https://www.governing.com/now/Many-Rural-Californians-Find-Free-COVID-Tests-Are-Too-Costly.html?utm_term=READ%20MORE&utm_campaign=As%20Pandemic%20Wears%20On%2C%20Legislators%20Challenge%20Governors%27%20Authority&utm_content=email&utm_source=Act-On+Software&utm_medium=email

On Sept. 9, a mobile testing site rolled up to Huron Middle School in the 7,000-person rural city 50 miles south of Fresno, Calif. In four hours, only four people showed up for free COVID-19 testing.

At five other coronavirus testing events organized by the Fresno County Health Department that month in Huron and the slightly larger city of Mendota, attendance remained in the single digits.

Besides the big cities, the rural farmworker communities of Fresno County have been hardest hit by the pandemic. But eight months into the virus, frontline workers and their families in small towns continue to avoid what experts deem a key step in overcoming the virus — testing.

For some, access to testing remains too remote. Others just never find out that a testing event is happening until it’s too late. Overwhelmingly, however, people in Fresno’s most impoverished communities fear that taking a test will result in nothing but losing their job, missed rent and mounting bills. Public health officials say relief is available, regardless of immigration status. But it may be too little too late, and outreach efforts remain out of touch with the community, advocates said.

“I think that there was an immense failure from the county to educate folks on, ‘This is what we know, this is what needs to happen, and these are the resources we have put out for you all,'” said Leslie Martinez, a policy advocate with Leadership Counsel for Justice and Accountability.

“Through an advocate lens, it’s been really frustrating and heartbreaking to work with community residents.”

‘If I Do Have It, What am I Going to Do?’

Fifteen years ago, Rosario Rodriguez moved from Mexico to Three Rocks, a small unincorporated community 50 miles west of Fresno surrounded by almond and pistachio fields.

She, her husband, and their two daughters never got tested for the coronavirus. Fear, misinformation and a lack of financial relief are reasons.

“What if they tell me I have it, but I don’t? What if they put the virus in me? And if I do have it, what am I going to do? That’s the fear of everyone here,” she told The Bee in Spanish. “People don’t have insurance, and they can’t get access to unemployment. So what resources are left for us?”

Fresno County public health officials say they know what they’re up against.

“There’s no benefit if you’re a farmworker if you get tested,” said Wayne Fox, director of the county’s Division of Environmental Health.

“If you’re positive, you stay home. You lose your job. You lose your pay. You get quarantined from your family. I mean, we’ve got a real barrier to overcome with that,” he said.

False claims that the government is giving people the virus have also made the county’s job more difficult, Fox said.

Cash Assistance Available in Fresno County

The state of California has mandated two weeks of paid leave for all employees. But employers have little incentive to remind them of what’s available, Fox said, and workers with precarious immigration status are often scared to demand it, advocates explained.

In partnership with the state, Fresno Economic Opportunities Commission launched Healthy Harvest in the summer, a program for farmworkers to get a free hotel room, meals, and transportation if they test positive or as they await a test.

So far, only five people have used their services, according to Kristine Morgan, communications manager for EOC, “but the word is just starting to get out there.”

Armando Valdez, director of Community Center for the Arts and Technology in Fresno, said the program was failing because it doesn’t take culture into consideration.

“Listen, Latinos are very united. We raise our families, and we don’t want to let go,” he said. “What I suggested is keep those families in their homes but give them the financial support so they can stay there. That was the suggestion a lot of our families were giving us. We will be quarantining, but keep them here. Help us financially.“

That help finally has arrived.

The COVID-19 Equity Project, launched late this summer as a result of $10 million set aside from federal CARES Act grants, has made available $1,200 in cash assistance for Fresno County residents who are sick or were exposed to the virus.

But few community members know about it.

“If you’re a farmworker, you’re not accessing the media; you’re not going to websites, you probably don’t have internet. So, this is something we’ve got to do a better job of making sure we get the word out,” Fox said.

To distribute the aid, the county paired up with 22 community-based organizations to serve immigrants, refugees, Black residents and people with disabilities. The idea is to reach people through “community health workers” who already form part of their community.

Residents can get in touch with the participating organizations to apply for aid.

To be eligible, Fresno County residents must show financial hardship as a direct result of COVID-19, like close contact or a positive COVID-19 test. The groups use different criteria to assess each household. Assistance is then given out through cash and by paying bills, like rent or utilities, according to Tania Pacheco-Werner, a research scientist at Fresno State who leads contact tracing and training efforts on the Equity Project.

County Struggles with Testing Outreach

For the first half of this year, Rodriguez lived in the slightly more central town of Cantua Creek, around the block from Cantua Elementary School. She visited the school daily to get breakfast for her two daughters. But she never found out about a testing event there on May 13 until a friend asked if she had been tested.

“I never saw a single flyer. There wasn’t much outreach so that people would know. I don’t think very many people showed up. I was there every day!” Rodriguez said in Spanish. “If I didn’t know then, how would people who live in Three Rocks or Halfway find out?”

According to the county health department, a total of 16 people were tested that day in May, more than the average of 12 people who showed up to their other rural testing events that month. Dave Pomaville, director of the health department, said the weekday, midday events were likely unpopular because of timing and because they lacked local clinic partners at the time.

Since the Equity Project launched in August, the county has partnered nonprofits with federally qualified health clinics to provide somewhat regular testing events. Partnering with these organizations has been crucial in building community trust, according to Dr. Trinidad Solis, who coordinates the Equity Project for the county.

At first, testing was only available during the workday. Attendance went up as they expanded into later hours and weekends.

“They’re still not where we’d like them to be, but we went from single-digit numbers into double-digit numbers,” said Fox, who also coordinates the project.

Why Did Outreach Take So Long?

Community advocates and local growers have been insisting on ideas like regular, local testing, and cash relief for months.

In June, west Fresno rancher Don Cameron told the county testing times in the middle of the workday were inconvenient for workers, he said in an interview. He suggested workplace testing.

Fox said they are only now starting to plan regular, returning testing sites, and workplaces are beginning to organize their own testing events.

Isabel Solorio, who organizes a food bank in the small farmworker town of Lanare, said she started asking for testing for her community in April.

“After six months, we got one. This is shameful. You hear about testing all over Fresno, except in the rural areas,” she said in Spanish.

Pomaville said coordinating testing has been an immense effort. Rural health clinics are already few and far between, and early versions of the COVID-19 test required a traditional lab environment.

He said he believes the answer lies in employers allowing employees to go to a clinic to get tested during work hours and expanding testing options that are less invasive and can be done out in the field.

“It’s been a lot of scrambling, and as soon as we think we have a plan in place, then things are changing,” Pomaville said. “But I think there have been huge steps in testing.”

Community advocates like Valdez say they believe elected officials don’t do enough to protect these communities because the undocumented aren’t part of the electorate.

Pomaville said he understands why many of these communities feel disenfranchised.

“We need to be more inclusive. I’m going to tell you, today we are not as inclusive as we want to be or need to be,” he said. “Sometimes advocates that are advocating for this feel like they’re not being heard. Sometimes it takes a little bit of time for that message not only to sink in but for the action to follow.”

Larger Issue?

The county’s slow response is a symptom of a much bigger issue, according to Pacheco-Werner, from Fresno State.

“You’re trying to catch up a public health infrastructure with decades of ongoing disinvestment overnight. People may think the starting point was here. No. The starting point was at negative.”

Small, rural communities like Cantua, Lanare, Huron and others developed as workforce farm labor towns. They were never seen as communities, but labor centers, she explained. Besides poor access to health care, most residents have lacked access to basic infrastructure and clean drinking water for decades.

The virus is simply opening up more people’s eyes to rural realities because “we’re all drowning in these numbers,” Pacheco-Werner said. “With COVID, you can visibly see what happens when you don’t try to make communities whole.”

Once a vaccine rolls around, the county will have to overcome the same barriers it has faced with testing, Pomaville said, “but hopefully we as a community are better prepared, as well.

“Hopefully, when the pandemic’s over, we are able to keep this framework together to solve the other problems we had before COVID started.”

https://www.kevinmd.com/blog/2020/11/i-am-an-emergency-medicine-physician-i-had-covid-19-infection-twice-and-im-tired.html

I am a critical care and emergency medicine physician, I have had COVID-19 infection twice, and I’m tired.

My first infection was early on in the pandemic.  I had to place a Blakemore tube in a young man who was going to die from his massive bleeding from cirrhosis.  I didn’t know then that the patient was positive for COVID, as he didn’t have any “typical” symptoms. I placed the tube and got him transferred to another facility, and am proud to say this patient lived. 

However, 5 days later, I came down with COVID.  It was awful.  My joints hurt more than I had ever experienced before.  It was like someone was trying to break them from the inside out.  I had trouble breathing and could actually feel my throat and airways swollen.  The fatigue and terrible headaches had me down for days.  I have migraines normally, but this was something much different. My food didn’t smell or taste like it normally did.  My daily decisions were weighing how important it was to get up to go to the bathroom as this took so much energy to do so.  Simple tasks would often lead me to take a nap.  Fortunately, I recovered, and because I was quarantined away from my family, my infant daughter and husband were spared.

I take all the precautions.  I thought I was doing everything right.  I wear a mask both in and out of work.  Once I get home, I take off my “dirty scrubs” and head straight for the shower, even if my daughter is screaming to be picked up.  My work shoes do not enter the house.  I wear full PPE for any procedure I perform in the hospital. I have picked up extra shifts to help out, which is exhausting but necessary.  I warned others about being cautious.  For many months, this complex system seemed to be working. Then 7 months later, I was diagnosed with COVID-19 again.

This time, my husband likely brought it home to me.  He lost his sense of taste and smell, and out of an abundance of caution, we both got tested, and we were both positive.  Thank goodness my daughter had spent the previous few nights with her Nana.  My mother and 14-month-old daughter were again spared infection and even got tested as a precaution.  I once again had fatigue and headaches.  This time I also had a “brain fog.”  My brain that is usually able to work in a rapid-fire manner, was slow and sluggish.  I knew I wasn’t processing things correctly, and I had trouble remembering words and names.  It was an awful feeling.  I once again was in quarantine; this time, instead of being alone, I was in the company of my husband.  I am grateful that we both recovered.  I have taken care of far too many, which were not as fortunate.

Some might say that being out of work and quarantining “isn’t too bad,” but I disagree.  I lost over a month of my young daughter’s life; it is time I will never be able to get back.  I indeed made the choice to stay away for her safety, but in reality, I didn’t have a choice, and the loss of time doesn’t hurt any less.  Quarantining twice also meant that my physician colleagues had to pitch in and cover for me.  This was a time that I was not available to help the medical team and care for so many other people’s mothers, fathers, grandparents, and children in a time when we are all stretched too thin.  This virus took me away from my job, from my ability to help and care for others.  It put added strain on an already strained medical system.  The virus didn’t care that I’m a doctor.

I am a critical care and emergency medicine physician and I’m tired.  I’m tired of COVID-19, but not for the same reasons as I hear other people say.  It’s not the wearing masks, social distancing, lack of travel, and the fact that I routinely wear full PPE to work.  No, it’s so much more.  I am tired of hearing the denial and the statements that COVID is “made up.”  I am emotionally exhausted from all the deaths, deaths of people who go from talking to me in one minute, and suffering a cardiopulmonary arrest or respiratory failure in the next.   I’m tired of the deaths of those whose loved ones cannot be by their sides, and I know I’m not alone in the medical community with this thought.  It’s heartbreaking to know that my masked face or that of a nurse is the last face a patient sees before they die.  I wish families could be present and care for their loved ones, but the risk is too high.  There are many times I have stayed in full PPE in a room while a patient died so that they wouldn’t die alone.  I have held their hand.  I have apologized that their family couldn’t be there.  I have apologized that we couldn’t save them.  I have cried behind that PPE too many times.  Each death still affects me even months later.  I am tired of these heartbreaking losses.

I am tired of being called uncaring or worse names. I understand it’s beyond imaginable that you cannot be at your dying loved one’s side for the entire time; I hate it too.  These protocols and policies are in place to protect people from the virus, but I know it’s causing harm to my patients’ emotional well-being and their loved ones.  I get it. I want to scream and yell and carry on with you about how unfair this all is.  It is unfair.

I am tired of the lack of community in the world.  Like it or not, we are all in this together.  We need to take care of each other, protect each other.  I get that there are a lot of people who recover from COVID-19; I am one of them, twice.  However, I work daily with patients that require ICU care.   They often stay for weeks to months.  Patients suffer from more than just a cough or trouble breathing, or the fatigue and brain fog.  I have seen strokes, heart attacks, renal failure ending up on dialysis, profound weakness from the constant cycle of paralyzing drugs, and placing patients on their stomachs to improve their oxygenation. I have treated patients that went from normal everyday walking and talking to needing full care with a breathing tube and feeding tube for months after they “recovered.”

I am tired, but each day I go to work, I continue to pour my heart, soul, and mind into my patients.   Being a critical care and emergency medicine physician is a job I love.  I want to help people, and I will continue to do so until my services are no longer needed or until I cannot. I promise you this; I will continue to fight for you.  This tired physician asks, please fight for us too. Wear your masks. Take care of your neighbors. We are all in this together, and only together will we survive.

https://www.medpagetoday.com/publichealthpolicy/generalprofessionalissues/89890?xid=nl_mpt_investigative2020-11-25&eun=g885344d0r&utm_source=Sailthru&utm_medium=email&utm_campaign=InvestigativeMD_112520&utm_term=NL_Gen_Int_InvestigateMD_Active

Houston physician Yolanda Hamilton, MD, was sentenced to 5 years in prison for her role in a $16-million Medicare fraud scheme, the Houston Chronicle reported.

The 57-year-old owner of HMS Health and Wellness Center was also ordered to pay $9.5 million in restitution for the scheme, according to the U.S. Department of Justice.

But while federal sentencing guidelines called for a prison term of 25 years, the judge overseeing the case decided she was “not as culpable as most offenders in Medicare fraud cases,” according to the Chronicle. “I do not think Dr. Hamilton knew what she was getting into,” the judge reportedly said in explaining the reduced sentence.

In October 2019, Hamilton was convicted by a federal jury on one count of conspiracy to commit healthcare fraud, one count of conspiracy to solicit and receive healthcare kickbacks, and two counts of making false statements.

Prosecutors said Hamilton made it look like patients qualified for and received home healthcare services when they didn’t. Hamilton also paid the patients to receive home healthcare services that were often medically unnecessary.

As well, Hamilton required home health agencies to pay her kickbacks, disguised as a co-pay, in order for her to certify or re-certify patients for their services. Hamilton allegedly collected over $300,000 in kickbacks this way.

The Justice Department said Hamilton’s co-conspirators, including other doctors and nurses, have also been either charged, found guilty, or pled guilty to conspiracy to commit healthcare fraud.

https://www.washingtonpost.com/history/2020/11/25/lincoln-thanksgiving-proclamation-civil-war/?utm_campaign=wp_main&utm_medium=social&utm_source=facebook&fbclid=IwAR2hQqUzGTRj9hazSdueoWrMohCwbgPo5aTo71t3kFU-3L-vb4Eaeg8yExs

As we prepare to celebrate Thanksgiving, an election has left the country politically divided. A pandemic has left many families physically divided.

In fact, Thanksgiving as a national holiday springs from the most bitter of national divisions: the Civil War.

Before that, there were sporadic regional celebrations for many years. As all schoolchildren know, the Pilgrims and the Wampanoag shared a feast in Plymouth, Mass., in 1621. And there were even earlier feasts of thanksgiving in Florida, Texas, Virginia and Maine.

George Washington was the first president to proclaim a national day of thanksgiving, one time only on Oct. 3, 1789.

But it was Sarah Josepha Hale, a renowned 19th-century lady’s magazine editor, who first suggested an annual national holiday. For 17 years, she wrote to four presidents, dozens of governors and other elected officials suggesting a national holiday of gratitude to bring the country together. Few of them responded to her.

Finally, Abraham Lincoln received her letter in the middle of the Civil War, and he loved the idea.

The first page of Sarah Josepha Hale’s letter to President Abraham Lincoln, imploring him that a “day of our annual Thanksgiving [be] made a National and fixed Union Festival.” (The Papers of Abraham Lincoln/Library of Congress)

On Oct. 3, 1863, three score and 14 years to the day after Washington’s proclamation, he released one of his own, designating the fourth Thursday of November a national day of Thanksgiving. Though Lincoln was a poet and could certainly write a moving speech — he would deliver the Gettysburg Address six weeks later — the text of the proclamation was drafted by then-Secretary of State William Seward.

Between 600,000 to 850,000 Americans died in the Civil War — most of them of disease. This year, we live in divided times again, and more than 250,000 have died of covid-19, the disease caused by the coronavirus, in the United States. The words of the proclamation to “fervently implore the interposition of the Almighty Hand to heal the wounds of the nation” resonate anew.

Here is the proclamation in full. Paragraph breaks have been added for readability.

The year that is drawing towards its close, has been filled with the blessings of fruitful fields and healthful skies. To these bounties, which are so constantly enjoyed that we are prone to forget the source from which they come, others have been added, which are of so extraordinary a nature, that they cannot fail to penetrate and soften even the heart which is habitually insensible to the ever-watchful providence of Almighty God.

In the midst of a civil war of unequalled magnitude and severity, which has sometimes seemed to foreign States to invite and to provoke their aggression, peace has been preserved with all nations, order has been maintained, the laws have been respected and obeyed, and harmony has prevailed everywhere except in the theatre of military conflict; while that theatre has been greatly contracted by the advancing armies and navies of the Union.

Needful diversions of wealth and of strength from the fields of peaceful industry to the national defence, have not arrested the plough, the shuttle or the ship; the axe has enlarged the borders of our settlements, and the mines, as well of iron and coal as of the precious metals, have yielded even more abundantly than heretofore.

Population has steadily increased, notwithstanding the waste that has been made in the camp, the siege and the battle-field; and the country, rejoicing in the consciousness of augmented strength and vigor, is permitted to expect continuance of years with large increase of freedom.

No human counsel hath devised nor hath any mortal hand worked out these great things. They are the gracious gifts of the Most High God, who, while dealing with us in anger for our sins, hath nevertheless remembered mercy.

It has seemed to me fit and proper that they should be solemnly, reverently and gratefully acknowledged as with one heart and one voice by the whole American People. I do therefore invite my fellow citizens in every part of the United States, and also those who are at sea and those who are sojourning in foreign lands, to set apart and observe the last Thursday of November next, as a day of Thanksgiving and Praise to our beneficent Father who dwelleth in the Heavens.

And I recommend to them that while offering up the ascriptions justly due to Him for such singular deliverances and blessings, they do also, with humble penitence for our national perverseness and disobedience, commend to His tender care all those who have become widows, orphans, mourners or sufferers in the lamentable civil strife in which we are unavoidably engaged, and fervently implore the interposition of the Almighty Hand to heal the wounds of the nation and to restore it as soon as may be consistent with the Divine purposes to the full enjoyment of peace, harmony, tranquillity and Union.

In testimony whereof, I have hereunto set my hand and caused the Seal of the United States to be affixed.

Done at the City of Washington, this Third day of October, in the year of our Lord one thousand eight hundred and sixty-three, and of the Independence of the United States the Eighty-eighth.

By the President: Abraham Lincoln