Labs warn COVID-19 testing demand will top capacity soon as new hotspots emerge

https://www.healthcaredive.com/news/labs-warn-covid-19-testing-demand-will-top-capacity-hotspots-new-surge/580730/

Dive Brief:

  • With the spike in coronavirus cases in Southern and Western states, commercial laboratories say they do not have the capacity to keep up with growing demand for their testing services and predict longer turnaround times for results over the coming weeks.
  • The American Clinical Laboratory Association, which represents LabCorp, Quest Diagnostics and other labs, said Saturday its members have seen a steady increase in the volume of COVID-19 test orders recently, specifically calling out the fact that critical testing materials are in short supply.
  • Quest on Thursday issued its own warning that despite the rapid expansion of its testing capacity, demand has been growing faster. In particular, the lab giant noted that orders for molecular diagnostic services have increased by about 50% over the past three weeks.

Dive Insight:

U.S. commercial labs had made “significant strides” during the coronavirus pandemic by expanding testing capacity from about 100,000 tests per day in early April to more than 300,000 currently, according to ACLA.

But newly emerging hotspots like Arizona, California and Texas are putting a strain on labs and an already limited supply of testing materials, the group said.

While labs nationwide are trying to increase capacity by purchasing more testing machines and attempting to secure additional test materials from suppliers, ACLA President Julie Khani cautioned, “the reality of this ongoing global pandemic is that testing supplies are limited” and “every country across the globe is in need of essential testing supplies, like pipettes and reagents, and that demand is likely to increase in the coming months.”

Khani said ACLA has been in talks with the Trump administration and supply chain partners about the challenges labs face as they try to increase their level of respective COVID-19 testing abilities to meet the anticipated increase in U.S. demand for tests over the coming weeks.

In the absence of a solution, Khani warned that significant demand “will likely exceed” labs’ testing capacities and “could extend turnaround times for test results.”

For its part, Quest’s statement on Thursday described the U.S. coronavirus outbreak as an “evolving” situation that is putting a “strain” on the company’s COVID-19 testing resources.

“Today, we have the capacity to perform approximately 110,000 of these tests a day (770,000 a week). Despite the rapid expansion of our testing capacity, demand for testing has been growing faster,” according to Quest.

Currently, Quest’s average turnaround time for test results are one day for hospital patients, pre-operative patients in acute care settings, and symptomatic healthcare workers, and two to three days for all other patient populations. However, the company warned that “given increased demand, we expect average turnaround times near term to extend in excess of 3 days.”

Nonetheless, Quest said it is taking actions to try to increase COVID-19 testing scale, with the goal of being able to perform 150,000 tests per day. Toward that end, the company is installing additional testing platforms in its network of U.S. labs and said it is collaborating with independent labs who currently have underused capacity.

Quest’s rival LabCorp was not immediately available for comment on its testing capacity amid reports of demand increasing across the country.

 

 

 

 

DOJ charges execs, others with elaborate $1.4B billing scheme using rural hospitals

https://www.healthcaredive.com/news/doj-charges-execs-others-with-elaborate-14b-billing-scheme-using-rural-h/580785/

Office of Attorney Recruitment & Management | Department of Justice

Dive Brief:

  • The U.S. Department of Justice is charging 10 defendants for an “elaborate” pass-through billing scheme that used small rural hospitals across three states as shells to submit fraudulent claims for laboratory testing to commercial insurers, jacking up reimbursement.
  • The defendants, including hospital executives, lab owners and recruiters, billed private payers roughly $1.4 billion from November 2015 to February 2018 for pricey lab testing, reaping $400 million.
  • The four rural hospitals used in the scheme are: Cambellton-Graceville Hospital, a 25-bed rural facility in Florida; Regional General Hospital of Williston, a 40-bed hospital in Florida; Chestatee Regional Hospital, a 49-bed facility in Georgia; and Putnam County Memorial Hospital, a 25-bed hospital in Missouri. Only Putnam emerged from the scheme relatively unscathed: Chestatee was sold to a health system that plans to replace it with a newer facility, Cambellton-Graceville closed in 2017 and RGH of Williston was sold for $100 to an accounting firm earlier this month.

Dive Insight:

The indictment, filed in the Middle District of Florida and unsealed Monday, alleges the 10 defendants, using management companies they owned, would take over rural hospitals often struggling financially. They would then bill commercial payers for millions of dollars for pricey urine analysis drug tests and blood tests through the rural hospitals, though the tests were normally conducted at outside labs, and launder the money to hide their trail and distribute proceeds.

The rural hospitals had negotiated rates with commercial insurers for higher reimbursement for tests than if they’d been run at an outside labs, so the facilities were used as a shell for fraudulent billing for often medically unnecessary tests, the indictment alleges.

The defendants, aged 34 to 60, would get urine and other samples by paying kickbacks to recruiters and healthcare providers, like sober homes and substance abuse treatment centers.

Screening urine tests, to determine the presence or absence of a substance in a patient’s system, is generally inexpensive and simple — it can be done at a substance abuse facility, a doctor’s office or a lab. But confirmatory tests, to identify concentration of a drug, are more precise and sensitive and have to be done at a sophisticated lab.

As such they’re more expensive and are typically reimbursed at higher rates than screening urine tests. None of the rural hospitals had the capacity to conduct confirmatory tests, or blood tests, on a large scale, but frequently billed in-network insurers, including CVS Health-owned Aetna, Florida Blue and Blue Cross Blue Shield of Georgia, for the service from 2015 to 2018, the indictment says.

Rural hospitals are facing unprecedented financial stress amid the pandemic, but have been fighting to keep their doors open for years against shrinking reimbursement and lowering patient volume. That can give bad actors an opportunity to come in and assume control.

One of the defendants, Jorge Perez, 60, owns a Miami-based hospital operator called Empower, which has seen many of its facilities fail after insurers refused to pay for suspect billing. Half of rural hospital bankruptcies last year were affiliated with Empower, which controlled 18 hospitals across eight states at the height of the operation. Over the past two years, 12 of the hospitals have declared bankruptcy. Eight have closed, leaving their rural communities without healthcare and a source of jobs.

“Schemes that exploit rural hospitals are particularly egregious as they can undermine access to care in underserved communities,” Thomas South, a deputy assistant inspector general in the Office of Personnel Management Office of Inspector General, said in a statement.

 

 

 

 

 

Quorum Health to emerge from bankruptcy next month

https://www.healthcaredive.com/news/quorum-bankruptcy-approval-emerging-in-july/580805/

Dive Brief:

  • For-profit hospital operator Quorum Health received approval of its plan to recapitalize the business Monday in U.S. Bankruptcy Court for the District of Delaware. Quorum expects to emerge from bankruptcy in early July, according to regulatory filings.
  • The system filed for Chapter 11 bankruptcy April 7 to address current liquidity needs while continuing to care for patients and keep its hospitals operating amid a pandemic, according to a statement. It entered into a restructuring agreement with a majority of its lenders and noteholders.
  • Quorum still needs the court to issue a final order, but said the reorganization will reduce its debt by about $500 million, as originally expected.

Dive Insight:

Tennessee-based Quorum Health, which operates 22 rural and mid-sized hospitals in 13 states, may have been more ill-positioned financially than other systems going into the pandemic.

The company went public in May 2016 with 38 hospitals — 14 of which have since shuttered. In 2017, private equity firm KKR took a 5.6% stake in the system for $11.3 million.

Beyond being Quorum’s largest debt-holder today, KKR also owns about 9% of its public shares. In December, the firm offered to buy Quorum out and take the hospital chain private at $1 a share.

But that didn’t pan out, and Quorum instead ended up filing for bankruptcy in April, soon after the COVID-19 pandemic hit. The restructuring agreement now “allows our company to begin a new chapter with the flexibility and resources to continue supporting our community hospitals as they serve on the frontlines of this pandemic and beyond,” Marty Smith, Quorum’s executive vice president and chief operating officer, said in a statement Monday.

“We are grateful for the confidence of our financial stakeholders and partners, as well as our dedicated employees and physicians, and look forward to building on the significant progress we have made in strengthening our operations in recent years,” he said.

 

 

 

 

Trinity Health expects $2B revenue plunge as it cuts, furloughs more staff

https://www.healthcaredive.com/news/trinity-health-cutting-cost-cutting-2-billion-revenue-shortfall/580738/

The Dumbest Things You Can Do With Your Money | Work + Money

Dive Brief:

  • Trinity Health, one of the nation’s largest nonprofit health systems, said Monday it will take more measures to cut costs due to the downturn spurred by the novel coronavirus. The restructuring plan includes eliminating positions, extending furloughs, severances and reductions in schedules. The decisions are being “customized” across the system based on factors that include volume projections and the cost and revenue challenges in each market.
  • The Livonia, Michigan-based hospital operator said it continues to treat COVID-19 patients, however, it has “for now seen declining numbers of very sick patients with COVID-19.”
  • The system said it expects revenue to be depressed or “below historical levels” for the remainder of this fiscal year and much of the next. It projects revenue to drop by $2 billion to $17.3 billion for fiscal year 2021, which starts after its June 30 year end.

Dive Insight:

In May, Trinity said it planned to furlough nearly 12% of its workforce — or 15,000 employees out of the 125,000 nationally.  

Trinity, one of the nation’s largest hospital operators with 92 facilities and operations across 22 states, is now broadening that restructuring, extending and adding new furloughs.

In a Monday bond filing, Trinity said its operations were “significantly” impacted by the effects of the pandemic as many operators saw depressed volumes due to shelter-in-place orders, which started in most of Trinity’s markets during the last two weeks of March.

“The effect of COVID-19 on the operating margins and financial results of Trinity Health is adverse and significant and, at this point, the duration of the pandemic and the length of time until Trinity Health returns to normal operations is unknown,” according to Monday’s bond filing.

The system said relief funds provided by the federal government have not been enough to cover its operating losses. Trinity has received $600 million in relief funds that do not have to be repaid and more in loans through the advanced Medicare payment program, according to a previous analysis by Healthcare Dive.

Still, the system said it has drawn on credit facilities totaling $1 billion to provide adequate liquidity during the pandemic. Trinity reported having 178 days cash on hand as of March 30.

Some nonprofits are faring better than Trinity and pulling back on earlier staffing cuts.

Mayo Clinic said last week it will call back its furloughed workers by the end of August and restore pay that had been cut due to the pandemic.

Mayo has some of the most cash on hand in terms of days when comparing other major nonprofit systems. Mayo had 252 days of cash on hand as of March 30, more than the other 20 largest nonprofits except Cleveland Clinic and New York-Presbyterian.

 

 

Pandemic Graphic of the Day

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Live updates: U.S. sets another single-day record for new coronavirus cases, surpassing 40,000 for first time

https://www.washingtonpost.com/nation/2020/06/26/coronavirus-live-updates-us/?fbclid=IwAR2rv7BC74tY4bLlGXlh70tcuv3V3vGz52MCFrCX2FYdMvhkOxd_XJoUsgM&utm_campaign=wp_main&utm_medium=social&utm_source=facebook

Coronavirus latest: Global coronavirus infections top 1 million ...

The United States has set a record for new covid-19 cases for the third time in three days, passing the 40,000 mark for the first time, according to tracking by The Washington Post.

Twelve states set their own records for the average number of new cases reported over the past seven days: Arizona, California, Florida, Georgia, Mississippi, Missouri, Oklahoma, South Carolina, Tennessee, Texas, Idaho and Utah.

Six states set new single-day highs, led by Florida with 8,942 cases, more than 60 percent higher than its previous high set on Wednesday. Georgia, South Carolina, Tennessee, Idaho and Utah also set new single-day records.

Florida announced Friday morning that bars must close immediately, a move echoed by Texas, a state also dealing with a surge in cases and nearing its capacity to care for those suffering.

“The trajectory that we’re on right now has our hospitals being overwhelmed, probably about mid-July,” Austin Mayor Steve Adler (D) said during an appearance on CNN.

Texas Gov. Greg Abbott (R) issued an executive order that revives restrictions on bars, restaurants and certain types of outdoor recreation, one day after suggesting he would not.

Here are some significant developments:

  • The Dow Jones industrial average slid 730.05 points, about 2.8 percent, as rising coronavirus infections roiled investors Friday.
  • Vice President Pence said during a White House coronavirus task force news briefing that it is “very encouraging news” that half of the increasing cases in Florida and Texas are among Americans under 35, because younger people tend to have less-serious outcomes.
  • The Trump administration official coordinating tests for the novel coronavirus did a partial pivot Friday, announcing that the government would briefly extend its management of five testing sites in Texas, a state with a recent spike of cases and hospitalizations.
  • Anthony S. Fauci, the nation’s leading infectious-disease doctor, urged Americans to see their role in taking safety precautions as a “societal responsibility.” He begged them not to let their guards down even if the risk to their own health is considered minimal, because they can still transport it.
  • In another sign that hopes of a swift economic recovery may be losing steam, the number of homeowners delaying their mortgage payments shot up by 79,000.
  • Portugal is reinstating lockdown measures for about 700,000 people in 19 civil parishes around Lisbon next week after a worrying rise in cases in communities in the capital’s outskirts.

Six states set record number of new cases

As the United States logged a record number of infections Friday, six states announced their own new single-day high case totals: Georgia, Utah, South Carolina, Tennessee, Idaho and Florida.

Georgia reported four straight days of more than 1,700 new infections and two days in a row of records. The 1,900 cases reported by state health officials Friday surpassed the previous record, 1,714 cases, announced Thursday.

The seven-day average of new infections also hit a new high — 1,569 — and has been rising steadily since late May. That figure is up about 77 percent from a week ago and nearly 115 percent since Memorial Day.

In Utah, the single-day case total hit 676 and set a record for the fourth day in a row. The rolling average has also been on a steady upward swing for 10 days.

Current hospitalizations of Utah’s confirmed covid-19 patients are rising quickly, from 149 a week ago to 174 on Friday. Hospitalizations were at 102 when the month began.

South Carolina’s 1,301 new cases and 1,094 rolling average also set records. The state started the month with an average of 281 daily cases.

Tennessee announced 1,410 new infections, surpassing its previous record number of single-day cases by more than 200.

Current hospitalizations are also rising in South Carolina and Tennessee.

In addition to the states that set records, Louisiana has joined the states with rapidly increasing case numbers. Health officials announced 1,354 new cases Friday, compared with 523 two weeks ago and none two weeks before that.

 

 

 

Florida reports massive single-day increase of 9,000 coronavirus cases

https://www.axios.com/florida-single-day-increase-coronavirus-cases-a6d5578b-527c-4be4-88e6-eb7289a7be97.html?stream=health-care&utm_source=alert&utm_medium=email&utm_campaign=alerts_healthcare

Florida reports massive single-day increase of 9,000 coronavirus ...

Florida on Friday reported nearly 9,000 new coronavirus cases in 24 hours totaling 122,960 cases.

Why it matters: The state is one of many that are experiencing a fresh surge of infections.

Go deeper: The coronavirus surge is real, and it’s everywhere

 

 

 

3 moral virtues necessary for an ethical pandemic response and reopening

https://theconversation.com/3-moral-virtues-necessary-for-an-ethical-pandemic-response-and-reopening-140688?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20June%2026%202020%20-%201662516009&utm_content=Latest%20from%20The%20Conversation%20for%20June%2026%202020%20-%201662516009+Version+A+CID_98447eb9cb25b06b85aed07c7fd721bd&utm_source=campaign_monitor_us&utm_term=3%20moral%20virtues%20necessary%20for%20an%20ethical%20pandemic%20response%20and%20reopening

3 moral virtues necessary for an ethical pandemic response and ...

The health and economic impacts of the coronavirus pandemic are not equally felt. From the United States to Brazil and the United Kingdom, low-wage workers are suffering more than others and communities of color are most vulnerable to the virus.

Despite the disparities, countries are reopening without a plan to redress these unequal harms and protect the broader community going forward. Our ethics research examines the potential for using virtues as a guide for a more moral coronavirus response.

Virtues are applied morals – actions that promote individual and collective well-being. Examples include generosity, compassion, honesty, solidarity, fortitude, justice and patience. While often embedded in religion, virtues are ultimately a secular concept. Because of their broad, longstanding relevance to human societies, these values tend to be held across cultures.

We propose three core virtues to guide policymakers in easing out of coronavirus crisis mode in ways that achieve a better new normal: compassion, solidarity and justice.

1. Compassion

Compassion is a core virtue of all the world’s major religions and a bedrock moral principle in professions like health care and social work. The distinguishing characteristic of compassion is “shared suffering:” Compassionate people and policies recognize suffering and take actions to alleviate it.

As the French philosopher André Comte-Sponville said, compassion “means that one refuses to regard any suffering as a matter of indifference or any living being as a thing.”

Individual acts of compassion abound in the coronavirus crisis, like frontline health care professionals and neighbors who deliver food, among other examples.

Compassion and solidarity on display at New York’s Elmhurst Hospital, during the April peak of the city’s coronavirus outbreak. Noam Galai/Getty Images

Some pandemic-era policies also reflect compassion, such as regulations preventing evictions and expanding unemployment benefits and giving food aid to poor familes.

A compassion-guided reopening aimed at preventing or reducing human suffering would require governments to continually monitor and alleviate the pain of their people. That includes addressing new forms of suffering that arise as circumstances change.

2. Solidarity

In a global pandemic, the actions people do or don’t take affect the health of others worldwide. Such shared emergencies require solidarity, which recognizes both the inherent dignity of each individual person and the interdependence of all people. As United Nations officials have emphasized, “we are all in this together.”

Public health measures like stay-at-home orders, social distancing and wearing masks reflect solidarity. While compliance in the United States has not been universal, data indicate broad approval for these measures. A new study found that 80% of Americans nationwide support staying home and social distancing and 74% support using face coverings in public.

To achieve these acts of solidarity, the leaders most praised in their countries and abroad – from U.S. National Institutes of Health director Dr. Anthony Fauci to New Zealand prime minister Jacinda Ardern – have relied primarily on moral persuasion, not threats of punishment.

By delivering clear information, giving simple and repeated behavioral guidance, and setting a good example, they’ve helped convince millions to take personal responsibility for protecting their community.

Face masks signal that wearers care about protecting others around them. Islam Dogru/Anadolu Agency via Getty Images

3. Justice

Justice focuses on the fair distribution of resources and the social structures that enable what the Dutch philosopher Patrick Loobuyck has called a “condition of equality.”

Justice-oriented policies are necessary for a moral reopening because of the pandemic’s disproportionate health and economic impacts. The evidence clearly shows that communities of color, low-income populations, people in nursing homes and those on the margins of society, such as homeless people and undocumented immigrants, are hardest hit.

Justice-oriented policies would aim for equitable balancing of necessary pandemic resources. That means directing testing and health equipment toward vulnerable communities – as identified by COVID-19 tracking data and risk factors like housing density and poverty – and ensuring free, widespread vaccine distribution when it becomes available.

In the U.S., economic justice will also require aggressively investing in minority-run businesses and poorer areas to guard against further harm to owners, employees and neighborhoods.

Similarly, all American school children have lost critical classroom hours, but lower-income children have been disproportionately damaged by remote learning in part due to the digital divide and loss of free lunch programs. Justice would demand channeling additional resources to the students and schools that need them most.

A moral reopening

Using virtues to guide social policies is an old idea. It dates back at least to the Greek thinker Aristotle.

Social distance stickers to prepare Nepal’s empty Tribhuwan International Airport for reopening. Narayan Maharjan/NurPhoto via Getty Images

New Zealand is a good example of virtuous pandemic policymaking, even considering its advantages in having wealth, low density and no land borders. Its coronavirus response included not only aggressive public health measures but also a well articulated message of being united in the COVID-19 fight and recurring government payments so workers did not have to risk their health for their job.

Note that it isn’t enough to apply just one virtue in a crisis of this magnitude. Policies built on compassion, solidarity and justice should be deployed in combination.

A compassionate post-pandemic response that does not address underlying inequalities, for example, ignores certain communities’ specific needs. Meanwhile, tackling specific injustices without engaging everyone in efforts like mask-wearing endangers the public health.

Bolstered by scientific evidence, virtue ethics can help nations reopen not just economically but morally, too.

 

 

 

 

U.S. Healthcare System vs. Socialized Medicine during the Pandemic

https://www.commondreams.org/news/2020/06/25/why-socialized-system-medicare-all-beats-profit-healthcare-one-chart-covid-19?fbclid=IwAR1qT_AI5KFreoEKOqQfvdWUHPyW80fa2Iefxb5Ul5wJQtf8rSvZXkL8RHM

 

“All countries successfully combatting this virus have robust public health systems, which provide for coordination of effort.”

A recent rise in cases of Covid-19 and the overt failure of the for-profit healthcare system throughout the pandemic in the U.S. are making the case for Medicare for All, advocacy groups and activists say, as countries with socialized systems see their infection rates decline.

“All countries successfully combatting this virus have robust public health systems, which provide for coordination of effort,” remarked a popular healthcare advocate who uses the @AllOnMedicare handle on Twitter.

Calls for the U.S. to adopt a single-payer heathcare system have increased as the pandemic has raged around the country. Cases and deaths in the U.S are now the highest in the world, a result critics blame on both the private healthcare system and the mismanagement of the crisis by President Donald Trump.

Public Citizen’s health care policy advocate Eagan Kemp told Common Dreams that the current for-profit healthcare system that has driven millions of Americans in to bankruptcy and leaves millions more without care will only continue to exacerbate the pain of the outbreak. 

“While no health care system can completely protect a country from Covid-19, the U.S. has failed to respond for a number of reasons, not least of which is a for-profit health care system where Americans are too afraid to go to the doctors for fear of the cost,” said Kemp. “Far too many Americans will face medical debt and even bankruptcy if they are lucky enough to survive getting Covid-19, something unheard of in all other comparably wealth countries.”

As University of Massachusetts professor Dean E. Robinson wrote in a piece that appeared at Common Dreams earlier this month, the coronavirus is impacting people of color at a disproportionate rate in cities and communities nationwide—a dynamic that bolsters the call for a universal Medicare for All program to help close those gaps.

“The obvious and immediate need of Black and other working class populations caught in the teeth of the pandemic is the right to health care treatment without the burden of cost,” wrote Robinson. “Even before the pandemic, lower-income, Latino, and younger workers were more likely to be uninsured. Undocumented workers had the highest rates of uninsurance.”

On June 18, Ralph Nader in an opinion piece for Common Dreams expressed his hope that the ongoing pandemic would make essential workers in the health field “the force that can overcome decades of commercial obstruction to full Medicare for All.”

 

 

 

 

Jobless claims: Another 1.48 million Americans file for unemployment benefits

https://finance.yahoo.com/news/coronavirus-covid-weekly-initial-jobless-claims-june-20-195644738.html

More than three months into the COVID-19 crisis in the U.S., countless Americans are still unemployed. According to the U.S. Labor Department, weekly initial jobless claims data showed yet another week of claims exceeding 1 million.

Another 1.48 million Americans filed for unemployment benefits in the week ending June 20, exceeding economists’ expectations for 1.32 million. The prior week’s figure was revised higher to 1.54 million from the previously reported 1.51 million claims. While this week’s report marked 12 consecutive weeks of deceleration, more than 47 million Americans have filed for unemployment insurance over the past 14 weeks.

“Jobless claims are not falling fast enough,” Renaissance Macro’s Neil Dutta said in an email Thursday. “Everything we have seen in the last week or two between rising case counts/hospitalizations, stalling economic progress in some important states, government job cuts, means one thing: the Phase 4 of fiscal stimulus must be bigger. Things should be better in 3-4 weeks, but the news will get worse before it gets better. Take some chips off the table and reload the chamber for August.”

Continuing claims, which lags initial jobless claims data by one week, totaled 19.52 million in the week ending June 13, down from 20.29 million in the week ending June 6. Consensus expectations were for 20 million continuing claims.

“Initial jobless claims continue to moderate only gradually,” Nomura economist Lewis Alexander wrote in a note Wednesday. “While the labor market remains exceptionally weak, signs of gradual improvement suggest another month of NFP gains during June.”

In the week ending June 20, California reported the highest number of jobless claims at an estimated 287,000 on an unadjusted basis, up from 241,000 in the previous week. Georgia had 124,000, down from 132,000, Florida reported 93,000, New York had roughly 90,000 and Texas reported 89,000 jobless claims.

Additionally, Pandemic Unemployment Assistance (PUA) program claims, which include those who were previously ineligible for unemployment insurance such as self-employed and contracted workers, was also closely monitored in Thursday’s report.

PUA claims totaled 728,120 on an unadjusted basis in the week ending June 20, down from the prior week’s 770,920.

As states reopen their economies, cases and hospitalization figures are back on the rise. As of Thursday morning, there were more than 9.4 million cases and 483,000 COVID-19 deaths around the world, according to Johns Hopkins University data. The U.S. had 2.3 million cases and 121,000 deaths.