Health a couple of miles away in Kendall Square.

Kari Kuelzer, owner of Grendel’s Den, drops her nasal swab into the pooled container for coronavirus testing.

Combining the samples is known as pooled testing — an increasingly popular way for employers, schools and others on limited budgets to keep an eye out for coronavirus infections. If the pool comes back negative, everyone’s good. If it’s positive, each person needs an individual test.

Kuelzer has been pushing the city of Cambridge and the broader restaurant community to get more testing,” to help us essentially achieve the sort of workplace safety that they achieved at Harvard University over the course of the fall,” she says.

Frequent testing helped Harvard and many other universities keep coronavirus rates low.

“If there’s people in our community in the university setting and at large institutions that are receiving that level of protection, there has to be a way to extend it to people who are not in that bubble of privilege, of being part of a major university,” Kuelzer says.

Until recently, she says, there wasn’t an affordable way to get her staff tested, and she had to ask them to do it on their own. In November, an outbreak hit seven staff members, and Grendel’s closed.

It recently reopened, and she found that testing had evolved to the point that she could get the staff pooled testing, twice a week, for $150 each time.

CIC Health already offers individual tests, and pooled testing to big institutions like schools, says chief marketing officer Rodrigo Martinez.

“And the other piece that is missing is exactly how do you offer pooled testing to a small company, restaurant, organization, team, nonprofit, whatever it is, in a way that they can actually access it?” he says. “And this is exactly the service that we’re piloting in beta.”

By “beta,” Martinez means that the Grendel’s Den arrangement is basically a field test to see how it goes and iron out kinks, and CIC Health isn’t marketing it broadly yet. But the market could be large.

“In theory, every small business that wants testing might be in need and desire of being able to do pooled testing,” he says.

The market could also be temporary. At Grendel’s, Kari Kuelzer says she sees the pooled testing as only a stopgap until the staff can get vaccinated.

It’s a stopgap that patrons can help support if they choose, in a brand new type of tipping: They can buy their server a coronavirus test for $15.

“If you want to help this waitress or that bartender who you care about because they make your day good stay safe, you can buy them a test,” Kuelzer says.

Overall, she says, it’s so far so good for the Grendel’s Den testing experiment. The result from the first round of testing came back last week in less than 24 hours — and it was negative for the coronavirus.

Deborah Birx says Trump received a “parallel set of data” on the coronavirus

https://www.washingtonpost.com/politics/2021/01/25/health-202-hospitals-drag-feet-new-regulations-disclose-costs-medical-services/

The former White House coronavirus response coordinator told CBS News’s “Face The Nation” that she saw Trump presenting graphs about the coronavirus that she did not help make. Someone inside or outside of the administration, she said, “was creating a parallel set of data and graphics that were shown to the president.”

Birx also said that there were people in the White House who believed the coronavirus was a hoax and that she was one of only two people in the White House who routinely wore masks.

Birx was often caught between criticism from Trump, who at one point called her “pathetic” on Twitter when she contradicted his more optimistic predictions for the virus, and critics in the scientific community who thought she did not do enough to combat false information about the virus from TrumpThe Post’s Meryl Kornfield reports.

“Colleagues of mine that I’d known for decades — decades — in that one experience, because I was in the White House, decided that I had become this political person, even though they had known me forever,” she told CBS. “I had to ask myself every morning, ‘Is there something that I think I can do that would be helpful in responding to this pandemic?’ And it’s something I asked myself every night.”

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told the New York Times that Trump repeatedly tried to minimize the severity of the virus and would often chide him for not being positive enough in his statements about the virus. 

Fauci also described facing death threats as he was increasingly vilified by the president’s supporters. “One day I got a letter in the mail, I opened it up and a puff of powder came all over my face and my chest,” he said. The powder turned out to be benign.