Maryland physicians, specialists urge CareFirst to reimburse phone appointments; Telehealth; COVID deaths Still on the Rise; and What About those Masks?

I needed to let everyone know that telehealth is a scam and also that it is doing more harm than good. It doesn’t help care for many of our patients and is there to make money, first for the technology companies and also to bring in revenues for the physicians during this pandemic. They are taking advantage of our patient’s fears and the physicians who are in a bind not “allowed” to see their patients and therefore not able to bill the insurance companies. But as we have found out, both in our families needing care, our friends and our patients, that not all insurers are paying for these services and if paid the rate of payment is so poor and yes, it will end soon. Then what?

This week in fact, I had to see 3 patients whose cancers were very large and should have been evaluated and treated months ago, and yes, my office was open for those cancer patients. They also had medical conditions which should have been evaluated and treated which puts me in a bind knowing that I need to do surgery on these patients and now because of many conditions, I have to remove these large cancers in my office under local anesthesia. Yes, this has been a very depressing week.

Hallie Miller further discusses this problem. CareFirst BlueCross BlueShield, Maryland’s largest health insurer, is not reimbursing some medical and mental health providers for appointments held over the phone or via audio-only platforms to the dismay of those providers.

CareFirst, which serves over 3 million members, is only reimbursing primary care physicians, obstetricians and gynecologists, and behavioral health providers under specific conditions. They are paid a flat rate of $20 regardless of the length of the call.

Other specialists such as cardiologists, ophthalmologists and neurologists are not reimbursed by CareFirst for any phone or audio-only services.

With the coronavirus pandemic prompting doctors’ offices and hospitals to restrict in-person patient visits and elective surgeries, physicians and medical professionals have been forced to rapidly adjust to telehealth methods to provide routine care. Much of the daily grind has shifted to virtual channels, with video visits and phone calls replacing face-to-face interaction between doctors and patients as public health experts caution against gathering in close proximity indoors.

Most insurers, public and private, are now paying for telemedicine. But the lack of uniformity in policy and standards among insurers has caused frustration among Maryland’s physicians and mental health professionals, who have to navigate a new mode of care with differing guidelines and rates across the board.

“If we genuinely want to meet patients where they are, we need to have multiple flexible platforms, and if the payer isn’t flexible, that’s a challenge,” said Dr. George Ruiz, the chief of cardiology at MedStar Union Memorial Hospital, MedStar Good Samaritan Hospital and MedStar Harbor Hospital. “If payment structures come into place, we can overcome one of the major barriers to care that exist in medicine.”

Ruiz said insurers should not discount phone and audio-only sessions, which can serve vulnerable patient populations that may not have the technology or the ability to set up a video visit. Phone appointments also offer patients more convenience during time-sensitive situations and keep people out of hospitals and emergency rooms.

Gene Ransom, the CEO of MedChi, the state’s medical society, said his group has lobbied CareFirst to reconsider its audio and phone-only reimbursement policy.

“By not paying for audio-only services, you’re paying for much more expensive visits to emergency rooms later,” said Ransom, adding that some CareFirst-insured patients might not seek out care in the first place if they know their insurance will not cover it. “Carving out certain specialties could lead to a really bad outcome for the patient.”

In a statement, CareFirst said it only began reimbursing for phone and audio calls as a result of the coronavirus pandemic and then only for some doctors to allow check-ins to maintain continuity of care. It will continue such coverage after July 24 when a member cost share waiver put in place during the outbreak expires.

It also will continue to cover telemedicine, which it defines as a combination of interactive audio and video, as it did before the pandemic, CareFirst said.

“Visits that include both audio and visual components allow for provision of quality care for our members,” according to the statement.

CareFirst, in its statement, also noted that many doctors’ offices have reopened to provide on-site care.

Dr. Michael Silverman, managing physician at Cardiovascular Specialists of Central Maryland, a Johns Hopkins affiliate, believes video adds little to the substance of a telehealth visit. A phone call, he said, can deliver urgent care to patients with physical or technological limitations.

Silverman said a patient called him on June 10 for a 22-minute consultation about his spinal surgery the next day, which precipitated another 20 minutes of medical record review and note writing. CareFirst did not reimburse him for this effort, he said.

“There are physicians right now who are really suffering, financially,” said Silverman, adding that he came close to having to close his practice when the coronavirus pandemic reached Maryland in March.” A call to a cardiologist goes a long way, but if they can’t call, so be it.”

Ransom said insurers should follow the federal government’s lead, which has issued guidelines for Medicare and Medicaid — the services that cover older adults and people with low incomes — to cover audio and phone appointments and waive member cost shares until further notice. Other providers such as Aetna, Cigna and UnitedHealthcare also cover audio-only visits, though the guidelines differ from company to company.

Some providers said insurers should standardize telehealth so it can be utilized beyond the fall, as such services offer a number of benefits for both patients and doctors.

Paul Berman, a Towson-based psychologist and director of professional affairs for the Maryland Psychological Association, said telemedicine has proven especially effective for people with depression and severe phobias who struggle with leaving the home or driving. It also serves as a vital lifeline for people with substance use disorders or those suffering from acute crises.

Berman said CareFirst’s $20 flat fee for “phone consultations” for behavioral health providers covers only specific sessions that are initiated by the patient and are not related to matters discussed within seven days prior or 24 hours after the call. As a result, it does not provide for continuity of care.

“You have people who benefit from, and even need, ongoing treatment in order to stabilize their emotional state and physical health, and if they don’t have access to services, their functioning deteriorates,” Berman said. “Many psychologists … are not able to make paid contact with patients because of this exclusion.”

Berman said psychologists and counselors, in particular, will be put at risk if they are forced to return to their offices during the ongoing pandemic, as therapy requires face-to-face interaction for up to an hour. Public health experts have warned that such interaction, especially indoors, can lead to transmission of COVID-19 through aerosols.

To mitigate out-of-pocket costs for patients, Berman said some psychologists have decided to provide low-fee services, or have patients to scale back the number of sessions scheduled per month. But this can create gaps in care for patients that lead to regression in their mental health, he said.

“People have been locked out of the ability to make use of mental health services if insurance has not waived the telephone exclusion,” he said. “It makes no sense.”

U.S. COVID-19 deaths rise for second week in a row and it continues to rise 

Reporter Lisa Shumaker noted that the U.S. deaths from COVID-19 rose for a second week in a row to more than 5,200 people in the week ended July 19, up 5% from the previous seven days, a Reuters analysis found.

The country reported over 460,000 new coronavirus cases last week, up nearly 15% from the prior week, according to the analysis of data from The COVID Tracking Project, a volunteer-run effort to track the outbreak.

Nineteen states have reported increases in deaths for at least two straight weeks, including, Arizona, Florida and Texas.

Testing for COVID-19 rose by 9% in the United States last week and set a new record high on Friday, with over 850,000 tests performed, the Reuters analysis found.

Nationally, 8.5% of tests came back positive for the novel coronavirus, down from 8.8% the prior week but still higher than the 5% level that the World Health Organization considers concerning because it suggests there are more cases in the community that have not yet been uncovered.

Thirty-one states had positivity test rates above 5%, according to the analysis, including Arizona at 24%, Florida and Nevada at 19%, and Idaho and Alabama at 18%.

Nationally, new COVID-19 cases have risen for seven straight weeks. Forty-three states reported more new cases of COVID-19 last week compared to the previous week, the analysis found.

For the first time since April, cases rose in New York State week over week, breaking a 13-week streak of declines. New Jersey now leads the nation with cases falling for two weeks in a row. The other six states have only seen cases decline for one week.

U.S. Coronavirus Deaths Could Be Cut 67 Percent With ‘Universal Mask Usage,’ Study Finds

Almost everyone is arguing about the use of masks and part of the problem is the changing opinions on mask wearing as well as the exhaustion of lockdowns and quarantines. Soo Kim reports that with novel coronavirus cases in the U.S. approaching nearly 3.9 million, several local authorities have issued orders requiring face coverings in public in a bid to reduce the spread of infection.

While many people have been opposed to mask mandates, the widespread use of masks could potentially help significantly reduce the country’s daily case count and daily death toll, according to data from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

The U.S. daily death toll is currently projected to be around 815 by November 1, according to projections from the IHME. . This daily death toll projected for November 1 could be reduced by over 66.4 percent if “universal masks” were applied across the country, the institute noted.

Universal mask usage refers to a 95 percent usage of masks in public in every location, with “mandates re-imposed for six weeks if daily deaths reach eight per million (0.8 per 100,000),” the institute explained.

Universal masks could also reduce the country’s projected daily case count for November 1 by more than half, according to the research. The daily case count in the U.S. is currently projected to reach around 124,929 by November 1, the IHME noted.

If universal masks were applied across the country, the projected daily case count could be reduced to about 46,495 by November 1, over 62.7 percent less than the current daily case count projected by the institute for the same date.

The daily case count and daily death toll in Arizona, which was found to be the most “anti-mask” state by a survey of over 150,000 Twitter posts using anti-mask-related hashtags, could also be reduced by around 70 percent if universal masks were applied across the state.

The state’s daily case count is projected to hit around 3,176 by November 1, which could be reduced to around 899 with universal mask usage, according to the IHME projection, a more than 71.6 percent reduction in daily new cases.

Arizona’s daily death toll is expected to reach nearly 20 by November 1. But the projected daily death toll could be reduced by over 68 percent if universal masks were applied, the IHME noted.

Statewide mask mandates have been issued in several parts of the country, including most recently in Texas, Kansas, Pennsylvania and Oregon.

Masks are currently not required in Iowa, Montana, South Dakota, and Wisconsin.

Face coverings are required in certain counties and cities within Alaska, Arizona, Florida, Georgia, Idaho, Kentucky, Minnesota, Mississippi, Missouri, New Hampshire, North Dakota, Ohio, Oklahoma, South Carolina, Tennessee, West Virginia, and Wyoming.

This week, President Donald Trump appeared to have shifted from a reluctance to wearing face masks to suggesting they are patriotic, while sharing a photo of himself wearing one in a post Monday on his official Twitter account.

Telehealth could grow to a $250B revenue opportunity post-COVID-19: analysis

Heather Landi pointed out that during the COVID-19 pandemic, consumer adoption of telehealth has skyrocketed, from 11% of U.S. consumers using telehealth in 2019 to 46% of consumers now using telehealth to replace canceled healthcare visit, according to consulting firm McKinsey & Company’s COVID-19 consumer survey conducted in April.

McKinsey’s survey also found that about 76% of consumers say they are highly or moderately likely to use telehealth in the future. Seventy-four percent of people who had used telehealth reported high satisfaction.

Health systems, independent practices, behavioral health providers, and other healthcare organizations rapidly scaled telehealth offerings to fill the gap between need and canceled in-person care. Providers are ready for the shift to virtual care: 57% view telehealth more favorably than they did before COVID-19 and 64% are more comfortable using it, according to McKinsey’s recent provider surveys.

Pre-COVID-19, the total annual revenues of U.S. telehealth players were an estimated $3 billion, with the largest vendors focused on virtual urgent care.

Telehealth is now poised to take a bigger share of the healthcare market as McKinsey estimates that up to $250 billion, or 20% of all Medicare, Medicaid, and commercial outpatient, office, and home health spend could be done virtually.

The consulting firm looked at anonymized claims data representative of commercial, Medicare, and Medicaid utilization.

The company’s claims-based analysis suggests that approximately 20% of all emergency room visits could potentially be avoided via virtual urgent care offerings, 24% of healthcare office visits and outpatient volume could be delivered virtually, and an additional 9% “near-virtually.”

Up to 35% of regular home health attendant services could be virtualized, and 2% of all outpatient volume could be shifted to the home setting, with tech-enabled medication administration.

Many of the dynamics that have helped to expand telehealth adoption are likely to be in place for at least the next 12 to 18 months, as concerns about COVID-19 remain until a vaccine is widely available.

Going forward, telehealth can increase access to necessary care in areas with shortages, such as behavioral health, improve the patient experience, and improve health outcomes, McKinsey reported.

Providers and patients are concerned that recent federal and state policies expanding access to telehealth will be rolled back once the emergency period ends.

Industry groups, including the College of Healthcare Information Management Executives (CHIME), are calling on lawmakers to ensure the changes enacted by Congress and the administration become permanent.

McKinsey’s research indicates providers’ concerns about telehealth include security, workflow integration, effectiveness compared with in-person visits, and the future for reimbursement.

“We call on Medicare and all other insurers to continue to fund telehealth programs and work collaboratively on coverage and coding to lessen provider burden. We cannot go back to pre-COVID telehealth; instead, we must go forward. Patients will demand it and providers will expect it,” CHIME CEO and President Russell Branzell said in a recent statement.

Telehealth also is drawing bipartisan support. Senator Marsha Blackburn, R-Tenn., urged Congress to “continue to support this expansion and codify the administration’s changes to support the health needs of the American people,” in a recent news release.

Rep. Robin Kelly, D-Illinois, is introducing a bill directing HHS Secretary Alex Azar to oversee a telehealth study looking at the technology’s impact on health and costs, Politico reported in its newsletter today.

Taking advantage of the telehealth opportunity

Healthcare providers and payers will need to take action to ensure the full potential of telehealth is realized after the crisis has passed, according to McKinsey.

There continue to be challenges as providers cite concerns about telehealth include security, workflow integration, effectiveness compared with in-person visits, and the future for reimbursement. There also is a gap between consumers’ interest in telehealth (76%) and actual usage (46%). Factors such as lack of awareness of telehealth offerings and understanding of insurance coverage are some of the drivers of this gap.

“The current crisis has demonstrated the relevance of telehealth and created an opening to modernize the care delivery system,” McKinsey consultants wrote. “Healthcare systems that come out ahead will be those who act decisively, invest to build capabilities at scale, work hard to rewire the care delivery model, and deliver distinctive high-quality care to consumers.” 

McKinsey outlined steps industry stakeholders should take to drive the growth of telehealth.

Payers: Health plans should look to optimize provider networks and accelerate value-based contracting to incentivize telehealth. Align incentives for using telehealth, particularly for chronic patients, with the shift to risk-based payment models.

Payers also should build virtual health into new product designs to meet changing consumer preferences, This new design may include virtual-first networks, digital front-door features (for example, e-triage), seamless “plug-and-play” capabilities to offer innovative digital solutions, and benefit coverage for at-home diagnostic kits.

Health systems: Hospitals and health systems should accelerate the development of an overall consumer-integrated “front door.” Consider what the integrated product will initially cover beyond what currently exists and integrate with what may have been put in place in response to COVID-19, for example, e-triage, scheduling, clinic visits, record access.

Providers also should build the capabilities and incentives of the provider workforce to support virtual care, including, workflow design, centralized scheduling, and continuing education. And, health systems need to take steps to measure the value of virtual care by quantifying clinical outcomes, access improvement, and patient/provider satisfaction. Include the potential value from telehealth when contracting with payers for risk models to manage chronic patients, McKinsey said.

Investors and health technology firms: These players also can support the new reality of expanded telehealth services. Technology firms should consider developing scenarios on how virtual health will evolve and when, including how usage evolved post-COVID-19, based on expected consumer preferences, reimbursement, CMS and other regulations.

Investors also should develop potential options and define investment strategies based on the expected virtual health future. For example, combinations of existing players/platforms, linkages between in-person and virtual care offerings and create sustainable value. Investors and technology companies also can identify the assets and capabilities to implement these options, including specific assets or capabilities to best enable the play, and business models that will deliver attractive returns.

And Now Payment Problems as Patients Lose Coverage due to COVID                Leigh Page reviewed what many practices are seeing happen as the lockdowns ease up. Percy Erachshaw, DO, a general surgeon, was happy and encouraged when New York City started to open up a bit during the COVID outbreak and patients began coming back into doctors’ offices and having online visits. But Erachshaw, like many physicians nationwide, is quickly learning that the insurer payments he’s expecting may be a thing of the past.”The patient volume is back,” said Erachshaw, who manages four practice sites in Brooklyn and Queens, New York. Two of the sites that had been closed for 2 or 3 months recently reopened. However, “I have patients who don’t have insurance coverage anymore. They lost their jobs, but they are my long-term patients, so I can’t turn them away”. Many of these patients need help getting on Medicaid, but Erachshaw doesn’t have enough staff to help them. Much of his former staff left the practice and are not returning. With unemployment benefits temporarily enhanced by federal dollars, “They discovered they were making more money staying at home than working,” he said.                                                                                                            Many Patients Lost Healthcare Coverage                                                  Because of layoffs during the COVID-19 crisis, an estimated 12.7 million Americans lost employer coverage from early March to May 1. Even some workers who have not been laid off may lose coverage. Although the Affordable Care Act requires large employers to provide health insurance, small businesses can cancel coverage.

“Depending on how long the high unemployment lasts, practices could have many more uninsured patients,” said Lori Foley, managing principal in Atlanta, Georgia, for PYA, a national healthcare consulting and accounting firm.

Patients who lose coverage have the option of buying their own insurance, but in many cases, Foley says, they can’t afford to do so. “Premiums for individual health insurance can be expensive, and laid-off workers may not have been saving for that, because they did not expect to be laid off,” she said.

Indeed, many people simply don’t have the funds to take out a new insurance policy. According to one analysis, 40% of Americans do not have $400 to cover unexpected expenses.

Don’t expect patients who have been laid off to turn up at your office with a new form of coverage, says Kathryn I. Moghadas, a healthcare consultant in Winter Springs, Florida. “They’re not going to run out and get new coverage,” she said. “If they come in, they’ll want to use their credit cards and negotiate a cheaper rate with the office.”

Many people who are still working are concerned about their finances or about getting the virus, so they’re limiting their medical care. Health insurers Humana and Aetna recently noted that use of medical services has plummeted by at least 30%.

High deductibles, which have become increasingly common, also incentivize people to cut back on care, particularly at the beginning of the year, before they have met their deductible. Among workers who have a health insurance deductible, the average deductible is $1655 this year.

Many patients are selecting health services on the basis of price. More hospitals are providing their prices online and even offer tools to calculate payment estimates. Patients also have begun to expect price quotes from practices.

“When these patients call a practice, they may not want to simply book an appointment,” Foley said. “They will want to hear about your prices. Many practices are still not used to this. They often don’t have the self-pay prices and payment plan information available.”

Payers Are Making It Tougher                                                                                           Some health insurers are taking longer to pay because, like many other businesses in the COVID-19 era, they have fewer staff, says Michael La Penna, a practice management consultant in Grand Rapids, Michigan. “Due to the lower staffing, it can take an insurer longer than the usual 30 to 45 days to process a payment,” he said.                                                                                                 Low staffing has also made it hard to get prior authorizations, such as for primary care physicians’ (PCPs’) referrals to specialists in health maintenance organizations (HMOs). “We will call the HMO and we would be put on hold forever,” Erachshaw said. “It has been a mess and a half. If you don’t have an approval for a referral, you can’t refer the patient.”                                                                                                              Some payers have temporarily waived the prior authorization process for certain services during the COVID-19 crisis, but they may not implement those changes. “Many payers claim to have relaxed authorizations for ‘most’ or ‘many’ services,” the report said, “but what ‘most’ or ‘many’ means is anyone’s guess.”                Another area of confusion is the new or enhanced telehealth payments that Medicare and many private payers are temporarily allowing during the COVID crisis. “The typical PCP has six, seven, eight different payers, each with a different telehealth policy,” said Robert L. Phillips, MD, executive director Center for Professionalism and Value In Healthcare, a think tank in Washington, DC. “As a working clinician, I can’t manage all of those policy differences in my head.” “Each insurer has slightly different rules on telehealth, and they keep changing,” said Rebecca Etz, PhD, co-director of the Larry A. Green Center, another think tank in Washington, DC, which promotes primary care. “For example, some won’t pay for telephone-based care if the call lasts less than 10 minutes.”                                Insurance companies themselves may be confused about their own telehealth policies and thus underpay or deny payment to providers. Telehealth organizations say insurers have been slow to update their software and policies. Spotty payments for telemedicine and many other services mean many doctors are reimbursed only a fraction of what they are entitled. In an April survey of physicians and other clinicians in primary care, 57% said that fewer than half of their visits in the past week were reimbursable.                                                                                          Here are some ways practices can deal with patients who lose insurance and the insurance plans that represent them.                                                                                   Keep the bill low. Look for ways to keep costs in check. For example, “physicians could find less expensive form of meds for patients who are concerned about high costs,” Moghadas said.                                                                                                              Know your prices. “Practices should be able to tell self-pay patients what they basically can expect to pay,” Foley said. At the least, a practice could state that a new visit would cost $150 for the visit, plus additional costs for labs and x-rays, and a visit for an established patient would cost $75, she says.                                             Bring your patients back in. Many of your patients are not going to return to you without a little nudge. “You can’t sit back and wait. You need to remind them,” said Phil Boucher, MD, a pediatrician in Lincoln, Nebraska, who has been a speaker on the online Back to Busy Summit for physicians who want to revive their practices in the era of COVID-19.                                                                                                               “Reach out to your patients by sending them an email, if not a text or a message on social media,” he advised. “Better yet, go on local news and talk about your practice opening. Give them a reason to come in, such as annual checkups and routine care.” For example, Moghadas notes that diabetes patients generally need to come in every 3 months, and women need to see their gynecologist more often than once a year. “You can set up your EHR system to determine when each patient needs to come in,” she said.                                                                                                                                      Update insurance coverage information. “Asking every year about insurance coverage is not frequent enough right now because there are so many changes going on,” Foley said. “Ask about coverage on each visit.” adds that when employees are laid off, coverage often lasts for the rest of the month. If patients inform you of the change immediately, you might be able to get them in to see you before coverage ends, he says. Help patients get coverage. “Help to get patients signed up with Medicaid or COBRA,” Boucher said. “Your billing people can do this through a phone call.”

Small practices, however, may not have extra staff to do this work, Foley says. Also, many practices have staff shortages, such as Erachshaw’s practice. “I still have to find and train enough staff to get vital signs,” Erachshaw said. “I don’t have enough people to sign patients up for Medicaid.”

Effective Tactics to Collect from Patients                                                                   Having many uninsured patients means you have to shift to getting more payments from patients, which is harder to do than getting paid by insurers, Moghadas says. “It really takes a lot of effort to collect this money,” she said.                                     “Most practices are already experienced with patient collections, due to high deductibles,” Foley said. “Practices need to identify who is self-pay and what their discount approach is. “You have to collect at the time of service,” Foley adds. “If you wait until after the appointment, the chances of payment drop considerably.” If the bill is past due, “tell them about it when they come in for their next appointment,” she said. “It’s easier to collect a bill face to face.”                                                                                                        When patients say they can’t pay the bill, ask about their financial hardship. “Find out their household income,” Foley said. “Set up a sliding scale in which payments are reduced depending on the patient’s income. Health systems do this all the time.” After sending a few bills, Foley says, the next letter to the patient ― the pre-collect letter ― should state that the bill will now go to a collection agency unless it is paid in full. “People worried about their credit rating, such as those buying a house, will pay, but others are willing to let their debt go to a collection agency,” she said. Creating payment plans requires setting a reasonable monthly amount to be paid. “If you set the amount too low, it could take years to pay off,” she said. If the amount owed is $500 or less, she recommends setting up three monthly payments, and if it’s over $1000, then six monthly payments.                                                                               The Future                                                                                                                                     The road ahead for doctors still seems very bumpy. The reopening of public places is coming in fits and starts, and when the number of COVID-19 cases rises again, patients stay away for a while, Phillips says. “Each temporary spike in COVID cases has a lasting effect on practices,” he said. “Patients will disappear for a while afterward.             Philips predicts that because of the epidemic, primary care practices will lose almost $20 billion by the end of the year. If temporary telemedicine payments were removed, the losses could be double that, he says.                                                         When Medicare and other payers drop the current higher payments for telemedicine, as planned, many doctors will be forced to give up telemedicine, predicts La Penna. “At lower or nonexistent reimbursement rates for telemedicine, it would not be worth their while to use it,” he said.                                                       Some doctors, however, are doing surprisingly well now that the virus is abating and some restrictions have been lifted in some areas. When surgeries were temporarily banned because of COVID-19, George Waring IV, MD, an ophthalmologist in Mt. Pleasant, South Carolina, lost almost all his patients. When he reopened in May, he was not sure whether his previous volume of patients would return. Many of his patients undergo Lasik surgery to replace glasses or contact lenses, or they receive advanced lens implants after cataract surgery, both of which are usually not covered by health insurance.                                                           But as it turned out, he’s had more visits than at this time last year. Was this the result of pent-up demand for services, as many observers expected after bans on elective surgery are lifted? “No,” he said, “it’s much more than that.”                            He has several explanations for the high demand. “Having to wear masks against COVID makes people less comfortable wearing glasses, because they steam up,” he said. “Also, people need to avoid putting their hand on their face, which you have to do to insert contact lenses. So, they want Lasik. “Furthermore,” he added, “sheltering in place has made some people more contemplative, and they may get a new perspective on life and consider visual self-improvement.”

The question is what does the future look like and how do we prepare, which is what a paper that I wrote with two co-authors and was just accepted for publication considered (Science and Data Driven Choice: Shaping Empowerment During COVID-19 and Beyond)… Yeah!

It’s Official: COVID-19 Was Bad for the Healthcare Business; Mask Wearing in My Office and Some Good News.

COVID-19 Took a Huge Cut of Clinicians’ Business in March and April

If you have a business, whether it is a medical practice, or other form of business you recognize the stress and changes in your business, most of them bad for your bottom line. Also, as lock-downs have been eased you realize the overall change in the way business will be managed in your immediate and probable long-term futures. Richard Franki noted that in the first 2 months of the COVID-19 pandemic, health care professionals experienced sharp drops in both utilization and revenue, according to an analysis of the nation’s largest collection of private health care claims data.

For the months of March and April 2020, use of medical professional services dropped by 65% and 68%, respectively, compared with last year, and estimated revenue fell by 45% and 48%, FAIR Health, a nonprofit organization that manages a database of 31 billion claim records, said in a new report.

For the Northeast states – the epicenter of the pandemic in March and April – patient volume was down by 60% in March and 80% in April, while revenue fell by 55% in March and 79% in April, the organization said.

For this analysis, “a professional service was defined as any service provided by an individual (e.g., physician, nurse, nurse practitioner, physician assistant) instead of being billed by a facility,” FAIR Health noted. Figures for 2019 were adjusted using the Consumer Price Index.

The size of the pandemic-related decreases in utilization and income varied by specialty. Of the seven specialties included in the study, oral surgery was hit the hardest, followed by gastroenterology, cardiology, orthopedics, dermatology, adult primary care, and pediatric primary care, FAIR Health said.

After experiencing a 2% drop in utilization this January and an increase of 4% in February, compared with 2019, gastroenterology saw corresponding drops of 73% in March and 77% in April. Estimated revenue for the specialty was flat in January and rose by 10% in February, but plummeted by 75% in March and 80% in April, the FAIR Health data show.

In cardiology, patient volume from 2019 to 2020 looked like this: Down by 4% in January, up 5% in February, down by 62% in March, and down by 71% in April. The earnings numbers tell a similar story: Down by 2% in January, up by 15% in February, down by 57% in March, and down by 73% in April, the organization reported.

Dermatology did the best among the non–primary care specialties, but that was just a relative success. Utilization still dropped by 62% and 68% in March and April of 2020, compared with last year, and revenue declined by 50% in March and 59% in April, FAIR Health said.

For adult primary care, the utilization numbers were similar, but revenue took a somewhat smaller hit. Patient volume from 2019 to 2020 was fairly steady in January and February, then nosedived in March (down 60%) and April (down 68%). Earnings were up initially, rising 1% in January and 2% in February, but fell 47% in March and 54% in April, FAIR Health said.

Pediatric primary care, it appears, may have been buoyed somewhat by its younger patients. The specialty as a whole saw utilization tumble by 52% in March and 58% in April, but revenue dropped by just 32% and 35%, respectively, according to the report.

A little extra data diving showed that the figures for preventive care visits for patients aged 0-4 years in March and April were –2% and 0% for volume and –2% and 1% for revenue. Meanwhile, the volume of immunizations only dropped by 14% and 10% and vaccine-related revenue slipped by just 7% and 2%, FAIR Health noted.

“Across many specialties from January to April 2020, office or other outpatient [evaluation and management] visits became more common relative to other procedures. This may have been due in part to the fact that many of these E&M services could be rendered via telehealth,” FAIR Health said.

Telehealth, however, was no panacea, the report explained: “Even when medical practices have continued to function via telehealth, many have experienced lower reimbursements for telehealth visits than for in-person visits and more time educating patients on how to use the technology.

Patients Who Refuse to Wear a Mask: Responses That Won’t Get You Sued

Carolyn Buppert, MSN, JD, related a case that we in my office have recently seen. Your waiting room is filled with mask-wearing individuals, except for one person. Your staff offers a mask to this person, citing your office policy of requiring masks for all persons in order to prevent asymptomatic COVID spread, and the patient refuses to put it on.

In our case the patients are all told ahead of time that they must bring and wear a mask if they want to be admitted to our office. Last week this patient came into our office and refused to wear a mask and of course wasn’t wearing a mask.

What can you/should you/must you do? Are you required to see a patient who refuses to wear a mask? If you ask the patient to leave without being seen, can you be accused of patient abandonment? If you allow the patient to stay, could you be liable for negligence for exposing others to a deadly illness?

I’ll let all of you know that we refuse to see patients or even have them enter our office if they don’t wear masks. This is a requirement for our practice to protect my staff, my other patients and yes, even me that practitioner.

We will not even see patients who have traveled from those states where the COVID-19 infection rate has surged. They must self-quarantine and must have a negative COVID test before we will see them as a patient. And yes, this has happened, even this happened just this past Monday.

The rules on mask-wearing, while initially downright confusing, have inexorably come to a rough consensus. By governors’ orders, masks are now mandatory in most states, though when and where they are required varies. For example, effective July 7, the governor of Washington has ordered that a business not allow a customer to enter without a face covering.

So far, there are no cases or court decisions to guide us about whether it is negligence to allow an unmasked patient to commingle in a medical practice. Nor do we have case law to help us determine whether patient abandonment would apply if a patient is sent home without being seen.

We can apply the legal principles and cases from other situations to this one, however, to tell us what constitutes negligence or patient abandonment.

The practical questions, legally, are who might sue and on what basis?

Who Might Sue?

Someone who is injured in a public place may sue the owner for negligence if the owner knew or should have known of a danger and didn’t do anything about it. For example, individuals have sued grocery stores successfully after they slipped on a banana peel and fell. If, say, the banana peel was black, that indicates that it had been there for a while, and judges have found that the store management should have known about it and removed it.

Compare the banana peel scenario to the scenario where most news outlets and health departments are telling people, every day, to wear masks while in indoor public spaces, yet owners of a medical practice or facility allow individuals who are not wearing masks to sit in their waiting room. If an individual who was also in the waiting room with the unmasked individual develops COVID-19 two days later, the ill individual may sue the medical practice for negligence for not removing the unmasked individual.

What about the individual’s responsibility to move away from the person not wearing a mask? That is the aspect of this scenario that attorneys and experts could argue about, for days, in a court case. But to go back to the banana peel case, one could argue that a customer in a grocery store should be looking out for banana peels on the floor and avoid them, yet courts have assigned liability to grocery stores when customers slip and fall.

Let’s review the four elements of negligence which a plaintiff would need to prove:

  • Duty: Obligation of one person to another
  • Breach: Improper act or omission, in the context of proper behavior to avoid imposing undue risks of harm to other persons and their property
  • Damage
  • Causation: That the act or omission caused the harm

Those who run medical offices and facilities have a duty to provide reasonably safe public spaces. Unmasked individuals are a risk to others nearby, so the “breach” element is satisfied if a practice fails to impose safety measures. Causation could be proven, or at least inferred, if contact tracing of an individual with COVID showed that the only contact likely to have exposed the ill individual to the virus was an unmasked individual in a medical practice’s waiting room, especially if the unmasked individual was COVID-positive before, during, or shortly after the visit to the practice.

What About Patient Abandonment?

“Patient abandonment” is the legal term for terminating the physician-patient relationship in such a manner that the patient is denied necessary medical care. It is a form of negligence.

Refusing to see a patient unless the patient wears a mask is not denying care, in this attorney’s view, but rather establishing reasonable conditions for getting care. The patient simply needs to put on a mask.

What about the patient who refuses to wear a mask for medical reasons? There are exceptions in most of the governors’ orders for individuals with medical conditions that preclude covering nose and mouth with a mask. A medical office is the perfect place to test an individual’s ability or inability to breathe well while wearing a mask. “Put the mask on and we’ll see how you do” is a reasonable response. Monitor the patient visually and apply a pulse oximeter with mask off and mask on. In our office each patient has pulse oximetry done as part of our COVID screening and anyone with a problem is sent out to their primary care doctor to be assessed for a COVID infection. There are no exceptions. As I have said before, this is to protect the patient, our other patients, my staff and yes, me the practitioner. No exceptions!

Dr. Atlas: Coronavirus surges linked mostly to protests — and proximity to US-Mexico border

Victoria Garcia of Fox News reported that the recent surges, as the daily infections approach 70,000, in U.S. coronavirus cases can be traced to two key factors — crowds of protesters and proximity to the U.S.-Mexico border, Dr. Scott Atlas, a senior fellow at The Hoover Institution, said Saturday night. ‘Protesting, sharing megaphones, screaming. That’s a setup to spread cases,’ Atlas says

Most of the cases in the Southwest — California, Arizona and Texas — are occurring in counties closest to the U.S.-Mexico border, Atlas told anchor Jon Scott during an appearance on “Fox Report Weekend.”

“When you look in the southern counties of California, Arizona and the bordering counties of Texas — with the Mexico border — these are where most of these cases are really exploding,” Atlas said. “And then you look at the Mexico map and in Mexico, that’s where their cases are. Their cases are in the northern border zone states. And it turns out the timeline here correlates much more to the Mexico timeline of increasing cases than anything else.”

Spikes in Texas, Florida and Arizona don’t essentially line up with reopening but with Mexico’s surge and the recent protests that have gripped the U.S., Atlas said.

“When you really look closely at these so-called re-opening policies, whether it’s in Georgia or Florida or Texas, you know, we didn’t really see a big correlation of cases and hospitalizations from that,” Atlas said. “That’s really not true. That’s sort of some sloppy thinking, I think, again. We really have to look closely at why these things are happening.

“By the way. California didn’t really reopen. Yet they have cases coming up. Why is that? I mean, that’s because these cases don’t really correlate to that.”

‘A setup to spread cases’

“They correlate mainly to two things — the big thousands and thousands of people with protesting, sharing megaphones, screaming. That’s a setup to spread cases,” Atlas said. “And also, when you look at the analysis of the border counties, there’s a tremendous amount of cases coming over the border and exchanging with families in the northern Mexico states.”

Atlas also explained the hospital capacity situation in Texas and Arizona. “So, the real concern that that I see right now is that there are hospitals getting crowded in their ICUs and this is clearly a concern,” Atlas said. “The crowding is from the reinstatement of regular medical care, which is actually very important. We have locked that down before and that policy kills people. So, we don’t want to go back to that.”

“The solution to this is really protect the high risk in a more diligent way than we are, the very highest-risk group. We have been very, very clear about that to people,” Atlas said. “The second part is increasing the hospital capacity.”

Fauci says states need to address problems with COVID-19 response: ‘If you don’t admit it, you can’t correct it’

Savannah Behrman of the USA TODAY reported that Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Wednesday that states need to face problems with their coronavirus responses because “if you don’t admit it, you can’t correct it.”

In an interview with “The Journal,” a podcast from the Wall Street Journal, Fauci, the nation’s top infectious disease expert, discussed the alarming rates of coronavirus cases that are surging in some states that reopened quickly. 

“What we’re seeing is exponential growth, it went from an average of about 20,000 to 40,000 and 50,000. That’s doubling,” Fauci said.

Fauci told Congress last week that new coronavirus infections could increase to 100,000 a day if the nation doesn’t get its surge of cases under control. During the interview, he discussed conversations the White House coronavirus task force has been having with governors and health officials from states where cases are spiking. “Among the states, and there is admission from within,” the doctor explained. “Some states went too fast, some states went according to what the time table was, but the people in the state didn’t listen, and threw caution to the wind.”

Fauci was pressed on “mixed messaging” coming from the White House coronavirus task force regarding warnings he and other health officials such as Dr. Deborah L. Birx have sounded versus comments from elected officials such as Vice President Mike Pence. 

“Well, you know, I think in fairness to the vice president, the vice president understands that. But he is trying in his role as the vice president to really in a certain sense also point out some of the things that are going well,” Fauci said. “So, he is a person who is an optimistic person and is doing a very good job as the leader of the task force, I must say.”

He continued that he and other public health officials are “coldly” looking at the data that results in recommendations from the task force, but that as “a member of the task force, I’m telling you that we have a serious situation here that we really do need to address.” 

His comments come a day after President Donald Trump disputed Fauci’s comments that the U.S. is still “knee-deep in the first wave” of the pandemic. “I think we are in a good place. I disagree with him,” Trump said in an interview. 

The nation surpassed 3 million coronavirus cases and 132,256 deaths Wednesday, according to data from Johns Hopkins University. The grim milestone represents roughly a quarter of the world’s cases and the same percentage of its deaths.

Tuesday saw a record 60,021 new cases as the nationwide surge showed no signs of ebbing.  Cases are surging in states such as Texas, Florida, and Arizona, and some have now paused or reversed their reopenings. 

Fauci stressed that the public health “message” needs to work in tandem with states reopening in order for states to be able to protect their citizens’ health and the economy.

And this all has to be considered as we get closer to the school year. Do we send our children back to school and how do we educate our kids?

And Now Some Good News Regarding this Pandemic: New study suggests COVID-19 brought American families closer together

From developmental milestones to simple heart to hearts, three-quarters of parents polled experienced a key moment, which they otherwise may have missed, with their children while in lockdown. Seventy-five percent of American parents witnessed a key moment in their child’s life while in self-isolation, according to new research.

The survey of 2,000 Americans — of which about 1,200 were parents — asked respondents about their time sheltering in place due to the COVID-19 pandemic and the perks of being surrounded by family. From developmental milestones to simple heart-to-hearts, three-quarters of parents polled experienced a key moment that they otherwise may have missed with their children while in lockdown. The survey found 66% of those surveyed said the pandemic has brought them closer to their family than ever before. (iStock)

Respondents were asked to share the key moments they experienced, and one respondent said their child got to meet an aunt for the first time, while another was able to successfully potty train their little one. Another respondent shared how their child confided in them that they were being bullied at school, while someone else shared they were able to watch their son be sworn into the National Guard via a livestream.

Conducted by OnePoll on behalf of Juice Plus+, the survey found 66 percent of those surveyed said the pandemic has brought them closer to their family than ever before. It’s no surprise that 77 percent of respondents were also in agreement that they’ve enjoyed spending more time with the members of their household. The survey also found respondents have learned a lot about their families while sheltering in place as well.

Nearly half of respondents admitted they didn’t really know what their significant other’s job was before they began working from home during self-isolation. Seventy-nine percent of parents surveyed said they’ve also learned more about their children’s hobbies and passions during this time. While another 77 percent of parents said their children have become more open to learning new things around the house and trying new activities.

In fact, 31 percent of those surveyed said they’ve taught a family member a new skill while they’ve been in quarantine. Seven in 10 respondents also shared their increased time indoors has been a wake-up call for them to focus on their families’ unhealthy habits. Forty-one percent of those polled said they’ve added more priority to eating meals as a family during their time in isolation.

“During these unprecedented times, it has been a delight to see families becoming closer than ever before and enjoying the additional time they have gotten together while staying home,” said Dr. Mitra Ray, Ph.D., research biochemist and health ambassador with Juice Plus+. “In turn, this has led to an increase in family meals, which are proven to form better eating habits and a healthier lifestyle for years to come.”

Another 29 percent of respondents shared they learned how to cook a new family recipe. Seventy-one percent of respondents shared this has all been possible because it’s been easier for them to adhere to a new and improved schedule for themselves and their families while they’ve been sheltering in place. For those surveyed who’ve been working from home during this time, 41% said they’ve enjoyed having a more flexible schedule. A further 38 percent of these respondents shared another perk of working remotely is they’ve been able to enjoy more quality time with their family. Regardless of whether respondents are working from home, 68% shared they’ve used lockdown to improve their family’s communication skills.

“As more people become accustomed to working from home, they are finding silver linings in its flexible benefits, such as forming stronger relationships with their families,” observed Sean Hopkins, chief revenue officer for Juice Plus+. “We value and support the impact of year-round remote working models allowing more people to stay home – offering the opportunity to work according to their own schedules and give greater priority to their loves ones and their overall happiness and well-being.”

TOP PRIORITIES ADDED TO AMERICANS’ ROUTINES IN SELF-ISOLATION

Eaten more meals as a family or with members of my household – 41%
Spent more time with my family/household – 37%
Started a new exercise routine – 36%
Learned something new about someone I live with – 33%
Made more purchases online – 32%
Taught a family member a new skill – 31%
Tuned in more to the news – 31%
Learned how to cook a new family recipe – 29%
Started a new hobby – 26%
Focused more on my/my family’s nutrition – 25%
Connected virtually with my peers – 25%
Focused more on sleep – 20%

TOP BENEFITS OF WORKING REMOTELY DURING COVID-19

Enjoying a more flexible schedule – 41%
Being able to enjoy more quality time with their family – 38%
Being more productive – 33%
Not having to commute – 29%
Not having to dress up – 29%
Being able to work from the comfort of their home – 27%
Saving money – 27%
Being able to improve their communication skills – 21%
Feeling more motivated to work – 18%
Having fewer distractions than at the office – 17%

Maryland man may be first person successfully vaccinated against COVID-19

Isabelle Friedberg in the New York Post, noted that a Maryland man believes he may be one of the first people to be successfully vaccinated against the coronavirus after participating in a trial that has reported promising early results in producing antibodies, according to reports.

David Rach, a graduate immunology student, was the first person to be injected in the trial at the University of Maryland in May, where US pharmaceutical giant Pfizer and German firm BioNTech are working together in the global race to create a vaccine, the Daily Mail reports.

Now, early indications show the vaccine is working by stimulating the growth of antibodies at rates equal or higher to those who have the illness, according to WJLA.

” There is a component of relief seeing that it’s actually producing results, that the vaccine is producing antibodies,” Rach told the news station. Rach cannot be certain he was given the actual vaccine or a placebo saline solution but after a slight reaction from his second dose, he is convinced he is one of the very few people in the world vaccinated against COVID-19, the outlet said. He is due to be tested in October to determine if he does have immunity against the virus. Remember, we need to know if the immunity is long term, especially with the mutation of this virus. If the trial proves successful, Pfizer said it will produce 100 million doses before the end of the year and more than a billion doses next year, WJLA reports.

Preparing for Fall’s Second Wave — and Then Some, Spikes and Masks. And How Can the White House Build Trust?

When COVID-19 and flu season coexist, we need the right tests to tell which is which

Fred Pelzman reflected on his past training as a physician. Long ago, when I was a resident, I worked an overnight emergency room shift and saw a patient who presented with episodes of shortness of breath both at rest and on exertion.

As a fairly freshly minted new intern, I was still definitely getting the hang of things, and probably took way longer to do my history and physical exam, before I was finally ready to present to the attending who was staffing the emergency department that night. Maybe I wasn’t very good at taking a history back then, and I may have missed some critical questions that needed to be asked or hadn’t ordered the right tests, but I remember finishing up my evaluation and still not really being sure what was going on with this patient.

“Let’s Treat Both”

Back then we didn’t have troponins and BNPs and D-dimers run on everyone who showed up in the emergency room, but as I remember this, all we had was a chest X-ray and an EKG that were both pretty unrevealing. I remember thinking that I wasn’t sure whether this case was pulmonary or cardiac in nature.

But I also remember being confused by the advice I got from that particular doctor that day, as his way of solving a diagnostic dilemma. “Let’s treat both,” he said, “and see if he gets better.” His recommendation was that we send the patient out with an albuterol inhaler, in case this was a flare of reactive airway disease, as well as sublingual nitroglycerin, in case it was angina pectoris. “Take both of these next time this happens and call me in the morning.”

Since the patient wasn’t having symptoms at the time of their ED visit, neither treatment given in the emergency room was likely to answer the question, so the attending physician decided to try the two most obvious, and then see what worked. What bothered me most, I recall thinking at the time, was that if he tried both, how were we going to know which one was working?

Trying serial treatments for a non-life-threatening illness is a reasonable option we have all pursued (“Let’s try treatment A for a week, and if that does not do it, we can switch to treatment B and see how that goes”). But throwing everything and the kitchen sink never seems to clear things up; instead, it just muddies the waters.

Double Trouble

This long-ago case reminds me of what we may be facing as we head into a second wave of COVID-19, if the pandemic continues its now-apparent summer push and builds into a torrent in the fall as the inevitable flu season rises up to join us.

In the early days of this pandemic, before we had much testing at all (in fact, at one point there was absolutely no outpatient testing allowed, and the limited tests we had were reserved for the sickest inpatients), in the outpatient world we pretty much assumed that anybody with a cough, shortness of breath, or a fever, was COVID-19, and for the most part we couldn’t even prove otherwise. There were restrictions on our use of respiratory viral panels (to diagnose influenza, RSV, or other viral pathogens), and no PCR testing for SARS-CoV-2 was available to us, so we pretty much assumed you had COVID-19, and if you were stable enough to go home, then that was it.

Luckily, in those earliest days, influenza had already significantly tapered off for the season, so there was little that we were seeing in the community to confuse the clinical picture. But what happens when they’re both here at the same time? What happens when we have both of these significant respiratory pathogens, and knowing which one is going on may make all the difference in the world?

The right test at the right time can make that difference. When we had no tests, we assumed everything was COVID-19, and either sent them home or sent them to the hospital to be admitted. Then, when we got the ability to test certain selected patients, we were able to further distinguish between the sickest that we needed to send to the emergency room, and those we could safely send home and give them their COVID-19 test results the next morning. But what if there are two virulent diseases raging through our community at the same time? At that point, having a rapid test that can safely distinguish influenza or other respiratory pathogens from COVID-19 may be just what we need.

Thinking About the Next Wave

As we begin to think about the next wave, about what the coming months may hold for us, it seems like having rapid flu testing available in the office, as well as rapid point-of-care testing for COVID-19, may be what we need to safely diagnose, safely treat, safely send home, safely quarantine, and safely track contacts, to prevent the second wave from being as devastating as the first. We need to begin now preparing for the next, not reacting after it’s already here, not wishing we had more testing, more PPE, more ICU beds, more ventilators.

This is how we need to be thoughtful, how we need to see this with the eyes of a public health officer, an epidemiologist, a scientist, a physician. Because when the time comes, when we’re knee-deep in this stuff, when things are going all to hell, we don’t want to wish we had what we need to do the right thing for our patients.

Hopefully those who are facing the new surge of this virus elsewhere in this country, away from the epicenter that was New York City, are heeding the lessons we learned about who is at highest risk for decompensation, who can safely go home, and how to treat the sickest of the sick. And while the next wave is still over the horizon, we need to ensure that those who have the power to make the decisions about how we might respond to what comes next are listening to the most experienced voices in the room. Otherwise we might be sending people home with a Z-Pak, some oral steroids, an albuterol inhaler, Tamiflu, an antihistamine, and a PPI just in case.

‘Cause you never know.

How the White House can build public trust and end the coronavirus crisis

Dan Goldberg reported on the mixed messages on the severity of the pandemic from federal and state officials helped drive a coronavirus surge in June across much of the United States and that the window to act is closing.

Now, top public health officials are warning that the country could see as many as 100,000 new cases per day, testing capacity is reaching its limit and the virus is spreading out of control. After months of downplaying the coronavirus threat, the White House has changed course, urging Americans to wear masks and avoid large gatherings. But it is not clear whether the public will listen, after months of recovery talk and political battles over everything from masks to infectious disease modeling.

Public health experts say the window to act is closing, and that if the government wants to change the course of the U.S. outbreak, officials need to deliver clear, consistent messages. They should be frank about what we still don’t know about the virus, emphasize that our fates are collectively tied and focus on the need for face coverings, social distancing and frequent hand-washing.

“National leaders, including the vice president and president and governors, should not only be talking about and encouraging people to follow public health guidance — they should be modeling it themselves wherever they can,” said Tom Inglesby, director of Johns Hopkins University’s Center for Health Security. “No more of this kind of strange commentary about ‘personal choice.’ The point is to protect your neighbor, so the idea of it being a personal choice is illogical.”

An administration official rejected the idea that the messages coming from the White House have been confusing or inconsistent. “Since March, the administration has consistently recommended the use of face coverings consistent with CDC guidelines, and that messaging has been included in every set of guidance from the administration,” the official said. “The messaging understands the urgency of certain states.”

Marc Lipsitch, an epidemiologist at the Harvard T.H. Chan School of Public Health, says the first step the Trump administration should take is unmuzzling its scientists.

Anthony Fauci with Vice President Mike Pence. | Susan Walsh/AP Photo

The CDC abruptly stopped its regular briefings on the virus in March and has held only a handful since then. The White House coronavirus task force, whose members include top government scientists such as Anthony Fauci, no longer addresses the nation via daily televised briefings. And its once-daily private meetings are down to twice a week.

At the same time, more than 80 percent of Americans trust medical scientists, and more than two-thirds trust Fauci, the government’s top infectious disease expert, according to a recent New York Times/Siena College poll.

“The CDC and the other public health experts within the government need to be on the front lines talking to the country every day,” Lipsitch said. “People without scientific qualifications … do not need to be stealing the show in terms of public communication.”

But that is what has happened over the last few months, as President Donald Trump, Vice President Mike Pence and other political leaders have dominated the national conversation about how to fight the virus — often contradicting the government’s own health experts.

As cases soared in the Southeast in June, Trump repeatedly said that the new infections were simply a reflection of more testing. And as hospital capacity reached alarming levels in Texas and Arizona last week, Pence tried to tamp down concern by emphasizing that most new infections were in younger adults. He also attended a huge indoor rally at a Dallas church last Sunday and defended Trump’s decision to hold a rally in Arizona days before — where thousands of mostly maskless supporters spent hours cheering — saying it gave people the freedom to participate in the political process.

“It sends a message that those things are okay, and they are not,” Inglesby said. “These political leaders know the information and they still attended, suggesting these things are low risk. They are not low risk.”

With no clear message from the top, governors are sending their own mixed signals. Bars in Texas reopened in May while North Carolina’s stayed closed. Churches were allowed to remain open in Florida but not in Kentucky. Face coverings are mandated in New Jersey but a “personal preference” in Oklahoma.

The White House has sought to correct course over the last two weeks — with mixed results. Days after Pence said “panic is overblown,” he urged younger Americans, who were ignoring “the guidance that we gave on the federal level for all the phases of reopening,” to be more vigilant because they were a growing cause of the spread. The same administration official said there are also political considerations at play — if the vice president isn’t shaping the conversation, then the void will be filled by Trump critics or political opponents.

Trump on Wednesday told Fox Business that he’d wear a mask when he could not socially distance, in line with CDC recommendations, but only once has he been spotted wearing one. At a news conference in late May, Trump taunted a Reuters journalist for wearing a facial covering and accused the reporter of wanting to be “politically correct.” The president also mocked Joe Biden, the presumptive Democratic nominee, for wearing a mask.

There is evidence that the president’s skepticism has influenced public behavior. Three-quarters of Democrats who responded to a recent Pew poll said they wore masks most or all of the time in public, while just 53 percent of Republicans did the same. The split held even after controlling for differences in the severity of the outbreak in different parts of the country. “The president has a unique ability to derail good policy,” Lipsitch said.

Going forward, the government needs to do a better job of managing expectations, said Jeffrey Shaman, an infectious disease researcher at the Columbia University School of Public Health. The coronavirus was unknown to science until December, and our understanding of it is changing as time passes and more people are infected.

The CDC, for example, first said masks would do little good and that the virus mostly affected the respiratory system. The guidance has evolved along with the understanding of the disease. Public health experts now know that children are more vulnerable than originally thought.

“This is where leadership and messaging are so important,” Shaman said. “People have to understand it’s not like you can spend a month wearing masks and then it’s done. We don’t have our Get Out of Jail Free card yet.”

White House messengers need to express more humility and explain how much we still don’t know, said Lori Freeman, CEO for the National Association of County and City Health Officials.

The cost of coronavirus treatment

Janette Setembre of Fox Business noted that the cost of the coronavirus can be devastating.

Americans could spend thousands of dollars on medical bills if they need treatment for COVID-19 – with or without insurance. And those who were hospitalized or caring for a loved who is could have to defer credit card bills, mortgage payments and deplete their savings to afford them.

Broadway star Nick Cordero died Sunday at 41 after spending nearly four months in the hospital battling COVID-19. Days earlier, his wife, Amanda Kloots, posted on social media about having to refinance her home to help pay for the treatment costs. A family friend created a GoFundMe page for Cordero’s medical costs with a goal of raising $400,000. It received nearly 5,000 donations raising $813,507.

The Cordero family is one of the millions grappling with the emotional and burdening financial costs of the deadly virus. An estimated 15 percent of people who contract COVID-19 could end up in the hospital, according to data published in April by the Kaiser Family Foundation, a nonprofit that focuses on medical issues. The data shows that up to an estimated 2 percent to 7 percent – or 670,000 to slightly more than 2 million — of uninsured people will require hospitalization for the novel coronavirus.

That would have been the case for Denver-based Tim Regan, 40, who went to the emergency room in March when he experienced a fever, chest pain and shortness of breath. He went to the emergency room when a nurse advised him to, explaining he had COVID-19 symptoms. Regan received a chest X-ray and an electrocardiogram (EKG) but was told he wasn’t sick enough to qualify for a COVID test.

“The doctor told me he was convinced I had it, several people in the medical field told me I had it without giving me a test,” Regan told FOX Business. Regan worried that if he had to be admitted to a hospital, he would deplete his savings so he continued working from home while he was sick. “I was thinking I had to make all the money I could in case we all had to be hospitalized,” he said, worried that he might infect his wife and child. Regan was billed $3,278 for his ER visit. “The insurance told us, ‘We’re not paying for it.’ We would have been stuck with everything. I don’t think we quite met the deductible. It would have wiped out any savings we had,” Regan said.

Medical bills for uninsured patients can range between $42,486 to $74,310, according to a report by FAIR Health, an independent nonprofit. But even those who do have insurance could be saddled with out-of-pocket costs between $21,936 and as much as $38,755.

“Even after you get the treatment it leaves a bunch of financial questions. If you have traditional insurance, the reason for that is so many plans have high deductibles, and if you’re on a high deductible plan you’re responsible for that deductible amount; it can be $5,000, $8,000 or more,” said Patrick Quigley, CEO and co-founder of Sidecar Health, which provides personalized and affordable health insurance.

“The second issue is the network – if you happen to go to a hospital that’s out of network your traditional insurance company isn’t responsible for those charges – they may help, but they don’t have negotiated rates with those hospitals so people with insurance will have to pay the remaining balance,” Quigley said.

And some survivors who battled for their lives while seeking treatment for the virus are left with shocking medical costs. The Seattle Times reported last month the case of Michael Flor, a 70-year-old man from Seattle who was hit with a $1.1 million hospital bill, which included 181 pages of expenses like $9,736 per day for the intensive care room, almost $409,000 for it to be sterilized and $82,000 for the ventilator, among other treatment costs. Flor had Medicare insurance and would be covered for most of the expenses, the Times reported.

Congress allocated more than $100 billion to assist insurance companies and hospitals dealing with the unprecedented treatment costs during COVID-19.

Arizona is #1, Bahrain is #4
There is no country in the world where confirmed coronavirus cases are growing as rapidly as they are in Arizona, Florida or South Carolina. The Sun Belt has become the global virus capital.
This chart ranks the countries with the most confirmed new cases over the past week, adjusted for population size, and treats each U.S. state as if it were a country. (Many states are larger in both landmass and population than some countries.)

Coronavirus expert says Americans will be wearing masks for ‘several years’

Shawn Carter reported that health experts won’t ask Americans to take off their masks any time soon. That’s the take of Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security. He has been preparing for an outbreak like the novel coronavirus as part of his work for years.

Johns Hopkins practices virus simulations as part of is preparedness protocol, with the goal of offering public health experts and policymakers a blueprint of what to do in a pandemic. One of those simulations took place in October 2019, when Toner and a team of researchers launched a coronavirus pandemic simulation in New York, running through various scenarios on how residents, governments and private businesses would hypothetically react to the threat.

One thing that stood out to him: Face coverings are a vital defense to stop the spread of the virus. He believes COVID-19 won’t slow down in the U.S. even as states start to slowly reopen.

“There’s going to be no summertime lull with a big wave in the fall,” he said as part of CNET’s Hacking the Apocalypse series. “It’s clear that we are having a significant resurgence of cases in the summer, and they’ll get bigger. And it’ll keep going until we lock things down again.”

The U.S. recently added about 43,000 positive COVID-19 cases to its 2.9 million totals, according to the Johns Hopkins University of Medicine. The death total has surpassed 130,000.

Toner, contrasting the novel virus to seasonal influenza, said until there is a vaccine, communities’ best defense to fight it is through creating distance and wearing masks. “I think that mask wearing and some degree of social distancing, we will be living with — hopefully living with happily — for several years,” he said. “It’s actually pretty straightforward. If we cover our faces, and both you and anyone you’re interacting with are wearing a mask, the risk of transmission goes way down.”

Dr. Anthony Fauci, a top official handling the U.S. COVID-19 response, said recently he was cautiously optimistic that there could be a vaccine for the virus by 2021. For those who refuse to wear a mask in the interim, Toner said they’ll eventually wise up. “They will get over it,” he says. “It’s just a question of how many people get sick and die before they get over it.”

One final thought, Congress must decide whether to extend federal aid for the unemployed beyond July. Ten million more Americans are out of work than in February, but evidence has emerged of falling poverty levels due to the stimulus. Could the coronavirus change the politics of poverty?

World hits coronavirus milestones amid fears worst to come and Consider Rationing Health Care and the Effect of Virtual Classrooms and the Effect of All These Protests on Disease Management.

The world surpassed two sobering coronavirus milestones last Sunday—500,000 confirmed deaths, 10 million confirmed cases—and hit another high mark for daily new infections as governments that attempted reopenings continued to backtrack and warn that worse news could be yet to come.

“COVID-19 has taken a very swift and very dangerous turn in Texas over just the past few weeks,” said Gov. Greg Abbott, who allowed businesses to start reopening in early May but on Friday shut down bars and limited restaurant dining amid a spike in cases.

California Gov. Gavin Newsom rolled back reopenings of bars in seven counties, including Los Angeles. He ordered them to close immediately and urged eight other counties to issue local health orders mandating the same.

South Africa’s health minister warned that the country’s current surge of cases is expected to rapidly increase in the coming weeks and push hospitals to the limit. Health Minister Zwelini Mkhize said the current rise in infections has come from people who “moved back into the workplace. It was therefore inevitable that there would be cluster outbreaks as infections spilled over from communities into places of congregation such as mines, factories, taxis and buses.”

New clusters of cases at a Swiss nightclub and in the central English city of Leicester showed that the virus was still circulating widely in Europe, though not with the rapidly growing infection rate seen in parts of the U.S., Latin America and India.

Poland and France, meanwhile, attempted a step toward normalcy as they held elections that had been delayed by the virus.

Wearing mandatory masks, social distancing in lines and carrying their own pens to sign voting registers, French voters cast ballots in a second round of municipal elections. Poles also wore masks and used hand sanitizer, and some in virus-hit areas were told to mail in their ballots to avoid further contagion.

“I didn’t go and vote the first time around because I am elderly and I got scared,” said Fanny Barouh as she voted in a Paris school.

In Texas, Abbott appeared with Vice President Mike Pence, who cut campaign events from upcoming visits to Florida and Arizona because of rising virus cases in those states.

Pence praised Abbott for both his decision to reopen the state, and to roll back the reopening plans.

“You flattened the curve here in Texas … but about two weeks ago something changed,” Pence said.

Pence urged people to wear masks when unable to practice social distancing. He and Abbott wore face masks as they entered and left the room, taking them off while speaking to reporters.

HHS Secretary Alex Azar, meanwhile, defended the fact that President Donald Trump has rarely worn a mask in public, saying he doesn’t have to follow his own administration’s guidance because as a leader of the free world he’s tested regularly and is in “very different circumstances than the rest of us.”

Addressing spikes in reported coronavirus cases in some states, Azar said on NBC’s “Meet the Press” that people “have to take ownership” of their own behaviors by social distancing and wearing masks if possible.

A reported tally Sunday from Johns Hopkins University researchers said the death toll from the coronavirus pandemic had reached 500,108.

About 1 in 4 of those deaths—more than 125,000—have been reported in the U.S. The country with the next highest death toll is Brazil, with more than 57,000, or about 1 in 9.

The true death toll from the virus, which first emerged in China late last year, is widely believed to be significantly higher. Experts say that especially early on, many victims died of COVID-19 without being tested for it.

To date, more than 10 million confirmed cases have been reported globally. About a quarter of them have been reported in the U.S.

The World Health Organization announced another daily record in the number of confirmed coronavirus cases across the world—topping over 189,000 in a single 24-hour period. The tally eclipses the previous record a week earlier at over 183,000 cases, showing case counts continue to progress worldwide.

Overall, the U.S. still has far and away the most total cases. At more than 2,450,000—roughly twice that of Brazil. The number of actual cases worldwide is much higher.

New York, once the nation’s pandemic epicenter, is now “on the exact opposite end,” Gov. Andrew Cuomo said in an interview with “Meet the Press.”

The state reported five new virus deaths Saturday, its lowest reported daily death toll since March 15. During the state’s peak pandemic in April, nearly 800 people were dying every day. New York still leads the nation in COVID-19 deaths with nearly 25,000.

In the state of Washington, Gov. Jay Inslee put a hold on plans to move counties to the fourth phase of his reopening plan as cases continue to increase. But in Hawaii, the city of Honolulu announced that campgrounds will reopen for the first time in three months with limited permits to ensure social distancing.

Britain’s government, meanwhile, is considering whether a local lockdown is needed for the central English city of Leicester amid reports about a spike in COVID-19 among its Asian community. It would be Britain’s first local lockdown.

“We have seen flare-ups across the country in recent weeks,” Home Secretary Priti Patel told the BBC on Sunday.

Polish voters were casting ballots, in person and by mail, for a presidential election that was supposed to have taken place in May but was chaotically postponed amid the pandemic. President Andrzej Duda, a 48-year-old conservative backed by the nationalist ruling Law and Justice party, is running against 10 other candidates as he seeks a second five-year term. Iwona Goge, 79, was encouraged to see so many people voting in Warsaw. “It’s bad. Poland is terribly divided, and people are getting discouraged,” she said.

French voters were choosing mayors and municipal councilors in Paris and 5,000 towns and cities in a second round of municipal elections held under strict hygiene rules. Key battlegrounds include Paris, where the next mayor will preside over the 2024 Summer Olympics.

Italy was honoring its dead later Sunday with an evening Requiem concert in hard-hit Bergamo province. The ceremony in the onetime epicenter of the European outbreak came a day after Italy registered the lowest daily tally of COVID-19 deaths in nearly four months: eight.

European leaders were taking no chances in tamping down new clusters. German authorities renewed a lockdown in a western region of about 500,000 people after about 1,300 slaughterhouse workers tested positive. Swiss authorities ordered 300 people into quarantine after a “superspreader” outbreak of coronavirus at a Zurich nightclub.

Africa’s confirmed cases of COVID-19 continued to climb to a new high of more than 371,000, including 9,484 deaths, according to figures released Sunday by the African Centers for Disease Control and Prevention.

Justice Department Issues Warning About Fake Mask Exempt Cards

Jason Slotkin reported that The Department of Justice has issued an alert about a card circulating online falsely claiming that holders are legally exempt from wearing a mask. Public health officials overwhelmingly recommend wearing a mask when going out in public.

Public health experts overwhelmingly agree that one of the best ways to slow the spread of the coronavirus is to wear a mask. Still, the seemingly straightforward recommendation to secure a covering over one’s nose and mouth has proven one of the pandemic’s more partisan issues.

The Department of Justice is now warning that a card circulating online is falsely claiming its holder is lawfully exempt from wearing a mask.

A recently issued alert by the department is urging the public not to heed information printed on the fraudulent cards, which purport to carry the authority of the “Freedom to Breathe Agency,” which is neither a federal nor a state agency.

The fake card states that wearing a mask will incur mental or physical risk for the holder. The card also posits that the Americans with Disabilities Act forbids raising questions about the health condition aggravated by mask usage. Penalties are threatened if a business owner does not act accordingly.

“If found in violation of the ADA you could face steep penalties. Organizations and businesses can be fined up to $75,000 for your first violation and $150,000 for any subsequent violations. Denying access to your business/organization will be also reported to FTBA for further actions,” the card reads, according to images that have been posted online.

At least some versions of the card appear to bear an official looking Justice Department insignia. In its alert, the department disavowed any role in the card’s creation or dispersal, saying, “These postings were not issued by the Department and are not endorsed by the Department.”

The department also said not to rely on information included on the card and instead to visit the Americans with Disabilities Act website.

It’s unclear how many cards are in circulation, but it appears to have been spread via a Facebook page belonging to a group calling itself the Freedom to Breathe Agency.

The Centers for Disease Control and Prevention has been recommending people wear cloth or fabric face coverings since April. Many states and localities have gone on to require or urge their wearing in public — especially in enclosed spaces. Businesses large and small have also adopted the recommendation, requiring both staff and customers to wear them.

Masks have emerged as a major political flashpoint — often in response to stay-at-home orders that state and local governments put in place to slow the outbreak. Despite his own government’s guidance, President Trump has said he will not be wearing a face mask, and protesters in multiple states have been seen without masks as they amassed in defiance at coronavirus restrictions.

In many online videos, staffers at food and retail establishments have been seen contending with customers who refuse to cover their faces.

The CDC — still — recommends wearing a mask when going out in public.

Dr. Saphier on prolonged school and summer camp closures: The mental health effects for kids are real

David Montanaro of Fox NewsFox reported that news medical contributor Dr. NicoleSaphier said Wednesday that the mental health effects on children during the coronavirus shutdowns are a real concern, as many summer camps have declined to open this year.

Speaking on “Fox & Friends,” Saphier said “94 percent of superintendents” across the country are not ready to talk about plans for reopening schools in the fall, raising concerns about the effects on children.

“This conversation is being prompted by surveys out of Italy and China where they reported that children were experiencing anxiety up to 70 percent of the time, saying that they were having feelings of anxiety or difficulty breathing. Those surveys were done from March and April. I would like to see more modern ones or more up-to-date ones. Let me tell you, as a mother having three kids at home, the mental health effects of these shutdowns are real,” she said.

Saphier said she’s concerned that the negative impact on children will be long-lasting if they continue to be kept at home rather than going to school. “Going to school for children is not just the fundamental basics of education. It’s learning conflict resolution, socialization skills and building the very necessary relationships and my biggest concern is that the mental health effects are going to be here to stay,” she said, adding that doctors have learned more about COVID-19, including that children are “significantly less susceptible to illness” and they are less likely to transmit the virus than adults.

“There are smart ways that schools can come together and get those kids back in session.”

Sen. Lamar Alexander, R-Tenn., said last week that there is a “growing awareness” among Americans that kids need to go back to school as soon as possible and plans must be created to do that in a safe way.

In an interview on “America’s Newsroom” with hosts Sandra Smith and Ed Henry, the chairman of the Senate Health, Education, Labor and Pensions (HELP) Committee pointed out that while kids must be kept safe from coronavirus, both children and their parents are “about up to here with remote learning.” “Any teacher or parent can tell you [about] the emotional [and] the intellectual impact, especially among minority kids,” Alexander told the “Newsroom” hosts.

“I mean, this is a time when we’re all talking a lot about racial injustice and disproportionate effects on low-income and minority kids. The single best thing we can do to help minority children [and] low-income children is to get them back in school. That’s where they learn. That’s where they learn to deal with other children. That’s where many get one meal, sometimes two,” Alexander concluded.

Dr. Fauci says George Floyd protests provide ‘perfect recipe’ for new coronavirus surges

Brie Stimson of Fox News noted that recent protests across the U.S. over the death of George Floyd could lead to new surges in coronavirus cases, Dr. Anthony Fauci  warned Friday.

“It is the perfect set-up for the spread of the virus in the sense of creating some blips which might turn into some surges,” Fauci, a member of President Trump’s Coronavirus Task Force, told radio station WTOP-FM in Washington, D.C.

“It is the perfect set-up for the spread of the virus in the sense of creating some blips which might turn into some surges.”

— Dr. Anthony Fauci 

His comments came as the U.S. edged closer to 2 million confirmed infections and 110,000 virus-related deaths, and the globe neared 7 million infections and 400,000 deaths since the pandemic began, according to Johns Hopkins University.

After months of confinement due to governors’ stay-at-home orders, thousands across the country have taken to the streets for more than a week to protest the police-custody death of Floyd – a black man who succumbed after a white officer kneeled on his neck for nearly nine minutes on May 25 in Minneapolis.

“As I sat in front of the TV and watched the screen go from Washington, D.C., to New York City, to Los Angeles, to Philadelphia, I got really concerned,” Fauci told the Sunday Times of London. “I was going, ‘Oh my goodness. I hope this doesn’t set us back a lot.’ [After] all of the work in trying to maintain the physical distance and doing all the things, I became very concerned that we might see a resurgence.”

While some in the massive crowds have worn masks, others haven’t — and no one is social distancing, he said.

The protests bring together people from different areas, many of them virus hotspots, Fauci said. The participants then return home and create a “perfect recipe” for a resurgence of the virus.

Chanting and yelling, as people typically do during protests, also increases the risk of spread, he said. “I get very concerned, as do my colleagues in public health, when they see these kinds of crowds,” Fauci said. “There certainly is a risk. I can say that with confidence.”

The only thing public health officials can do is constantly remind people to be careful and always wear a mask, Fauci, the director of the National Institute for Allergy and Infectious Diseases, told WTOP.

Officials in cities with protests have urged demonstrators to get tested for the virus. Cities such as Seattle and San Francisco have set up mobile testing centers for protesters. “It’s a difficult situation. We have the right to peacefully demonstrate and the demonstrators are exercising that right,” Fauci added. “It’s a delicate balance because the reasons for demonstrating are valid and yet the demonstration itself puts oneself at an additional risk.”

Note Well-Arizona’s rules for rationing healthcare in the COVID-19 pandemic should terrify you

Michael Hilzik pointed out a scary fact regarding the rationing of healthcare.  You may think that the coronavirus and COVID-19, the disease it causes, are frightening enough. But Arizona has just activated a rulebook for rationing hospital care that is truly terrifying.

In brief, the rules allow hospitals to deny critical healthcare resources such as ventilators to patients based on medical judgments about their likelihood of living even five more years despite surviving COVID-19.

In practical terms, that means that on average, older adults are more likely to be denied care than younger persons. Those with medical conditions other than COVID-19 would be more vulnerable to denials than those judged to be healthier, whatever their age.

Health care planning must do everything possible never to need [Crisis Standards of Care].

National Academies of Science, Engineering and Medicine

Under the rules, doctors making triage judgments that deprive patients of necessary care will be immune from legal liability.

Arizona’s so-called crisis standards of care, or CSC, isn’t unique among the states. But it provides an up-to-the-minute look at the harsh choices facing medical personnel across the country thanks to our unfit and unprepared political leadership, if one can call it leadership at all.

From the federal government down through the states, the vacuum of leadership has exposed millions of Americans to sickness and death while reducing our healthcare system to a patchwork of overwhelmed facilities.

The lack of planning and preparedness is the outstanding failure of the response to the crisis in the United States. That’s the implicit judgment of the National Academies of Science, Engineering and Medicine.

The academies stated in an assessment of crisis standards of care in March that the primary principle was that “health care planning must do everything possible never to need CSC.”

The academies also specified that in the current pandemic, “public trust is essential.” That means that leaders would have to be “proactive, honest, transparent and accountable” when discussing the condition of their healthcare systems and institutions.

Has that happened? The answer obviously is no. President Trump and Republican governors such as Arizona’s Doug Ducey and Florida’s Ron DeSantis have suppressed statistics showing the true rate of infection in their states. Trump’s approach to the crisis has been focused in large part in trying to minimize its impact, even denying its existence.

States other than Arizona have similar rulebooks to be dusted off in a major emergency. Arizona, however, is the only state that has activated its crisis standard of care procedures — so far.

Arizona residents have been among the most resistant to wearing face masks in the coronavirus crisis. (Statista)

“A lot of states actually have activated their crisis standards of care plans,” Cara Christ, director of Arizona’s Department of Health Services, said during a press conference Monday with Ducey. That appears to be untrue. Though most states have prepared a crisis plan, no others have activated it.

Several, however, may be on the verge of doing so, at least regionally, since the surge in cases is placing immense stresses on local capacities. In California, for example, Riverside County’s ICU beds were reported to be 99% occupied over the weekend and Los Angeles County is projecting the possibility of running out of hospital beds in two to three weeks and exhausting its intensive care unit beds sometime in July.

In Imperial County, an agricultural county on the Mexican border where 23% of tests are coming back positive for COVID-19, 500 patients were transferred to adjoining counties to relieve the local pressure, Gov. Gavin Newsom said Monday.

California is one of several states ranking as leading hot spots of coronavirus infection, though its statewide test positivity average of 5.9% over the last seven days remains lower than other surging states such as Arizona (24.4%), Florida (15.6%) and Texas (14.1%).

All those states are guilty of having reopened commercial and retail establishments, as well as public facilities such as beaches, too soon — notably before it was clear that they had adequately clamped down on the community spread of the coronavirus.

Newsom has urged Californians to continue social distancing and mask-wearing throughout the crisis; his error was to give local officials too much latitude to decide for themselves when they could reopen their economies. Now Newsom is signaling that such deference may be coming to an end.

Newsom pressured Imperial County into rolling back its reopening, in part by threatening that “the state of California will assert itself and make sure that happens” if officials fail to do so. As my colleague Taryn Luna reports, he also has hinted at statewide orders aimed at imposing anti-virus rules, though he has not been specific.

In other states, governors have been more permissive and even interfered with local officials’ judgments. Until June 17, Ducey forbade cities and counties to impose stricter rules than the state. In practical terms, that prevented them from keeping bars, restaurants and retail establishments closed or requiring residents to wear masks in public.

Ducey relented under pressure from the mayors of Phoenix, Tucson and Flagstaff and in the face of an undeniable surge in COVID-19 cases.

The politicization of mask-wearing, a fundamental tool to defeat the virus, has hampered America’s response. (Yougov)

Ducey’s indulgent approach to social distancing measures probably contributed to his constituents’ failure to embrace them. Polls taken from late March through the end of April showed that only 30% to 40% of Arizona residents regularly wore face masks in public; in California, New York and New Jersey, the rate was as high as 60%.

Arizona waited until March 30 to issue a stay-at-home policy, long after other states. Ducey lifted the policy early, on May 15.

Ducey joined Trump at an indoor political rally in Phoenix on June 23 at which an estimated 3,000 persons were in attendance, crammed shoulder to shoulder and mostly maskless — even though a week earlier the city had ordered masks to be worn. Ducey wore a mask bearing the Arizona state seal, but Trump was maskless.

Not until Monday did Ducey reimpose anti-virus measures, prohibiting large gatherings, ceasing the issuance of new special event licenses, and closing bars, gyms, movie theaters, waterparks and tubing rentals. His order will remain in effect through the month. He didn’t order masks to be worn in public.

By then, the state already had activated its crisis standards of care, or rationing plan. Let’s take a look.

Like other states’ plans, Arizona’s relies chiefly on a metric known as a SOFA Score, for “sequential organ failure assessment.” The score is based on the condition of six major organ systems: lungs, circulatory, heart, kidney, liver and neurological.

Arizona assigns points to patients according to their SOFA score range, to a maximum of four points for the most severely affected. Then it adds up to four more points for a subjective assessment of a patient’s survivability: two points for those whose death is expected within five years despite successful treatment of COVID-19, and four for those whose death is expected within one year despite successful treatment. Priority for treatment is given to those with lower scores.

The guidelines state that judgments are to be made regardless of “race, ethnicity, color, national origin, religion, sex, disability, veteran status, age, genetic information, sexual orientation, gender identity, quality of life, or any other ethically irrelevant criteria.”

But several of these factors obviously will play into the point system. Black patients on average tend to suffer from more medical conditions than others, in part because their incomes are lower on average and their access to medical care more limited. Older residents also suffer from more health challenges. And how do medical personnel assess a patient’s “quality of life”?

Some of these factors are especially relevant in Arizona, where residents 65 and older constitute 23% of the adult population, above the national average of 20.7%. Florida skews even older, with 25.6% of its adult population 65 and older.

The prospects of subjective judgments creeping into triage judgments is great because the SOFA score itself, despite its apparent objectivity, is an imperfect tool.

The scores are “poor predictors of individual patients’ survival,” the National Academies found in its assessment of crisis standards. That’s especially true for patients suffering acute respiratory failure, one of the key symptoms of COVID-19.

As a result, “these scores are not suitable for excluding patients with acute respiratory failure… from receiving critical care” in the pandemic.

One can’t blame Arizona for implementing a rationing plan aimed at delivering crisis care to those judged most likely to benefit from it. But its leaders can be blamed for allowing the state to reach the point where rationing is deemed necessary. The seeds of its disaster were planted long ago.

Fauci says new mutation of coronavirus spreads quickly: report

Jack Hobbs in the New York Post reported that the country’s top infectious disease expert said Thursday that a more infectious strain of the coronavirus may be emerging.

Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, made the claim Thursday in an interview with The Journal of the American Medical Association.

Fauci said research suggests Italy was devastated by a different strain of the coronavirus than the one that originated in Wuhan, China.

The main difference between the two, Fauci said, is that Italy’s version passes from person to person more effectively, making it even more difficult to contain.

“It just seems that the virus replicates better and may be more transmissible,” says Fauci.

The study he references, which was released by researchers affiliated with the Sheffield COVID-19 Genomics Group, states that the new strain “has become the most prevalent form in the global pandemic.”
However, the researchers also found no evidence that this new strain causes worse symptoms than the original.

As of Thursday, The United States had more than 2.7 million confirmed cases, the highest in the world and Dr. Fauci also is warning us that the U.S. could see 100,000 Coronavirus cases a day if this surge continues.

What do we do to protect ourselves and conquer this disease?

And remember to celebrate Independence Day, the Fourth of July! Remember why we celebrate this holiday!

Coronavirus update: Florida spike raises doubts over reopening strategy; mask debate gets more political. Then there is the Brazil and Sweden Experience! When will we Learn?

Senior reporter Anjalee Khemlani reported that recently Florida became the focus of rising fears it could become the next U.S. coronavirus hotspot, with surging cases in the West and South leading to increased safety measures, and fanning doubts about nationwide plans to reopen.

Globally cases have surged past 8.5 million, and more than 454,000 have died. In the U.S. nearly 2.2. million cases have been reported, and more than 118,000 are dead. On Friday, the Sunshine State reported a rise in COVID-19 cases of 4.4%, sharply higher than the previous 7-day average of 3.2%.

The relentless climb in domestic cases prompted California’s governor to require mask-wearing in public, while Texas and Arizona recently began to ok enforcing masks in public, amid a spike in new diagnoses in those states. The question is who is going to enforce these regulations? More to come.

Meanwhile, the economy has sent mixed signals about the trajectory of a recovery, according to Morgan Stanley data, underscoring volatility in markets hopeful for a “V-shaped” rebound.

“We note a continuous upward inflection in eating out in restaurants to 26% (from 17% two weeks ago), mainly driven by the South region and rural areas. Visits to the mall, albeit still low, are up to 13% from 8% a month ago,” the bank wrote on Friday.

Political debate over masks

As the debate over wearing face coverings in public gets increasingly political, critics point out that several areas have been lax with mask and distancing measures. The mask controversy — which took center stage in a debate over President Donald Trump’s weekend rally in Tulsa — is rooted in a perceived infringement on individual freedom, and disputed claims about face masks reducing the intake of oxygen.

Yet public health experts point to the success in New York and New Jersey, two former epicenters that are now relaxing stay-at-home orders, in implementing such measures to control the outbreak. Actually, if you want to see success, look at the Maryland strategy regarding the management, restrictions, etc. of the coronavirus complexities.

Public health experts expressed concerns with AMC’s (AMC) plan to reopen theaters without enforcing masks Thursday. The company’s CEO explained he wanted to avoid the politically controversial topic of mask-wearing — a decision that sparked more debate.

The company reversed the decision Friday, announcing in a statement that moviegoers will be required to wear masks.

Dr. Ashish Jha, director of Harvard’s Global Public Health Institute, said on Twitter the politicizing of masks will create more confusion and a “dilemma” for businesses eager to return to normal.

“It may feel easier to let customer choose. But long run success requires companies courageously undertake evidence-based actions that keep customers safe,” Jha said.

Separately, Japan has lifted all coronavirus restrictions for businesses, marking another country’s full reopening this month. The country has had fewer than 100 cases daily in the past month.

Vaccine coverage

China appeared to gain a leg up in the worldwide race for a COVID-19 vaccine, announcing on Friday that one of its pharmaceutical companies could begin the next phase of human tests as early as the fall.

Senior U.S. government officials said this week that any successful COVID-19 vaccine was likely to be free to “vulnerable” individuals who can’t afford them.

In addition, health plans are likely to cover at no cost to members— similar to the coverage of testing and inpatient services, which has seen bills as high as $1.1 million settled between insurers and funding from Congress.

Vulnerable individuals, those without insurance or on Medicaid, belong to a largely underserved population. Some providers refuse to accept Medicaid because of its traditionally low reimbursement for care.

The CARES Act has provisions, along with the preventative coverage mandates of the Affordable Care Act, that could address some pockets of accessibility. The bill includes language “to cover (without cost-sharing) any qualifying coronavirus preventive service” for commercial insurers.

For Medicare, in addition to the flu vaccine, the law now includes “COVID–19 vaccine and its administration,” and for Medicaid, states are required to cover “any testing services and treatments for COVID– 19, including vaccines, specialized equipment, and therapies” without cost-sharing.

But it still leaves out self-insured and uninsured — which make up more than half of the U.S. population. At least 56% of the population is on self-insured plans, which have had the option to cover. members’ COVID-19 testing and hospital visits during the pandemic.

As states see coronavirus surges, health officials say combination of factors responsible

So, what is the cause of these surges? Bryn McCarthy reported that this past week, states throughout the nation have seen surges in coronavirus cases, with the average number of new cases per day increasing by about 20 percent to nearly 24,000 cases per day. Health officials say a combination of factors is likely responsible for these increases.

“It’s multifactorial,” said Dr. Janette Nesheiwat, family and emergency medicine physician and medical director of CityMD, said. “The initial wave of COVID-19 is still with us, hitting each state at different points in time. We see more cases because we are doing more testing. Also, the country is reopening, which means an increase in mobility of people, which by nature means we will have more cases.”

States reopening, increased testing and “quarantine fatigue” are largely responsible for these surges, according to experts. Dr. Marty Makary, professor of surgery, health policy and management at Johns Hopkins and Fox News medical contributor, said the disregard for distancing and use of masks in some parts of the country has greatly influenced the hospitalization highs of late. “We are seeing increases in hospitalizations in Texas, North Carolina, South Carolina, Arizona, Florida, Arkansas and other states resulting not from institutional spread, such as nursing homes and meatpacking outbreaks,” Makary said, “but instead from daily activity.”

Health officials stress the importance of hospitalization rates and number of deaths over the number of positive cases. Over the past week, there were, on average, about 660 deaths due to COVID-19 in the U.S. Over the past three days there were on average about deaths 770. “This is very concerning because we are seeing these increases amidst an expected seasonal decline associated with entering the summer,” Makary said. “I’m concerned we’ll have a lot of cases seeding the next wave in the fall. If you think about it, the current wave was seeded by a few dozen cases in January and early February. We may be seeding the next wave with 100,000-200,000 cases going into the next cold season.”

A model produced by the University of Washington predicts that the United States will have over 201,000 COVID-19 deaths by Oct. 1. Nesheiwat feels this prediction is accurate. “We have roughly 600 to 700 cases per day,” Nesheiwat said. “Mobility increases transmission of COVID, for example, the protests where we had massive large crowd gatherings with people shouting and screaming spewing viral particles into the air close in contact with each other, or Mother’s Day church gatherings, or states that opened without following recommended guidelines.”

So how can we bring these numbers back down? “Aggressive case management is the way to bring down case numbers and hospitalizations,” said Dr. Amesh Adalja, infectious disease doctor and senior scholar at the Johns Hopkins Center for Health Security. “The virus is with us. People need to take actions realizing that there is nothing that is without risk. It will be important to think about social distancing as we go through this pandemic without a vaccine.” He says the best way for people to decrease their risk of becoming infected is by decreasing their physical interaction with others, observing social distancing norms, handwashing frequently, avoiding highly congregated places and possibly wearing face shields.

Makary said it’s all about slowing the spread. “More important than creating new regulations is convincing people to practice good behavior around best practices,” Makary said. “I would say that complacency is our greatest threat going into the fall.”

Health experts are urging people to reconsider nonessential activities in areas where cases and hospitalizations are on the rise. “For example, schools can hold classes but should consider postponing nonessential field trips and contact sports this year in areas with active infections,” Makary said. “National organizations should postpone their in-person conferences since travel is a well-known vector of transmission. Retail should attempt to move their activities outdoors if feasible to do so.”

While health officials recognize that humans are, by nature, social creatures who crave interaction with others, the novel virus and its deathly effects are not exaggerated, as some have started to believe. “COVID is not an exaggeration,” Nesheiwat said. “I have seen firsthand patients dying in my arms. It is heart-wrenching to see someone’s life taken too soon. The virus can affect anyone at any age. It is still here and it’s deadly.”

Makary agreed, reiterating how the virus affects all of society, especially the most vulnerable members, such as children, those with disabilities and the elderly. But nonetheless he remains optimistic and urges others to do the same. “This is not a fate we have to accept, but one we can impact,” Makary said.

Brazil’s coronavirus cases top 1 million as the virus spreads

Caitlin McFall noted that Brazil’s government announced Friday that its coronavirus outbreak has surpassed a million cases, making it second-leading nation in the world to the United States in coronavirus infection rates. “Almost half of the cases reported were from the Americas,” World Health Organization General-Director Tedros Adhanom Ghebreyesus told a virtual briefing. “The world is in a new and dangerous phase … the virus is still spreading fast, it is still deadly, and most people are still susceptible.”

The Brazilian President Jair Bolsonaro maintains that the repercussions from social distancing measures still outweigh the severity of the virus in the country. Bolsonaro has repeatedly downplayed the virus, referring to the coronavirus as a “little flu,” and told reporters earlier this month that he “regret[s] all the dead but it is everyone’s destiny.”

The United States, which has a population 56 percent bigger than Brazil, has reported over 2.2 million cases. But health experts believe that the infection rate could be as much as seven times higher in Brazil. Johns Hopkins University has reported that Brazil is conducting 14 tests a day for every 100,000 people, but medical officials say the number of tests is up to 20 percent less than what they should be to accurately track the virus. Although data shows that the virus is reaching a plateau in the cities near the Atlantic in the north, the rural countryside towns, which are less equipped to deal with the crisis, are seeing a spike in cases.

“There is a lot of regional inequality in our public health system and a shortage of professionals in the interior,” Miguel Lago, executive director of Brazil’s Institute for Health Policy Studies. said. “That creates many health care deserts, with people going long distances to get attention. When they leave the hospital, the virus can go with them,” Lago added.

Brazil, which has seen 50,000 deaths according to their Ministry of Health, has struggled to maintain a health minister during the crisis. Former Health Minister Dr. Nelson Teich resigned in May, after serving in office for only month. Reports later surfaced of his disagreements with Bolsonaro on social distancing measures and whether or not the anti-malaria drug, chloroquine, should be distributed. Teich referred to the drug as “an uncertainty” and differed with the president over how to balance the economy with the crisis.

His predecessor, Luiz Henrique, was fired from his position of health minister after also disagreeing with the president on how to handle the pandemic. Bolsonaro has not yet filled the health minster role, even as the country has evolved into the new epicenter of the coronavirus.

California county sheriff says he won’t enforce Newsom’s coronavirus mask order

Remember my question at the beginning of this post, who will enforce the mask and then stay-at home orders? Nick Givas reported that the sheriff’s office for Sacramento County announced on Friday that it will not enforce Gov. Gavin Newsom’s coronavirus order, which requires residents to wear masks or facial coverings while they are out in public. Can you blame them?

The announcement came just one day after Newsom, a Democrat, issued the statewide order mandating the use of facemasks.

In a statement posted to Facebook, the sheriff’s office said residents should be “exercising safe practices” in the face of COVID-19, including the use of masks, but it also deemed the idea of enforcement to be “inappropriate,” because it would criminalize average Americans for a relatively small infraction.

“Due to the minor nature of the offense, the potential for negative outcomes during enforcement encounters, and anticipating the various ways in which the order may be violated, it would be inappropriate for deputies to criminally enforce the Governor’s mandate,” Sheriff Scott Jones’ statement read. Deputies will instead work “in an educational capacity,” alongside health officials, to avoid any further escalation between bystanders and law enforcement.

Jones added, however, that employees will comply with the governor’s order as much as is pragmatically possible. “As for the Sheriff’s Office and its employees, we will comply with the Governor’s mask recommendations to the extent feasible,” the message concluded.

Newsom said in his initial statement that, “Science shows that face coverings and masks work,” and “they are critical to keeping those who are around you safe, keeping businesses open and restarting our economy.” This news comes as California gets ready to broadly reopen the state economy. People can now shop, dine in at restaurants, get their hair done and go to church in most counties. Overall, there have been 157,000 reported cases of coronavirus in the state and more than 5,200 deaths, as of Thursday.

New Study Casts More Doubt on Swedish Coronavirus Immunity Hopes

Johan Ahlander reported that Sweden’s hopes of getting help from herd immunity in combating the coronavirus received a fresh blow on Thursday, when a new study showed fewer than anticipated had developed antibodies.

Sweden’s has opted for a more liberal strategy during the pandemic, keeping most schools, restaurants, bars and businesses open as much of Europe hunkered down behind closed doors.

While Health Agency officials have stressed so-called herd immunity is not a goal in itself, it has also said the strategy is only to slow the virus enough for health services to cope, not suppress it altogether.

However, the study, the most comprehensive in Sweden yet, showed only around 6.1% of Swedes had developed antibodies, well below levels deemed enough to achieve even partial herd immunity.

“The spread is lower than we have thought but not a lot lower,” Chief Epidemiologist Anders Tegnell told a news conference, adding that the virus spread in clusters and was not behaving like prior diseases.

“We have different levels of immunity on different parts of the population at this stage, from 4 to 5% to 20 to 25%,” he said.

Herd immunity, where enough people in a population have developed immunity to an infection to be able to effectively stop that disease from spreading, is untested for the novel coronavirus and the extent and duration of immunity among recovered patients is equally uncertain as well.

Sweden surpassed 5,000 deaths from the coronavirus on Wednesday, many times higher per capita than its Nordic neighbors but also lower than some countries that opted for strict lockdowns, such as Britain, Spain and Italy.

Now No-lockdown Sweden is compelling parents to send their children to school. Some fear their kids could ultimately be taken away if they refuse.

Sweden has kept schools open for children under 15, part of its policy of avoiding a widespread lockdown during the coronavirus pandemic. Its policy is that students must physically attend school in almost all circumstances, including students with conditions that some evidence suggests may make them more at risk of catching COVID-19.

Business Insider spoke to parents across Sweden who are disobeying the rules to keep their kids home. Many say local officials have threatened to involve social services if the parents do not relent and send their children to school. Some parents say their ultimate fear is having their children taken away.

Swedish officials told Business Insider they would not usually resort to such an extreme measure, though did not deny that it is a possibility. Sweden is compelling parents to keep sending their children to school — including students with conditions that some evidence suggests may make them more at risk of catching COVID-19 — as part of its policy to avoid a full scale lockdown in response to the coronavirus.

While school systems in other countries have ceased or greatly restricted in-person learning, Sweden says that anyone under 15 should keep going to school. There are almost no exceptions. Some parents have refused to comply, sparking a stand-off with state officials. They worry this could eventually end with their children being taken away — the ultimate reprisal from the government — though officials stress that this would only happen in extreme scenarios.

Business Insider spoke to seven parents and teachers across Sweden, many of whom have decided to keep their children home despite instructions from the government to the contrary. For some, it is their children who they believe are at elevated risk for COVID-19, while others consider themselves vulnerable and fear their children could bring the disease home. In each case, Business Insider contacted officials responsible for the child’s education, but none offered a response by the time of publication. Mikaela Rydberg and Eva Panarese are both mothers in Stockholm who are keeping their children home.

Ryberg’s son Isac, who is eight years old, has cerebral palsy and suffers badly from respiratory illnesses. Rydberg said he had been hospitalized before with colds and flu. However, her efforts to persuade his school that he should be kept home to shield from COVID-19 have not been successful.

Swedish health officials do not consider children as a group to be at risk from the coronavirus — even children like Isac. As this is the official advice, doctors have declined to give Isac a medical exemption from school. Instead, Rydberg has kept him home since March against the school’s instructions, which she said prompted local government officials to tell her that they may have to involve social services. 

The school did not respond to Business Insider’s request for comment, while the local government, Upplands Väsby, said, “We follow the recommendations from our authorities and we do not give comments on individual cases.” She said that because it is a question of her child’s welfare, she is not worried about what could follow. “I am so certain myself that I am right, I am not worried about what they threaten me with,” she said.

“Unless you can 100% reassure me that he won’t be really, really sick or worse by this virus, then I will not let him go to school.”

‘School is compulsory’- This is lunacy!!

Eva Panarese is a mother of two. She is keeping her son home to minimize exposure to her husband, who has recently suffered from pneumonia. Panarese said she reluctantly sent her daughter back to school because exam seasons is approaching and she felt there was no other option.

Emails from the child’s school reviewed by Business Insider insist that children come to school during the pandemic, citing government policy. One message, sent in April, said: “We need to emphasize again that school is compulsory.”

Panarese said her situation shows that it isn’t possible to protect some members of a household if others are still obliged to go to school and risk infection. “I don’t know who will be right or wrong but I don’t want the risk,” she said. “I don’t want to be part of a grand experiment.” The school did not respond to Business Insider’s request for comment.

No exceptions

Sweden’s Public Health Agency says there is “no scientific evidence” that closing schools would help mitigate the spread of the virus. The agency said doing so “would have a negative impact on society” by leaving essential workers struggling to find childcare. It said such a policy might put other groups of people — like grandparents — at increased risk if they care for children.

Sweden has strong beliefs in the rights of the child, which includes the right to education, and typically does not allow that learning to take place outside of school. Only staff or children with symptoms should stay home, the Public Health Agency says.

Sweden does not include children as an at-risk group, even children who have conditions that they acknowledge increase the vulnerability of adults, like diabetes, blood cancers, immunosuppressive conditions, or ongoing cancer treatments.

Studies suggest children are generally less at-risk than other groups, but most countries have nonetheless closed schools, or radically changed the way they operate. New effects of the virus on children are also being discovered as the pandemic progresses.

The government is continuing its usual policy, which says that when children are repeatedly absent, schools are supposed to investigate and, in some cases, report the situation to local authorities, which can involve social services. Fears over the coronavirus is not considered a valid reason for keeping children home.

Afraid of losing their kids

Ia Almström lives in Kungälv, around half an hour’s drive from Sweden’s second-largest city, Gothenburg. Authorities there have threatened to take her to court if her kids remain out of school. Almström has three children, whom she has kept home since April because she faces an increased risk from the virus because of her asthma. She received a letter from the local government on May 5, seen by Business Insider, which said that she could be referred to social services, where she could face a court order or a fine.

The authority in question, Kungälvs Kommun, declined to comment on Almström’s case. Almström said: “It is heartless how Sweden treats us. They do not take our fears seriously. We get no help, only threats.” Almström said she and many parents “are afraid to lose our children or something.” “That is what they do when they think that parents [cannot] take care of the children. Then they move the children away. So that’s something we are afraid of.”

Last resort. Read on This is more than lunacy!!

A spokeswoman for Sweden’s National Board of Health and Welfare said that taking a child away is the government’s last resort. She said: “Normally, the social services will talk to the child, parents, and the school – trying to find out the underlying problem.” “It is a big step to take a child away from the parents – not only school absence will normally be a reason to place a child in residential care or in foster home,” she said, implying that other issues with how the children are being treated or raised would need to be found for the action to take place.

However, escalation is not the only way out — some parents reach a compromise with their schools. Jennifer Luetz, who is originally from Germany, lives some 100 miles from Stockholm in the town of Norrköping. She said she contacted her children’s school on March 12 to say they would be staying home, as she has a weakened immune system.

She said the school was “understanding” and helped her children to work at home. The officials, she said, decided not to escalate her case as she what she described as a “valid reason” to keep her them at home.

Other parents have struggled to reach similar agreements. And Luetz said she is still worried by Sweden’s public health approach, and has faced social consequences for her decision. “My Swedish support network basically dried up overnight,” she said. “My Swedish friends stopped talking to me.” 

Teachers worry, too

One teacher in Stockholm, who asked to remain anonymous as they were not authorized to speak, said that they agree with many of the parents keeping their children away.

The teacher told Business Insider: “I do not believe that a good epidemiologist would make us send our children to school when many homes have at-risk people living in the same household.” The teacher is originally from the US but has lived in Stockholm for six years, and said their spouse is in a risk group. The teacher said they worry for the health of older teachers and parents who are elderly or otherwise vulnerable. 

Andreia Rodrigues, a preschool teacher who also works in Stockholm, called the government’s plan “unacceptable.” She said it leaves parents having “to decide if they want to take on a fight with the school and then take the consequences.” “Even if kids have parents who are confirmed to have COVID-19 at home, they are still allowed to be there,” she said. “We cannot refuse taking kids, even if the parents come to us and admit ‘I have COVID-19.'” ‘We have been lucky not to be reported yet’

Lisa Meyler, who lives in Stockholm, said she has been keeping her 11-year-old daughter home since March. Meyler has an autoimmune disease while her husband is asthmatic. “We refuse to knowingly put our daughter’s health and life at risk,” Meyler said, saying she will “not let her be a part of this herd immunity experiment.” “We have been lucky not to be reported yet, but it has been made clear that it is not an option to let her stay home after the summer holidays.”

The school that her daughter attends did not respond to Business Insider’s request to clarify its policy. She said having “children taken away is the ultimate fear” for parents.

Fauci: Next Few Weeks ‘Critical’ in COVID Fight

I think that Dr. Fauci is correct in his comments before the House panel. Dr. Anthony Fauci testified before a House panel Tuesday, and his assessment of the coronavirus fight is notably darker than President Trump’s. Fauci summed it up as a “mixed bag,” citing progress in states such as New York but a “disturbing surge in infections” elsewhere, in part because of “community spread.” That’s in contrast to statements from Trump and Mike Pence chalking up the rise to increased testing, reports the Washington Post. Fauci’s warning: “The next couple of weeks are going to be critical in our ability to address those surges we are seeing in Florida, Texas, Arizona, and other states,” he said, per the New York Times.

3 States See Record High in Daily Coronavirus Infections After Reopening; and What About the Rest of the World?

Many were waiting whether lockdowns were the answer to this pandemic, especially when we learned that Sweden didn’t mandate lockdowns or self-quarantines. But low and behold we learn of the spike in infections and deaths at the end of last week. In the article by Meghan Roos, 6/12/2020, In Sweden, Where No Lockdown was Ever Implemented, there was an increase one day spike of 1,474 on Thursday, 6/11/2020. Swedish health officials reported 49,684 infections and 4,854 deaths by Friday 6/12/2020. This country now has one of the highest per capita fatality rates in the world with an estimate 10 per cent of all COVID-19 cases resulting in death, accounting to date from John Hopkins University.

Now, as Nick Visser reported that Texas, Arizona and Florida all reported their highest daily increases in new coronavirus cases on Tuesday, even after all three states implemented and later lifted stay-at-home orders meant to stop the spread of infections.

State officials in Florida reported 2,783 new cases, in Texas, 2,622, and in Arizona, 2,392. All three states have seen social distancing regulations relaxed for weeks, and most businesses have been allowed to reopen in some capacity.

The figures come amid ongoing efforts by President Donald Trump and other Republican leaders to downplay the ongoing spread of the virus. At least 21 states have seen rates of new cases increase over the last two weeks as a majority of the country reopens.

At the same time, Trump has been pushing misleading claims that infections are only increasing because there’s more testing, going so far as to claim Monday, without evidence, that “if we stop testing right now, we’d have very few cases, if any.”

The president is also preparing to hold a massive rally in Oklahoma this weekend with 20,000 attendees at an indoor arena, despite pleas from local officials and health professionals that the event could quickly lead to a renewed outbreak in the state. Infection rates in Oklahoma rose 68% in the second week of June. 

“I’m extremely concerned,” Bruce Dart, the executive director of the Tulsa health department, told the Tulsa World. “I think we have the responsibility to stand up when things are happening that I think are going to be dangerous for our community, which it will be. It hurts my heart to think about the aftermath of what’s going to happen.”

Other state leaders have pushed back their own reopening efforts as cases have surged, including the governors of Utah and Oregon.

But in Florida, Gov. Ron DeSantis (R) said he was not considering another shutdown despite the surge in cases. He also rolled out the White House’s misleading talking point that cases were rising only because of increased testing.

“We’re not rolling back,” DeSantis said during a press briefing, according to the Miami Herald. “The reason we did the mitigation was to protect the hospital system.”

“You have to have society function,” he added. “To suppress a lot of working-age people at this point I don’t think would be very effective.”

In Arizona, some health officials were already reporting a strain on hospitals’ intensive care capacity due to a spike in coronavirus cases, even as Gov. Doug Ducey (R) said any concern was “misinformation” and said the facilities were prepared to handle an influx in patients.

And in Texas, Gov. Greg Abbott (R) said that, despite his own state’s figures, hospital capacity remained “abundant.”

“The more Texans protect their own health, the safer our state will be and the more we will be able to open up for business,” he said Tuesday.

Dr. Anthony Fauci, the country’s top infectious disease expert, said that, despite the attempts to alleviate any concern, some states jumped the gun on reopening before meeting White House criteria on case levels.

“There certainly were states that did not strictly follow the guidelines that we put out about opening America again,” Fauci said in an interview with NPR. “Clearly there were states that ― left to their own decision about that ― went ahead and opened to a varying degree … certainly before they got to the benchmarks that they needed to get.”

Recent news report is that multiple Florida hospitals have run out of ICU beds as the Coronavirus cases continue to spike.

In This State, the Virus Is ‘Spreading Like Wildfire’

Jenn Gidman noted that as states start to reopen, as well as the recent ongoing protests, amid the pandemic, there’s a red flag rising out of the Southwest. Business Insider reports the coronavirus outbreak “is going very badly” in Arizona, with more than 4,400 new cases over the weekend, bringing the total number of cases in the state to more than 37,500 as of Sunday, with nearly 1,200 deaths. Per Healthline, there’s been a 300% increase in reported cases since May 1. Tucson.com reports that in just one week (from May 31 to June 6), the state saw its biggest week-to-week increase yet: 7,121 new coronavirus patients, or about a 54% increase from the previous week. Meanwhile, the Arizona Republic reports that hospitalizations are on the rise as well, with two straight weeks of statewide hospitalizations surpassing 1,000 daily—the highest number since state reporting began in the beginning of April. Will Humble, a former director of the state’s Department of Health Services, says the spike is “definitely related” to the state’s stay-at-home order being dropped on May 15, per Newsweek. More on the Grand Canyon State:

Eyewitness to tragedy: CBS 5 talked to one doctor who works at two Phoenix hospitals, and he described what he’s been seeing in ERs and ICUs. “He asked if he could make a call in the hospital,” he says of one elderly patient. “It was very tragic to hear him say goodbye to his godkids and grandchildren, who you could really tell loved him.”

Texas Governor Says ‘No Reason Today to Be Alarmed’ As Coronavirus Cases Set Record

One question that I have is if states or cities declare a lockdown whether people will adhere to the lockdown?  Laurel Wamsley reported that Texas has seen a recent uptick in the number of COVID-19 cases, with a record level of new cases and hospitalizations announced Tuesday. People are seen here Monday along the San Antonio River Walk.

Texas Gov. Greg Abbott announced on Tuesday the state’s highest-ever number of new COVID-19 cases: 2,622.

He also reported a second record high: 2,518 people hospitalized with the virus in Texas, up from 2,326 a day earlier.

Despite the concerning uptick in people sick with the virus, Abbott said that the reason for his news conference was to let Texans know about the “abundant” hospital capacity for treating people with COVID-19. He and other officials spent much of the briefing touting the state’s hospital bed availability.

Disclosing the new record high number of hospitalizations related to COVID-19, Abbott emphasized that figure is “really a very small percentage of all the beds that are available.” Texas has so far been spared the high case numbers in other populous states. While it’s the second-largest state by population, Texas currently ranks sixth in terms of cumulative case numbers.

Before releasing the number of new cases, Abbott delved into what he said accounted for the previous daily high on June 10, which had 2,504 new cases. The governor said that spike could be largely attributed to 520 positive tests of inmates in Texas prisons being reported at once as well as a data error in a rural county.

He said there are also reasons for why Tuesday’s new case count was so high: tests results coming from an assisted living facility near Plano; a county south of Austin where positive cases seemed to be reported in batches; and 104 cases in one East Texas county that appear to be primarily from tests at a prison.

But he also pointed to uncareful behavior as a possible driver in some of the new cases. Abbott said there were a number of counties where a majority of those who tested positive for the coronavirus were under the age of 30, which he attributed to people going to “bar-type” settings or Memorial Day celebrations and not taking health precautions.

Abbott said that measures such as wearing masks, hand sanitizing and social distancing are what make it possible to reopen the state’s economy and Dr. John Hellerstedt, commissioner of the Texas Department of State Health Services, struck the same note.

“The message is we are seeing some increase in the number of COVID patients in the state. We expected this,” he said. “But we are seeing it occurring at a manageable level. I really want to stress that the continued success is up to the people of the state of Texas.”

Despite Abbott’s emphasis on the importance of masks, he has barred Texas cities from implementing any rules that would require face coverings. Abbott signed an executive order on April 27 that says while individuals are encouraged to wear face masks, “no jurisdiction can impose a civil or criminal penalty for failure to wear a face covering.”

On Tuesday, the mayors of nine Texas cities — including Houston, Dallas, San Antonio, Austin, Fort Worth and El Paso — sent a letter to the governor asking for the authority to set the rules and regulations on the use of face coverings.

“A one-size-fits-all approach is not the best option. We should trust local officials to make informed choices about health policy. And if mayors are given the opportunity to require face coverings, we believe our cities will be ready to help reduce the spread of this disease,” they wrote. “If you do not have plans to mandate face coverings statewide, we ask that you restore the ability for local authorities to enforce the wearing of face coverings in public venues where physical distancing cannot be practiced.”

Abbott said Tuesday that judges and local officials have other tools available for enforcement such as issuing fines for gatherings that don’t follow state protocols.

Austin Mayor Steve Adler extended a stay-at-home warning on Monday amid the news of rising cases – but that warning could only be advice to residents and not an order due to the state’s preemption.

“People are confused,” Adler told NPR’s Steve Inskeep on Tuesday. “They just don’t know at this point if it’s really important to wear face coverings or not, because I think they’re feeling like they’re getting mixed messaging — not only from state leadership but from national leadership. So, we’re just not getting the vigilance that we need on these efforts.”

And the Surges In COVID-19 Cases Cause Friction Between Local Leaders, Governors

In Austin, Adler said, you’ll see most everyone wearing a mask in grocery stores but not in restaurants or music clubs: “When we started opening up the economy and when the governor took away from cities the ability to make it mandatory, more and more people stopped wearing them.”

Adler said he agreed with Abbott that face coverings are key to reopening parts of the economy, even if they’re unpleasant for wearers.

“I know it’s inconvenient. I know it’s hot. I know it’s a nuisance,” Adler said. “And it’s hard to do, and people don’t like it. But at the same time, our community has to decide just how much we value the lives of folks in our community that are over 65 and older. We have to decide how much we value the lives of the communities of color that are suffering disproportionately because of this virus.”

Florida Officials Spar Over Rising COVID-19 Cases

Greg Allen reported that in Florida, where there’s a surge of new COVID-19 cases, officials are divided over what to do about it. The state saw 2,783 new cases Tuesday. It was the third time in the past seven days that Florida set a new daily record.

Florida Gov. Ron DeSantis and other Republican officials, including President Trump, say the rising number of new cases was expected and is mostly the result of increased testing. Florida is now testing more than 200,000 people a week, more than double the number tested weekly in mid-May.

But local officials and public health experts are concerned about other statistics that show that the coronavirus is still spreading in Florida. The state’s Department of Health reports that the number of people showing up in hospital emergency rooms with symptoms of the flu and COVID-19 is rising. Also, worrisome — the percentage of people who are testing positive for the virus is going up, total positive residents are 63,374 with 11,008 hospitalizations and 2,712 deaths.

In Palm Beach County, health director Alina Alonso says the rising positivity rate is a clear sign that the new cases can’t just be attributed to increased testing. Since Palm Beach County began allowing businesses to reopen, Alonso says, the percentage of people testing positive has jumped from 4.9% to 8.9%. “The fact that these are going up means there’s more community spread,” she says. “The virus now has food out there. It has people that are out there without masks, without maintaining distancing. So, it’s infecting more people.”

Alonso say the number of people hospitalized for the coronavirus has also gone up in Palm Beach County. “The numbers are very concerning to the hospitals,” she says. So far, the number of deaths from COVID-19 has remained low. But Alonso says deaths lag behind new recorded cases by about six weeks. She thinks the number of deaths will also rise. “We need to be cautious at this time. Wait a little bit until we see whether or not that happens,” she says. “If we go forward without waiting to see what is going on … by the time we get those deaths, it will be too late.”

Palm Beach County currently isn’t requiring residents to wear face coverings when in public places. County commissioners are now considering following the lead of Broward and Miami-Dade counties and making face masks mandatory.

In Tallahassee, DeSantis held a news conference where he responded to concerns about the rising positivity rate. Much of it, he said, is related to outbreaks among farmworkers and people in prison. Among the incidents he highlighted — a watermelon farm near Gainesville where, out of 100 workers tested, 90 were positive. DeSantis said, “When you have 90 out of 100 that test positive, what that does to positivity — that’s huge numbers.” Some of the other localized outbreaks among farmworkers, he noted, were in Palm Beach County.

DeSantis said there’s no reason to consider rolling back the rules allowing businesses to reopen at the moment. He has encouraged the resumption of sports events and attended a NASCAR race in Homestead, Fla., on Sunday with a few hundred other spectators. And he successfully lobbied for Florida to host President Trump’s acceptance speech at a Republican National Convention event in Jacksonville. That gathering is expected to draw thousands.

Democrats have become increasingly critical, saying DeSantis is ignoring important data that favor a more cautious response. Florida’s top elected Democrat, Agriculture Commissioner Nikki Fried, said, “Refusing to acknowledge the alarming patterns in cases, hospitalizations and positivity is not only arrogant but will cost lives, public health and our economy.”

Asymptomatic coronavirus transmission appears worse than SARS or influenza — a runner can leave a ‘slipstream’ of 30 feet

Quentin Fottrell reported that the WHO currently estimates that 16% of people are asymptomatic and can transmit the novel coronavirus, while other data show that 40% of coronavirus transmission is due to carriers not displaying symptoms of the illness. One study says that asymptomatic transmission “is the Achilles” heel of COVID-19 pandemic control. How worried should you be about asymptomatic transmission of COVID-19?

 hours earlier that transmission of the novel coronavirus in carriers who don’t show apparent symptoms happened in “very rare” cases.

Maria Van Kerkhove said it was a “misunderstanding to state that asymptomatic transmission globally is very rare,” and that her comments during a WHO news briefing had been based on “a very small subset of studies.” “I was just responding to a question; I wasn’t stating a policy of WHO,” she said.

The WHO currently estimates that 16% of people with COVID-19 are asymptomatic and can transmit the coronavirus, while other data show that 40% of coronavirus transmission is due to carriers not displaying symptoms of the illness.

Public-health officials have advised people to keep a distance of six feet from one another. Face masks are designed to prevent the wearer, who may be infected with COVID-19 but have very mild or no symptoms, from spreading invisible droplets to another person and thereby infecting them too. But “there’s nothing magic about six feet,” said Gregory Poland, who studies the immunogenetics of vaccine response in adults and children at the Mayo Clinic in Rochester, Minn., and is an expert with the Infectious Diseases Society of America.

“The virus can’t measure,” he told MarketWatch. “For example, the viral cloud while speaking will extend 27 feet and linger in the air for about 30 minutes. This is more like influenza in the sense that people transmit the virus prior to experiencing any symptoms and some people, of course, will not get sick.”

Asymptomatic transmission “is the Achilles’ heel of COVID-19 pandemic control through the public-health strategies we have currently deployed,” according to a study by researchers at the University of California, San Francisco published May 28 in the New England Journal of Medicine.

“Symptom-based screening has utility, but epidemiologic evaluations of COVID-19 outbreaks within skilled nursing facilities … strongly demonstrate that our current approaches are inadequate,” researchers Monica Gandhi, Deborah Yokoe and Diane Havlir wrote.

Brazil is on track to lead the world in coronavirus cases and deaths, and it still doesn’t have a plan for tackling the outbreak

Amanda Perobelli reported that Brazil could surpass the US in coronavirus cases and deaths by the end of July, according to estimates from the University of Washington.

The country recorded a daily record of 34,918 new coronavirus cases on Tuesday, according to Reuters. And despite the growing number of cases, the country has not created a plan to tackle the outbreak. Brazil could surpass the US in both coronavirus infections and deaths by the end of July, according to the main coronavirus tracking model from the University of Washington.

The country, which has yet to impose a national coronavirus lockdown, is on its way to registering more than 4,000 daily deaths, The Washington Post reported, citing the university. As of Tuesday, Brazil had more than 923,000 coronavirus infections and more than 45,000 deaths. Experts told Reuters the true number of cases was most likely higher.

As The Post noted, the country doesn’t have the same infrastructure to help it handle such a large outbreak as the US. But that hasn’t stopped President Jair Bolsonaro from largely dismissing the crisis the novel coronavirus is causing. In fact, he’s even attacked governors who chose to impose restrictions and threatened to host large barbecues in spite of public-health advice, The Post reported.

Brazil has not initiated a national testing campaign, has not implemented a national lockdown, and is dealing with insufficient healthcare expansion. Reuters reported that that country counted 34,918 new daily coronavirus cases on Tuesday.

In a report in early May, Carlos Machado, a senior scientist with Brazil’s Oswaldo Cruz Foundation, and his team warned that without a lockdown in Rio de Janeiro, the outcome would be “in a human catastrophe of unimaginable proportions.” He now says had his warnings been taken seriously, the outcome would not have been so bleak.

“From the point of view of public health, it’s incomprehensible that more-rigorous measures weren’t adopted,” Machado told The Post. “We could have avoided many of the deaths and cases and everything else that is happening in Rio de Janeiro. It was an opportunity lost.”

Scientists in the country told The Post that the country was veering into unknown territory. “We are doing something that no one else has done,” Pedro Hallal, an epidemiologist at the Federal University of Pelotas, told The Post. “We’re getting near the curve’s peak, and it’s like we are almost challenging the virus. ‘Let’s see how many people you can infect. We want to see how strong you are.’ Like this is a game of poker, and we’re all in.”

Bolsonaro’s approach has been to ignore the problem and sideline health experts

Reuters reported that senior officials leading Brazil’s coronavirus response had claimed the outbreak was under control.

“There is a crisis, we sympathize with bereaved families, but it is managed,” said Braga Netto, who spoke during a webinar held by the Commercial Association of Rio de Janeiro.

The World Health Organization’s regional director Carissa Etienne said Brazil was a major concern, Reuters reported. “We are not seeing transmission slowing down” in Brazil, Etienne said. Etienne said the country accounted for about 4 million coronavirus cases in the Americas and about 25% of the deaths.

The Post described Bolsonaro’s approach as being to ignore and sideline health experts. The Brazilian president fired Luiz Henrique Mandetta, his first health minister, after disagreements on social distancing, and then he fired his replacement, Nelson Teich, because he disagreed with the use of chloroquine as a treatment for coronavirus.

Similar to US President Donald Trump, Bolsonaro has boosted the use of hydroxychloroquine in the past. On Monday, the US Food and Drug Administration revoked the emergency-use authorization issued for the antimalarial drug.

One expert said even the public in Brazil did not heed public-health advice to limit the spread of the virus and continued to congregate without any safety measures implemented.

“It was a failure,” Ligia Bahia, a professor of public health at the Federal University of Rio de Janeiro, told The Post. “We didn’t have enough political force to impose another way. The scientists alone, we couldn’t do it. There’s a sense of profound sadness that this wasn’t realized.”

Presently there is only one country that has declared it COVID-19 cleared, that is Montenegro. New Zealand has declared their country COVID-19 free and then two cases turned up as two people from Europe who traveled to New Zealand tested positive and are now quarantined.

Look at the recent world numbers where the total cases are 8,174,327 with 443,500 deaths. Way too many!

When will it all be over?

Mood darkens in Sweden as high death rate raises tough questions over lack of lockdown, and Now A Second Wave and a Possible Kids’ Epidemic!

Richard Orange noted that Sweden, in deference to the rest of the countries believing in the strategy to lockdown their populace, decided not to use stay-at-home or lockdowns except for the elderly.  Sweden’s opposition has attacked the government for its handling of the coronavirus pandemic, with the stubbornly high death rate fueling questions over the decision not to impose a lockdown. 

Jimmie Akesson, the leader of the populist Sweden Democrats, first called for Anders Tegnell, the architect of Sweden’s less restrictive coronavirus strategy, to resign. The attacks continued in heated televised leaders’ debate on Sunday night.  

“The strategy in Sweden was not to try to hold back the infection, but instead to try to limit it at the same time as protecting risk groups,” Mr Akesson wrote in a debate article in the Dagens Nyheter newspaper.

“By that measure, it has failed miserably. Anders Tegnell should therefore resign. Only then will he show the Swedish people that he takes responsibility for the mistakes FHM [Public Health Agency of Sweden] has made.”

During a party leaders’ debate on Sunday evening, Ebba Busch-Thor, leader of the Christian Democrat party, blamed Sweden’s strategy – and by extension the government that allowed it – for some of the 4,659 deaths due to the virus. 

“What we can say about Sweden is that many of those who are mourning over those they have lost this spring are doing so because Sweden knowingly and deliberately allowed a large spread of the infection,” she said.  

Ulf Kristersson, the leader of the Moderate Party, the biggest party on the Centre-Right, held back from joining Mrs. Busch-Thor’s attack on the strategy, instead attacking the implementation of it.

“I had no problem with the strategy. It was a bit slow but, when it was in place, I had nothing against it,” he said. “But the government didn’t put any power behind the words.”

The Prime Minister, Stefan Lofven, continued to back Sweden’s strategic decision not to impose a lockdown, instead laying the blame for the death rate on failures within elderly care. 

“I think the strategy is the right one,” he said. “But it has transpired that that very many people, in certain areas, have died in elderly care. There’s no doubt that elderly care needs to be improved.” 

Mr Akesson faced an immediate counter-attack from Johan Carlsson, the director of FHM, who dismissed his call as “almost pathetic”. 

Dagens Nyheter’s political commentator Ewa Stenberg wrote on Sunday that the debate marked an end to the “borgsfred”, or “castle truce”, in Sweden.

“The tone was harsh and quite contrary to how it was when the virus hit the country. Then all the parties backed the government’s decision to let the Public Health Authority take the lead,” she wrote.

However, the return of political opposition does not yet seem to reflect a loss of support for the government among the public.

Kids During Lockdown: Is Another Epidemic About to be Revealed?

Ingrid Walker-Descartes noted that even in non-pandemic years, the summertime “back-to-school” rush of appointments in many pediatric practices can be a logistical challenge. This year could be even more hectic after many families delayed routine appointments during quarantine. Hoping to return to their routines, children and teens will need vaccines, physical exams for sports clearances and school forms, and all the regular developmental and emotional surveillance that is so important to keep them healthy.

As pediatricians, we should be adding another layer to our checklists in these visits this year. For many children, this visit may be the first time in weeks or months that someone outside their immediate family has had eyes on them.

We must be careful to listen, very carefully, to what the children and parents tell us, both in their words and in other signs. How has the family coped with the stress of being stuck at home? Are there financial struggles? Food insecurity? Other stresses? As a child abuse pediatrician, I know all of these things can put tremendous stress on a family, and ultimately can lead to a child being maltreated or abused. We have a real opportunity right now to intervene and provide critical support to families, and to protect children.

Sadly, we know from previous disasters that during these times of intense emotional and economic stress, rates of child abuse and neglect increase. Injuries and deaths among infants due to abusive head trauma increase during times of economic stress, and scattered reports among physicians at children’s hospitals in various states are reporting that is happening now, too. For example, a hospital in Fort Worth, Texas, and a hospital in Philadelphia, are reporting an increase in the number of severe physical abuse cases. Many times, this abuse occurs when a parent or caregiver is frustrated or at the “end of their rope,” and in a moment of anger, makes a devastating choice that injures a child.

For the past few months, during sheltering in place, children have lacked many of the people who often step forward as protectors — the aunt they may confide in, a teacher who sees a bruise, or a physician who notices an injury where there reasonably should be none. Reports to child abuse hotlines and child protective services have declined during the pandemic, but this is not necessarily because fewer children are being injured. We know that teachers and school counselors are the most frequent reporters of suspected abuse, and for months children have not had access to these trusted protectors. Many of them have not seen their pediatrician, either. These combined realities have left some of our most vulnerable children without several much-needed layers of protection.

As a pediatrician who specializes in diagnosing abuse and protecting children from further abuse, I am well versed in talking with children to understand what happened to cause their injuries. Some may convey lessons learned from their choices made due to curiosity or naivete. Others struggle to elaborate on marks or scars made in anger by a caregiver. Post COVID-19, it will be important for all pediatricians to have a careful approach as they are talking with families, listening and observing to understand what children experienced during the pandemic, and how we can help them and their families be safe and healthy.

Some families may benefit from a referral to a nutrition program, caregiver support program, parental counseling, or other resources. In other cases, a pediatrician may notice a sign of potential abuse that should be reported to the relevant child protection agencies. This is always difficult, but it can be the first step to making sure a child is safe and protected while a family gets the support they need.

The American Academy of Pediatrics (AAP) recently provided a webinar guide on how to identify child abuse during the pandemic, and additional resources are provided on the AAP website, including a list of child abuse programs across the country to help support you in this difficult role.

The stress on families and children will not end when the stay-at-home orders lift. Let’s be prepared to help all our children emerge healthy and strong, and ready to learn.

CDC wants states to count ‘probable’ coronavirus cases and deaths, but most aren’t doing it

Reinhard, Emma Brown Reis Thebault and Lena H. Sun reported that fewer than half the states are following federal recommendations to report probable novel coronavirus cases and deaths, marking what experts say is an unusual break with public health practices that leads to inconsistent data collection and undercounts of the disease’s impact.

A Washington Post review found that the states not disclosing probable cases and deaths include some of the largest: California, Florida, North Carolina and New York. That is one reason government officials and public health experts say the virus’s true toll is above the U.S. tally as of Sunday of about 1.9 million coronavirus cases and 109,000 deaths — benchmarks that shape policymaking and public opinion on the pandemic.

The U.S. Centers for Disease Control and Prevention works closely with a group of health officials called the Council of State and Territorial Epidemiologists to issue guidelines for tracking certain illnesses. The guidelines are voluntary, though states generally comply. The goal: solid comparisons between states and accurate national statistics that inform public health decision-making.

In April, as coronavirus infections multiplied and laboratory testing was limited, the CSTE and the CDC advised states to count both probable cases and deaths — where symptoms and exposure pointed to infection — along with those confirmed by tests.

Yet weeks after the guidance was handed down to standardize coronavirus reporting, a Post review found states as of early June counting cases and deaths in all sorts of ways.

At least 24 states are not heeding the national guidelines on reporting probable cases and deaths, despite previously identifying probable cases in other national outbreaks, including H1N1 flu during the country’s last pandemic in 2009.

The failure of many states to document probable coronavirus cases and deaths is “historic in many ways because there are lots of probable case classifications and probables are regularly and normally reported on,” said Janet Hamilton, the CSTE executive director. “We are definitely concerned about the undercounting of covid-19 deaths and cases.”

New Jersey says it began reporting probable cases and deaths to the CDC on May 15 but does not disclose them publicly on its website. Georgia says it tracks the information internally but is not reporting those numbers on its website or to the CDC.

“We do have intentions of sharing them but not yet,” said Nancy Nydam, a spokeswoman for the Georgia Department of Public Health, who said as of late May the department had tracked 1,658 probable cases and potentially dozens of probable deaths.

Officials in Montana, Rhode Island and the District of Columbia say they haven’t reported any probable cases or deaths because they have not had any, citing low numbers or the wide availability of testing.

Seven states did not respond to The Post’s requests for a breakdown of cases and death counts. Five of those are not reporting probable cases or deaths, according to data the CDC began publishing June 2. South Dakota reports probable deaths but not cases.

Officials in the remaining 17 states say they are reporting probable and confirmed coronavirus cases and deaths on their websites and to the CDC. Some states distinguish between probable and confirmed while others group them.

In some states not reporting probable cases, officials cite the demands of an unprecedented crisis in which Americans press for daily updates from public health data systems that are chronically underfunded and outdated.

In Washington state, where many of the nation’s first deaths occurred, health department spokeswoman Lisa Stromme Warren said documenting probable cases and deaths “is one of many urgent priorities.” The state has identified about 100 people whose death certificates list covid-19 but were never tested, so they are not included in the public death count or reported to the CDC.

“We suspect that we are actually more likely to be undercounting deaths than overcounting them,” Katie Hutchinson, the health department’s health statistics manager, said during a recent briefing.

CDC spokeswoman Kristen Nordlund said that the agency is working with health departments to improve the flow of data. “In pandemic circumstances, such as with covid-19, collecting complete information on each case is challenging,” Nordlund said. “The current case and deaths counts reported to CDC are likely an undercount.”

During the H1N1 flu pandemic, states initially counted probable and confirmed cases individually. But about three months into the outbreak, the CDC said those individual counts represented “only a fraction of the true burden” of the disease. The agency stopped collecting individual case reports and instead began publishing estimates based on hospitalizations, symptoms and other data.

The CDC is planning to come up with similar estimates for the coronavirus but has no immediate plans to stop counting individual cases. “CDC is actively working on a model to address and assess the true burden of covid-19 in the U.S.,” Nordlund said.

All eyes on numbers

For government officials assessing how quickly to reopen the economy and individuals deciding what risks to take, their daily judgment calls are based, in part, on the case and death counts publicized on television and computer screens.

That has propelled the pandemic counts into the contentious political arena, where some allies of President Trump and conservative voices on social media have claimed that the covid-19 death toll is inflated. The debate over whether counts of probables are crucial or misleading extends beyond the nation’s capital.

In Illinois, two Republican lawmakers and three businesses have sued the Democratic governor over coronavirus disaster orders. A spokeswoman for the health department, Melaney Arnold, said the state is not divulging probable deaths on its website “because there is concern from the public that the number of deaths is being inflated. . . . We need the public to have confidence in the data and therefore are reporting only those deaths that are laboratory confirmed.”

The state website lists about 5,700 deaths as of June 5, excluding the approximately 185 probable deaths tracked internally as of that day and reported to the CDC.

But a resident looking at a state chart and then turning to the CDC might not find the same numbers. The newly posted CDC table does not reflect the probables that officials in some states said they have reported. Officials say that’s because the reports sent to the CDC include those with confirmed cases in one figure and because the national update can run slightly behind state websites.

Since the 1950s, CSTE has recommended which diseases states should track and what those reports to the federal government should look like. The CDC works closely with the epidemiologists’ council and adopts its guidelines to “enable public health officials to classify and count cases consistently across reporting jurisdictions,” according to the CDC website.

States usually follow these recommendations and report the incidence of dozens of different diseases to the CDC, with some exceptions. A state may not report cases of a disease that does not occur within its borders, yet may track another illness found only in its part of the country.

Hawaii, for example, does not report Lyme disease, as every other state does, but it does report hallucinogenic fish poisoning.

“It’s more of a handshake agreement between the states and CDC that we will send you the data in this way so that you can then aggregate it,” said Kathy Turner, Idaho’s deputy epidemiologist. “In general, there’s no argument. We all do it because we realize the importance of being able to look at a disease on a national level.”

Some reportable diseases rarely result in deaths, so CSTE directives have typically focused on how to count cases, not fatalities. Then came the coronavirus and a mushrooming death toll. The CDC acknowledged in early April that the death count was an “underestimation” because it included only fatalities in which the virus was laboratory confirmed. Testing shortages, people dying at home or in nursing homes, and spotty postmortem testing meant victims were overlooked.

“When the outbreak first started and we were all just counting lab-confirmed cases by default, it became clear that we were not going to be able to describe the burden of the pandemic because so many people were not being tested,” said Turner, lead author of the CSTE statement on covid-19.

“We usually don’t approach a death separately from a case, but in this situation, we decided it was needed,” she said.

The CSTE recommended reporting probable and confirmed cases and deaths on April 5. The CDC’s written response to the recommendations, which was shared with The Post, said the agency “concurs” and that adoption by states is “very important” for covid-19 record-keeping. On April 14, the CDC noted on its website that the national tally includes probables, although the agency did not at that time provide a state-by state breakdown. The CDC also modified the form states use for coronavirus reports, adding boxes that can be checked to indicate a “lab-confirmed” case or “probable” case.

Probable cases were defined as showing symptoms and having contact with an infected person, or meeting one of those criteria and testing positive for coronavirus antibodies, rather than for the virus itself. Probable deaths meant those who were never tested for the virus but whose death certificates listed covid-19 as the cause of death or a significant condition contributing to death.

The CSTE statement also says that confirmed and probable counts should be included in the tallies “released outside the public health agency,” which could mean a state website or written report, according to the organization.

“When states are using different approaches, it always begs the question: ‘Why does one state choose one over another? Why a more conservative approach over a more sensitive one?’’’ asked Lorna Thorpe, director of the division of epidemiology at NYU Grossman School of Medicine. “That’s the reason we have standards and guidance that are technically sound.”

Information varies

The erratic reporting of coronavirus cases and deaths means that what residents can learn about the extent of the pandemic in their community varies widely.

Ohio was one the first states to begin disclosing probable cases and deaths in early April. “It usually is a given when CSTE makes a recommendation like that,” said Brian Fowler, chief data officer for the Ohio Department of Health. “When they made that recommendation, we looked at it and said, okay, well this is what we need to use.”

As of June 5, Ohio’s website showed 2,117 confirmed deaths and 222 probables. By breaking out the numbers separately, Fowler said, “you can’t be accused of hiding information and you can’t be accused of inflating numbers — it’s all out there.”

The transition to counting probables was not “a huge lift,” Fowler said. Epidemiologists at the health department were already reviewing all suspected coronavirus cases.

Some health officials were candid about how adding probable deaths would boost the overall tally. “I want to make sure that everyone understands that these are not new deaths,” Indiana Health Commissioner Kristina Box said at an April 20 news conference. “Rather, we are capturing the deaths that have occurred really since this pandemic began.” Box suggested other states would do the same: “Indiana — like every other state — will include these deaths in our reporting in order to better capture the toll that covid-19 has truly taken.”

One week earlier, Michigan officials had said they intended to begin disclosing probable cases and deaths. When the state finally began doing that on June 5, more than 5,000 cases and 200 deaths were added to coronavirus totals.

California’s state health department is reviewing the process to track probable deaths and “working to provide as much data as possible about COVID 19 while ensuring that the data are valid and useful for understanding the pandemic,” according to a May 20 email to The Post.

Hilda Solis, a supervisor in Los Angeles County who represents a heavily Hispanic and impoverished district, said she was surprised that the state is not following national recommendations on counting coronavirus deaths. She has called for more post-mortem testing by the medical examiner. “A lot of people are dying at home. Poor people are dying at home. Homeless people are dying,” said Solis, a former U.S. labor secretary under President Barack Obama. “I do believe covid-19 is being underreported and that we need to take more responsibility.”

The scale of undercounting that results from reporting only confirmed cases became clear when New York City on April 14 added more than 3,700 probable deaths to its numbers, sending the city’s tally over 10,000.

The city that sits at the epicenter of the pandemic in the United States still is not counting probable cases, however. New York Gov. Andrew M. Cuomo, a Democrat praised for his command of daily news briefings during the pandemic, has indicated skepticism about recording probable cases. “Probable is different than confirmed,” he said at a news conference in late May. “Probable is ‘probable, but I have to check, I don’t know, I have to do further testing.’ We’ve had many cases that were probable coronavirus and turned out not to be coronavirus and that’s why they call them probable.” Covid-19 websites for New York and New Jersey include probable deaths at nursing homes, but those numbers are not included in the states’ overall death totals. A spokesperson for North Carolina’s health department said the state is not reporting probables because of wariness about the reliability of antibody tests, and because of concerns that the CSTE’s definition of a probable case is overly broad. Officials in Florida did not respond to repeated requests for comment about why the state isn’t following federal guidelines.

People behind ‘probables’

Behind each probable death is a person. Barnes O’Neal, 83, checked into the Brightmoor Nursing Center in Georgia in March to recover from a 10-day hospitalization. Less than a month into his stay at the facility about 40 miles south of Atlanta, a coronavirus outbreak forced a lockdown. O’Neal developed a fever and pneumonia. His daughter, Natalie Turner, pleaded with her father’s caretakers and the state health department for a coronavirus test. She said she wanted his illness on the record.

On April 20, just hours after Turner had spoken with him by phone, O’Neal died. He was never tested, but Turner said his doctor told her there was “zero doubt” it was covid-19 and wrote it on her father’s death certificate.

Still, her father, a frequent volunteer at the local soup kitchen, would not be included in the death toll on the state website because he was never tested. “It’s just important to me because my dad’s life counted,” Turner said. “I feel like there’s a face behind every statistic, and that’s forgotten many times.”

And now the pandemic’s overall death toll in U.S. has exceeded 100,000, but what are the real numbers?

Second U.S. Virus Wave Emerges as Cases Top 2 Million

Emma Court and David Baker noted that a second wave of coronavirus cases is emerging in the U.S., raising alarms as new infections push the overall count past 2 million Americans. Texas on Wednesday reported 2,504 new coronavirus cases, the highest one-day total since the pandemic emerged. A month into its reopening, Florida this week reported 8,553 new cases — the most of any seven-day period. California’s hospitalizations are at their highest since May 13 and have risen in nine of the past 10 days.

A fresh onslaught of the novel coronavirus is bringing challenges for residents and the economy in pockets across the U.S. The localized surges have raised concerns among experts even as the nation’s overall case count early this week rose just under 1%, the smallest increase since March.

“There is a new wave coming in parts of the country,” said Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security. “It’s small and it’s distant so far, but it’s coming.”

Though the outbreaks come weeks into state reopenings, it’s not clear that they’re linked to increased economic activity. And health experts say it’s still too soon to tell whether the massive protests against police brutality that have erupted in the past two weeks have led to more infections.

In Georgia, where hair salons, tattoo parlors and gyms have been operating for a month and a half, case numbers have plateaued, flummoxing experts.

Puzzling differences show up even within states. In California, which imposed a stay-at-home order in late March, San Francisco saw zero cases for three consecutive days this week, while Los Angeles County reported well over half of the state’s new cases. The White House Coronavirus Task Force has yet to see any relationship between reopening and increased cases of Covid-19, Food and Drug Administration Commissioner Stephen Hahn said on a podcast.

But in some states, rising numbers outpace increases in testing, raising concerns about whether the virus can be controlled. It will take a couple of weeks to know, Toner said, but by then “it’s going to be pretty late” to respond.

Since the pandemic initially swept the U.S. starting early this year, 2 million people have been infected and more than 112,000 have died.

After a national shutdown that arrested the spread, rising illness had been expected as restrictions loosened. The trend has been observed across 22 states in recent weeks, though many increases are steady but slow.

In New York, the state hardest hit by Covid-19, Governor Andrew Cuomo only recently started reopening by region. New York City, the epicenter, began the first of four phases Monday.

“We know as a fact that reopening other states, we’re seeing significant problems,” Cuomo said Tuesday. “Just because you reopen does not mean you will have a spike, but if you are not smart, you can have a spike.”

Experts see evidence of a second wave building in Arizona, Texas, Florida and California. Arizona “sticks out like a sore thumb in terms of a major problem,” said Jeffrey Morris, director of the division of biostatistics at University of Pennsylvania’s Perelman School of Medicine.

Arizona Spike

Arizona’s daily tally of new cases has abruptly spiked in the last two weeks, hitting an all-time high of 1,187 on June 2.

This week, its Department of Health Services urged hospitals to activate emergency plans. Director Cara Christ, told a Phoenix television station that she was concerned about the rising case count and percentage of people tested who are found to be positive.

Valleywise Health, the public hospital system in Phoenix, has seen an increase in Covid-19 cases during the past two weeks. It’s expanded its intensive-care capacity and those beds are 87% full, about half with Covid patients, according to Michael White, the chief medical officer.

White said Valleywise has adequate protective gear for staff, but hospitals aren’t getting their entire orders. A surge in Covid cases could put that supply under stress, he said.

The increase in transmission follows steps to resume business and public life as well as the riots and protests.

“Within Phoenix, we’ve been more relaxed than I’ve seen in some of the other parts of the country,” White said, with some people disregarding advice to wear masks and maintain six feet of distance from others. “People are coming together in environments where social distancing is challenging.”

Texas on Wednesday reported a 4.7% jump in hospitalizations to 2,153, the fourth consecutive daily increase. The latest figures showing an escalation came as Governor Greg Abbott tweeted a public service announcement featuring baseball legend Nolan Ryan urging Texans to wash their hands and to not be “a knucklehead.”

Abbott was criticized for an aggressive reopening last month. Mobile-phone data show activity by residents is rebounding toward pre-Covid levels, according to the Children’s Hospital of Philadelphia’s PolicyLab.

That could reflect a perception that the virus wasn’t “ever a big threat,” said Morris, who recently moved to Philadelphia after 20 years in Houston.

Florida’s health department said in a statement that it attributes the increase in cases to “greatly expanded efforts in testing,” and noted that overall positivity rates remain low, at about 5.5%.

Bucking the trend is Georgia, which was the first U.S. state to reopen. Covid cases there have plateaued. Despite local outbreaks in the state, “their sea levels did not rise,” said David Rubin, director of the PolicyLab, which has been modeling the virus’ spread. “They’ve kind of held this fragile equilibrium.”

Creeping In

California was the earliest state to shut down its economy over the coronavirus, after one of the nation’s first outbreaks in the San Francisco Bay Area. It has been slower than most to reopen.

Even so, the state has also seen the number of people hospitalized with Covid-19 rebound in the past two weeks, as commerce accelerates. Case counts are climbing too, although officials attribute that to increased testing and say it’s a sign of preparation.

In part, rising numbers represent the virus spreading into places that largely avoided the first round of infections, including rural Imperial County in California’s southeastern desert. Yet the contagion remains present in places that bore the brunt of the first wave, including Los Angeles County. Hospitalizations there are lower than at the start of May, but deaths remain stubbornly high, with 500 in the past week alone.

Barbara Ferrer, Los Angeles County public health director, said the region has likely not seen the end of the first wave. And despite concerns about infections coming out of mass demonstrations in the sprawling city, she thinks the reopening of the economy will have a bigger impact.

“We’re not at the tail end of anything,” Ferrer said. “We never had a huge peak. We’ve kind of been within this band. We’re not in decline, we’re kind of holding our own in ways that protect the health-care system.” But, she added, “go to Venice and see the crowds, and you’ll understand why I have concerns.”

Another Onslaught

The U.S. has long been bracing for another wave, but future outbreaks are likely to take a different shape. Social distancing and mask-wearing, as well as careful behavior by individuals, are likely to have staying power even as economies reopen.

Experts are steeling for autumn, when changes in weather and back-to-school plans could have damaging repercussions.

“The second wave isn’t going to mirror the first wave exactly,” said Lance Waller, a professor at Emory University’s Rollins School of Public Health in Atlanta. “It’s not snapping back to exactly the same thing as before, because we’re not exactly the way we were before.”

Daniel Lucey, a fellow at the Infectious Diseases Society of America, compared the virus’ new paradigm with a day at the beach: The U.S. has been bracing for another “high tide” like the one that engulfed New York City. Today is a low tide, but “the waves are always coming in.”

ICU doctor warns: ‘We could lose control of the virus again’, Especially with the George Floyd protests! What About AI to Help in the Post Pandemic Planning!

I am concerned about what I see in society, what I am calling pandemic fatigue and its effect on the behavior of the average bored, anxious and moderately depressed citizens. Adriana Belmonte reported that the U.S. has the highest number of coronavirus cases around the world, but the rate of infections has declined in several parts of the country as a result of social distancing restrictions.

Dr. Lakshmana Swamy, an ICU physician at Boston Medical Center, warned what could happen if people take too much of a lackadaisical approach towards the pandemic.

“What are people seeing across the country in our numbers?” Swamy said on Yahoo Finance’s The Ticker recently. “They’re seeing coronavirus cases go down. That’s fantastic.” 

But, he added, “what you’re not seeing is that the hospital is still jam-packed with people that were deferring care, who were staying at home, scared of coming in. So, the hospital is still really busy. No one’s getting a break here. It’s terrifying to think that now on top of this, as we start to reopen, we could lose control of the virus again.”

‘What I’m seeing in Alabama … terrifies me’

There are currently 20 states experiencing an increase in the number of coronavirus cases. Most of these states — including Alabama, Florida, and Georgia — were among the first ones to reopen their economies over the last month. 

“What I’m seeing in Alabama, of course, terrifies me, as it does so many people,” Swamy said. “We’re all suffering from lockdown. It’s a huge hit, of course, to the economy, to individual people, to health, to everything. But it pales in comparison to the cost that the virus takes when it runs free.” 

Although many are calling for an end to social distancing restrictions because of its impact on the economy, research from the National Bureau of Economic Research (NBER) has indicated that reopening the economy “will have a much smaller-than-expected impact.”

“You look across the country where people haven’t been hit as hard, thank god,” Swamy said. “But you see that people don’t get it. It’s a really abstract concept. It’s hard to believe in that, right? It takes a lot of trust to believe what you’re seeing and hearing.”

“The masks are sort of a symbol of it,” he continued. “The bigger thing is social distancing. I mean, crowds together in open spaces, or especially in closed spaces, it’s terrifying. And it takes weeks to see the effects of that. So people will feel like ‘oh, look, we did that. It’s no problem. Hey, look, they did it over there. We can do it here, too.’”

Although there is still a lot to be known about the coronavirus, one thing that Swamy said he pretty much knows for certain is that there doesn’t seem to be herd immunity, which would mean that enough people had the coronavirus that they wouldn’t be able to get it and transmit it again.

“It’s a lot of science that’s unknown there,” he said. “But I think what we know is that we can’t rely on the virus not being able to hop around and catch like wildfire, even in Boston.” 

‘We’re going to see a spike in COVID-19’

Adding to the stress are the recent protests against police brutality that have taken place over the past week in response to the killing of George Floyd by a Minneapolis police officer, Derek Chauvin. 

Large crowds amassed in major cities across the country, and although many of the participants wore face masks, they were still in close proximity to others protesting. Some health officials worry this could cause a new spike in coronavirus cases.

“I am deeply concerned about a super-spreader type of incident,” Minnesota Gov. Tim Walz said on Saturday. “We’re going to see a spike in COVID-19. It’s inevitable.”

Gov. Andrew Cuomo (D-NY) and NYC Mayor Bill DeBlasio voiced similar concerns during recent press conferences, with Cuomo urging people to “demonstrate with a mask on.”

“It’s heartbreaking, because what we see over and over again is two to three weeks later, the cases start hitting and you see a surge and you see spikes,” Swamy said. “I hope that doesn’t happen anywhere else. But the virus is here. It’s everywhere. So it’s heartbreaking. I hope we can get to people before the virus does.”

Health officials worry about second coronavirus wave after George Floyd

Edmund DeMarche of Fox News was also concerned about another spike in the pandemic especially in light of the George Floyd protests. Health officials in the U.S. have new concerns that the nationwide protests over the George Floyd death in police custody could spark a wider spread of the coronavirus after many cities reported bringing the virus under control.

Scott Gottlieb, the former Food and Drug Administration commissioner, told CBS News’ “Face the Nation” that there are still some “pockets of spread” in communities. He said there has been an uptick in new coronavirus cases in recent days at the epicenter of the protests.

Minnesota Health Department Spokesman Doug Schultz said Sunday that any spike from the protests will not be seen until six to 10 days after its transmission, the Star Tribune reported. The report pointed out that the Minneapolis provided hundreds of masks for protesters.

Gov. Tim Walz said, according to the paper, that he is “deeply concerned about a super-spreader type of incident … after this. We are going to see a spike in COVID-19. It’s inevitable.”

The U.S. has seen more than 1.7 million infections and over 104,000 deaths in the pandemic, which has disproportionately affected racial minorities. Protests over Floyd’s death have shaken the U.S. from New York to Los Angeles.

“There’s no question that when you put hundreds or thousands of people together in close proximity, when we have got this virus all over the streets … it’s not healthy,” Maryland Gov. Larry Hogan said Sunday on CNN’s “State of the Union.”

Demonstrators are packed, many without masks, many chanting, shouting or singing. The virus is dispersed by microscopic droplets in the air when people cough, sneeze, talk or sing.

Dr. William Schaffner, an infectious disease expert at Vanderbilt University, told the New York Times that the “outdoor air dilutes the virus and reduces the infectious dose that might be out there, and if there are breezes blowing, that further dilutes the virus in the air. There was literally a lot of running around, which means they’re exhaling more profoundly, but also passing each other very quickly.”

Despite much of the protest and riots taking place outdoors, looters ransacked stores in various cities. The virus is notoriously transmitted by asymptomatic carriers. The Times reported that Keisha Lance Bottoms, the mayor of Atlanta, told those out protesting to “go get a COVID test this week.”

Fauci Estimates That 100,000 To 200,000 Americans Could Die From The

And now look at Dr. Fauci’s prediction for ultimate mortality rate. Bobby Allyn reported that Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said on Sunday that 100,000 to 200,000 Americans could die of COVID-19, the disease caused by the novel coronavirus.

The nation’s leading expert on infectious diseases and member of the White House’s coronavirus task force says the pandemic could kill 100,000 to 200,000 Americans and infect millions.

Dr. Anthony Fauci said based on modeling of the current pace of the coronavirus’ spread in the U.S., “between 100,000 and 200,000” people may die from COVID-19, the disease caused by the novel coronavirus.

Fauci’s comments on CNN’s State of the Union underscore just how far away the U.S. is from the peak of the outbreak based on predictions from top federal officials. As of early Sunday afternoon, there were 125,000 cases in the U.S. and nearly 2,200 deaths, according to data from Johns Hopkins University.

Public health experts say that because of undocumented chains of transmission in many parts of the country, the number of new coronavirus cases in the U.S. is set to keep surging as more and more test results become known.

Dr. Anthony Fauci says there could potentially be between 100,000 to 200,000 deaths related to the coronavirus and millions of cases. “I just don’t think that we really need to make a projection when it’s such a moving target, that you could so easily be wrong,” he

Fauci said the 100,000-to-200,000 death figure is a middle-of-the-road estimate, much lower than worse-case-scenario predictions.

He said preparing for 1 million to 2 million Americans to die from the coronavirus is “almost certainly off the chart,” adding: “Now it’s not impossible, but very, very unlikely.”

However, Fauci cautioned people not to put too much emphasis on predictions, noting that “it’s such a moving target that you could so easily be wrong and mislead people.”

What we do know, he says, is that “we’ve got a serious problem in New York, we’ve got a serious problem in New Orleans and we’re going to have serious problems in other areas.”

Fauci’s coronavirus fatality estimate comes as the White House considers ways to reopen the economy, including easing social distancing guidelines that officials have set forth to curb the spread of the fast-moving virus.

One in three Americans is now being asked to stay indoors as new cases soar, especially in New York, which accounts for nearly half of the country’s cases.

When asked if it is the right time to begin relaxing some of the social distancing measures, Fauci said not until the curve of new infections starts flattening out.

He refused to guess when exactly that may occur.

“The virus itself determines that timetable,” Fauci said.

According to the Centers for Disease Control and Prevention, the seasonal flu has killed between 12,000 and 61,000 people a year since 2010. The coronavirus death rate is far greater than the flu’s. For the elderly population, the coronavirus has been found to be six times as deadly.

There is currently no vaccine for the coronavirus. Experts say developing a vaccine for the virus could take at least a year.

Artificial Intelligence in Healthcare: A Post-Pandemic Prescription

David Nash noted that in what now seems a distant pre-pandemic period, excitement about the potential of artificial intelligence (AI) in healthcare was already escalating. From the academic and clinical fields to the healthcare business and entrepreneurial sectors, there was a remarkable proliferation of AI — e.g., attention-based learning, neural networks, online-meets-offline, and the Internet of Things. The reason for all this activity is clear — AI presents a game-changing opportunity for improving healthcare quality and safety, making care delivery more efficient, and reducing the overall cost of care.

Well before COVID-19 began to challenge our healthcare system and give rise to a greater demand for AI, thought leaders were offering cautionary advice. Robert Pearl, MD, a well-known advocate for technologically advanced care delivery, recently wrote in Forbes that because technology developers tend to focus on what will sell, many heavily marketed AI applications have failed to elevate the health of the population, improve patient safety, or reduce healthcare costs. “If AI is to live up to its hype in the healthcare industry the products must first address fundamental human problems,” Pearl wrote.

In a December 2019 symposium addressing the “human-in-the-middle” perspective on AI in healthcare, internationally acclaimed medical ethicist Aimee van Wynsberghe made the case that ethics are integral to the product design process from its inception. In other words, human values and protections should be central to the business model for AI in healthcare.

Health equity should be a driving principle for how AI is designed and used; however, some models may inadvertently introduce bias and divert resources away from patients in greatest need. Case in point, a predictive AI model was built into a health system’s electronic health record (EHR) to address the issue of “no-show” patients by means of overbooking. Researchers determined that the use of personal characteristics from the EHR (ethnicity, financial class, religion, body mass index) could result in systematic diversion of resources from marginalized individuals. Even a prior pattern of “no-show” was likely to correlate with socioeconomic status and chronic conditions.

Fast forward to today when AI seems to be a permanent fixture in national news coverage. Noting that journalists often overstate the tasks AI can perform, exaggerate claims of its effectiveness, neglect the level of human involvement, and fail to consider related risks, self-professed skeptic Alex Engler offered what I believe are important considerations in his recent article for the Brookings Institution. Here are a few:

  • AI is only helpful when applied judiciously by subject-matter experts who are experienced with the problem at hand. Deciding what to predict and framing those predictions is key; algorithms and big data can’t effectively predict a badly defined problem. In the case of predicting the spread of COVID-19, look to the epidemiologists who are building statistical AI models that explicitly incorporate a century of scientific discovery.
  • AI alone can’t predict the spread of new pandemics because there is no database of prior COVID-19 outbreaks as there is for the flu. Some companies are marketing products (e.g., video analysis software, AI systems that claim to detect COVID-19 “fever”) without the necessary extensive data and diverse sampling. “Questioning data sources is always a meaningful way to assess the viability of an AI system,” Engler wrote.
  • Real-world deployment degrades AI performance. For instance, in evaluating CT scans, an AI model that can differentiate between healthy people and those with COVID-19 might start to fail when it encounters patients who are sick with the regular flu. Regarding claims that AI can be used to measure body temperature, real-world environmental factors lead to measurements that are more imperfect than laboratory conditions.
  • Unintended consequences will occur secondary to AI implementation. Consolidation of market power, insecure data accumulation, and surveillance concerns are very common byproducts of AI use. In the case of AI for fighting COVID-19, the surveillance issues have been pervasive in countries throughout the world.
  • Although models are often perceived as objective and neutral, AI will be biased. Bias in AI models results in skewed estimates across different subgroups. For example, using biomarkers and behavioral characteristics to predict the mortality risk of COVID-19 patients can lead to biased estimates that do not accurately represent mortality risk. “If an AI model has no documented and evaluated biases, it should increase a skeptic’s certainty that they remain hidden, unresolved, and pernicious,” said Engler.

Based on what we’ve learned about the limitations and potential harms of AI in healthcare — much of which has been amplified by COVID-19 — what treatment plan would I prescribe going forward? First, I would encourage all healthcare AI developers and vendors to involve ethicists, clinical informatics experts, and operational experts from the inception of product development.

Second, I would recommend that healthcare AI be subjected to a higher level of scrutiny. Because AI is often “built in” by a trusted business partner and easily implemented, objective evaluation may be waived. As data science techniques become increasingly complex, serious consideration must be given to multidisciplinary oversight of all AI in healthcare.

Another paper that I am working reviews the need for a more complete method to contact trace and follow-up the recovered as well as those not infected on a large scale so that we can predict the next spike early. This way we can avoid the horrid effect of a second pandemic and the ultimate effect on healthcare and the economy.

Dr. Atlas and Others on coronavirus lockdowns: ‘The policy … is killing people’ and Not from the Corona virus!

As a physician I only stopped seeing my patients for two weeks during the pandemic. Why? I considered my patients cancer care a necessary demand. My cancer patients needed surgical procedures and the hospital didn’t consider those procedures urgent. So, I offered to do their surgical procedures in my office surgical suite under local anesthesia. If I didn’t the tumors would continue to grow and possibly metastasize or spread reducing their chances for cure. This brings up the important consideration that this pandemic is allowing our regular medical and surgical patient to result in delayed diagnoses and treatment. Victor Garcia reported that the Coronavirus lockdowns may be “killing” just as many people as the virus because as I mentioned, many people with serious conditions unrelated to the virus have been skipping treatment, Hoover Institution senior fellow Dr. Scott Atlas said Saturday on “Fox Report.”

“I think one thing that’s not somehow receiving attention is the CDC just came out with their fatality rates,” Atlas said. “And lo and behold, they verify what people have been saying for over a month now, including my Stanford epidemiology colleagues and everyone else in the world who’s done this analysis — and that is that the infection fatality rate is less than one-tenth of the original estimate.”

Even White House coronavirus task force member Dr. Anthony Fauci is acknowledging the harm caused by the lockdown, Atlas said. “The policy itself is killing people. I mean, I think everyone’s heard about 650,000 people on cancer, chemo, half of whom didn’t come in. Two thirds of cancer screenings didn’t come in. 40 percent of stroke patients urgently needing care didn’t come in,” Atlas said. “And now we have over half the people, children in the United States not getting vaccinations. This is really what [Fauci] said was irreparable harm.”

More on Dr. Fauci later in this post.

“And I and my colleagues from other institutions have calculated the cost of the lockdown in terms of lives lost,” Atlas said. “Every month is about equal to the entire cost of lives lost during the COVID infection itself. This is a tragic, misguided public policy to extend this lockdown, whether or not it was justifiable in the beginning.”

Many states are currently reopening their economies slowly, while a few have pledged to extend the lockdowns through the summer.

The doctor also argued against keeping children out of schools, saying there’s no reason they can’t go back. “There’s no science whatsoever to keep K-through-12 schools closed, nor to have masks or social distancing on children, nor to keep summer programs closed,” Atlas said. “What we know now is that the risk of death and the risk of even a serious illness is nearly zero in people under 18.”

Lockdown measures have kept nearly 80 million children from receiving preventive vaccines

Caitlin McFall of Fox News reported that the coronavirus pandemic has resulted in stay-at-home orders that are putting young children at risk of contracting measles, polio and diphtheria, according to a report released Friday by the World Health Organization (WHO).

Routine childhood immunizations in at least 68 countries have been put on hold due to the unprecedented spread of COVID-19 worldwide, making children under the age of one more vulnerable.

More than half of 129 counties, where immunization data was readily available, reported moderate, severe or total suspensions of vaccinations during March and April.

“Immunization is one of the most powerful and fundamental disease prevention tools in the history of public health,” said WHO Director-General Tedros Adhanom Ghebreyesus. “Disruption to immunization programs from the COVID-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles.”

The WHO has reported the reasons for reduced immunization rates vary. Some parents are afraid to leave the house due to travel restrictions relating to the coronavirus, whereas a lack of information regarding the importance of immunization remains a problem in some places.

Health workers are also less available because of COVID-19 restrictions.

The Sabin Vaccine Institute, the United Nations Children’s Fund (UNICEF) and GAVI, The Vaccine Alliance also contributed to the report.

Experts are worried that worldwide immunization rates, which have progressed since the 1970s, are now being threatened.

“More children in more countries are now protected against more vaccine-preventable diseases than at any point in history,” said Gavi CEO Dr. Seth Berkley. “Due to COVID-19 this immense progress is now under threat.”

UNICEF has also reported a delay in vaccine deliveries because of coronavirus restrictions and is now “appealing to governments, the private sector, the airline industry, and others, to free up freight space at an affordable cost for these life-saving vaccines.”

Experts say that children need to receive their vaccines by the age of 2. And in the case of polio, 90 percent of the population need to be immunized in order to wipe out the disease. Polio is already making a comeback in some parts of the world, with more than a dozen African countries reporting polio outbreaks this year.

“We cannot let our fight against one disease come at the expense of long-term progress in our fight against other diseases,” said UNICEF’s Executive Director Henrietta Fore. “We have effective vaccines against measles, polio and cholera,” she said. “While circumstances may require us to temporarily pause some immunization efforts, these immunizations must restart as soon as possible or we risk exchanging one deadly outbreak for another.”

Six Social Health System Teams to Encourage People to Seek Healthcare

Alexandra Wilson Pecci noted that the campaign, which aims to encourage people to get healthcare when they need it, comes as providers across the country have seen a dramatic drop in visits and revenue during the COVID-19 pandemic.

Six of Los Angeles County’s largest nonprofit health systems with hospitals, clinics, and care facilities are teaming for BetterTogether.Health, a campaign that aims to encourage people to get healthcare when they need it, despite the current pandemic.

The campaign, from Cedars-SinaiDignity HealthProvidenceUCLA HealthKeck Medicine of USC, and Kaiser Permanente, comes as hospitals and healthcare provider offices across the country have seen a dramatic drop in visits and revenue.

“We know many patients who in the past dialed 911 for life-threatening emergencies are now not accessing these vital services quickly,” Julie Sprengel, President, Southwest Division of Dignity Health Hospitals, CommonSpirit Health, said in a statement. “We are instead seeing patients that delayed, postponed or cancelled care coming to emergency departments with serious conditions that should have been treated far earlier.”

Indeed, outpatient hospital visits experienced a record one-week 64% decline during the week of April 5-11, compared to pre-COVID-19 volumes, according to research from TransUnion Healthcare. In addition, hospital visit volumes further declined 33%-62% between the weeks of March 1-7 and April 12-18.

Those stats were echoed in a Medical Group Management Association (MGMA) survey last month showing that physician practices reported a 60% average decrease in patient volume and a 55% average decrease in revenue since the beginning of the public health emergency. 

In addition, nearly two-thirds of hospital executives expect full year revenues will decline by at least 15% due to the coronavirus disease 2019 (COVID-19) outbreak, according to a Guidehouse analysis of a survey conducted by the Healthcare Financial Management Association (HFMA).

The campaign’s website and PSAs communicate messages like “Life may be on pause. Your health isn’t.,” “Thanks L.A. for doing your part.,” and “Get care when you need it.”

In addition to lost revenue, healthcare providers are warning of a “silent sub-epidemic” of those who are avoiding getting medical care when they need it, which could result in serious, negative health consequences that could be avoided.

“There is concern that patients with serious conditions are putting off critical treatments,” Tom Jackiewicz, CEO of Keck Medicine of USC, said in a statement. “We know that seeking immediate care for heart attacks and strokes can be life-saving and may minimize long-term effects. Our hospitals and health care providers are ready and open to serve your needs.”

The BetterTogether.Health public service effort combines those health systems’ resources to create a joint message that will include multi-language television and radio spots, and billboards, messages in newspapers, magazines, digital, and social media; online information, and links to healthcare resources.

It’s reminding people to seek care for things ranging from heart attack symptoms to keeping up with children’s immunization schedules.

“Receiving timely treatment by skilled medical professionals is essential to helping us achieve for our patients and communities the best possible outcomes,” Tom Priselac, President and CEO of Cedars-Sinai Health System. “Please do not delay getting your health care. We encourage you to call a trusted health care provider like your doctor’s office, hospital or urgent care center.”

Doctors raise alarm about health effects of continued coronavirus shutdown: ‘Mass casualty incident’

Furthermore, Tyler Olson reported something that most of us physicians realized as this pandemic continued that and that more than 600 doctors signed onto a letter sent to President Trump Tuesday pushing him to end the “national shutdown” aimed at slowing the spread of the coronavirus, calling the widespread state orders keeping businesses closed and kids home from school a “mass casualty incident” with “exponentially growing health consequences.”

The letter what I stated in the beginning of this post, which outlines a variety of consequences that the doctors have observed resulting from the coronavirus shutdowns, including patients missing routine checkups that could detect things like heart problems or cancer, increases in substance and alcohol abuse, and increases in financial instability that could lead to “poverty and financial uncertainty,” which “is closely linked to poor health.”

“We are alarmed at what appears to be the lack of consideration for the future health of our patients,” the doctors say in their letter. “The downstream health effects … are being massively under-estimated and under-reported. This is an order of magnitude error.”

The letter continues: “The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.

“Because the harm is diffuse, there are those who hold that it does not exist. We, the undersigned, know otherwise.”

The letter comes as the battle over when and how to lift coronavirus restrictions continues to rage on cable television, in the courts, in protests and among government officials. Those for lifting the restrictions have warned about the economic consequences of keeping the shutdowns in effect. Those advocating a more cautious approach say that having more people out and about will necessarily end with more people becoming infected, causing what National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci warned in a Senate hearing last week would be preventable “suffering and death.”

But these doctors point to others that are suffering, not from the economy or the virus, but simply from not being able to leave home. The doctors’ letter lists a handful of patients by their initials and details their experiences.

“Patient E.S. is a mother with two children whose office job was reduced to part-time and whose husband was furloughed,” the letter reads. “The father is drinking more, the mother is depressed and not managing her diabetes well, and the children are barely doing any schoolwork.”

“Patient A.F. has chronic but previously stable health conditions,” it continues. “Her elective hip replacement was delayed, which caused her to become nearly sedentary, resulting in a pulmonary embolism in April.”

 Dr. Mark McDonald, a psychiatrist, noted in a conversation with Fox News that a 31-year-old patient of his with a history of depression who was attending school to get a master’s degree in psychology died about two weeks ago of a fentanyl overdose. He blames the government-imposed shutdown.

“She had to stay in her apartment, essentially in-house arrest as most people here in [Los Angeles] were for weeks and weeks, she could not see her therapist — she could speak to the therapist over the phone but she couldn’t see her in person. She could not attend any of her group meetings, which were helping to maintain her abstinence from opiates … and she relapsed into depression.

“She was just too withdrawn to ask for help,” McDonald continued before noting that due to regulations only six people could be at her funeral. “She was simply trying to escape from her pain… I do blame these actions by the government for her death.”

Fox News asked McDonald, as well as three other doctors who were involved with the letter, if they thought the indirect effects of the shutdowns outweighed the likely direct consequences of lifting them — the preventable “suffering and death” Fauci referred to in last week’s Senate hearing. All four said that they believe they do.

“The very initial argument … which sounded reasonable three months ago, is that in order to limit the overwhelmed patient flux into hospitals that would prevent adequate care, we needed to spread out the infections and thus the deaths in specific locales that could become hotspots, particularly New York City… It was a valid argument at the beginning based on the models that were given,” McDonald said. “What we’ve seen now over the last three months is that no city — none, zero — outside of New York has even been significantly stressed.”

McDonald is referring to the misconception that business closures and stay-at-home orders aimed at “flattening the curve” are meant to reduce the total number of people who will fall ill because of the coronavirus. Rather, these curve-flattening measures are meant largely to reduce the number of people who are sick at any given time, thus avoiding a surge in cases that overwhelms the health care system and causes otherwise preventable deaths because not all patients are able to access lifesaving critical care.

McDonald said that “hospitals are not only not overwhelmed, they’re actually being shut down.” He noted that at one hospital in the Los Angeles area where Dr. Simone Gold, the head organizer of the letter, works “the technicians in the ER have been cut by 50 percent.”

Gold also said the effects of the shutdown are more serious for the vast majority of people than the potential virus spread if it is quickly lifted.

“When you look at the data of the deaths and the critically ill, they are patients who were very sick to begin with,” she said, “There’s always exceptions. … But when you look at the pure numbers, it’s overwhelmingly patients who are in nursing homes and patients with serious underlying conditions. Meaning, that that’s where our resources should be spent. I think it’s terribly unethical… part of the reason why we let [the virus] fly through the nursing homes is because we’re diverting resources across society at large. We have limited resources we should put them where it’s killed people.”

People of all ages, of course, have been shown to be able to catch the coronavirus. And there have been reported health complications in children that could potentially be linked to the disease. Fauci also warned about assuming that children are largely protected from the effects of the virus.

“We don’t know everything about this virus … especially when it comes to children,” Fauci said in a Senate hearing last week. “We ought to be careful and not cavalier.”

Newport Beach, Calif., concierge doctor Dr. Jeffrey Barke, who led the letter effort with Gold, also put an emphasis on the disparity in who the virus effects.

“There are thousands of us out there that don’t agree with the perspective of Dr. Fauci and [White House coronavirus response coordinator] Dr. Deborah Birx that believe, yes, this virus is deadly, it’s dangerous, and it’s contagious, but only to a select group of Americans,” he said. “The path forward is to allow the young and healthy, the so-called herd, to be exposed and to develop a degree of antibodies that both now is protective to them and also prevents the virus from spreading to the most vulnerable.”

Dr. Scott Barbour, an orthopedic surgeon in Atlanta, reflected the comments the other doctors made about how the medical system has been able to handle the coronavirus without being overwhelmed, but also noted that the reported mortality rates from the coronavirus might be off.

“The vast majority of the people that contract this disease are asymptomatic or so minimally symptomatic that they’re not even aware that they’re sick. And so the denominator in our calculation of mortality rate is far greater than we think,” he said. “The risk of dying from COVID is relatively small when we consider these facts.”

Gold, an emergency medicine specialist based in Los Angeles, led the letter on behalf of a new organization called A Doctor a Day.

A Doctor a Day has not yet formally launched but sent the letter, with hundreds of signatures from physicians nationwide, to the White House on Tuesday. Gold and the group’s co-founder, Barke, said they began the organization to advocate for patients against the government-imposed coronavirus shutdowns by elevating the voices of doctors who felt that the negative externalities of the shutdowns outweigh the potential downside of letting people resume their normal business.

To gather signatures for the letter, Gold and Barke partnered with the Association of American Physicians and Surgeons (AAPS), a doctors’ group that advocates for less government interference in the relationship between doctors and patients, and notably has taken part in legal challenges against the Affordable Care Act and advocated to allow doctors to use hydroxychloroquine on themselves and their patients.

Gold, in a conversation with Fox News, lamented that the debate around hydroxychloroquine has become politicized, noting that it is taken as a preventative measure for other diseases and that the potentially harmful effects of the drug mainly affect people with heart issues.

The drug is approved to treat malaria, lupus and rheumatoid arthritis, but the Food and Drug Administration has said that “hydroxychloroquine and chloroquine have not been shown to be safe and effective for treating or preventing COVID-19.”

The FDA has also warned health professionals that the drug should not be used to treat COVID-19 outside of hospital or research settings.

Gold said she has direct knowledge of physicians who are taking hydroxychloroquine and said that although “we will see” about its efficacy as it is studied more, there have been some indicators that it could be effective at preventing or mitigating COVID-19 and she could therefore understand why doctors might take the drug themselves or prescribe it to their patients.

There is also other research that appears to indicate hydroxychloroquine is not an effective treatment for the coronavirus, which has largely informed the consensus that the risks of the drug outweigh the potential benefits.

Gold, who is a member of the national leadership council for the Save Our Country Coalition — an assortment of conservative groups that aim “to bring about a quick, safe and responsible reopening of US society” — also said she was concerned that her message about the harms of shutdowns is becoming politicized. She said that she agreed with the general principles of the coalition and decided to sign on when asked, but hasn’t done much work with it and is considering asking to have her name removed because people are largely associating her message on reopening the country with a conservative political point of view.

“I haven’t done anything other than that,” she said. “It’s causing a big misunderstanding about what I’m doing so I actually think I’m just going to take my name off because it’s not really supposed to be political.”

Gold also said she is not associated with the Trump reelection campaign in any way, referring to her inclusion in an Associated Press story about the Trump campaign’s efforts to recruit doctors to support the president’s message on lifting coronavirus restrictions. The AP story details a call organized CNP Action, also part of the Save Our Country Coalition, which involved a senior Trump campaign staffer and was aimed at recruiting “extremely pro-Trump” doctors to make television appearances calling for the reopening of the economy as quickly as possible.

Fauci says extended stay-home orders could cause ‘irreparable damage’

Just recently Dr. Fauci changed his view on stay-home orders. Dom Calicchio reported that stay-home orders that extend too long could cause the U.S. “irreparable damage,” Dr. Anthony Fauci finally warned Friday.

Strict crackdowns on large gatherings and other orders, such as for home quarantines, were needed when the coronavirus first hit the nation, but those rules can now begin to be lifted in many parts of the country, Fauci said during an interview on CNBC.

“I don’t want people to think that any of us feel that staying locked down for a prolonged period of time is the way to go,” the member of the White House coronavirus task force said.

“But now is the time, depending upon where you are and what your situation is, to begin to seriously look at reopening the economy, reopening the country to try to get back to some degree of normal.” He warned, however, against reckless reopenings and called for the use of “very significant precautions” as restrictions are lifted.

Fauci told CNBC that staying closed for too long could cause “irreparable damage.” He said the US had to institute severe measures because #Covid19 cases were exploding “But now is the time, depending upon where you are and what your situation is” to open.

“In general, I think most of the country is doing it in a prudent way,” he said. “There are obviously some situations where people might be jumping over that. I just say, ‘Please, proceed with caution if you’re going to do that.’”

Fauci’s comments came one day after two top Republicans – Sen. Rand Paul of Kentucky and Rep. Andy Biggs of Arizona – wrote in an op-ed that Fauci’s initial safety recommendations had “emasculated” the nation’s health care system and “ruined” its economy.

“Fauci and company have relied on models that were later found to be deficient. He even has suggested that he can’t rely, on any of the models, especially if the underlying assumptions are wrong,” the pair wrote in USA Today. “Yet, Fauci persists in advocating policies that have emasculated the medical care system and ruined the economy.”

They also pointed to Fauci’s testimony last week before a Senate committee that opening too soon would “result in needless suffering and death.”

“What about the countless stories of needless suffering and death produced by Fauci’s one-size-fits-all approach to public health?” Paul and Biggs asked.

They called for policies based on trusting the risk assessment of the American people rather than a federal government mandate.

Earlier Friday, Fauci said it was “conceivable” that the U.S. could begin to distribute a coronavirus vaccine by December. “Back in January of this year when we started the phase 1 trial, I said it would likely be between a year and 18 months before we would have a vaccine,” Fauci said during an interview on NPR. “I think that schedule is still intact.

“I think it is conceivable,” he continued, “if we don’t run into things that are, as they say, unanticipated setbacks, that we could have a vaccine that we could be beginning to deploy at the end of this calendar year, December 2020, or into January, 2021.”

My question is what does the future of medicine look like going forward from this pandemic and how do we plan for a better healthcare system and assist in the recovery of our economy?

More on that in future posts.

People are Truly Stupid- People are furious over 2020 graduation ceremonies, the latest coronavirus political battleground

Lilly Altavena reported that people are furious about not being able to have their graduation ceremonies. How silly! Keiv Soliman doesn’t want to receive his diploma joined on-stage by a hologram of his principal. 

But as the coronavirus continues to cast a shadow on American traditions, making large gatherings like graduation ceremonies dangerous, a virtual ceremony might be the Highland High School senior’s only chance at pomp and circumstance. 

Soliman’s school, in Gilbert, Arizona, is staging an elaborate virtual graduation ceremony, where Highland seniors will be filmed walking across a stage to receive their diploma.

Their principal will read student names from a different room. Using “holographic technology,” video editors will then edit the ceremony to make it appear as if everyone was in the same room together.

But Soliman’s friends don’t want a studio-produced graduation, he said. They want a real ceremony. Soliman started a petition, which has more than 600 signatures so far, asking for an in-person ceremony — with masks and social distancing.

“You can’t really replace the real thing with anything but the real thing,” Soliman said. 

Graduation ceremonies have become a political battleground for schools, students and parents in the wake of school closures caused by the coronavirus. Some believe they can have a ceremony safely while others are accusing the high-schoolers and their parents of being selfish during a global pandemic.

“This is much bigger than a graduation ceremony,” said Reed Burris, a Gilbert resident opposed to in-person ceremonies. “You should be pushing for people to stay inside.” 

Soliman’s petition is one of more than 500 on Change.org, pleading for the preservation of in-person ceremonies across the U.S. 

Not the real thing, but… Students will cross the finish line to high school with a lap at the Daytona 500In Knoxville, Tennessee, district leaders backpedaled on a plan to hold graduation without guests when parents revolted. 

“There’s a lot more involved in these ceremonies than a student getting a paper diploma and turning their tassel,” Knox County Mayor Glenn Jacobs said.

The discourse shares similarities with the fervent demonstrations staged for and against reopening America’s businesses, as well as the debate over the use of masks in public places. The rancor underscores an increasingly fractured conversation around COVID-19. 

Uncertainty looms over ceremonies

Arizona’s stay-at-home order expires Friday. The governor isstill encouraging social distancing, but nothing in his new order appears to forbid gatherings.

The Arizona Department of Health Services recommended on Monday “that mass gatherings (such as graduations, concerts) are not held at this time.” 

Even still, the agency outlined steps for attendees and organizers to take if they planned to forge ahead with a ceremony: 

  • Anyone sick should stay home. 
  • Attendees should stay six feet away from each other.
  • Anyone in a high-risk group should not attend, including older adults and anyone with a serious underlying medical condition. 
  • Attendees should not touch their eyes, nose or mouth and should use hand sanitizer after leaving the event. They should also wash their hands with soap and water for at least 20 seconds upon returning home. 
  • Attendees should cover their faces at the event.
  • They should not borrow or rent graduation regalia.

Major Arizona school districts have either postponed ceremonies or have decided to hold virtual ceremonies.

Chandler Unified, the second-largest school district in the state, wrote to families on May 5 that the district is working on a plan to hold graduation ceremonies at each high school “while still adhering to the recommended CDC guidelines.”

At the ceremonies, students would be seated six feet apart and the audience would likely be limited. The ceremonies would be livestreamed for families to watch.

One superintendent in suburban Milwaukee, Wisconsin, initially resisted the idea of a virtual graduation because it made the emotional event seem so impersonal.

Back in early April, Wauwatosa School District Superintendent Phil Ertl said he hoped to just keep pushing back the date of an in-person ceremony for as long as it took to do it safely. But by early May, his district had gone the route of many others, with a planned video celebration set for June 7.

“We are also still hanging on to July 26 in hopes that we can do something in person,” Ertl said this week. “So much is changing. To cancel that date right now doesn’t make sense to me.”  

Pleas for the show to go on 

People in at least nine school districts across Arizona have started Change.org petitions to hold in-person graduation ceremonies. 

After Arizona Gov. DougDucey announced that businesses could start to reopen, a group of Arizona seniors made a video pleading for an in-person ceremony.

“There are ways we can make this happen,” one of the students in the video said. “We deserve a graduation.” 

The video was posted on Twitter and received nearly 100 retweets. But some who responded to the tweet scoffed at the idea.

“You’re asking to put your friends’ parents at risk of dying so you can feel accomplished for a completely normal and baseline accomplishment,” one Twitter user responded.

Others have tried to come up with alternatives to graduation. 

Beth Obermeyer, who works with high school students at New Foundation church in Goodyear, held driveway graduations for seniors. Using a megaphone, church staff surprised students by showing up on their driveway and holding impromptu celebrations, six feet apart. 

“We were trying to think of a way to make our high school seniors feel better because they’ve had such a rough spring,” Obermeyer said.

No prom, either: So, these families toasted a high school couple in their own backyard prom

In Great Falls, Montana, district officials said they did not want the coronavirus to end the tradition of graduating seniors’ ringing a school bell. Officials are leaving the bell in the school’s parking lot for students to ring. 

If students choose to ring the bell, they are asked to maintain social distancing, wear the supplied disposable gloves and sanitize hands before and after ringing the bell. The school is setting up a hand-sanitizing station.

‘We’re not taking this lightly’: Small Montana school to be among first in US to reopen

Some have said schools are being too cautious.

A group of Mountain View High parents in Mesa, Arizona, are throwing a senior salute parade for grads. Seniors on May 16 will line up six feet apart on the sidewalk of a Mesa street for cars to drive by in celebration.

Destinee Mack, a parent and one of the event’s organizers, initially asked the district if parents could drop their student off in the high school’s parking lot so the students could safely line up.

Mesa Public Schools denied that request, Mack said. Mesa did not respond to a request for comment. 

“I do think there’s a risk, but I do also think that if we follow the social distancing protocols . I think we can still do this in a socially responsible way,” Mack said. 

Harvard epidemiologist: Beware COVID-19’s second wave this fall

Len Strazewski writer for the AMA questioned whether sunshine and warm weather bring an end to face masks, physical distancing and other pandemic mitigation tactics? Several states may be easing stay-at-home orders, but the joy of the release of COVID-19 restrictions may be short-lived. And that is what we saw last weekend here in Ocean City, Maryland. The crowds were amazing!

People believe the talk of the second wave, which I became more aware when one of my cosmetic surgery patients, scheduled for her surgery rescheduled for September just cancelled her surgery due to her belief that there would be a second wave of the COVID-19 disease.

Featured updates: COVID-19

Track the evolving situation with the AMA’s library of the most up-to-date resources from JAMA, CDC and WHO.

Summer may slow the spread of the coronavirus a bit, but it will back by fall with a second wave that looks a lot like the first wave, said a leading epidemiology researcher. And the immunity that will bring a real end to the pandemic may be a long time coming.

Marc Lipsitch, DPhil, is professor of epidemiology at the Harvard T.H. Chan School of Public Health and director of the Center for Communicable Disease Dynamics. He discussed the prospects for mitigating a second wave of the COVID-19 pandemic and the potential approaches to faster development of a vaccine, with JAMA Editor-in-Chief Howard Bauchner, MD, on Dr. Bauchner’s podcast, “Conversations with Dr. Bauchner.”

“Almost every government is talking about lifting control measures. Not every government, but many, because of the economic burdens. Given the fairly high caseloads that we have in the United States, that’s a really risky thing to do right now,” Lipsitch said.

“I hope that the summer weather will help,” he added, but his research indicates that the warmer weather will only reduce transmission rates by about 20%. “That’s only enough to slow it down, but not enough to stop it.”

Jurisdictions may learn more about which tactics work best in mitigating transmission during this period and may learn whether some mitigation tactics such as school closings are valuable.

“But the downside,” Lipsitch warned, “is that many jurisdictions will have a plan to open up but not a plan to reclose, leading to more situations like New York, New Orleans and Detroit where there’s extreme strains on the heath care.”

Learn more with the AMA about the four signposts to safely reopen America. Also consult the AMA’s new physician practice guide to reopening.

Stay up to speed on the fast-moving pandemic with the AMA’s COVID-19 resource center, which offers a library of the most up-to-date resources from JAMA Network™, the Centers for Disease Control and Prevention, and the World Health Organization. Also check out the JAMA Network COVID-19 resource center.

Serological studies

Testing will be important, Lipsitch said, and medical researchers need to learn more about infection rates. Preliminary research indicates that rates may vary widely around the country and a real understanding may have to wait until comprehensive serological testing, he explained.

Local leaders will need to understand more about who gets infected before they can make good decisions about openings and staying open. Sociological factors such as poverty and transportation maybe important determinants in understanding infection and serological surveys may help in understanding who gets infected and which intervention and mitigation tactics are most valuable.

Fall will be difficult

Lipsitch said that despite hopes that summer will bring continued relief from the spread of the virus, “fall will be very much like the spring,” and the usual pattern of coronaviruses is likely continue with new transmission peaking in November and cases peaking in December.

“We will have a harder time controlling coronavirus in the fall … and we will all be very tired of social distancing and other tactics. The hard thing will be to keep enough of it to protect our ICUs and keep the number of cases from flaring up,” he said.

Controlling the virus may call for a return to the tactics that have worked in spring and a continued focus on maintaining resources such as personal protective equipment and increasing viral testing.

Illinois mandated ‘Stay-at-home’ orders, nearby Iowa didn’t: here’s what happened

Healthday reporter, Dennis Thompson noted that Statewide stay-at-home orders appear to help slow the spread of COVID-19 above and beyond other steps like banning large gatherings and closing non-essential businesses.

That’s the suggestion from a new cross-border study.

Certain counties in Iowa—one of five states that didn’t issue a stay-at-home order for its citizens—experienced a 30% greater increase in COVID-19 cases compared to counties right across the border in Illinois, which did issue such an order, the researchers reported.

“It does line up with a lot of other evidence that’s coming up from other national studies,” said senior researcher George Wehby, a professor of health management and policy with the University of Iowa College of Public Health. “Overall, there’s evidence the more restrictive measures were associated with greater declines in COVID case growth.”

For this study, Wehby and a colleague compared COVID-19 rates for counties on either side of the Iowa/Illinois border. “Border counties serve as nice controls because they tend to be somewhat similar,” Wehby said.

As the pandemic unfolded, Iowa issued a series of social distancing orders. The state banned gatherings and closed bars and restaurants, then closed non-essential businesses, and then closed all primary and secondary schools.

But Iowa did not issue a broad shelter-in-place order directing residents to stay home unless absolutely necessary, a step taken by Illinois on March 21.

The researchers found that the addition of a stay-at-home order was associated with a slower growth of cases in seven Illinois counties compared with eight neighboring counties in Iowa.

Within a month of the Illinois stay-at-home order, that state had nearly five fewer COVID-19 cases per 10,000 residents in border counties, compared with their neighbors across the line in Iowa, according to the report published online May 15 in JAMA Network Open.

Dr. Amesh Adalja, a senior scholar with the Johns Hopkins Center for Health Security, said, “It is not surprising that when a stay-at-home order is issued that you see a decrement in cases. The virus requires social interaction to transmit and a stay-at-home order delimits social interaction.” Adalja was not involved with the new study.

“However,” he continued, “the key metric is not necessarily the number of cases but the hospital stress load induced by the cases. Stay-at-home orders ideally should be issued with the primary aim of preserving hospital capacity.”

It’s important to know which social distancing measures work best as the world refines its response to COVID-19, Wehby said.

“Understanding what might be working more or less is a key question,” Wehby said. “This study only adds a little more information into the bucket of evidence that needs to be accumulated.”

For some unknown reason, stay-at-home orders appear to be associated with less transmission of the coronavirus, according to these results.

“These shelter-in-place or stay-at-home orders, there is something about them that seems to add above and beyond just closing restaurants,” Wehby said.

“Do people behave differently even when they go out under a stay-at-home order?” Wehby pondered. “Are you more cautious? Do you keep a larger distance? Are you more likely to wear a mask or avoid being close to people? People with more health risks, are they more likely to stay home following these orders?”

A COVID-19 survivor’s warning: Don’t rush back to normal. It doesn’t exist

The problem with recovery from COVID is that it may never be normal. Cortlynn Stark of the Kansas City Star reported that Stacy Jackson given birth five times. She’s not being dramatic. She could barely breathe.

“My body felt like someone had beat me and drugged me and then hung me up and beat and drugged me again,” Jackson said.

She had COVID-19.

Two of her uncles also later tested positive and were hospitalized. One of them, Marvin Jackson, died.

After nearly being placed on a ventilator, her kidneys beginning to fail, and spending five days unconscious, Jackson survived. Now she has a warning for Kansas City: Don’t rush to go back to normal. It doesn’t exist.

A positive test

Stacy Jackson started to feel sick on March 23. By the 26th, she tried to see her primary care physician. Staff asked Jackson, who also has Type 2 diabetes, over the phone if she was running a temperature. Jackson didn’t know, so staff came out with a thermometer to take her temperature. It was 104 degrees. Her doctor couldn’t see her.

From there, she went to the emergency room at Truman Medical Center. She was given a cocktail of drugs to help, what she called the “COVID super pack,” and a test for the coronavirus. Her test results would be ready in two days.

March 27 was her 21st wedding anniversary. Jackson and her husband had already taken the day off. She spent the day in bed, sick. She lost her senses of taste and smell. Her appetite was gone. Jackson spent the next day in bed as well.

Two days after her anniversary, she received her positive test result. Her condition continued to deteriorate and she went back to the hospital for a couple hours.

“I was scared to death,” Jackson said.

It was still in the early days of the virus in Kansas City. Fewer than 300 people had tested positive in the metro and no one in the city had died of it, according to statistics tracked by The Star.

By March 31, Jackson was struggling to breathe. Nearly 500 people across the metro had tested positive. “I just told myself, ‘you’re not gonna die,'” Jackson said. She told her husband he had to take her back to the hospital. He dropped her off outside. He couldn’t go in, of course. Health care facilities had already begun limiting visitors.

Jackson said she thinks the lack of oxygen took a toll on her brain as the disease took its toll on her mentally and physically. She was placed in the ICU and was in and out of consciousness from March 31 to April 4. Sometime during those five days, she became aware of two doctors in her room talking to each other: She may have to be put on a ventilator.

“I remember shaking my head no,” Jackson said. In a phone call a month later, she said she worried that if she was put on a ventilator, she wouldn’t survive. A study of patients in a New York placed on ventilators found that just 3% left the hospital alive. A quarter of them died. About 72% were still in the hospital.

On April 5, her fever broke and she started becoming more responsive. But every time she got up, “it was like running around Kansas City seven times,” Jackson said. By this time, more than 700 people tested positive in the metro.

For the first time since March 31st, she was able to call her husband. But talking was still painful. “He said ‘babe don’t talk, I’m just so glad I’m able to hear you,'” Jackson said. She left the hospital three days later.

A solitary battle

Jackson is used to being surrounded by family. But she hadn’t seen her mother since before Kansas City’s stay-at-home order went into effect on March 24. The month before, her mother, who lives at an assisted living facility in Overland Park, was in the hospital battling the flu and pneumonia. Jackson was by her side.

“We are a face to face family,” Jackson said. “When people are stricken with disease in our family, we pray together.” But no one could be by her side. Or the sides of her two sick uncles.

COVID-19 is isolating. Instead of family members by her hospital bed, she was surrounded by nurses and doctors—genuine and caring, she said—covered in personal protective equipment. One nurse, Jackson said, told her that if she left the hospital, she would be one of the first to leave the COVID-19 dedicated floor alive.

Her uncle Marvin Jackson died on April 23—one of three to die that day and one of 106 people to die across the metro since the outbreak began.

Never the same

When Jackson left the hospital on April 8, staff played the “Rocky” theme song for her. At home, four of her six children and her husband were waiting for her.

Her oldest two children have their own apartments in Kansas City. The middle two were home from college. Her youngest, twin boys, are seniors in high school. She was on oxygen support for two weeks. But she’s worried about reopening.

Beginning May 15, Kansas City businesses can reopen under a “10/10/10” rule. In Kansas, Gov. Laura Kelly’s phased reopening plan last week includes rules that businesses opening must maintain 6 feet of separation between customers and limit gatherings to less than 10. On the Missouri side, Gov. Mike Parson ordered businesses to maintain social distancing, but did not limit social gatherings.

“We’re risking millions of lives for comfortability,” Jackson said. “We need to stop the madness. I would rather have a light bill that I can’t pay than lose my life.”

She wants people to take the virus seriously and respect the severity. With most of her immediate and large family in the Kansas City area, they often have large gatherings of up to 45 people at her home.

Not anymore.

Jackson said her family would often rent out four tables at a Japanese steakhouse on the County Club Plaza.

Not anymore.

And even though she has cable, and a number of streaming services, she would still go to movie theaters.

Not anymore.

“We can’t go back to the way it was,” Jackson said. “I don’t know when I’ll be able to go back to a restaurant and feel safe.”

She couldn’t throw the usual Mother’s Day brunch for her aunts, cousins and sister-in-law either. By May 9, the day before Mother’s Day, 2,900 people tested positive and 146 people in the metro died of COVID-19. More than 1.3 million people across the country tested positive and more than 78,000 people have died.

“I value life a little bit more and how precious life is,” Jackson said. “We could be gone in the blink of an eye. We need to do everything in our power not to make it worse.”

Jackson is thankful to be alive.

74% of people are worried social distancing will not be followed as lockdown is eased

A University College London reported on a study that nearly eight in 10 people are worried about COVID-19 infections rising and people not adhering to social distancing as lockdown is eased, according to UCL’s COVID-19 study.

The study, launched in the week before the lockdown, is the UK’s largest on adult wellbeing and mental health during the coronavirus epidemic and has over 90,000 participants who report their feelings about the lockdown, government advice, along with wellbeing and mental health.

It is funded by the Nuffield Foundation with additional support from Wellcome and UK Research and Innovation (UKRI). Findings are broken down by age, gender, income, those living with children, those who are keyworkers and those living in rural areas and whether people live alone or not.

This week’s findings, which focus on how people have been feeling between 4-10 May, find that economic concerns about recession and unemployment levels rising also rank highly. Additionally, around one in three people express concern about pollution increasing, social cohesion decreasing, and crime levels rising.

Lead author, Dr. Daisy Fancourt (UCL Epidemiology & Health Care) said: “Our findings show that concern about increasing cases of COVID-19 are consistent across all ages, but concern about hospitals becoming overwhelmed is higher in younger adults, while concern about people not adhering to social distancing is higher in older adults.

“Concerns about unemployment and recession are consistent across ages, but concern about crime rising is higher in older adults, while concern about pollution increasing and social cohesion decreasing is slightly higher in adults under the age of 30.”

This week’s report also finds that half of people do not feel in control of their future plans with 23% of people and 39% of people feeling the same about their mental health and employment respectively.

Dr. Fancourt (UCL Epidemiology & Health Care) added: “This week we also found 50 % of our participants do not currently feel in control of their future plans, and many feel unable to manage their mental health and are worried about their future employment.

“However, in terms of physical health, eight out of ten people feel in control and the same can be said for their marriage or relationship. When we compare ‘sense of control’ across age groups, younger adults report feeling less in control across all domains. “The study team has also received support from Wellcome to launch an international network of longitudinal studies called the COVID-MINDS Network. Through the network, dozens of scientists and clinicians are coming together internationally to collate results from mental health studies running in countries around the world and compare findings. The initiative will support the launching of new mental health studies in other countries and show whether actions taken in specific countries are helping to protect mental health.

Unfortunately, I have to agree with this study, that is, as the lockdowns are eased, people will not take responsibility for their actions and ignore social distancing. As I mentioned from the beginning, people are stupid and are only concerned about what they want rather what is best for the general public and this disease. I do understand that many want to get back to work so that they can save their businesses and support themselves, their family and their employees.

And lastly, Happy Memorial Day Weekend and remember why we celebrate this day and those who gave their lives to protect us, our country and our freedoms!