Our new default coronavirus strategy: herd immunity

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The U.S.'s new default coronavirus strategy: herd immunity - Axios

By letting the coronavirus surge through the population with only minimal social distancing measures in place, the U.S. has accidentally become the world’s largest experiment in herd immunity.

Why it matters: Letting the virus spread while minimizing human loss is doable, in theory. But it requires very strict protections for vulnerable people, almost none of which the U.S. has established.

The big picture: Cases are skyrocketing, with hospitalizations and deaths following suit in hotspots. Not a single state has ordered another lockdown, even though per capita cases in Florida and Arizona have reached levels similar to New York and New Jersey’s in April.

  • Most states never built up the testing, contact tracing and isolation systems it would take to prevent the virus from spreading widely.
  • The Trump administration is generally ignoring or downplaying soaring caseloads across the South and West, and is pushing schools to fully reopen in the fall.
  • In Florida, where infections, hospitalizations and deaths are surging, Gov. Ron DeSantis “has repeatedly ruled out a sweeping mask mandate or taking the state back into a lockdown to stem the virus, although local governments have acted on their own,” per Bloomberg.

Between the lines: Separating older, sicker people from younger, healthier ones while the virus burns through the latter group could be a way to achieve herd immunity — assuming immunity exists — without hundreds of thousands of people dying.

  • But the U.S. hasn’t adopted such a strategy with any planning or foresight. Although younger people make up a larger portion of coronavirus cases now than they did earlier in the pandemic, vulnerable people still go to work or live with non-vulnerable people.

Yes, but: Some cities and states, particularly in the Northeast, are focused on containing the virus rather than living with it.

 

 

 

 

U.S. sets one-day record with more than 60,500 COVID cases; Americans divided

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Texas, Florida and Arizona see increase in COVID-19 deaths | Daily ...

More than 60,500 new COVID-19 infections were reported across the United States on Thursday, according to a Reuters tally, setting a one-day record as weary Americans were told to take new precautions and the pandemic becomes increasingly politicized.

The total represents a slight rise from Wednesday, when there were 60,000 new cases, and marks the largest one-day increase by any country since the pandemic emerged in China last year.

As infections rose in 41 of the 50 states over the last two weeks, Americans have become increasingly divided on issues such as the reopening of schools and businesses. Orders by governors and local leaders mandating face masks have become particularly divisive.

“It’s just disheartening because the selfishness of (not wearing a mask) versus the selflessness of my staff and the people in this hospital who are putting themselves at risk, and I got COVID from this,” said Dr. Andrew Pastewski, ICU medical director at Jackson South Medical Center in Miami.

“You know, we’re putting ourselves at risk and other people aren’t willing to do anything and in fact go the other way and be aggressive to promote the disease. It’s really, it’s really hard,” he said.

Stephanie Porta, 41, a lifelong Orlando, Florida, resident, said only about half the shoppers at her grocery store wore masks, though that was more than she saw two weeks ago.

“They’re trying to make everything seem normal, when it’s not. People are dying, people are getting sick. It’s insane,” she said.

Florida on Thursday announced nearly 9,000 new cases and 120 new coronavirus deaths, a record daily increase in lives lost. Governor Ron DeSantis called the rising cases a “blip” and urged residents not to be afraid.

“I know we’ve had a lot of different blips,” DeSantis said. “We’re now at a higher blip than where we were in May and the beginning of June.”

Florida is one of the few states that does not disclose the number of hospitalized COVID patients. But more than four dozen Florida hospitals reported their intensive care units reached full capacity earlier this week.

In Texas a group of bar owners sued Governor Greg Abbott, a Republican, saying his June 26 order closing them down violates the state constitution, the Dallas Morning News reported.

Dr. Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, said Thursday that keeping schools closed would be a greater risk to children’s health than reopening them.

California and Texas, the two most populous states, announced record increases in COVID deaths on Wednesday.

California has seen cases and hospitalizations surge, even though it imposed one of the strictest lockdowns. After several lawmakers and staffers at the state Capitol in Sacramento were infected, lawmakers said the legislature would not return from summer break until July 27.

Riverside University Health System, east of Los Angeles, expanded its 44-bed intensive care unit after it filled up with patients.

“It’s been very consistent every day in the last couple of weeks. Every day has been like a full moon,” Riverside emergency room physician Stephanie Loe said, referring to doctors’ beliefs that a full moon brings more patients to the emergency room.

Governors in California, Florida and Texas have either ruled out forced business closures and quarantines or called them a last resort. But Los Angeles Mayor Eric Garcetti warned he would impose a new stay-at-home order in two weeks if the latest surge did not ease.

The rise in infections also weighed on the stock market Thursday on fears of new lockdowns, which would take a toll on the economic recovery. The Dow .DJI and the S&P 500 .SPX ended down about 1%.

 

 

 

 

Sutter loses bid to delay $575M antitrust settlement approval

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https://www.healthcaredive.com/news/sutter-loses-bid-to-delay-575m-antitrust-settlement-approval/581393/

Dive Brief:

  • A San Francisco Superior Court judge on Thursday denied Sutter Health’s request to delay preliminary approval of a $575 million antitrust settlement with California amid the uncertainty and financial upheaval of the COVID-19 pandemic.
  • The approval process and settlement agreement are flexible enough to continue as scheduled and the needs of the plaintiffs — a union that operates a trust for employee healthcare benefits and California Attorney General Xavier Becerra — to see the health system’s behavior change are pressing, Judge Anne-Christine Massullo wrote in her order.
  • In a statement Thursday, Becerra applauded the court’s decision. “Sutter’s practices harmed California’s healthcare market by charging higher prices unrelated to quality or cost of care,” he said. “They did that long before the COVID-19 pandemic. There is no period of time that medical providers, like Sutter, should be able to carry out such destructive market practices.”

Dive Insight:

Sutter, like health systems throughout the country, has taken a significant hit to its bottom line as the pandemic forced lucrative elective procedures to be put off for weeks earlier this year. The company posted a net loss of more than $1 billion in the first quarter of this year.

It said the financial losses from the COVID-19 crisis could force it to close or divest hospitals. In its June argument to delay the settlement approval, Sutter said the agreement’s cap or chargemaster prices could be too low “to cover the unprecedented and unforeseeable increases in expenditures to respond to COVID-19 particularly given declining revenue.”

But the judge did not agree, saying the court is “not persuaded that the proposed injunction will interfere with Sutter’s ability, or the broader healthcare system’s ability, to provide patient care during the COVID-19 pandemic.”

Massullo continued: “To the extent that a provision of the proposed injunction poses a threat to patient care or the public interest during the COVID-19 pandemic, or as a result of some other presently unforeseen circumstance, any party may seek a modification of the offending provision if and when such a modification becomes appropriate.”

The preliminary approval hearing is now set for Aug. 12 and Aug. 13, according to multiple news reports.

Sutter avoided a jury trial late last year by agreeing to the settlement, which in addition to the $575 million payout includes stipulations like ceasing contracts that require all of its facilities be in an insurer’s network or none of them. The system, however, did not admit guilt as part of the agreement.

 

 

 

Trump sidelines public health advisers in growing rift over coronavirus response

Posted on by • Posted in 2020 Election Issues, Centers for Disease Control & Prevention (CDC), Coronavirus, Data Integrity, Dept of Health and Human Services (HHS), Economic Crisis, Economy Reopening, Evidence-Based Care, Evidence-based Leadership, Evidence-Based Plan, Evidence-Based Policy, False Hope, False Narrative, Health Policy, Infection Control, Infection Control Plan, Infectious Virus, Integrity, Intimidation, Leadership Culture, Leadership Decentralized, Mislead, Misleading, Mortality, National Strategy, Pandemic, Personal Protective Equipment (PPE), Physician, Public Health, Public Safety, Retaliation, Scientists, Transparency, Trust, Truth, Womens Health • Leave a comment

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The Health 202: Health officials promise to ramp up pandemic ...

The June 28 email to the director of the Centers for Disease Control and Prevention was ominous: A senior adviser to a top Health and Human Services Department official accused the CDC of “undermining the President” by putting out a report about the potential risks of the coronavirus to pregnant women.

The adviser, Paul Alexander, criticized the agency’s methods, and said its warning to pregnant women “reads in a way to frighten women . . . as if the President and his administration can’t fix this and it is getting worse.”

As the country enters a frightening phase of the pandemic with new daily cases surpassing 62,000 on Wednesday, the CDC, the nation’s top public health agency, is coming under intense pressure from President Trump and his allies, who are downplaying the dangers in a bid to revive the economy ahead of the Nov. 3 election. In a White House guided by the president’s instincts, rather than by evidence-based policy, the CDC finds itself forced constantly to backtrack or sidelined from pivotal decisions.

The latest clash between the White House and its top public health advisers erupted Wednesday, when the president slammed the agency’s recommendation that schools planning to reopen should keep students’ desks six feet apart, among other steps to reduce infection risks. In a tweet, Trump — who has demanded schools at all levels hold in-person classes this fall — called the advice “very tough & expensive.”

“While they want them open, they are asking schools to do very impractical things. I will be meeting with them!!!” Trump tweeted Wednesday. Within hours, Vice President Pence had asserted the agency would release new guidance next week.

“The president said today we just don’t want the guidance to be too tough,” Pence told reporters. “And that’s the reason next week the CDC is going to be issuing a new set of tools.”

Analysts say the deepening divide is undermining the authority of one of the world’s premier public health agencies, which previously led fights against malaria, smallpox and HIV/AIDS. Amid the worst public health crisis in a century, the CDC has in recent months altered or rescinded recommendations on topics including wearing masks and safely reopening restaurants and houses of worship as a result of conflicts with top administration officials.

“At a time when our country needs an orchestrated, all-hands-on deck response, there is simply no hand on the tiller,” said Beth Cameron, former senior director for global health security and biodefense on the White House National Security Council.

In the absence of strong federal leadership, state and local officials have been left to figure things out for themselves, leading to conflicting messaging and chaotic responses. Trump’s decision to pull the U.S. out of the World Health Organization further undermined efforts to influence global strategies against the coronavirus, including how vaccines will be distributed.

The CDC, meanwhile, is increasingly isolated — a function both of its growing differences with the White House and of its own significant missteps earlier in the outbreak.

Those stumbles include the botched rollout of test kits likely contaminated at a CDC lab in late January, which led to critical delays in states’ ability to know where the virus was circulating. And the CDC’s initial decision to test only a narrow set of people gave the virus a head start spreading undetected across the country.

During a May lunch with Senate Republicans, Trump told the group the CDC “blew it” on the coronavirus test and that he’d installed a team of “geniuses” led by his son-in-law Jared Kushner to handle much of the response,” according to two people familiar with the lunch who spoke on the condition of anonymity.

“There is a view the CDC is staffed with deep state Democrats that are trying to tweak the administration,” said one adviser who also spoke on the condition of anonymity to reveal private conversations.

White House officials, who see the president’s reelection prospects tied to economic recovery, also say they’ve been deeply frustrated by what they view as career staffers at the agency determined “to keep things closed,” according to a senior administration official who spoke on the condition of anonymity to reveal internal deliberations.

Trump believes the CDC is “ineffective” and a “waste of time,” but doesn’t blame CDC Director Robert Redfield and generally likes him, said another official speaking on the condition of anonymity. “He just thinks he is a poor communicator,” the official added.

Joe Grogan, former head of the White House Domestic Policy Council, said Redfield had fans inside the White House who work on “addiction issues, on life issues, on HIV issues,” among other topics.

But he said Redfield has few political appointees to help him run a complex agency. “How do you run a place like that with … [few] appointees?” Grogan asked.

HHS Secretary Alex Azar called the director “a key scientific guide for the President and his administration, a trusted source for the American people, and a closely engaged partner of state and local governments.”

But Redfield is not a voice in coronavirus task force meetings, and “is never really in the Oval [Office] with the president,” said another senior administration official, who also spoke on the condition of anonymity to discuss the internal dynamics.

Even Redfield’s supporters say he has failed to be an effective advocate for the agency.

“Bob Redfield’s commitment to public health is completely strong,” said William Schaffner, a veteran infectious-disease specialist at Vanderbilt University. But he said Redfield lacks the standing, deftness, and communication capacity to persuade skeptical audiences, including those in the White House, that protecting public health and fostering economic recovery are not opposing goals.

Redfield, for his part, downplayed Trump’s criticism of the CDC school reopeniing guidelines after a coronavirus task force briefing Wednesday, saying the agency and the president were “totally aligned.”

“We’re both trying to open the schools,” he said.

White House spokesman Judd Deere also disputed big differences, saying in a statement the White House and the CDC “have been working together in partnership since the very beginning of this pandemic to carry out the President’s highest priority: the health and safety of the American public.

“The CDC is the nation’s trusted health protection agency and its infectious disease and public health experts have helped deliver critical solutions to save lives. We encourage all Americans to continue to follow the CDC’s guidelines and use best-practices they have learned, such as social distancing, face coverings, and good hygiene, to maintain public health and continue our Transition to Greatness.”

But some health experts were indignant the agency had been ordered to rewrite guidance to reopen schools to “make it easier and cost less” — a demand that effectively “turns science on its head,” said Tom Inglesby, director of Johns Hopkins University’s Center for Health Security.

“CDC should be giving their best judgments on how to lower risks to make schools safer,” he said. “That’s their job. If they aren’t allowed to do that, the public will lose confidence in the guidance.”

Why are they ‘not shouting “fire”?’

The diminished role of the 74-year-old agency has bewildered infectious-disease experts, as well as members of the public seeking guidance.

After six states set one-day case records on July 3, Carlos del Rio, executive associate dean at Emory University’s School of Medicine, tweeted at Tom Frieden, a former CDC director, “Tom, where is @CDCgov ? Why are they not out there shouting ‘fire’?”

Frieden shot back: “They are still there, still doing great work, just not being allowed to talk about it, not being allowed to guide policy, not being allowed to develop, standardize, and post information that would give, by state and county, the status of the epidemic and of our control measures.”

Jeffrey Duchin, the health officer at Seattle and King County health department, added: “Agree. Muzzled, neutered and exiled.”

The agency has been largely invisible. After more than three months of silence, it resumed briefings for the public last month. There have been two.

By comparison, when the H1N1 swine flu pandemic hit the United States in the spring of 2009, the CDC held briefings almost every day for six consecutive weeks.

During this outbreak, the agency’s regular briefings ended abruptly after White House officials were angered when a top CDC leader warned that Americans could face “significant disruption” to their lives as a result of the virus’s spread to the United States.

CDC officials say they are still getting their message out, pointing to more than 2,000 documents providing pandemic-related information about reopening and staying safe for dozens of groups and venues, including funeral home directors, amusement parks, and pet owners. Each Friday, the CDC also posts CovidView, a weekly report of selected data and trends on testing, hospitalizations, and reported deaths.

But the information is posted without additional explanation or analysis.

“I want to hear a real person give me three minutes based on these findings,” said del Rio, also a global health and infectious-disease professor at Emory. “I want to see them in the news, being interviewed, giving us the data.”

Scientists at the CDC and former colleagues speak of deep frustration and low morale over its inability to fully share and explain scientific and medical information.

Researchers are fearful for their jobs and want to protect the integrity of the data they release. “If you want to say something, you’re thinking, ‘what’s the White House going to say and how are they going to use it,’ ” said one longtime scientist who spoke on the condition of anonymity for fear of retaliation.

The lack of briefings has fostered misunderstandings at times. In early April, for instance, when the agency reversed its position and recommended the use of cloth face coverings, CDC scientists gave no public briefings explaining why they made the change.

“It’s not rocket science,” said Nancy Cox, a virologist and former CDC official who led the influenza program for 22 years and was part of the agency’s response during the 2009 H1N1 swine flu pandemic. “But the reasoning behind those changes should be explained as clearly as possible and then you can get everyone on board.”

In the CDC’s absence, academic medical centers, public health and professional disease groups have filled the void by holding coronavirus briefings and providing analysis of key issues, data and research studies. Frieden, the president of Resolve to Save Lives, a New York nonprofit, has also been posting long Twitter threads analyzing the weekly CDC data released on Fridays.

Speaking ‘with an unfettered voice’

Alarmed at the agency’s diminished role, nearly 350 public health organizations sent a letter Tuesday to Azar urging him to advocate for the CDC. The agency must be allowed to speak based on the best available science “and with an unfettered voice,” said John Auerbach, president and chief executive of Trust for America’s Health, a public health nonprofit that led the effort.

House Democrats echoed those concerns in a separate letter to Azar last month. Reps. Diana DeGette of Colorado and Frank Pallone Jr. of New Jersey, who chairs the House Energy and Commerce Committee, said they were troubled by reports that administration officials are considering narrowing the CDC’s mission and embedding more political appointees at the Atlanta-based agency.

Traditionally the CDC has one political appointee, the director. Now it has Redfield and five other political appointees, including two advisers who were added in recent weeks.

“Now more than ever, the American people need a robust and effective CDC that is not repeatedly undermined by others in the administration, including the President and the Vice President,” the letter said.

White House Chief of Staff Mark Meadows views the agency as a problem and has criticized the CDC repeatedly to other administration officials, said a senior administration official.

White House and HHS officials are discussing what the CDC’s “core mission needs to be,” said one adviser familiar with the talks who spoke on the condition of anonymity to comment on policy deliberations. The discussions were first reported by Politico.

Over the years, the agency that was founded to fight malaria now works on virtually every aspect of public health. “It has tried to be everything to everyone,” the adviser said, suggesting the agency might need to refocus more narrowly.

On the global front, administration officials are also weighing a $2.5 billion initiative called the President’s Response to Outbreaks that would move a significant portion of national and international pandemic responses to the State Department, according to a draft obtained by The Post. Details were first reported by Devex.

“There is no clear leadership role for CDC” in this plan, said Jennifer Kates, a senior vice president for global health and HIV policy at the Kaiser Family Foundation. “In global health, you need an engaged CDC.”

Taken together, the administration efforts seem “designed to position CDC to the margins,” said one federal health official who spoke on the condition of anonymity for fear of retaliation.

‘Boogeyman where there aren’t any’

The report that drew the email attack, accusing the agency of undermining the president, had provided detailed but incomplete information about pregnancy risks related to the coronavirus. It found pregnant women with covid-19 were more likely to be hospitalized, admitted to an intensive care unit, and to need ventilator support than infected women who are not pregnant.

The sender, Alexander, a specialist in health research methods, is a senior adviser to Michael Caputo, a longtime Trump ally who was recently appointed assistant HHS secretary for public affairs , which includes the CDC.

The email was directed to Redfield and Caputo.

Even amid the intense criticism of the agency, the email “crosses the line,” said the official, who was aware of the content.

Like all of the CDC’s reports, the analysis itself noted several limitations. One key one that researchers acknowledged was that they did not have data to indicate whether the pregnant women were hospitalized because of labor and delivery, or because they had covid-19.

Administration officials are “seeing political boogeymen where there aren’t any,” the federal health official said, adding that such narratives could further hamper the U.S. response.

“It could feed the fire to limit the flow of scientific data and communication to the general population,” the official said. “People are getting sick and dying. Can we just focus on the science?”

Alexander said in his email that the lack of data about why women were hospitalized was a “key issue.”

“The CDC is undermining the President by what they put out, this is my opinion and sense, and I am reading it and can see the subtle and direct hits,” he wrote.

Alexander, also a part-time assistant professor at McMaster University in Hamilton, Ontario, did not respond to emails and telephone calls seeking comment.

Caputo said in an interview that he agreed with Alexander. The CDC represents itself as the gold standard for public health agencies, he said, “but in the case of pregnancy analysis, it wasn’t even bronze.”

He called CDC’s track record “spotty” and “questionable,” pointing to Zika diagnostic testing errors in 2016.

“In many cases over the years, regardless of administration, the CDC has undermined presidents and themselves,” Caputo said, referring to leaked drafts of CDC guidances. “Who says the CDC is the sole font of wisdom when it comes to detecting and fighting deadly pathogens?”

Experts say that even with some big unanswered questions, the pregnancy findings represent the best available evidence and are important. The lack of data reflects decades of long-neglected national surveillance on pregnancy.

“I don’t think this is frightening women,” said Denise Jamieson, who heads the obstetrics and gynecology department at Emory University and Emory Healthcare. True, the report “suffers from completeness of data,” she said. But now doctors can be more confident that pregnant women are more likely to have severe disease and use “this really important information” to counsel patients, she said.

 

 

Another 1.3 million people applied for new jobless benefits last week as the pandemic’s toll on the economy continued

Posted on by • Posted in 2020 Election Issues, Coronavirus, Crisis, Crisis Management, Economic Crisis, Economic Recovery, Employee Furlough, Employee Hiring Freeze, Employee Layoffs, Employee Pay Cuts, Job, Job Market, Job Search, Job Security, Market Outlook, Pandemic, Paycheck Protection Program, Unemployment, Unemployment Insurance • Leave a comment

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Another 1.3 million people applied for new jobless benefits last ...

Another 1.3 million people filed for unemployment for the first time last week, a slight decrease from the week before, as novel coronavirus cases and closures surged around the country, according to data released Thursday by the Department of Labor.

The numbers of new unemployment filings have remained above a million each week since the pandemic began mid-March. That number has averaged about 1.4 million the past four weeks.

In addition, states reported that another 1 million claims were made under the Pandemic Unemployment Assistance program, which grants jobless benefits for gig workers, self-employed workers and contractors, the agency reported.

When combined, the two numbers for initial unemployment claims have ticked up the past three weeks, from 2.24 million in mid-June to 2.44 million last week.

The numbers for the first few days of July come as rising cases of coronavirus infections have hit states and counties nationwide, touching off a new round of closures and restrictions and sending some workers back to the unemployment insurance queue for the second time in just a few short months.

“The bad news is that initial claims are still historically very high and they suggest that damage is continuing to accumulate in the economy,” Adam Ozimek, chief economist at Upwork, said in an interview.

The unemployment rate, which is tabulated separately from the weekly jobless claims, has trended downward the past two months, to 11.1 percent last month, as many laid off or furloughed workers in industries like food service and retail were called back to work. Yet a rising number of workers have reported permanent layoffs.

And the jobless statistics don’t capture the damage from the new round of cases yet.

“All these factors look more like an economy that is riding into a recession than out of one,” Ozimek said. “At this stage in the game, when we’re this far from initial shock, it becomes less likely that new layoffs are the types of jobs that snap back.”

The numbers of people continuously receiving benefits at the end of June has also trended gradually downward. The last week of June saw 18.1 million people on unemployment insurance, down from 19.3 million people the week before that, as re-hirings have slightly outpaced new layoffs week by week.

But as hopes fade for a quick rebound from the pandemic — the United States reported more than 60,000 new cases on Wednesday, a new high — signs of longer term economic damage are emerging.

Levi Strauss & Co. said this week that it planned to cut about 15 percent of its nonretail and nonmanufacturing positions, or about 700 jobs this year. United Airlines warned it may need to furlough nearly 40 percent of its workforce this year, about 36,000 employees. Industrial and aerospace manufacturer the Barnes Group said it would layoff 400 workers; BAE Systems, a defense and aerospace company, said it planned to layoff 300 employees.

There are many workers like Samantha Hartman, 29, whose temporary layoff — she was furloughed in March from Rosen Hotels & Resorts, the hospitality company she works for in Orlando — became permanent this week.

Hartman said her supervisor called her this week to tell her that the company had tried to come up with a way to keep employees but found their hands tied with almost no business coming in.

“Everything is up in the air,” Hartman said. “I fully expect not to find another job in this industry.”

The company, which received a Paycheck Protection Program small business loan of more than $6 million according to the Orlando Sentinel, announced Wednesday that it would layoff a “substantial” amount of its workforce by July 31.

Hartman, who has a heart condition, said the company is letting her keep her health care through August. She moved to Orlando two years ago for the job. Now, she says she’ll probably move back with her family in California when her lease is up next year.

She said Florida’s challenges — including large delays in unemployment insurance processing, mishandling of the coronavirus response, a governor she doesn’t trust — make her less likely to stay in Florida. “If I’m going to struggle financially, I’d rather do that back home where I have a support system,” Hartman said.

Plunging consumer demand amid the virus’s surge and ensuing shutdowns have shuttered businesses across the country. Bed Bath & Beyond announced it would close 200 stores; Brooks Brothers, which filed for bankruptcy protection this week, said it would close 51 stores.

And there’s a grim waiting game for what are expected to be widespread layoffs in state and municipal governments, as budgets are drastically pared to meet declining tax revenue.

Initial weekly jobless claims remain well above the record before the pandemic, of 695,000 in 1982. They have dropped every week since the peak of 6.9 million, from a week in late March, but have plateaued for more than a month.