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Florida And Texas Both Set Coronavirus Death Records Thursday
TOPLINE
Coronavirus deaths are again on the rise in the U.S., with all three of the nation’s largest states setting new highs for daily death tolls Thursday following weeks of record increases in new cases and hospitalizations, even as President Donald Trump and other conservatives have touted death statistics as a sign the U.S. is handling the pandemic well.
KEY FACTS
California, Texas and Florida all reported new record daily highs for deaths Thursday.
California reported 149 deaths, while Florida reported 120 and Texas set a new record for the third-straight day, with 105.
Deaths are rising rapidly in Texas, with the 105 deaths breaking Wednesday’s record of 98, which shattered the record of 60 that was set on Tuesday.
Coronavirus deaths in the U.S. declined from early May through mid-June, but have picked up recently, and are now pacing at just under 1,000 per day.
The rise is being driven by record new death tolls in the nation’s largest states—the same states that have in large part contributed to the U.S.’s record rise in new cases recently.
Experts have said that deaths lag behind increases in cases and hospitalizations, with former FDA Commissioner Scott Gottlieb saying in an interview Sunday that “the total number of deaths is going to start going up again.”
KEY BACKGROUND
Coronavirus deaths reached a peak nationally in April through early May with over 2,000 a day on many days, largely driven by the severe outbreak in New York. Now the pandemic has eased in the Northeast while states in the South and West are the new national epicenters for coronavirus.
CHIEF CRITICS
Trump and Republican politicians had used the decline in deaths and a decrease in mortality rates to argue that the U.S. response to coronavirus has worked. However, there has also been a massive increase in testing, meaning that many less severe cases are now being identified.
BIG NUMBER
4.3%. According to Johns Hopkins University, that’s what the current mortality rate is among confirmed coronavirus cases in the U.S., a number that’s continually dropped as testing has increased. However, health experts like Dr. Anthony Fauci said early on in the pandemic that they believe the actual mortality rate is around 1%, which is still at least 10 times the lethality of the seasonal flu. And Gottlieb noted that even if the reported death rate continues to drop, if there is an increase in infections, the amount of deaths will ultimately rise, as well.
CRITICAL QUOTE
“It’s a false narrative to take comfort in a lower rate of death,” Fauci said on Tuesday, adding “There’s so many other things that are very dangerous and bad about this virus, don’t get yourself into false complacency.”
619-bed California hospital to join Cedars-Sinai
Huntington Hospital in Pasadena, Calif., has entered into a definitive agreement to join Los Angeles-based Cedars-Sinai Health System, roughly four months after the organizations signed a letter of intent to explore an affiliation.
The agreement calls for investments in 619-bed Huntington Hospital’s information technology, ambulatory services and physician development. Under the agreement, Huntington Hospital would be governed by a local board and its philanthropy and volunteer support would be locally controlled, the organizations said.
“On behalf of everyone at Huntington Hospital, we are all very pleased to have reached this important milestone,” said Jaynie Studenmund, chair of the Huntington Hospital board of directors, in a news release. “We pledge to work cooperatively with all the relevant parties and believe that this proposed affiliation is in the best interest of all of our stakeholders and the greater San Gabriel Valley community.”
The definitive agreement will now be submitted for regulatory review and approval. The review process is expected to take several months.
Texas has the highest uninsured rate in the U.S., with 29 percent of adults uninsured as of May
Texas has the highest uninsured rate in the U.S., with 29 percent of adults uninsured as of May, according to a report from Families USA.
The report compared uninsured rates in 2018 to rates in May 2020 using data from the U.S. Bureau of Labor Statistics and the Urban Institute. Every state saw an increase in the number of uninsured, and the total number of uninsured in the U.S. climbed 21 percent.
The increase was due in part to layoffs tied to the COVID-19 pandemic in recent months. Nearly 5.4 million Americans lost health insurance coverage from February to May of this year due to job losses, according to the report.
Below is the total percentage of all uninsured adults in each state and the District of Columbia as of May.
Texas: 29 percent
Florida: 25 percent
Oklahoma: 24 percent
Georgia: 23 percent
Mississippi: 22 percent
Nevada: 21 percent
North Carolina: 20 percent
South Carolina: 20 percent
Alabama: 19 percent
Tennessee: 19 percent
Idaho: 18 percent
Alaska: 17 percent
Arizona: 17 percent
Missouri: 17 percent
Wyoming: 17 percent
New Mexico: 16 percent
South Dakota: 16 percent
Arkansas: 15 percent
Kansas: 15 percent
Louisiana: 14 percent
Virginia: 14 percent
California: 13 percent
Colorado: 13 percent
Illinois: 13 percent
Indiana: 13 percent
Maine: 13 percent
Montana: 13 percent
New Jersey: 13 percent
Oregon: 13 percent
Utah: 13 percent
Michigan: 12 percent
Nebraska: 12 percent
Washington: 12 percent
West Virginia: 12 percent
Delaware: 11 percent
Maryland: 11 percent
New Hampshire: 11 percent
North Dakota: 11 percent
Ohio: 11 percent
Connecticut: 10 percent
Hawaii: 10 percent
Kentucky: 10 percent
New York: 10 percent
Pennsylvania: 10 percent
Wisconsin: 10 percent
Iowa: 9 percent
Rhode Island: 9 percent
Massachusetts: 8 percent
Minnesota: 8 percent
Vermont: 7 percent
District of Columbia: 6 percent
Fitch: Nonprofit hospital margins unlikely to recover until COVID-19 vaccine
Median financial ratios for nonprofit hospitals and health systems improved before the COVID-19 pandemic, which will provide some financial cushion to withstand financial pressures, according to a report from Fitch Ratings.
The medians for 2019, based on 2018 data, showed the nonprofit hospital and health system sector stabilized after a period of operational softness. The medians for 2020, based on 2019 audited data, are expected to show improvement in operating margins driven by higher revenues, cost reductions and increased cash flow, Fitch said.
“We expect the 2020 medians will represent peak performance levels until the sector is able to recover from the effects of the pandemic on operations,” Fitch said.
The credit rating agency said the nonprofit healthcare sector is unlikely to stabilize until a COVID-19 vaccine is widely available.
“The sector has shown considerable resiliency over the years, weathering significant events such as the Great Recession and legislative changes to funding,” Fitch said. “However, the coronavirus presents entirely new and fundamental challenges for the sector in the short term in the form of volume and revenue disruption, and over the medium to longer term with expected deterioration of individual provider payor mixes and possible changes in the behavior of healthcare consumers.”
12-hospital CHI Franciscan-Virginia Mason system would be part of CommonSpirit under new deal
Washington health systems CHI Franciscan and Virginia Mason agreed to explore a combination through a joint operating company that would be part of CommonSpirit Health, the organizations said July 16.
The proposed 12-hospital system would include more than 250 care sites and nearly 5,000 employed and affiliated providers. Combining the two systems would allow Tacoma-based CHI Franciscan and Seattle-based Virginia Mason to “shape healthcare nationally,” according to Virginia Mason CEO Gary Kaplan, MD. He told Becker’s Hospital Review in an interview that the organizations “envision creating a health system of the future.”
Ketul Patel, the CEO of CHI Franciscan and president of the Pacific Northwest division at parent system CommonSpirit Health, said in the same interview that, “Together, we’re going to not only be able to boast that we have the largest access point in the state, but we are going to be the largest and best-quality [system] in the state of Washington. We’re in a unique place to scaling and being a showcase for the entire country.”
Dr. Kaplan and Mr. Patel would serve as co-CEOs of the organization, and the health system’s board would have equal representation from both organizations.
Quality and innovation are major focuses of the proposed deal. Virginia Mason is one of only 32 hospitals in the U.S. and the only hospital in Washington to receive an A grade in quality and patient safety from The Leapfrog Group every spring and fall since the organization started publishing grades. All but two of CHI Franciscan’s hospitals received A rankings from Leapfrog this spring, Dr. Kaplan said. Outside of that, Virginia Mason and CHI Franciscan draw patients nationally for cardiology and complex spine programs, Mr. Patel said.
Dr. Kaplan said details of the deal will be hammered out as the organizations move toward a final agreement, with hopes to finalize the process by the end of the year. The joint operating company would be in addition to the organizations’ prior relationships, which include partnerships in obstetrics and women’s health, as well as radiation oncology.
No financial information about the proposal was disclosed. Virginia Mason reported total revenues of $1.2 billion in fiscal year 2019, while Chicago-based CommonSpirit’s totaled nearly $21 billion.
Back Into the Lion’s Den: COVID-19 and Post-Acute Care
Returning COVID patients to unprepared facilities a “recipe for disaster”
As Florida becomes the new epicenter of the COVID-19 outbreak in the U.S., the state is trying to ensure that nursing homes and rehabilitation facilities aren’t quickly overwhelmed by patients still suffering from the disease.
So far, it has dedicated 11 facilities solely to COVID patients who need post-acute or long-term care: those who can’t be isolated at their current facilities, as well as those who’ve gotten over the worst of their illness and who can be moved to free up hospital beds for the flow of new patients.
One of those facilities is Miami Medical Center, which was shuttered in October 2017 but now transformed to care for 150 such patients. In total, the network of centers will handle some 750 patients.
“We recognize that that would be something that would be very problematic, to have COVID-positive nursing home residents be put back into a facility where you couldn’t have proper isolation,” Florida Gov. Ron DeSantis (R) said during a press briefing last week. “[That] would be a recipe for more spread, obviously more hospitalizations and more fatalities, and so we prohibited discharging COVID-positive patients back into nursing facilities.”
Whether 750 beds will be enough to accommodate the state’s needs remains a question, but it’s a necessary first step, given testing delays that in some cases stretch more than a week. Experts have warned that patients recovering from COVID shouldn’t be transferred to a facility without being tested first.
Without dedicated facilities, hospitals in Florida in dire need of beds for new patients might have had no other choice.
Key Role for Testing
There are no national data on the percentage of hospitalized COVID-19 patients who need rehabilitation or skilled nursing care after their hospital stay.
In general, about 44% of hospitalized patients need post-acute care, according to the American Health Care Association and its affiliate, the National Center for Assisted Living, which represent the post-acute and long-term care industries.
But COVID has “drastically changed hospital discharge patterns depending on local prevalence of COVID-19 and variations in federal and state guidance,” the groups said in an email to MedPage Today. “From a clinical standpoint, patients with COVID-19 symptoms serious enough to require hospitalization may be more likely to require facility or home-based post-acute medical treatment to manage symptoms. They also may need rehabilitation services to restore lost function as they recover post-discharge from the acute-care hospital.”
The level of post-acute care these patients need runs the spectrum from long-term acute care hospitals and inpatient rehabilitation facilities to skilled nursing facilities and home health agencies.
The variation is partly due to the heterogeneity of the disease itself. While some patients recover quickly, others suffer serious consequences such as strokes, cardiac issues, and other neurological sequelae that require extensive rehabilitation. Others simply continue to have respiratory problems long after the virus has cleared. Even those who are eventually discharged home sometimes require home oxygen therapy or breathing treatments that can require the assistance of home health aides.
Yet post-acute care systems say they haven’t been overwhelmed by a flood of COVID patients. Several groups, including AHCA, NCAL, and the American Medical Rehabilitation Providers Association (AMRPA) confirmed to MedPage Today that there’s actually been a downturn in post-acute care services during the pandemic.
That’s due to a decline in elective procedures, the societies said, adding that demand is starting to pick back up and that systems will need to be in place for preventing COVID spread in these facilities.
Testing will play a key role in being able to move patients as the need for post-acute care rises, specialists told MedPage Today.
“You shouldn’t move anyone until you know a status so that the nursing facility can appropriately receive them and care for them,” said Kathleen Unroe, MD, who studies long-term care issues at the Regenstrief Institute and Indiana University in Indianapolis.
AHCA and NCAL said they “do not support state mandates that require nursing homes to admit hospital patients who have not been tested for COVID-19 and to admit patients who have tested positive. This approach will introduce the highly contagious virus into more nursing homes. There will be more hospitalizations for nursing home residents who need ventilator care and ultimately, a higher number of deaths.”
Earlier this week, the groups sent a letter to the National Governors Association about preventing COVID outbreaks in long-term care facilities. They pointed to a survey of their membership showing that, for the majority, it was taking 2 days or longer to get test results back; one-quarter said it took at least 5 days.
The Centers for Medicare & Medicaid Services (CMS) recently announced that it would send point-of-care COVID tests to “every single” nursing home in the U.S. starting next week. Initially, the tests will be given to 2,000 nursing homes, with tests eventually being shipped to all 15,400 facilities in the country.
Hospitals can conduct their own testing before releasing patients, and this has historically provided results faster than testing sites or clinical offices, especially if they have in-house services. However, demand can create delays, experts said.
Preparing for the Future
Jerry Gurwitz, MD, a geriatrician at the University of Massachusetts Medical School in Worcester, says now is the time to develop post-acute care strategies for any future surges.
Gurwitz authored a commentary in the Journal of the American Geriatrics Society on an incident in Massachusetts early in the pandemic where a nursing home was emptied to create a COVID-only facility, only to have residents test positive after the majority had already been moved.
“We should be thinking, okay, what are the steps, what’s the alternative to emptying out nursing homes? Can we make a convention center, or part of it, amenable to post-acute care patients?” Gurwitz said. “Not just a bed to lie in, but possibly providing rehabilitation and additional services? That could all be thought through right now in a way that would be logical and lead to the best possible outcomes.”
Organizations can take the lead from centers that have lived through a surge, like those in New York City. Rusk Rehabilitation at NYU Langone Health created a dedicated rehabilitation unit for COVID-positive patients.
“We were able to bring patients out from the acute care hospital to our rehabilitation unit and continue their COVID treatment but also give them the rehabilitation they needed” — physical and occupational therapy (PT/OT) — “and the medical oversight that enhanced their recovery and got them out of the hospital quicker and in better shape,” Steven Flanagan, MD, chair of rehabilitation medicine at NYU Langone, said during an AMRPA teleconference.
Flanagan noted that even COVID patients who can be discharged home will have long-term issues, so preparing a home-based or outpatient rehabilitation program will be essential.
Jasen Gundersen, MD, chief medical officer of CareCentrix, which specializes in post-acute home care, said there’s been more concern from families and patients about going into a facility, leading to increased interest in home-based services.
“We should be doing everything we can to support patients in the home,” Gundersen said. “Many of these patients are elderly and were on a lot of medications before COVID, so we’re trying to manage those along with additive medications like breathing treatments and inhalers.”
Telemedicine has played an increasing role in home care, to protect both patients and home health aides, he added.
Long-term care societies have said that emergency waivers implemented by CMS have been critical for getting COVID patients appropriate levels of post-acute care, and they hope these remain in place as the pandemic continues.
For instance, CMS relaxed the 3-hour therapy rule and the 60% diagnostic rule, Flanagan said. Under those policies, in order to admit a patient to an acute rehabilitation unit, facilities must provide 3 hours of PT/OT every day, 5 days per week.
“Not every COVID patient could tolerate that level of care, but they still needed the benefit of rehabilitation that allowed them to get better quicker and go home faster,” he said.
Additionally, not every COVID patient fits into one of the 13 diagnostic categories that dictate who can be admitted to a rehab facility under the 60% rule, he said, so centers “could take COVID patients who didn’t fit into one of those diagnoses and treat them and get them better.”
AHCA and NCAL said further waivers or policy changes would be helpful, particularly regarding basic medical necessity requirements for coverage within each type of post-acute setting.
But chief among priorities for COVID discharges to post-acute care remains safety, the groups said.
“The solution is for hospital patients to be discharged to nursing homes that can create segregated COVID-19 units and have the vital personal protective equipment needed to keep the staff safe,” they said. “Sending hospitalized patients who are likely harboring the virus to nursing homes that do not have the appropriate units, equipment and staff to accept COVID-19 patients is a recipe for disaster.”
Nearly one-third of children tested for COVID in Florida are positive.
Palm Beach County’s health director warns of risk of long-term damage.
Nearly one-in-three children tested for the new coronavirus in Florida has been positive, and a South Florida health official is concerned the disease could cause lifelong damage even for children with mild illness.
Dr. Alina Alonso, Palm Beach County’s health department director, warned county commissioners Tuesday that much is unknown about the long-term health consequences for children who catch COVID-19.
X-rays have revealed the virus can cause lung damage even in people without severe symptoms, she said.
“They are seeing there is damage to the lungs in these asymptomatic children. … We don’t know how that is going to manifest a year from now or two years from now,” Alonso said. “Is that child going to have chronic pulmonary problems or not?”
Her comments stand in contrast to Gov. Ron DeSantis’ messaging that children are at low risk, and classrooms need to be reopened in the fall. DeSantis has said he would be comfortable sending his children to school if they were old enough to attend.
Some studies suggest that children are less likely to catch COVID-19 than adults. Children are also far less likely to die of the disease. About 17,000 of Florida’s roughly 287,800 cases have been people younger than 18. Of the 4,514 COVID-19 deaths reported by Florida as of Tuesday, four have been younger than 18.
Still, it’s possible COVID-19 could have long-term consequences that will take time to understand, Alonso said.
“This is not the virus you bring everybody together to make sure you catch it and get it over with,” she said. “This is something serious, and we are learning new information about this virus every day.”
State statistics also show the percentage of children testing positive is much higher than the population as a whole. Statewide, about 31% of 54,022 children tested have been positive. The state’s positivity rate for the entire population is about 11%.
Researchers have linked a serious and potentially deadly inflammatory condition with COVID-19 in children. The condition, called pediatric multisystem inflammatory syndrome, doesn’t appear to be widespread. The Florida Department of Health lists 13 confirmed cases of the syndrome.
Dr. Jorge Perez, co-founder of Kidz Medical Services, said it’s too early to say how common and severe long-term damage could be from COVID-19, but early evidence suggests some children infected with the virus could have lasting damage.
“We are learning something every day,” said Perez, who operates pediatric offices throughout South Florida. “We have to be knowledgeable about this and continue to monitor to see what effects it has in children.”
DeSantis told talk radio host Rush Limbaugh last week that the risk to children is “very low.”
“I’ve got a 3-year-old daughter, 2-year-old son, and a newborn daughter,” DeSantis said in the radio interview. “And I can tell you if they were school age, I would have zero concern sending them.”
HENRY KOTULA 