Category Archives: Public Safety

States build contact tracing armies to crush coronavirus

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Emergency Preparedness, Food and Drug Administration (FDA), Health Policy, Infection Control, Infectious Virus, Leadership Decentralized, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing, World Health Organization (WHO) • Leave a comment

States build contact tracing armies to crush coronavirus

Coronavirus: Why are there doubts over contact-tracing apps? - BBC ...

State governments are building armies of contact tracers in a new phase of the battle against the coronavirus pandemic, returning to a fundamental practice in public health that can at once wrestle the virus under control and put hundreds of thousands of newly jobless people back to work.

California is already conducting contact tracing in 22 counties, and it eventually plans to field a force of 10,000 state employees, who will be given basic training by University of California health experts.

Massachusetts and Ohio have partnered with Partners in Health, a global health nonprofit originally established to support programs in Haiti, to field teams of contact tracers. Maryland will partner with the University of Chicago and NORC, formerly the National Opinion Research Center, to quadruple its contact tracing capacity.

Washington, West Virginia, Iowa, North Dakota and Rhode Island are using their National Guards to trace contacts of those who have been infected with the coronavirus. In Kansas, 400 people have volunteered to trace contacts; in Utah, 1,200 state employees have raised their hands.

Contact tracing is a pillar of basic public health, a critical element in battling infectious disease around the globe. The goal is to identify those who have been infected with a virus and those with whom the infected person has come into contact. 

If those contacts then come down with the virus, they can be quickly isolated so they do not spread it further. They can also be treated, making it less likely they develop the most severe symptoms.

The practice works even in areas where health systems are thin at best and nonexistent at worst.

Tracking down those who had the Ebola virus in Guinea, Liberia and Sierra Leone, three of the poorest nations on Earth, was critical to ending the world’s largest outbreak of the deadly hemorrhagic fever in 2015. World Health Organization trackers and health officials in Congo have tracked as many as 25,000 people at a time during an Ebola outbreak that is still simmering in an eastern province, even as they face the threat of what is an almost active war zone.

“Our ability to suppress transmission relates to our ability to detect the virus,” Maria Van Kerkhove, the American who leads the World Health Organization’s technical team studying the coronavirus, told reporters last week.

The focus on contact tracing comes as public health experts warn that the coronavirus will not end as a threat to humankind until so many people have become infected that the virus has nowhere else to turn — a terrifying prospect that conjures images of overwhelmed health systems and death on a mass scale — or until scientists develop and distribute an effective vaccine to billions of people across the globe.

There are more than 100 vaccines in some stage of testing, though determining their effectiveness is still months away, and production at a mass scale is months beyond that. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and the country’s most well-known infectious disease expert, has estimated that a vaccine could be as close as 18 months away, though he has acknowledged that would blow the old record for speedy development out of the water.

“We have to fundamentally do everything possible to get a safe and effective vaccine as quickly as possible. At the same time, we have to assume that it’s not around the corner,” said Tom Frieden, former director of the Centers for Disease Control and Prevention who now runs Resolve to Save Lives, a global health nonprofit.

In the meantime, the federal government has largely left it up to the states to build their contact tracing capacity. 

Sen. Elizabeth Warren (D-Mass.) and Rep. Andy Levin (D-Mich.) have proposed adding a massive nationwide federal contact tracing program to the next round of coronavirus-related relief funding. In a nod to the New Deal-style scale such a program would require, they call the program the Coronavirus Containment Corps.

“Establishing a nationwide contact tracing program is the only way we can truly know the progress we’ve made in containing the virus, and how far we have left to go before we can transition back to normal life,” Levin said in a statement.

But contact tracing can work only if the number of new cases the United States confirms every day begins to bend down to a manageable number. The number of cases confirmed in the United States has grown by at least 25,000 on all but two of the first eight days of May.

And tracing will become an effective tool only when those who are conducting the tracing have the ability to test people broadly and to get the results of those tests back quickly. The Food and Drug Administration said Friday it had approved both the first diagnostic test that could be conducted using home-collected saliva samples and the first antigen test, a type of test that delivers results much faster than others on the market.

The lack of available tests at the earliest stages of the coronavirus outbreak has hidden the true extent of the virus’s spread around the United States. While some countries have the capacity to test huge percentages of their population on a given day, the United States is still testing only about 250,000 people per day, a level far short of the capacity necessary to conduct widespread contact tracing.

“Right from the start there has been a tremendous undercounting of cases, and that had to do with our now infamous slow testing rollout,” said Paul Sax, clinical director of the division of infectious diseases at Brigham and Women’s Hospital in Boston. 

President Trump has touted the raw number of tests performed — he rightly claims that the United States conducts more tests on a given day than any other country. But on a per capita basis, the United States is testing fewer of its residents than countries such as the United Kingdom, Italy and Estonia.

Until that changes, public health experts worry the United States will be stuck at a dangerous plateau.

“We’re doing deeply inadequate testing and functionally no tracing,” said Jeremy Konyndyk, a former head of the Office of Foreign Disaster Assistance at the U.S. Agency for International Development and now a senior fellow at the Center for Global Development. “We’re not going to half-ass our way out of a pandemic, and that’s where we are, and that’s why we’re stuck.”

 

 

 

 

Melinda Gates: US coronavirus response ‘lacking leadership at the federal level’

Posted on by • Posted in 2020 Election Issues, Childcare, Clinical Testing, Contact Tracing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Stimulus, Economy, Employee Furlough, Employee Layoffs, Employee Morale, Employee Pay Cuts, Employee Protections, Employer-Based Health Insurance, Health Policy, Infection Control, Infectious Virus, Leadership Decentralized, Mortality, Pandemic, Public Health, Public Safety, Sick Leave, Social Distancing • Leave a comment

https://finance.yahoo.com/news/us-coronavirus-response-lacks-leadership-at-the-federal-level-melinda-gates-151610533.html

Melinda Gates: US coronavirus response “lacks leadership at the ...

Philanthropist Melinda Gates on Thursday sharply criticized the U.S. response to the coronavirus outbreak, telling Yahoo Finance that the country is “lacking leadership at the federal level” and as a result has endured unnecessary deaths and economic pain.

“It’s highly distressing and disappointing,” says Gates, co-chair of the Bill and Melinda Gates Foundation, which she said has donated $300 million to organizations involved in the coronavirus response.

“To have 50 state-grown solutions is inefficient, it makes no sense, and it’s costing people their lives,” she adds.

President Donald Trump said on Tuesday “there’ll be more death” as states lift stay-at-home measures but has urged a path toward reopening the economy in order to blunt job loss and other damaging effects caused by the mandates.

The Trump administration has drawn criticism for what some consider a failure to adequately address the coronavirus outbreak in its early stages. Trump has repeatedly said “nobody” could have foreseen the pandemic though he reportedly received dire warnings as early as February.

“The lack of action is really causing harm and hurt unnecessarily in this country,” Gates says. “I’m incredibly disappointed to see that.”

The White House recently declined to take up guidelines written by the Centers for Disease Control and Prevention for how schools, restaurants, and other institutions can safely reopen, the Associated Press reported on Thursday.

The Trump administration did release a set of conditions for coronavirus containment that it recommends states meet before they reopen, including a 14-day downward trajectory in new cases or positive test rates. However, many states that remain short of that benchmark have started to reopen or will do it soon, among them Kentucky, Ohio, and Utah, the AP reported on Thursday.

On Friday, the monthly jobs report showed the U.S. economy cut 20.5 million payrolls in April, and the unemployment rate jumped to 14.7%.

The severity of economic pain is a direct result of inaction from the federal government, Gates said.

“It is impacting families now, because if we had a good testing and tracing system like Germany has, we would have started to reopen slowly more places in the economy, people wouldn’t be struggling so much to put a meal on their table,” says Gates, who released a book last year entitled “The Moment of Lift: How Empowering Women Changes the World.”

‘Difficult tension’ faced by parents at home

She said the U.S. must bolster its benefits for paid sick, medical, and family leave in order to mitigate some of the economic pain and reopen the economy, since some workers will return to their jobs while others will need to remain home to care for sick family members or children educated remotely.

Speaking with Yahoo Finance, she called on Congress to improve the paid sick and family leave expansion passed in March, which excluded many companies from the benefits requirements.

“Congress made a first step that is in one of the stimulus packages, they really did put in sick days and paid leave,” she says. “The problem is, it doesn’t go far enough.”

Moreover, she advocated for a nationwide paid medical and family leave plan — a proposal backed in part by both parties, though they differ sharply on the details.

The Republican-controlled Senate and Democrat-controlled House remain divided over an additional stimulus measure, while President Donald Trump has sought likely-polarizing tax cuts to be included in the bill, the New York Times reported on Wednesday.

Nevertheless, Gates said she is optimistic that Congress will enact paid medical and family leave.

“Congress is hearing about this difficult tension moms and dads — but particularly moms — are facing at home,” she says.

 

 

 

Doctors Without Patients: ‘Our Waiting Rooms Are Like Ghost Towns’

Posted on by • Posted in 2020 Election Issues, Antitrust, Bankruptcy, Cash, Cash Reserves, Coronavirus, Crisis, Crisis Management, Economic Crisis, Financially Distressed, Market Consolidation, Market Power, Market Share, Medical Group, Medicare, Pandemic, Physician, Physician Practice Management, Primary Care, Private Equity, Public Health, Public Safety, Vaccination, Vaccine • Leave a comment

18 of the Spookiest Ghost Towns in America - Most Haunted Places

As visits plummet because of the coronavirus, small physician practices are struggling to survive.

Autumn Road in Little Rock, Ark., is the type of doctor’s practice that has been around long enough to be treating the grandchildren of its eldest patients.

For 50 years, the group has been seeing families like Kelli Rutledge’s. A technician for a nearby ophthalmology practice, she has been going to Autumn Road for two decades.

The group’s four doctors and two nurse practitioners quickly adapted to the coronavirus pandemic, sharply cutting back clinic hours and switching to virtual visits to keep patients and staff safe.

When Kelli, 54, and her husband, Travis, 56, developed symptoms of Covid-19, the couple drove to the group’s office and spoke to the nurse practitioner over the phone. “She documented all of our symptoms,” Ms. Rutledge said. They were swabbed from their car.

While the practice was never a big moneymaker, its revenues have plummeted. The number of patients seen daily by providers has dropped to half its average of 120. The practice’s payments from March and April are down about $150,000, or roughly 40 percent.

“That won’t pay the light bill or the rent,” said Tabitha Childers, the administrator of the practice, which recently laid off 12 people.

While there are no hard numbers, there are signs that many small groups are barely hanging on. Across the country, only half of primary care doctor practices say they have enough cash to stay open for the next four weeks, according to one study, and many are already laying off or furloughing workers.

“The situation facing front-line physicians is dire,” three physician associations representing more than 260,000 doctors, wrote to the secretary of health and human services, Alex M. Azar II, at the end of April. “Obstetrician-gynecologists, pediatricians, and family physicians are facing dramatic financial challenges leading to substantial layoffs and even practice closures.”

By another estimate, as many as 60,000 physicians in family medicine may no longer be working in their practices by June because of the pandemic.

The faltering doctors’ groups reflect part of a broader decline in health care alongside the nation’s economic downturn. As people put off medical appointments and everything from hip replacements to routine mammograms, health spending dropped an annualized rate of 18 percent in the first three months of the year, according to recent federal data.

While Congress has rushed to send tens of billions of dollars to the hospitals reporting large losses and passed legislation to send even more, small physician practices in medicine’s least profitable fields like primary care and pediatrics are struggling to stay afloat. “They don’t have any wiggle room,” said Dr. Lisa Bielamowicz, a co-founder of Gist Healthcare, a consulting firm.

None of the money allocated by lawmakers has been specifically targeted to the nation’s doctors, although the latest bill set aside funds for community health centers. Some funds were also set aside for small businesses, which would include many doctors’ practices, but many have faced the same frustration as other owners in finding themselves shut out of much of the funding available.

Federal officials have taken some steps to help small practices, including advancing Medicare payments and reimbursing doctors for virtual visits. But most of the relief has gone to the big hospital and physician groups. “We have to pay special attention to these independent primary care practices, and we’re not paying special attention to them,” said Dr. Farzad Mostashari, a former health official in the Obama administration, whose company, Aledade, works with practices like Autumn Road.

“The hospitals are getting massive bailouts,” said Dr. Christopher Crow, the president of Catalyst Health Network in Texas. “They’ve really left out primary care, really all the independent physicians,” he said.

“Here’s the scary thing — as these practices start to break down and go bankrupt, we could have more consolidation among the health care systems,” Dr. Crow said. That concerns health economists, who say the steady rise in costs is linked to the clout these big hospital networks wield with private insurers to charge high prices.

While the pandemic has wreaked widespread havoc across the economy, shuttering restaurants and department stores and throwing tens of millions of Americans out of work, doctors play an essential role in the health of the public. In addition to treating coronavirus patients who would otherwise show up at the hospital, they are caring for people with chronic diseases like diabetes and asthma.

Keeping these practices open is not about protecting the doctors’ livelihoods, said Michael Chernew, a health policy professor at Harvard Medical School. “I worry about how well these practices will be able to shoulder the financial burden to be able to meet the health care needs people have,” he said.

“If practices close down, you lose access to a point of care,” said Dr. Chernew, who was one of the authors of a new analysis published by the Commonwealth Fund that found doctor’s visits dropped by about 60 percent from mid-March to mid-April. The researchers used visit data from clients of a technology firm, Phreesia.

Nearly 30 percent of the visits were virtual as doctors rushed to offer telemedicine as the safest alternative for their staff and patients. “It’s remarkable how quickly it was embraced,” said Dr. Ateev Mehrotra, a hospitalist and associate professor of health policy at Harvard Medical School, who was also involved in the study. But even with virtual visits, patient interaction was significantly lower.

Almost half of primary care practices have laid off or furloughed employees, said Rebecca Etz, an associate professor of family medicine at Virginia Commonwealth University and co-director of the Larry A. Green Center, which is surveying doctors with the Primary Care Collaborative, a nonprofit group. Many practices said they did not know if they had enough cash to stay open for the next month.

Pediatricians, which are among the lowest paid of the medical specialties, could be among the hardest hit. Federal officials used last year’s payments under the Medicare program to determine which groups should get the initial $30 billion in funds. Because pediatricians don’t generally treat Medicare patients, they were not compensated for the decline in visits as parents chose not to take their children to the doctor and skipped their regular checkups.

“This virus has the potential to essentially put pediatricians out of business across the country,” said Dr. Susan Sirota, a pediatrician in Chicago who leads a network of a dozen pediatric practices in the area. “Our waiting rooms are like ghost towns,” she said.

Pediatricians have also ordered tens of thousands of dollars on vaccines for their patients at a time when vaccine rates have plunged because of the pandemic, and they are now working with the manufacturers to delay payments for at least a time. “We don’t have the cash flow to pay them,” said Dr. Susan Kressly, a pediatrician in Warrington, Pa.

Even those practices that quickly ramped up their use of telemedicine are troubled. In Albany, Ga., a community that was an unexpected hot spot for the virus, Dr. Charles Gebhardt, a doctor who is treating some infected patients, rapidly converted his practice to doing nearly everything virtually. Dr. Gebhardt also works with Aledade to care for Medicare patients.

But the telemedicine visits are about twice as long as a typical office visit, Dr. Gebhardt said. Instead of seeing 25 patients a day, he may see eight. “We will quickly go broke at this rate,” he said.

Although he said the small-business loans and advance Medicare payments are “a Godsend, and they will help us survive the next few months,” he also said practices like his need to go back to seeing patients in person if they are to remain viable. Medicare will no longer be advancing payments to providers, and many of the small-business funding represents a short-term fix.

While Medicare and some private insurers are covering virtual visits, which would include telephone calls, doctors say the payments do not make up for the lost revenue from tests and procedures that help them stay in business. “Telehealth is not the panacea and does not make up for all the financial losses,” said Dr. Patrice Harris, the president of the American Medical Association.

To keep the practices open, Dr. Mostashari and others propose doctors who treat Medicare and Medicaid patients receive a flat fee per person.

Even more worrisome, doctors’ groups may not be delivering care to those who need it, said Dr. Mehrotra, the Harvard researcher, because the practices are relying on patients to get in touch rather than reaching out.

Some doctors are already voicing concerns about patients who do not have access to a cellphone or computer or may not be adept at working with telemedicine apps. “Not every family has access to the technology to connect with us the right way,” said Dr. Kressly, who said the transition to virtual care “is making disparities worse.”

Some patients may also still prefer traditional office visits. While the Rutledges appreciated the need for virtual visits, Kelli said there was less time to “talk about other things.”

“Telehealth is more inclined to be about strictly what you are there for,” she said.

Private equity firms and large hospital systems are already eying many of these practices in hopes of buying them, said Paul D. Vanchiere, a consultant who advises pediatric practices.

“The vultures are circling here,” he said. “They know these practices are going to have financial hardship.”

 

 

 

 

Make (surgery) hay while the sun is shining

Posted on by • Posted in Clinical Testing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy, Economy Reopening, Elective Procedures, Elective Surgery, Health Policy, Health System, Hospital, Hospital Industry, Infection Control, Infectious Virus, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Social Distancing • Leave a comment

https://mailchi.mp/aa7806a422dd/the-weekly-gist-may-8-2020?e=d1e747d2d8

Growth Mindset & Feedback Cats: Make hay while the sun shines.

As we talk this week with leaders of health systems that have restarted non-emergent surgeries, they report that volume has been slower to return than anticipated. A typical data point: a Midwestern system opened up half of its outpatient surgery capacity two weeks ago, but by the end of this week saw just 15 percent of that capacity being utilized.

Most surgeons are ready to operate, but patients are still reticent to come into a healthcare setting. Many providers are facing more sobering forecasts and expecting that volume may not return to pre-COVID levels until 2021. They’re also anticipating challenges in filling the summer surgery schedule. Patients expecting to have procedures in June or July should be seeing their doctor now, and undergoing screening exams and other diagnostic testing—the months-long surgery “pipeline” has almost evaporated.

And looming over everything are worries about a COVID-19 resurgence forcing another shutdown. Taken together, the outlook seems grim, but one chief strategy officer told us it’s motivation to act quickly: “We have to do as much as we can, as fast as we can, until we can’t.” With a future resurgence and shutdown likely, hospitals and doctors must quickly recruit patients and make them feel comfortable, while finding ways to expedite diagnostics and testing amid operational challenges. And they must deliver as much care as they can while it’s safe to do so. That’s critical for providers’ finances, but even more important for the thousands of patients facing delayed diagnoses, postponed treatments, and prolonged pain as the pandemic continues.

 

 

 

 

Most consumers nervous about returning to care settings

Posted on by • Posted in Clinical Testing, Communication, Coronavirus, Economic Crisis, Economy, Economy Reopening, Health Insurance Coverage Adequacy, Health Policy, Health System, High Deductible Health Plans, High Drug Prices, High Premiums, High Prices, Hospital, Hospital Industry, Infection Control, Infectious Virus, Mortality, Office Visit, Out of Pocket Expenses, Pandemic, Public Health, Public Safety, Quarantine, Social Determinants of Health, Social Distancing, Telemedicine, Trust, Truth, Underinsured, Uninsured • Leave a comment

https://mailchi.mp/aa7806a422dd/the-weekly-gist-may-8-2020?e=d1e747d2d8

As non-essential businesses begin to reopen, there’s no guarantee that merely opening the doors will make customers return. A recent Morning Consult poll provides an assessment of the impact of COVID-19 on consumer confidence: fewer than one in five US adults are currently comfortable doing (formerly) everyday activities like eating at a restaurant or going to a shopping mall.

The graphic below provides similar data for healthcare. Consumers’ willingness to visit healthcare providers in person for non-COVID care is only slightly better, at 21 percent. Which providers might see patients return most quickly?

Consumers say they are about twice as likely to visit their primary care doctor’s office than other healthcare facilities, including hospitals, specialists, and walk-in clinics. And when it comes to scheduling a routine in-office visit, nearly half say they will wait two to six months, with almost one in ten not comfortable going to a doctor’s office in person for a year or more.

Healthcare facilities face an uphill battle in bringing back patients—many of whom have ongoing chronic diseases that necessitate care now. Reaching patients through telemedicine and providing concrete messages about how they can safely see their doctor will be critical to staving off a tide of disease exacerbations that will mount as fear delays much-needed care.

 

 

 

Reopening with a wary eye on troubling virus trends

Posted on by • Posted in 2020 Election Issues, Clinical Testing, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economy, Economy Reopening, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employee Protections, Health Policy, Infection Control, Infectious Virus, Job, Job Market, Job Search, Job Security, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Social Determinants of Health, Social Distancing • Leave a comment

https://mailchi.mp/aa7806a422dd/the-weekly-gist-may-8-2020?e=d1e747d2d8

Apex man diaries 13-day struggle with cough, fever, wait for ...

With most states either reopening or planning to reopen shortly, the coronavirus showed few signs of loosening its grip on the US this week. Daily death totals continued to hover near 2,000, with more than 77,000 Americans having succumbed to COVID-19—a statistic that almost surely undercounts the true toll of the virus. While the situation continues to improve in “hot-spot” areas hit early like New York City and Detroit, the number of newly confirmed cases is still rising in other parts of the country, including in many of the states that have already begun to reopen.

In testimony before the House appropriations subcommittee on Wednesday, a senior infectious disease researcher from the Johns Hopkins Center for Health Security said that no state now reopening meets recommended benchmarks for declining cases, sufficient testing and contact tracing, and adequate protective equipment for healthcare workers.

The White House sent mixed signals this week in response to states’ efforts to reopen ahead of the gating criteria it set in its Opening Up America Again plan, delaying the release of detailed CDC guidelines designed help businesses returning to work, denying the validity of leaked internal projections showing the likelihood of increasing infections and deaths, and oscillating between sidelining, and then refocusing, its coronavirus task force.

However, there was some good news this week in the battle with coronavirus. There are now 108 candidate vaccines under investigation, with a handful in clinical trials. One, a messenger RNA-based vaccine developed by drug company Moderna, was approved by Food and Drug Administration (FDA) to enter Phase 2 trials on Thursday. Coronavirus testing, critical to the country’s ability to reopen safely, continued to ramp up as well, and the closely-watched “positivity rate” (an indicator of how widespread testing is—lower is better) fell nationwide.

After last week’s FDA emergency use authorization for Gilead Sciences’ promising antiviral drug remdesivir, the company began ramping up production, although frustration mounted after only about two dozen hospitals were chosen by the government to receive scarce existing supplies. Meanwhile, the federal government began to share data on which providers have received bailout money from CARES Act funding—relief sorely needed given the massive economic hit caused by the shutdown.

With the release of April unemployment numbers on Friday—showing a staggering 14.7 percent unemployment rate—the disastrous impact of the virus on the healthcare industry became more apparent. The sector lost 1.4M jobs last month, mostly on the ambulatory side. With each passing week, it becomes clearer that the recovery from the coronavirus’ assault on America will be lengthy, uneven, and difficult.

 

 

 

See Which States Are Reopening and Which Are Still Shut Down

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Clinical Testing, Coronavirus, Economic Crisis, Economy, Economy Reopening, Health Policy, Infection Control, Infectious Virus, Mortality, Pandemic, Public Health, Public Safety, Quarantine, Social Determinants of Health, Social Distancing • Leave a comment

See Which States Are Reopening and Which Are Still Shut Down - The ...

In Georgia, barbers are giving haircuts armed with face masks and latex gloves. In Texas, movie theaters are filling with customers, who crunch on popcorn several seats away from the nearest stranger. People are sweating at gyms again in Tennessee.

America’s reopening has begun in force, just weeks after the coronavirus put most of the country on lockdown.

More than half the states have started to reopen their economies in some meaningful way or have plans to do so soon, raising concerns among public health experts about a possible surge in new infections and deaths. Many states that are reopening failed to meet criteria recommended by the Trump administration before loosening restrictions on businesses and social activities.

The New York Times is tracking when orders to stay at home are lifted in each state, as well as when broad reopenings are allowed in public spaces, such as restaurants, retail stores, salons, gyms and houses of worship. In some cases, stay-at-home orders are lifting separately from restrictions on businesses. This page will be updated regularly.

Businesses are almost universally reopening under restrictions, such as allowing fewer customers, requiring workers and customers to wear masks, and enforcing social distancing. Even as governors lift orders, stricter local orders may remain in place by city or county.

 

 

 

 

Administration’s Handling of Coronavirus Threatens a Long Unemployment Crisis

Posted on by • Posted in 2020 Election Issues, Blanket Liability Immunity, Clinical Testing, Congressional Budget Office (CBO), Contact Tracing, Coronavirus, Crisis, Crisis Management, Denial, Economic Crisis, Economic Stimulus, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Employee Protections, Employer-Based Health Insurance, Evidence, Evidence-Based Plan, Fear, Health Policy, Infection Control, Infectious Virus, Job, Job Market, Job Search, Job Security, Leadership Decentralized, Mortality, Out of Pocket Expenses, Pandemic, Paycheck Protection Program, Personal Protective Equipment (PPE), Preexisting Conditions, Public Health, Public Safety, Quarantine, Social Distancing, The CARES Act, Uncertainty, Underinsured, Unemployment, Unemployment Insurance, Uninsured • Leave a comment

https://www.americanprogress.org/issues/economy/news/2020/05/07/484795/trump-administrations-handling-coronavirus-threatens-long-unemployment-crisis/

The Trump Administration's Handling of Coronavirus Threatens a ...

On Friday, the Bureau of Labor Statistics will release employment numbers for April that are expected to show a tragic and historic increase in unemployment. Consensus estimates anticipate more than 20 million jobs lost and an unemployment rate of 16 percent—a figure that may well be an underestimate given that millions of people may not be looking for jobs, effectively exiting the labor force and reducing the labor force participation rate. Moreover, state-level unemployment claims data show that this economic pain is being felt across the country, with sharp rises in joblessness in every state. And Thursday’s jobless claims release suggests that job losses have continued at high levels since the April unemployment survey was taken.

While the immediate cause of this spike in joblessness is, of course, the necessary stay-at-home orders and social distancing measures taken to respond to the crisis, the rise in unemployment—and how long it lasts—cannot be separated from choices made by the Trump administration. In understanding the state of the economy, as well as what comes next, the following three elements of this crisis must be understood:

  1. The economic crisis we are facing—and the economic pain we expect in the months ahead—is the result of a failed public health response. The Trump administration ignored early warnings, misled the public, and made the coronavirus crisis worse. The fact that the administration bungled the testing regime early on in the crisis meant that the United States could never contain the virus, as other countries such as South Korea, New Zealand, and Taiwan have done. As a consequence of that failure, the United States has had to engage in social distancing that has meant economic shock in order to avoid significantly greater levels of infections and deaths. The depth and scope of the economic pain being felt is a consequence of the administration’s delayed response and complete failure take leadership during this crisis.
  2. The administration’s inability to put in place appropriate public health measures going forward—combined with its insistence that efforts to contain the virus should be lifted in the absence of those measures—is likely to not only prolong the public health crisis but also extend the economic pain. Rather than provide workers, businesses, and families the confidence that they can return to activity safely, the administration is taking steps that try to ignore the risk of infection, such as absolving employers of responsibility for worker safety through a liability shield or forcing workers to return to work even when they have concerns about their health. In this environment, we are likely to see decreased demand for some time to come because people will have little confidence in individual state reopening strategies disconnected from science—as we are already seeing across the country.
  3. By rejecting efforts that would support families, workers, and communities during this crisis, the administration and its allies in Congress are putting us on a path for continued double-digit unemployment even after the pandemic finally ends. Indeed, the Congressional Budget Office (CBO) projects that the unemployment rate—absent additional action—will be near 10 percent at the end of 2021, several months after they project social distancing as a result of the health crisis abates. By opposing efforts to provide sufficient aid to states and localities; relief to families and unemployed workers; and assistance to those struggling the most, President Donald Trump, Majority Leader Mitch McConnell (R-KY), and their allies are insisting on making this extended period of double-digit unemployment a reality.

There is an alternative path, however: Taking the necessary steps to address the public health crisis and ensure that people can go back to work safely and doing what is needed to address the immediate economic pain and avoid prolonged unemployment. As Congress and the administration consider an additional stimulus package, they should put in place necessary public health protections while providing robust aid to families, workers, and communities for as long as the crisis lasts. This will allow us to avoid double-digit unemployment from being a devastating reality for American families for the next year and a half or more.

Public health failures has driven unemployment up

The rise in unemployment over the past two months is a direct consequence of the public health crisis—one that could have taken a far less severe toll under an administration that had been better prepared for it and that had approached it more wisely. The Trump administration has failed to develop an evidence-based plan to end the coronavirus crisis. Instead, its mismanagement has resulted in widespread fear and uncertainty as to when it might be appropriate to reopen parts of the economy. President Trump did not take the pandemic seriously when cases first emerged in the United States; his administration failed to use the month of April—when the nation was largely shut down—to ramp up the testing, contact tracing, and other pieces necessary for the public health response. And now, Trump is pushing states to reopen too soon. Before people feel comfortable enough to once again venture out of their homes and reengage in work and other economic activities, we need to ensure the country has developed the necessary health infrastructure to allow us to gradually reopen our economy without sparking a second wave of infections.

The economic crisis cannot end until public health crisis is solved

The Trump administration and its allies are arguing that the way to solve the economic crisis is to open up the country, ending stay-at-home orders and engaging in aggressive efforts to force business to return to normal. But in the absence of public health measures that actually allow activity to return safely, the administration’s strategy appears to be one of “ignore and press on,” with potentially devastating results for workers and communities. This strategy includes:

  • Pushing communities to lift stay-at-home orders and other public health measures before sufficient testing, tracing, isolation and ongoing surveillance is in place
  • Forcing workers back on the job, even without sufficient personal protective equipment or workplace safety protections—whether by removing unemployment insurance for those who are recalled to unsafe situations or through executive actions such as those taken for the meatpacking industry
  • Proposing to absolve employers of the responsibility to keep workers and communities safe through blanket immunity from liability—a measure that would do nothing to keep workers safe or build confidence in economic reopening

These steps reflect an acceptance of elevated risks of transmission, and ultimately, death. And despite the president’s rhetoric, it will make it less likely that the economy can return faster.

First, it is clear that the public isn’t going to feel safe to return to normal economic activity absent additional public health measures. A recent Washington Post-University of Maryland poll found that “67 percent say they would be uncomfortable shopping at a retail clothing store, and 78 percent would be uncomfortable eating at a sit-down restaurant.” These results were similar both in states that had loosened restrictions and those that had not and is consistent with other data. As long as people are anxious that returning to normal activities could put them at risk of contracting the virus, the economy will be unable to recover.

Second, a strategy that fails to put in place the necessary protections against spreading the virus will increase transmission among the public, and especially workers, in ways that may force additional shutdowns and prolong the period of public health crisis. In sum, prolonged public health crisis equals a prolonged state of economic distress—extending the number of months with a job market like April’s. The best approach—an approach adopted by other countries who are faring better both with their health outcomes and their economic impacts—is a national plan to fight the virus that is based on testing, tracing, and isolation.

After the pandemic ends, double-digit unemployment will persist under the current course

The CARES act provided large, necessary relief to most Americans, including assistance for workers, families, and small businesses. But this assistance will run out before the economic emergency is behind us, forcing the economy into unnecessarily prolonged hardship.

Indeed, the measures in the CARES Act both leave important gaps and will expire long before the economy is expected to return to normal. States and localities are facing extreme budget shortfalls. If action is not taken before state budget deadlines on July 1, states are likely to begin implementing layoffs of teachers and first responders and service cuts in the coming months that will cause additional job loss. Expanded unemployment insurance benefits expire at the end of July, removing an important lifeline for those out of work. While the direct payments in the CARES Act provided important assistance to families, the $1,200 per person payment will not be enough to sustain households through a prolonged crisis. The initial Paycheck Protection Program (PPP) support for small businesses has run out, and a second round of funding may soon run out too. And in important areas such as housing, food assistance, child care, and health coverage, among others, the CARES Act failed to do enough to address the hardship being felt today, let alone over a prolonged crisis—even as it provided generous aid to corporations.

As a result, under baseline projections—those that assume no further action on the part of the government—double-digit unemployment is expected to be a feature of the economy for at least the next year and a half. As noted above, the CBO estimates that the unemployment rate will remain near 10 percent at the end of 2021—many months after they predict that social distancing due to the pandemic itself ends.

Yet the Trump administration and congressional Republicans have indicated that they are prepared to accept this reality, or at best, offer solutions that do nothing to shift it. White House economic adviser Kevin Hassett said that another round of coronavirus relief legislation might not be necessary, and chief economic adviser Larry Kudlow said on Sunday that nothing has been decided yet and that “there’s kind of a pause period right now” and that “we will wait and see.” Senator McConnell has dismissed state and local aid as a “blue state bailout,” despite pain being felt in all states.

To the extent the administration or its allies have signaled a desire to act, they have focused on measures that would be woefully insufficient to address the economic challenges we face. Aside from the liability shield, Trump has signaled a push for poorly targeted corporate tax cuts or a payroll tax cut that would fail to benefit those who are out of work. An illustrative example of Trump’s approach is his call for removing limits on corporate deductions for meals and entertainment—effectively allowing companies to deduct expenses for sports tickets, golf trips, or visits to casinos—which would provide a benefit to corporations and their wealthiest executives but do little to help put money in the hands of those who need it.

A better path: a response that meets the public health and economic challenge

As it considers another package to address this crisis, Congress has the opportunity to take a path that rejects double-digit unemployment as a lasting feature of this crisis. The approach Congress should take would allow economic activity to restart safely and ensure that, as the economy restarts, we are actually getting people back to work rather than accepting a recession that keeps millions unemployed.

First, that requires a sufficient public health response. The purpose of stay-at-home orders in the first place was to suppress transmission to low levels and buy time to put in place extensive testing and contact tracing programs, but we have yet to meet those goals. Nationally, we still need to increase our testing capacity and reach at least 500,000 tests a day; scale up contact tracing—both manually and by apps that meet privacy standards—in order to isolate people who test positive as well as their contacts; and have in place a far more robust disease surveillance system.

And second, it requires an economic response that offers relief that both addresses immediate pain that families, small businesses, and communities are facing and is sufficient to build back to a stronger economy.

In particular, the package must be:

  1. At a scale necessary to address the crisis. We need to pursue a fiscal response that is proportional to both the public health and economic threat posed by COVID-19. The economic consequences of this crisis are staggering. Children are going hungry; households are piling massive debts; millions of homeowners are delaying their mortgage payments; small businesses in hard hit states received fewer loans than others; minority small business owners are struggling to stay open; and state and local governments are preparing for significant layoffs of teachers and first responders in the absence of federal aid. Action needs to be sufficiently large to both address the immediate hardship that families are facing and get the economy back to work. This big push for aid has to be coordinated at the national, state, and local levels. An important lesson form the Great Recession was that austerity at the level of states and localities was a key factor in delaying economic recovery for years, since states were in austerity mode from 2008 until 2012, contributing to lower GDP growth. And, in contrast to concerns raised by some congressional Republicans—concerns that were absent during the passage of nearly $2 trillion in tax cuts in 2017—we have the fiscal capacity to respond robustly, especially with interest rates near zero. Indeed, evidence suggests that increased fiscal stimulus may increase fiscal sustainability.
  2. Sustained for the duration of the crisis. Relief must be sustained, automatic, and available with certainty for as long as it is needed. We should learn from the Great Recession, when stimulus was insufficient and removed too soon. During that crisis, unemployment insurance expired for many workers long before the crisis had passed; fiscal aid ended long before state and fiscal budget cuts ceased being a drag on the recovery. Key measures to support the economy, such as unemployment insurance, state and local aid, and direct relief to families, should automatically extend for the duration of the economic crisis—ensuring that we are providing sufficient relief and necessary stimulus as long as is needed to support a robust recovery.
  3. Targeted to all the areas where Americans are feeling economic hardship. There is no silver bullet that will bring the economy back. We need a multilayered attack that addresses the root cause of the problem—the spread of the virus—and ameliorates its symptoms in the form of hardship for families, workers, small businesses, and communities. Building off the CARES Act, additional aid needs to make sure it is reaching those who have been excluded. That requires ensuring that aid is more completely available—for example, ensuring that immigrant families can access needed relief or closing loopholes that prevent workers from having access to paid leave. It also means providing much needed assistance in areas such as food assistance, child care, housing, and for people with disabilities—areas that would both address concentrated harm and support the economy going forward. Finally, the package should be designed so that—rather than exacerbating structural problems in our economy that benefited corporations over workers—it puts us on a path for a stronger economy once the crisis ends.

The administration and its allies appear content to accept a prolonged period of public health and economic harm that is a result of the mismanagement of the COVID-19 crisis to date—essentially condemning the nation to a greater toll from the virus itself and a much longer period of economic distress. It must be clear that the harsh reality of the April jobs report—and the much broader pain that has been felt over recent weeks—was the result of both failed policy decisions and mismanagement. By the same token, we have the choice going forward as to whether we accept further pain or take steps that would both keep people healthy and get Americans back to work.

 

 

 

 

1.4 million healthcare jobs lost in April

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1.4 million health-care workers lost their jobs due to the ...

Healthcare lost 1.4 million jobs in April amid the COVID-19 pandemic, primarily in ambulatory healthcare services, according to the latest jobs report from the U.S. Bureau of Labor Statistics.

The April count compares to 43,000 healthcare jobs lost in March.

Within ambulatory healthcare services, April job losses included offices of dentists (503,300), offices of physicians (243,300), and offices of other healthcare practitioners (205,100).

Hospitals lost 134,900 jobs last month, compared to the 200 positions they added to the U.S. economy in March.

The April jobs report marks the second consecutive month that healthcare employment did not grow. In the 12 months prior to March — the month the World Health Organization declared the COVID-19 spread a pandemic — industry employment had grown by 374,000, according to the bureau.

Bloomberg reported the number of healthcare workers has doubled to 16 million in the last three decades, and until March, the industry has lost jobs in only four months during that period.

Overall, the U.S. lost 20.5 million jobs in April, and the unemployment rate reached 14.7 percent, the highest since the Great Depression, according to the bureau.

The unemployment rate does not reflect Americans still working who have had their hours or pay reduced, The New York Times noted.