Author Archives: raaorsini

Trump health officials “not aware” of how he would replace Obamacare; and what about the Vaccines?

Trump health officials “not aware” of how he would replace Obamacare; and what about the Vaccines?

It is truly amazing how out of touch the GOP and, I believe President Trump is, on health care, especially “after” or during this COVID pandemic. Consider the amount of monies spent on caring for the millions of patients diagnosed with COVID-19. One must remember that due to the EMTALA Act, which ensures public access to emergency services regardless of ability to pay. Think of all the COVID testing and ICU care that has been provided for all that needed it. This experience, etc. should convince, even the clueless that we need a type of universal health care policy.

They, the GOP and the President, promised us all that they would create, provide a wonderful healthcare for all, better than Obamacare. But have they? No!

And now is the time to produce a well-designed alternative, or consider Obamacare as a well thought out program, except for the lack of financial sustainability. And guess what happened after I had a phone call with a member of the Trump administration. He asked me what I thought Trump’s chances of winning re-election. I responded that I thought he had about a 20% chance of getting re-elected. He pressed me as what I thought that would increase his chances. My response was to finally reveal their, the GOP/Trump’s

, plan and I suggested that they should adopt the Affordable Care Act but outline a plan to sustainably finance the healthcare plan.

My suggestion- embrace the Affordable Care Act as a good starting point and use a federal sales tax to finance it instead of putting the onus on the young healthy workers.

 At a hearing on the coronavirus response, Senator Dick Durbin asked the Trump administration’s top health officials about the president’s comments touting a plan to replace the Affordable Care Act, also known as Obamacare. They said they did not know about such a plan.

And a Republican victory in Supreme Court battle could mean millions lose health insurance in the middle of a pandemic.

John T. Bennett noted that Ruth Bader Ginsburg, Barack Obama, Donald Trump and Mitch McConnell could soon be forever linked if the late Supreme Court justice’s death leads to the termination of the 44th president’s signature domestic policy achievement: the Affordable Care Act

All sides in the coming battle royal over how to proceed with filling the high court seat she left behind are posturing and pressuring, floating strategic possibilities and offering creative versions of history and precedent. Most Republicans in the Senate want to hold a simple-majority floor vote on a nominee Mr. Trump says he will announce as soon as this week before the end of the calendar year. Democrats say they are hypocrites because the blocked a Barack Obama high court pick during his final year.

It appears Democrats have only extreme options as viable tactics from preventing confirmation hearings and a floor vote before this unprecedented year is up. Speaker Nancy Pelosi on Sunday refused to rule bringing articles of impeachment against the president or even William Barr, his attorney general whom the Democrats say has improperly used his office to help Mr. Trump’s friends and use federal law enforcement unjustly against US citizens.

Unless Ms Pelosi pulls that politically dangerous lever, the maneuvering of the next few weeks most likely will end after Congress returns after the 3 November election with a high court with a 6-3 conservative bend. Analysts already are warning that conservatives appear months away from being able to partially criminalize abortion and also take down the 2011 Affordable Care Act, also known as Obama care.

Democrats have sounded off since Ms. Ginsburg’s death to warn that millions of Americans could soon lose their health insurance, especially those with pre-existing conditions. Last year, 8.5m people signed up for coverage using the Affordable Care Act, according to the Congressional Budget Office.

“Healthcare in this country hangs in the balance,” Joe Biden, who is the Democratic nominee for president and was vice president when Mr. Obama signed the health plan now linked to his name into law, said on Sunday.

Mr. Biden accused Republicans of playing a “game” by rushing the process to replace Ms. Ginsburg on the court because they are “trying to strip healthcare away from tens of millions of families.”

Doing so, he warned, would “strip away their peace of mind” because insurance providers would no longer be required to give some Americans policies. Should a 6-3 court decide to uphold a lower court’s ruling that the 2011 health law be taken down, those companies would “drop coverage completely for folks with pre-existing conditions,” Mr. Biden warned in remarks from Philadelphia.

“If Donald Trump has his way, the complications from Covid-19 … would become the next deniable pre-existing condition for millions of Americans.” That means they would lose their health insurance and be forced to either pay for care out of their pocket or use credit lines. Both could force millions into medical bankruptcy or otherwise create dire financial hardships.

Mr. Trump about a month ago promised to release a new healthcare plan that, if ever passed by both chambers of Congress and signed into law, would replace Obamacare.

So far, however, he has yet to unveil that alleged plan.

Trump Press Secretary Kayleigh McEnany told reporters last week that the White House’s Domestic Policy Council is leading the work on the plan. But when pressed for more details, she chose to pick a fight with a CNN reporter.

“I’m not going to give you a readout of what our healthcare plan looks like and who’s working on it,” Ms. McEnany said. “If you want to know, if you want to know, come work here at the White House.”

When pressed, Ms. McEnany said “stakeholders here in the White House” are working on a plan the president has promised for several years. “And, as I told you, our Domestic Policy Council and others in the White House are working on a healthcare plan,” she insisted, describing it as “the president’s vision for the next five years.”

The president frequently mentions healthcare during his rowdy campaign rallies, but only in general terms. He promises a sweeping plan that will bring costs down across the board and also protect those with pre-existing conditions. But he mostly brings it up to hammer Mr. Obama and Mr. Biden for pushing a flawed law that he has been forced to tinker with to make it function better for consumers.

Broad brush

His top spokeswoman echoed those broad strokes during a briefing on Wednesday. “In aggregate, it’s going to be a very comprehensive strategy, one where we’re saving healthcare while Democrats are trying to take healthcare away,” she told reporters. “We’re making healthcare better and cheaper, guaranteeing protections for people with preexisting conditions, stopping surprise medical billing, increasing transparency, defending the right to keep your doctor and your plan, fighting lobbyists and special interests, and making healthier and making, finding cures to diseases.”

If there is a substantive plan that would protect millions with pre-existing conditions and others affected by Covid-19, it would have made a fine backbone of Mr. Trump’s August Republican National Committee address in which he accepted his party’s presidential nomination for a second time. But healthcare was not the major focus, even though it ranks in the top two issues – along with the economy – in just about every poll that asks voters to rank their priorities in deciding between Mr. Trump and Mr. Biden.

If there is a coming White House healthcare plan that would protect those with pre-existing conditions and prevent millions from losing coverage as the coronavirus pandemic is ongoing, the president is not using his campaign rallies at regional airport hangars to describe or promote it.

“We will strongly protect Medicare and Social Security and we will always protect patients with pre-existing conditions,” said at a campaign stop Saturday evening in Fayetteville, North Carolina, before pivoting to a completely unrelated topic: “America will land the first woman on the moon, and the United States will be the first nation to land an astronaut on Mars.”

The push to install a conservative to replace the liberal Ms. Ginsburg and the lack of any expectation Mr. Trump has a tangible plan has given Democrats a new election-year talking point less than two months before all votes must be cast.

“Whoever President Trump nominates will strike down the Affordable Care Act,” Hawaii Democratic Senator Mazie Hirono told MSNBC on Sunday. “It will throw millions of people off of healthcare, won’t protect people with pre-existing conditions. It will be disastrous. That’s why they want to rush this.”

 About 1 In 5 Households in U.S. Cities Miss Needed Medical Care During Pandemic

Patti Neighmond noted that when 28-year-old Katie Kinsey moved from Washington, D.C., to Los Angeles in early March, she didn’t expect the pandemic would affect her directly, at least not right away. But that’s exactly what happened.

She was still settling in and didn’t have a primary care doctor when she got sick with symptoms of what she feared was COVID-19.

“I had a sore throat and a debilitating cough,” she says, “and when I say debilitating, I mean I couldn’t talk without coughing.” She couldn’t lie down at night without coughing. She just wasn’t getting enough air into her lungs, she says.

Kinsey, who works as a federal consultant in nuclear defense technology, found herself coughing through phone meetings. And then things got worse. Her energy took a dive, and she felt achy all over, “so I was taking naps during the day.” She never got a fever but worried about the coronavirus and accelerated her effort to find a doctor.

No luck.

She called nearly a dozen doctors listed on her insurance card, but all were booked. “Some said they were flooded with patients and couldn’t take new patients. Others gave no explanation, and just said they were sorry and could put me on a waiting list.” All the waiting lists were two to three months’ long.

Eventually Kinsey went to an urgent care clinic, got an X-ray and a diagnosis of severe bronchitis — not COVID-19. Antibiotics helped her get better. But she says she might have avoided “months of illness and lost days of work” had she been able to see a doctor sooner. She was sick for three months.

Kinsey’s experience is just one way the pandemic has delayed medical care for Americans in the last several months. A poll of households in the four largest U.S. cities by NPR, the Robert Wood Johnson Foundation and Harvard’s T.H. Chan School of Public Health finds roughly one in every five have had at least one member who was unable to get medical care or who has had to delay care for a serious medical problem during the pandemic (ranging from 19% of households in New York City to 27% in Houston).

We had people come in with heart attacks after having chest pain for three or four days, or stroke patients who had significant loss of function for several days, if not a week.

There were multiple reasons given. Many people reported, like Kinsey, that they could not find a doctor to see them as hospitals around the U.S. delayed or canceled certain medical procedures to focus resources on treating COVID-19.

Other patients avoided critically important medical care because of fears they would catch the coronavirus while in a hospital or medical office.

“One thing we didn’t expect from COVID was that we were going to drop 60% of our volume,” says Ryan Stanton, an emergency physician in Lexington, Ky., and member of the board of directors of the American College of Emergency Physicians.

“We had people come in with heart attacks after having chest pain for three or four days,” Stanton says, “or stroke patients who had significant loss of function for several days, if not a week. And I’d ask them why they hadn’t come in, and they would say almost universally they were afraid of COVID.”

Stanton found that to be particularly frustrating, because his hospital had made a big effort to communicate with the community to “absolutely come to the hospital for true emergencies.”

He describes one patient who had suffered at home for weeks with what ended up being appendicitis. When the patient finally came to the emergency room, Stanton says, a procedure that normally would have been done on an outpatient basis “ended up being a very much more involved surgery with increased risk of complications because of that delay.”

The poll finds a majority of households in leading U.S. cities who delayed medical care for serious problems say they had negative health consequences as a result (ranging from 55% in Chicago to 75% in Houston and 63% in Los Angeles).

Dr. Anish Mahajan, chief medical officer of the large public hospital Harbor-UCLA Medical Center in Los Angeles, says the number of emergencies showing up in his hospital have been down during the pandemic, too, because patients have been fearful of catching the coronavirus there. One case that sticks in his mind was a middle aged woman with diabetes who fainted at home.

“Her blood sugar was really high, and she didn’t feel well — she was sweating,” the doctor recalls. “The family called the ambulance, and the ambulance came, and she said, ‘No, no, I don’t want to go to the hospital. I’ll be fine.’ “

By the next day the woman was even sicker. Her family took her to the hospital, where she was rushed to the catheterization lab. There doctors discovered and dissolved a clot in her heart. This was ultimately a successful ending for the patient, Mahajan says, “but you can see how this is very dangerous — to avoid going to the hospital if you have significant symptoms.”

He says worrisome reports from the Los Angeles County coroner’s office show the number of people who have died at home in the last few months is much higher than the average number of people who died in their homes before the pandemic.

“That’s yet another signal that something is going on where patients are not coming in for care,” Mahajan says. “And those folks who died at home may have died from COVID, but they may also have died from other conditions that they did not come in to get cared for.”

Like most hospitals nationwide, Harbor-UCLA canceled elective surgeries to make room for coronavirus patients — at least during the earliest months of the pandemic, and when cases surged.

In NPR’s survey of cities, about one-third of households in Chicago and Los Angeles and more than half in Houston and New York with a household member who couldn’t get surgeries or elective procedures said it resulted in negative health consequences for that person.

“Back in March and April the estimates were 80[%] to 90% of normal [in terms of screenings for cancer]” at Memorial Sloan Kettering Cancer Center in New York, says Dr. Jeffrey Drebin, who heads surgical oncology there.

“Things like mammograms, colonoscopies, PSA tests were not being done,” he says. At the height of the pandemic’s spring surge in New York City, Drebin says, he was seeing many more patients than usual who had advanced disease.

“Patients weren’t being found at routine colonoscopy,” he says. “They were coming in because they had a bleeding tumor or an obstructing tumor and needed to have something done right away.”

In June, during patients’ information sessions with the hospital, Drebin says patients typically asked if they could wait a few months before getting a cancer screening test.

“In some cases, you can, but there are certainly types of cancer that cannot have surgery delayed for a number of months,” he explains. With pancreatic or bladder cancer, for example, delaying even a month can dramatically reduce the opportunity for the best treatment or even a cure.

Reductions in cancer screening, Drebin says, are likely to translate to more illness and death down the road. “The estimate,” he says, “is that simply the reduction this year in mammography and colonoscopy [procedures] will create 10,000 additional deaths over the next few years.”

And even delays in treatment that aren’t a matter of life and death can make a big difference in the quality of a life.

For 12-year-old Nicolas Noblitt, who lives in Northridge, Calif., with his parents and two siblings, delays in treatment this year have dramatically reduced his mobility.

Nicolas has cerebral palsy and has relied on a wheelchair most of his life. The muscles in his thighs, hips, calves and even his feet and toes get extremely tight, and that “makes it hard for him to walk even a short distance with a walker,” says his mother, Natalie Noblitt. “So, keeping the spasticity under control has been a major project his whole life to keep him comfortable and try to help him gain the most mobility he can have.”

Before the pandemic, Nicolas was helped by regular Botox injections, which relaxed his tight muscles and enabled him to wear shoes.

As Nicolas says, “I do have these really cool shoes that have a zipper … and they really help me — because, one, they’re really easy to get on, and two, they’re cool shoes.” Best of all, he says they stabilize him enough so he can walk with a walker.

“I love those shoes and I think they sort of love me, too, when you think about it,” he tells NPR.

Nicolas was due to get a round of Botox injections in early March. But the doctors deemed it an elective procedure and canceled the appointment. That left him to go months without a treatment.

His muscles got so tight that his feet would uncontrollably curl.

“And when it happens and I’m trying to walk … it just makes everything worse,” Nicolas says, “from trying to get on the shoes to trying to walk in the walker.”

Today he is finally back on his Botox regimen and feeling more comfortable — happy to walk with a walker. Even so, says his mom, the lapse in treatment caused setbacks. Nicolas has to work harder now, both in day-to-day activities and in physical therapy.

‘Warp Speed’ Officials Debut Plan for Distributing Free Vaccines

Despite the president’s statements about military involvement in the vaccine rollout, officials said that for most people, “there will be no federal official who touches any of this vaccine.”

Katie Thomas reported that Federal officials outlined details Wednesday of their preparations to administer a future coronavirus vaccine to Americans, saying they would begin distribution within 24 hours of any approval or emergency authorization, and that their goal was that no American “has to pay a single dime” out of their own pocket.

The officials, who are part of the federal government’s Operation Warp Speed — the multiagency effort to quickly make a coronavirus vaccine available to Americans — also said the timing of a vaccine was still unclear, despite repeated statements by President Trump that one could be ready before the election on Nov. 3.

“We’re dealing in a world of great uncertainty. We don’t know the timing of when we’ll have a vaccine, we don’t know the quantities, we don’t know the efficacy of those vaccines,” said Paul Mango, the deputy chief of staff for policy at the Department of Health and Human Services. “This is a really quite extraordinary, logistically complex undertaking, and a lot of uncertainties right now. I think the message we want you to leave with is, we are prepared for all of those uncertainties.”

The officials said they were planning for initial distribution of a vaccine — perhaps on an emergency basis, and to a limited group of high-priority people such as health care workers — in the final three months of this year and into next year. The Department of Defense is providing logistical support to plan how the vaccines will be shipped and stored, as well as how to keep track of who has gotten the vaccine and whether they have gotten one or two doses.

However, Mr. Mango said that there had been “a lot of confusion” about what the role of the Department of Defense would be, and that “for the overwhelming majority of Americans, there will be no federal official who touches any of this vaccine before it’s injected into Americans.”

Army Lt. Gen. Paul Ostrowski said Operation Warp Speed was working to link up existing databases so that, for example, a patient who received a vaccine at a public health center in January could go to a CVS pharmacy 28 days later in another state and be assured of getting the second dose of the right vaccine.

Three drug makers are testing vaccine candidates in late-stage trials in the United States. One of those companies, Pfizer, has said that it could apply for emergency authorization as early as October, while the other two, Moderna and AstraZeneca, have said they hope to have something before the end of the year.

Coronavirus vaccine study by Pfizer shows mild-to-moderate side effects

Pfizer Inc said on Tuesday participants were showing mostly mild-to-moderate side effects when given either the company’s experimental coronavirus vaccine or a placebo in an ongoing late-stage study.

The company said in a presentation to investors that side effects included fatigue, headache, chills and muscle pain. Some participants in the trial also developed fevers – including a few high fevers. The data is blinded, meaning Pfizer does not know which patients received the vaccine or a placebo. Kathrin Jansen, Pfizer’s head of vaccine research and development, stressed that the independent data monitoring committee “has access to unblinded data so they would notify us if they have any safety concerns and have not done so to date.”

The company has enrolled more than 29,000 people in its 44,000-volunteer trial to test the experimental COVID-19 vaccine it is developing with German partner BioNTech. Over 12,000 study participants had received a second dose of the vaccine, Pfizer executives said on an investor conference call.

The comments follow rival AstraZeneca’s COVID-19 vaccine trials being put on hold worldwide on Sept. 6 after a serious side effect was reported in a volunteer in Britain.

AstraZeneca’s trials resumed in Britain and Brazil on Monday following the green light from British regulators, but remain on hold in the United States.

Pfizer expects it will likely have results on whether the vaccine works in October. “We do believe – given the very robust immune profile and also the preclinical profile … that vaccine efficacy is likely to be 60% or more,” Pfizer’s Chief Scientific Officer Mikael Dolsten said.

Rushing the COVID-19 Vaccine Could Have Serious and Fatal Side Effects

Jason Silverstein noted that States have been told by the Centers for Disease Control and Prevention they should prepare for a coronavirus vaccine by “late October or early November,” according to reports last Wednesday. But an untested coronavirus vaccine may have serious and fatal side effects, could even make the disease worse, and may very well have an effect on the election.

What’s the worst that could happen if we give an untested vaccine to millions of people?

We received a reminder today, when one of the leading large coronavirus vaccine trials by AstraZeneca and Oxford University was paused due to a “suspected serious adverse reaction.” There are eight other potential coronavirus vaccines that have reached Phase 3, which is the phase that enrolls tens of thousands of people and compares how they do with the vaccine against people who only get a placebo. Those eight include China’s CanSino Biologics product that was approved for military use without proper testing back in July, and Russia’s coronavirus vaccine that has been tested in only 76 people.

If the CDC distributes an untested coronavirus vaccine this Fall, it would be the largest drug trial in history—with all of the risks and none of the safeguards.

“Approving a vaccine without testing would be like climbing into a plane that has never been tested,” said Tony Moody, MD, director of the Duke Collaborative Influenza Vaccine Innovation Centers. “It might work, but failure could be catastrophic.”

One concern about this vaccine is that it’s tracking to be an “October surprise.” From Henry Kissinger’s “peace is at hand” speech regarding a ceasefire in Vietnam less than two weeks before the 1972 election to former FBI Director James Comey’s letter that he would reopen the investigation into Hillary Clinton’s emails, October surprises have always had the potential to shift elections. But never before have they had the potential to catastrophically shift the health of an already fragile nation.

If there is an October surprise in the form of an untested coronavirus vaccine, it won’t be the first time that a vaccine was rushed out as a political stunt to increase an incumbent president’s election chances.

What happened with the last vaccine rush?

On March 24, 1976, in response to a swine flu outbreak, President Gerald Ford asked Congress for $135 million for “each and every American to receive an inoculation.”

How badly did the Swine Flu campaign of 1976 go? Well, one of the drug companies made two million doses of the wrong Swine Flu vaccine, vaccines weren’t exactly effective for people under 24, and insurance companies said, no way, they didn’t want to be liable for the science experiment of putting this vaccine into 120 million bodies.

By December, the Swine Flu vaccination program was suspended when people started to develop Guillain-Barré Syndrome, a rare neurological condition whose risk was seven times higher in people who got the vaccine and which paralyzed more than 500 people and killed at least 25.

What else can go wrong when vaccines are rushed

“Vaccines are some of the safest medical products in the world, but there can be serious side effects in some instances that are often only revealed by very large trials,” said Kate Langwig, Ph.D., an infectious disease ecologist at Virginia Tech.

One of the other possible side effects is known as vaccine enhancement, the very rare case when the body makes antibodies in response to a vaccine but the antibodies help a second infection get into cells, something that has been seen in dengue fever. “The vaccine, far from preventing Covid-19, might turn out to make a patient’s disease worse,” said Nir Eyal, D.Phil., a bioethics professor at Rutgers University.

We do not know whether a coronavirus vaccine might cause vaccine enhancement, but we need to. In 1966, a vaccine trial against respiratory syncytial virus, a disease that many infants get, caused more than 80 percent of infants and children who received the vaccine to be hospitalized and killed two.

All of these risks can be prevented, but safety takes patience, something that an American public which has had to bury more than 186,000 is understandably short on and Trump seems to be allergic to.

“To put this into perspective, the typical length of making a vaccine is fifteen to twenty years,” said Paul Offit, MD, the director of the Vaccine Education Center at Children’s Hospital of Philadelphia. Offit’s laboratory developed a vaccine for rotavirus, a disease that kills infants. That process began in the 1980s and wasn’t completed until 2006. The first scientific papers behind the HPV vaccine, for example, were published in the early 1990’s, but the vaccine wasn’t licensed until 2006.

An untested vaccine may also prove a deadly distraction. “An ineffective vaccine could create a false sense of security and perhaps reduce the emphasis on social distancing, mask wearing, hand hygiene,” said Atul Malhotra, MD, a pulmonologist at the UC San Diego School of Medicine.

Other issues with inadequately tested vaccines

Even worse, an untested vaccine may have consequences far beyond the present pandemic. Even today, one poll shows that only 57% of people would take a coronavirus vaccine. (Some experts argue that we need 55 to 82% to develop herd immunity.)

If we don’t get the vaccine right the first time, there may not be enough public trust for a next time. “Vaccines are a lot like social distancing. They are most effective if we work cooperatively and get a lot of people to take them,” said Langwig. “If we erode the public’s trust through the use of unsafe or ineffective vaccines, we may be less likely to convince people to be vaccinated in the future.”

“You don’t want to scare people off, because vaccines are our way out of this,” said Dr. Offit.

So, how will you be able to see through the fog of the vaccine war and know when a vaccine is safe to take? “Data,” said Dr. Moody, “to see if the vaccine did not cause serious side effects in those who got it, and that those who got the vaccine had a lower rate of disease, hospitalization, death, or any other metric that means it worked. And we really, really want to see that people who got the vaccine did not do worse than those who did not.

And finally, don’t forget to get your Flu vaccine, now!

The conspiracy theorists are wrong: Doctors are not inflating America’s COVID-19 death toll for cash. What about Herd Immunity and Oh, those Ignorant College Students!

As the terrible fires continue to burn and Nancy Pelosi says that Mother Nature is angry with us and the political atmosphere is all about hate, I sometimes don’t know who to believe, especially when it comes to the media. Andrew Romano reported that earlier this week, Iowa Republican Sen. Joni Ernst became the first member of “the world’s greatest deliberative body” to embrace a false online conspiracy theory that seeks to minimize the danger of COVID-19 by claiming only a few thousand Americans have died from the virus — not the 185,000 reported by state and local health agencies and hospitals. 

Ernst, who described herself as “so skeptical” of the official death toll, even went so far as to echo the nonsense argument spread by QAnon and other right-wing conspiracy-mongers that medical providers who have risked their own lives and health to treat COVID-19 patients have been attributing non-COVID deaths to the virus to rake in extra cash from the federal government. 

“These health-care providers and others are reimbursed at a higher rate if COVID is tied to it, so what do you think they’re doing?” Ernst, who is facing a tight reelection race, said Monday at a campaign stop near Waterloo, Iowa, according to a report by the Waterloo-Cedar Falls Courier.

“They’re thinking there may be 10,000 or less deaths that were actually singularly COVID-19,” Ernst added in an interview with the paper. “I’m just really curious. It would be interesting to know that.”

Since Ernst is “really curious,” here are the facts.

Yes, Medicare pays hospitals more for treating COVID-19 patients — 20 percent more than its designated rate, to be exact. Incidentally, this additional payment was approved 96-0 in the U.S. Senate — including by Joni Ernst. The reason Ernst (and all of her Senate colleagues) voted for it is simple: It helped keep U.S. hospitals open and operating during a worldwide emergency.

“This is no scandal,” Joseph Antos, a scholar in health care at the conservative American Enterprise Institute, explained in a recent PolitiFact fact-check. “The 20 percent was added by Congress because hospitals have lost revenue from routine care and elective surgeries that they can’t provide during this crisis, and because the cost of providing even routine services to COVID patients has jumped.”

In other words, no one is getting rich by misclassifying COVID-19 deaths.

It’s also fair to say that fewer than 185,000 Americans have died “singularly,” as Ernst put it, from COVID-19. According to a recent update by the Centers for Disease Control and Prevention, 94 percent of patients whose primary cause of death was listed as COVID-19 were also judged to have comorbidities — secondary conditions like diabetes that often exacerbate the virus’s effects. For the remaining 6 percent, COVID-19 was the only cause listed in conjunction with their deaths.

On Sunday, President Trump retweeted a QAnon backer who falsely claimed this meant that only 6 percent of reported COVID-19 deaths — that is, 10,000 or so — were actually caused by the virus. Perhaps this “report” is what Ernst was referring to when she agreed Monday with an audience member who theorized that COVID-19 deaths had been overcounted. “I heard the same thing on the news,” she said.

Yet Twitter quickly removed the tweet for spreading false information, and for good reason.   

Despite all the innuendo, there’s nothing unusual about the way the government is counting coronavirus deaths, as we have previously explained. In any crisis — whether it’s a pandemic or a hurricane — people with preexisting conditions will die. The standard for attributing such deaths to the pandemic is to determine whether those people would have died when they did if the current crisis had never happened.

When it comes to the coronavirus, the data is clear: COVID-19 is much more likely to kill you if your system has already been compromised by some other ailment, such as asthma, HIV, diabetes mellitus, chronic lung disease or cardiovascular disease. But that doesn’t mean patients with those health problems would have died this week (or last week, or next month) no matter what. The vast majority of them probably wouldn’t have. COVID-19 was the cause of death — the disease that killed them now, and not later.

A closer look at the CDC data, meanwhile, reveals that many of the comorbidities listed by medical providers are complications caused by COVID-19 rather than chronic conditions that predated infection: heart failure, renal failure, respiratory failure, sepsis and so on.

Feverishly creating a baseless fiction from two threads of unrelated information — the additional Medicare payments and the CDC update about comorbidities — is a classic conspiracy-theorist move. But that doesn’t make it true.

“Let there not be any confusion,” Dr. Anthony Fauci, the nation’s top infectious disease expert, said Tuesday. “It’s not 9,000 deaths from COVID-19. It’s 180,000-plus deaths.”

“The point that the CDC was trying to make was that a certain percentage of [deaths] had nothing else but COVID,” Fauci continued. “That does not mean that someone who has hypertension or diabetes who dies of COVID didn’t die of COVID-19. They did.”

In reality, it’s more likely that the U.S. is undercounting rather than overcounting COVID-19 deaths. According to a recent New York Times analysis of CDC estimates, at least 200,000 more people than usual died in the U.S. between March and early August — meaning that the official COVID-19 death count, which hit 140,000 over the same period, is probably too low. 

In the Hawkeye State, COVID-19 had killed at least 1,125 as of Wednesday afternoon. Over the past week, the state has reported an average of 1,177 cases per day, an increase of 124 percent from the average two weeks earlier. Its positive testing rate has risen from 10 percent to 18.5 percent since then. 

So while Republican lawmakers such as Ernst seek to downplay the lethality of the virus, Theresa Greenfield, Iowa’s Democratic Senate candidate, seized on her opponent’s baseless claim to underscore the gravity of the situation in one of the only states in America where the pandemic is getting worse.    

“It’s appalling for you to say you’re ‘so skeptical’ of the toll this pandemic has on our families and communities across Iowa,” Greenfield tweeted Tuesday, addressing the senator. “We need leaders who will take this seriously.”

Why a herd immunity approach to COVID-19 could be a deadly disaster

Reporter Rebecca Corey noted that since the coronavirus pandemic began, herd immunity has been floated by some experts as a possible solution to the deadly virus that has so far killed over 865,000 people worldwide. 

Herd immunity is possible when enough people have contracted and become immune to a virus, providing community-wide protection by limiting the number of people who can spread it. And while the strategy is considered controversial and even downright dangerous by many public health experts, it is also reportedly gaining momentum in the White House.    

According to a report by the Washington Post, herd immunity is a strategy being pushed by Dr. Scott Atlas — a neuroradiologist with no background in infectious diseases or epidemiology who recently joined the White House as a pandemic adviser. 

Atlas denied that he had encouraged the White House to adopt a herd immunity strategy, and on Wednesday White House coronavirus task force coordinator Dr. Deborah Birx and top infectious disease expert Dr. Anthony Fauci dismissed the idea that herd immunity was under consideration. An administration official, however, told CNN that the policies being promoted by Atlas are indeed akin to a herd immunity approach.   

Ordinarily, herd immunity would be acquired through a majority of the population being vaccinated — not through immunity acquired by natural infection. 

“Normally, when we talk about herd immunity, we talk about how much of the population needs to be vaccinated,” World Health Organization (WHO) COVID-19 technical lead Dr. Maria Van Kerkhove said on Aug. 27. “If we think about herd immunity in a natural sense of just letting a virus run, it’s very dangerous because you would need a lot of people to be infected.” 

It’s still uncertain what percentage of a population would need to be immune to the virus in order to attain herd immunity. According to Johns Hopkins University, in general, the answer is 70 to 90 percent of a population, depending on how contagious the infection is. But a model published last month in the magazine Science found that the threshold needed for coronavirus herd immunity could be as low as 43 percent. 

Proponents of herd immunity have looked to emulate Sweden’s more hands-off approach; unlike most countries in Europe, the Nordic country opted out of a nationwide lockdown and kept most businesses open. 

But Sweden’s strategy didn’t entail a total return to normalcy. The Swedish government implemented a ban on gatherings of 50 people or more, and many Swedes voluntarily followed social distancing guidelines. 

Former FDA Commissioner Scott Gottlieb noted in an op-ed published on Aug. 30 that in addition to being much larger than Sweden (a country with a population the same size as North Carolina’s), the U.S. has a high rate of citizens with preexisting conditions, which can lead to a higher rate of COVID-19 complications; about 10 percent of Americans have diabetes, and 40 percent are considered obese. 

Moreover, Sweden’s pursuit of natural herd immunity doesn’t appear to be working. A study released in June by the country’s Health Agency showed that only 6 percent of Swedes had developed antibodies to the coronavirus — though a recent study from Sweden’s Karolinska Institute and Karolinska University Hospital suggests that immunity in Sweden may be higher than antibody tests indicate. 

The role of antibodies and how much of an impact they have on long-term immunity is still questionable. A U.K. study, which had not yet been peer-reviewed, found that antibodies may start to decline 20 to 30 days after the onset of COVID-19 symptoms. And a Chinese study found that antibody levels in patients who had recovered from COVID-19 fell sharply within two to three months after infection. 

Falling antibody counts may not necessarily mean waning immunity; other immune responses such as T-cells could also affect how long immunity lasts. But the case for natural herd immunity is made even more improbable by reports of coronavirus reinfections in Hong Kong, Europe and the U.S. If natural immunity is as short-lived as a few months, that wouldn’t be stable enough to provide community or nationwide protection.    

Yahoo News Medical Correspondent Dr. Dara Kass says waiting to reach the minimal number of infections needed for natural herd immunity to work would not only take longer than waiting for a vaccine (which could come before the end of the year, according to the CDC) but would also likely cost more lives. Even if only 40 percent of the U.S. population needed to contract and recover from COVID-19 to reach natural herd immunity, Kass argues, that would mean another 126 million more Americans would still need to be infected.  

“It’s taken us six months to get to 6 million infections,” Kass says. “What if we just said, let’s live life like normal? Let’s not wear masks, let’s not socially distance, let’s ride the subways and go to work. How fast could we get to 126 million infections? One year? Two years? Three years? We don’t know. But what we know is, the faster we infect people, the more people will die.” 

“We’ve seen so far 185,000 Americans die of this coronavirus with 6 million people infected,” Kass continues. “If we want to intentionally infect another 126 million Americans, that means that over 1 million more Americans would die of this virus before we infected enough people to get to any possible natural herd immunity.” 

According to a Gallup poll conducted in late July, 35 percent of Americans said they would not get a coronavirus vaccine even if it were FDA-approved and available to them at no cost. But Kass says a vaccine will likely be the key to any workable herd immunity strategy.

“The bottom line is, will herd immunity be the answer to this coronavirus pandemic? And the answer will be yes — but not natural herd immunity. We will get to herd immunity hopefully with the development of a safe, effective vaccine,” Kass says.  

“Until we have a safe and effective vaccine that is available to the hundreds of millions of Americans that still need to be exposed and recovered from this virus, we just need to continue to do the hard work, which means wear a mask, be socially distanced from people you don’t know, wash your hands multiple times a day and listen to the science.”

College Students Are Already Itching to Sue Frats Over COVID-19

So, is anyone surprised at the stupidity of college students returning to campus after this long imposed “lock-down?” Are you surprised at the number of positive COVID-19 tested students after all of their large parties?

Emily Shugerman reported that across the country, as college students return to campus with masks and hand sanitizer, fraternities and sororities are doing what they’ve always done: drinking and partying. 

At the University of Washington this summer, 137 students living in frat houses tested positive for the coronavirus after hosting raucous parties that violated their own internal guidelines. At the University of Alabama, students completed an entirely virtual rush process that ended with new members showing up in person to sorority houses, packing themselves together to take photos and then crowding the neighboring bars. The next week, the university announced more than 500 cases on campus.

For responsible students and their families, who could fall ill or have their classes canceled due to their classmates’ Greek Life antics, it all seems ripe for a lawsuit, right?

Not necessarily.

Two attorneys who specialize in litigation against frats told The Daily Beast they have received multiple inquiries from concerned students or parents wondering what their legal rights are when it comes to potential super-spreader events on their campus.

Attorney Douglas Fierberg said filing a lawsuit is absolutely an option, arguing that violating public health rules around coronavirus is no different than violating other safety rules, like a speed limit. 

“The violation of [safety rules] by someone with no excuse or justification renders them responsible for the harm that’s caused,” he told The Daily Beast. “That precedent has been around since the dawn of American jurisprudence.”

But David Bianchi, an attorney who helped draft Florida’s anti-hazing law, said it isn’t so simple. In order to win such a suit, the plaintiff would have to prove not only that the defendant acted negligently, but that the negligent behavior directly caused them harm. And in a pandemic—where the virus could be picked up anywhere from a frat house to a grocery store parking lot—that could be difficult to prove. 

“The defense lawyer will have a field day asking questions of the plaintiff about every single place they went for the seven days before the fraternity party, the seven days after the fraternity party, and they’re going to come up with a list of 50 places,” he said. “How do you prove that that’s not where they got it from?”

Bianchi said half a dozen parents called his office asking about the possibility of filing a lawsuit, and he told them not to bother.

“I call ’em like I see ’em, and I just don’t see it here,” he said.

Lawsuits against Greek organizations, for everything from wrongful death to sexual assault, are big business for personal injury attorneys. (In 2018, the parents of a freshman at Northern Illinois University won a historic $14 million settlement after their son died at a fraternity party.) 

And there’s no question that some are bracing for suits against fraternal organizations: Holmes Murphy, an independent insurance brokerage with a specialty in frats, wrote a blog post on how clients could avoid trouble.

“We’ve received many questions about whether or not a house corporation has a duty to do anything,” the post said. “This is a question that will ultimately be tested after a case and spread within a house occurs. There is certainly no shortage of lawsuits as a result of the pandemic. Ultimately, doing the right thing comes first. Start with the basics. That may be all you can do. But it is better than doing nothing.”

What’s hazier is the prospect for coronavirus lawsuits in general. Thousands of suits have been filed since the pandemic started—against schools, businesses, prisons, and pretty much anywhere else you can pick up a virus—but few have been decided. Some legislators have also pushed for laws giving businesses widespread legal immunity, in hopes of getting the economy back up and running. 

On college campuses, Fierberg said, legal actions may not happen right away—classes have only just started, and it takes time for someone to get infected, suffer a grievous injury, and find a lawyer. He predicted a rash of such suits in the next six months to a year.

“The time period that this is incubating is now,” he said. “What’s gonna happen in that experiment is yet to entirely show itself. If it comes out as Frankenstein then that’s one thing. If it comes out as something nice… well that’s a different thing.”

Why a Vaccine Won’t Be a Quick Fix for COVID-19

Medscape’s Brenda Goodman noted that nine months into the COVID-19 pandemic, we are all exhausted, stressed out, and looking for the exit, so hopes for a vaccine are high. Not only are we all stressed out but with the election only weeks away there is pressure to have a vaccine so that President Trump sees a bump in his numbers for re-election possibilities.

Numerous efforts are underway around the world to test, manufacture, and distribute billions of doses. A table maintained by the World Health Organization (WHO) lists 33 vaccines against SARS-CoV-2, the virus that causes COVID-19, currently being tested in people, with another 143 candidates in preclinical testing and I just reviewed an article which noted that there were actually 210 vaccines being studied.

The effort is so critical, the U.S. government is spending billions to make doses of vaccine that may be wasted if clinical trials don’t show them to be safe and effective. The goal of this massive operation, dubbed Warp Speed, is to deliver 300 million doses of safe and effective vaccines by January 2021.

As important as a vaccine will be, some experts are already trying to temper expectations for how much it will be able to do.

“We all hope to have a number of effective vaccines that can help prevent people from infection,” Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, said at an Aug. 3 news briefing. “However, there is no silver bullet at the moment, and there might never be.”

Barry Bloom, PhD, an expert in infectious diseases and immunology at the Harvard T.H. Chan School of Public Health, is even more direct: The idea that a vaccine will end the pandemic just isn’t realistic.

“That’s not going to happen,” he says. First, not enough people will get the vaccine. Second, for those who do take it, the vaccine may only offer partial protection from the virus.

“I am worried about incomplete availability, incomplete protection, unwillingness of a portion of a country to be vaccinated,” Bloom says.

At least at first, not enough people will get the vaccine for the world to achieve herd immunity, or community protection. Community protection robs the virus of the chance to spread easily. It occurs when enough people become immune, either because they’ve recovered from the infection or been vaccinated against it. This high level of immunity in a population cuts the chances that someone without immunity ― say an infant or someone who can’t be vaccinated for medical reasons ― will be exposed to the virus and get sick.

Typically, the herd immunity threshold for an infection is somewhere between 70% and 90% of the population. We don’t yet know where the threshold is for COVID-19 because there are still big unanswered questions about how our bodies respond to the virus or a vaccine against it: Do most people respond in a way that protects them in the future? If so, how long does that protection typically last?

Even at the low end of the typical range for community protection ― 70% ― we’re still far short of that mark.

Recent studies checking blood samples submitted to commercial labs suggest that 5% to 10% of the population has recovered from a COVID-19 infection in the U.S. That’s just an average. The real number varies widely across the U.S., ranging from a low of about 1% in San Francisco to a high of about 20% in New York City, according to CDC data. Most of the country is still in the 3%-5% range ― still a long way from community protection against the virus.

So, most of the immunity needed to reach a level that would provide community protection would have to come from a vaccine.

“It’s not just getting a vaccine. It’s using it and using it appropriately,” Bloom says. “Vaccines don’t prevent anything. Vaccination does.”

Getting enough doses to enough people will take a while, even after a vaccine becomes available, for several reasons.

When vaccines against COVID are first approved, supplies will be tight. Initially, there may be enough doses for 10 million to 15 million people in the U.S. The first shots will be reserved for the people who need them most.

Just this week, the National Academy of Sciences came up with a draft plan for how to fairly distribute the vaccine, which would unfold in four phases. Those phases will take time to execute.

The first phase recommends that the first doses go to health care workers and first responders, with the next batch going to people with health conditions that put them at highest risk of dying from COVID, and to seniors living in group homes. Those groups make up just 15% of the population, according to the report.

Phase two, which covers about 30% of the population, calls for vaccination of essential workers at “substantially high risk of exposure,” teachers, people with health conditions that put them at moderate risk from the disease, people living in close contact with others (like prisoners and those staying in homeless shelters), and seniors who weren’t covered in phase one.

The largest chunk of the population, including children, who can be infected but may show few signs of illness, aren’t a priority until phase three, which also includes other essential workers. Phase three accounts for about 40% of the population. The last phase, everyone else, makes up about 5%.

Among those who are eligible for vaccination, not everyone is likely to agree to get one.

A recent poll by Gallup found that 35% of Americans ― or about one in three ― don’t plan on getting a COVID-19 vaccine, even if it’s free. Among the two-thirds of Americans who say they will be immunized, a large number plan to wait. A recent survey by STAT found that 71% will wait at least 9 months to get their shots.

Those numbers align with a recent poll by WebMD, which found that 73% of readers said they would wait at least 3 months to get a vaccine when one becomes available.

“I don’t find that shocking. I would think for people who are rational, wouldn’t you want to see what the data are on safety and efficacy before you made a decision?” Bloom says. “I’m worried about the 25% who, no matter what happens, won’t take the vaccine. Those are the people who really worry me.”

Vaccine hesitancy ― fear of getting any vaccine ― is growing. The WHO recently listed it as one of the top threats to global health, pointing to the recent resurgence in measles. Many countries have recently seen large outbreaks of measles. These outbreaks have been caused by an increasing number of parents refusing to vaccinate their kids.

Experts are worried that vaccine hesitancy will play a large role in whether the U.S. and other countries reach herd immunity thresholds. The Gallup poll found Republicans are less likely to be vaccinated than Democrats, and nonwhite Americans ― the group being disproportionately affected by COVID-19 infections ― are less likely to be vaccinated than whites.

Bloom and others believe that right now, we should be working on a way to overcome vaccine hesitancy.

“Policymakers have to start focusing on this,” says Robert Litan, PhD, JD, a nonresident senior fellow at the Brookings Institute.

He thinks we shouldn’t try to overcome hesitancy by forcing people to take the vaccine. Instead, he wants the government to pay people to take it ― $1,000 each, or $4,000 for a family of four.

“That’s a lot of money,” especially now with the economy sagging and so many people out of work, Litan says. “I think a thousand dollars would get a lot of people to take the shot who would otherwise not take it.”

Litan ran the numbers, looking at various scenarios of how many people would take it and how effective the vaccine might be. He says he realized not enough people would be protected to fully reopen the country.

He says he’s not sure $1,000 is the right sum, but it should be generous because if people think the amount could go up, they will wait until it does, which would defeat the purpose of the incentive.

“I can’t think of anything else,” he says. “You either have carrots or sticks, and we can’t use sticks. It won’t work.” How Well Will It Work?

Getting enough people to take it is only one piece of the puzzle. We still don’t know how well any of the shots might work, or for how long that protection lasts.

Researchers have now confirmed at least four cases of COVID-19 reinfection, proving that the virus infected the same person twice.

We still don’t know how common reinfection is, but these cases suggest that some people may need a booster dose of vaccine before they’re fully protected against the virus, says Gregory Poland, MD, an expert in immunity and vaccine responses at the Mayo Clinic in Rochester, MN.

That’s similar to the way we dole out vaccines for seasonal flu, with people urged to get the shot every year, he says.

That’s another reason it could take a while to reach herd immunity.

It’s also not clear how effective a vaccine may be.

The FDA and WHO have said that a vaccine should be at least 50% more effective than a placebo to be approved. But that could mean that a shot merely decreases how bad an infection is but doesn’t stop it. That would be an important effect, Bloom says, but it could mean that even vaccinated people would continue to spread the infection.

“If it prevents disease, but doesn’t prevent growth in the upper respiratory tract, there is a possibility there will be a group of people who will be infected and not get sick because of the vaccine but still have the virus in their respiratory tract and be able to transit,” Bloom says. “That would not be the ideal for a vaccine, but it would protect against disease and death.”

He says the first studies will probably measure how sick vaccinated people get and whether or not they need to be hospitalized.

Longer studies will be required to see if vaccinated people are still able to pass the virus to others.

How effective any vaccine may be will also depend on age. In general, older adults ― the ones who most need protection against COVID-19 ― don’t respond as well to vaccines.

Our immune systems get weaker as we get older, a phenomenon called immunosenescence.

Seniors may need specially formulated vaccines ― with added ingredients, called adjuvants ― to get the same response to vaccines that a younger person might have.

Lastly, there’s the problem of reintroduction. As long as the virus continues to spread anywhere in the world, there’s a risk that it could reenter the U.S. and reignite infections here.

That’s what happens every year with measles. In most states, more than 90% of people are vaccinated against measles. The measles vaccine is one of the most effective ever made. It gives people substantial and long-lasting protection against a highly contagious virus that can stay in the air for long periods. You can catch it by walking through the same room an infected person was in hours before.

Every year, travelers come to the U.S. carrying measles. If they go to a crowded place, like a theme park, it increases the chances that initial infection will touch off many more. As vaccine hesitancy has increased in the U.S. and around the world, those imported cases have sparked outbreaks that have been harder and harder for public health officials to extinguish, raising the risk that the measles virus could become endemic again in countries like the U.S.

For the world to be rid of COVID-19, most of the world has to be vaccinated against it. There’s an effort underway ― called COVAX ― to pay for vaccinations for poorer countries. So far, 76 of the world’s wealthier countries have chipped in to fund the effort. The U.S. has not. The Trump administration says it won’t join because of the WHO’s involvement in the effort, a move that may place the plan in jeopardy.

For all these reasons, it will probably be necessary to continue to spread out, wear masks, and be vigilant with hand hygiene to protect yourself and others for the foreseeable future.

“For now, stopping outbreaks comes down to the basics of public health and disease control,” Tedros said.

We may get a vaccine, but we will still need to be able to test enough people for the virus, warn their contacts, and isolate those who are infectious to keep the epidemic under control, or, as Tedros has urged, “Do it all.”

What would a Biden economy look like, and what will healthcare go from here? Also, When Should We Get Vaccinated for the Flu?

As I listened to the Democratic convention, I was horrified by the hate against President Trump, and the in general. My wife doesn’t want me to say it, but the average citizen, especially the socially and history ignorant citizens are basically stupid and believes those of the liberal democrats. As an Independent I don’t believe. But I thought that I would skip the updates regarding the Corvid pandemic and consider the economy and healthcare with former Vice President Biden in control. Oh, Horror!

The Week Staff wrote that if you’re wondering what a Biden presidency would mean for the economy, look to Biden’s last financial crisis, said Jeffrey Taylor at Bloomberg. In 2009, as vice president, Biden approached the crisis from a middle-class, Rust Belt viewpoint, aggressively pushing for an auto bailout while championing tighter restrictions on banks and arguing against Wall Street in key debates. While today’s situation is obviously different from the Great Recession, Biden sees “common threads” that could help him pursue an agenda focused on addressing income inequality and promoting public works. His top priority is a massive $3.5 trillion infrastructure, manufacturing, and clean-energy program “that appears likely to grow substantially if he is elected.” He plans to pay for the program by raising the corporate tax rate from 21 percent to 28 percent and increasing taxes on wealthy real-estate investors. In the wake of the pandemic, Biden has “edged away from the moderate economic approach he advocated last year,” but he is still not likely to “embrace punitive demands from the Left.”

“There is nothing ‘moderate’ about Biden’s tax plan,” said Mark Bloomfield and Oscar Pollock at The Wall Street Journal. For taxpayers with income above $1 million, Biden wants to tax capital gains as ordinary income. Combined with an upper-income tax increase, that would make top capital gains tax surge from the current 20 percent to 43 percent, exceeding the rate in “every one of the 10 largest economies.” We are not going to compete with China by adopting “tax policies that discourage those who are best able to invest, take risks, and start companies.”

Certain industries are sure to be in Biden’s crosshairs, said Anne Sraders at Fortune​. “Trump’s fight to lower drug prices will likely be carried on,” meaning “potential headwinds for Big Pharma.” And energy and “environment-sensitive industries” such as oil and gas production could underperform under a Democratic administration. But the naming of Kamala Harris as his vice-presidential nominee “might actually be good for Big Tech” because of her ties to Silicon Valley. For the first time in a decade, Wall Street donors are actually giving more to Democrats than to Republicans, said Jim Zarroli at NPR. Trump “still has friends in finance,” but many investors have “soured on his management style,” which makes it hard for them to make long-term plans.

Whatever the outcome, investors are starting to worry about “stock-market mayhem” surrounding the November election, said Gunjan Banerji and Gregory Zuckerman at The Wall Street Journal. “Markets tend to be volatile ahead of elections,” but pessimism about what might unfold appears “even more intense this time around.” One adviser is urging clients to insure themselves against losses by buying options that will profit if the S&P 500 index plunges more than 25 percent through December; other firms are telling clients to bet on gold. The behind-the-scenes anxiety is unfolding even as markets hit a record high. “October and November tend to be the wildest months of the year” in any case, and market uncertainty could skyrocket if in the days after the election there is no clear winner.

Here’s Where Joe Biden Stands on Every Major Healthcare Issue

Lulu Chang reviewed Biden’s stand on healthcare. The stage is set, the players have been finalized, and the countdown has begun in earnest. In less than three months, voters across the United States will head to the polls (or mail in their ballots) to elect their president.

The Democrats recently finalized their ticket, making history with the inclusion of Kamala Harris as Joe Biden’s vice-presidential pick, making her the first African American and Asian woman to appear on a major party ticket. Over the course of the next several weeks, the Biden and Harris team will make clear their platforms and policy suggestions to win over voters. I’ll discuss Harris’s stand on health in the next section of this post. And of course, in the face of a global pandemic, high on the list of priorities for many Americans is the Democratic nominee’s position on healthcare.

We’ve put together a list of where Joe Biden stands on every major health issue to help you make a more informed decision as you mail in your ballot or head to the polls in a few short months.

Medicare

  • No Medicare for All
  • Lower age to 60 (currently 65)
  • Add a public option

Biden supports making Medicare, the federal health insurance program for folks older than 65 and certain younger Americans with disabilities, more readily accessible to a greater swath of the population. He does not, however, support Medicare for All, which would offer complete health care to all Americans regardless of age without out-of-pocket expenses. Instead, Biden advocates for lowering the eligibility age for Medicare to 60, which would certainly expand the program’s reach.

In addition, Biden wants to add a public option to American healthcare, which was discussed during the writing of the Affordable Care Act, but ultimately passed over. A public option would allow folks to select into government-run insurance—like Medicare—instead of a private insurance plan. This too would allow a greater proportion of the population to access government-run healthcare options. As Biden explains on his campaign website, “If your insurance company isn’t doing right by you, you should have another, better choice…The Biden Plan will give you the choice to purchase a public health insurance option like Medicare. As in Medicare, the Biden public option will reduce costs for patients by negotiating lower prices from hospitals and other health care providers.”

Undocumented Immigrants

  • Allow undocumented immigrants to buy into a public option

The Biden Plan emphasizes the importance of providing affordable healthcare to all Americans, “regardless of gender, race, income, sexual orientation, or zip code.” But it is not only Americans who Biden seeks to cover under his policies—rather, his plan would allow undocumented immigrants to purchase the public option, though it would not be subsidized.

Affordable Care Act

  • Strengthen the ACA
  • Increase subsidies
  • Bring back the individual mandate

The Affordable Care Act was passed under the Obama administration, so it comes as little surprise that Biden wants to bring back many of the provisions from the bill that were dismantled under the Trump administration. As he notes in his official platform, Biden seeks to “stop [the] reversal of the progress made by Obamacare…[and will] build on the Affordable Care Act with a plan to insure more than an estimated 97% of Americans.”

This would involve increasing tax credits in order to reduce premiums and offer coverage to a greater swath of Americans. In particular, Biden wants to do away with the 400% income cap on tax credit eligibility, and lower the limit on cost of coverage from today’s 9.86% to 8.5%. In effect, that means that no one purchasing insurance would have to spend any more than 8.5% of their income on health insurance.

Biden would also bring back the individual mandate, which is a penalty for not having health insurance. Trump eliminated this element of the Affordable Care Act in 2017, but Biden claims that the mandate would be popular “compared to what’s being offered.”

Are you kidding? Remember the burden on our healthy young newly employed or new business owners!

Prescriptions

  • Lower prescription drug pricing

The prices of prescription drugs have skyrocketed in recent years, making big pharma companies a common target among presidential candidates. Biden promises to “stand up to abuse of power by prescription drug corporations,” condemning “profiteering off of the pocketbooks of sick individuals.”

The Biden Plan includes a repeal of the exception that allows pharmaceutical companies to avoid negotiations with Medicare over drug prices. Today, nearly 20% of Medicare’s spending is allocated toward prescription drugs; lowering this proportion could save an estimated $14.4 billion in medication costs alone.

Furthermore, Biden would limit the prices of drugs that do not have competitors by implementing external reference pricing. This would involve the creation of an independent review board tasked with evaluating the value of a drug based on the average price in other countries. Biden would also limit drug price increases due to inflation, and allow Americans to buy imported medications from other countries (provided these medications are proven to be safe). Finally, Biden would eliminate drug companies’ advertising tax breaks in an attempt to further lower costs.

Abortion

  • Expand access to contraception
  • Protect a woman’s right to choose

Joe Biden has been infamously inconsistent in his position on abortion; decades ago, Biden supposed a constitutional amendment allowing states to reverse Roe v. Wade. As a senator, Biden voted to ban certain late-term abortions as recently as 2003. But his official position as the Democratic nominee is to protect a woman’s right to an abortion, and increase access to birth control across the spectrum.

Under the Biden Plan, the proposed public option would “cover contraception and a woman’s constitutional right to choose.” Biden would seek to “codify Roe v. Wade” and put an end to state laws that hamper access to abortion procedures, including parental notification requirements, mandatory waiting periods, and ultrasound requirements.

Biden would also restore federal funding for Planned Parenthood, reissuing “guidance specifying that states cannot refuse Medicaid funding for Planned Parenthood and other providers that refer for abortions or provide related information.”

Surprise Billing

  • Stop surprise billing

Surprise billing, as the name suggests, allows healthcare providers to send patients unexpected out-of-network bills, often in large sums. Biden’s plan would prevent this practice in scenarios where a patient cannot decide what provider he or she uses (as is often the case in emergency situations or ambulance transport). While ending surprise billing could save Americans some $40 billion annually, it is not entirely clear how Biden would end surprise billing.

The plan suggests that Biden would address “market concentration across our health care system” by “aggressively” using the government’s antitrust authority. By promoting competition, Biden hopes to reduce prices for consumers, and more importantly, improve health outcomes. Next is Kamala’s stand on healthcare.

Kamala Harris’ Stance on Healthcare Is Pretty Different from Biden’s

Katherine Igoe noted that healthcare is also an issue that sees a lot of variety across Democratic candidates, ranging from a single-payer healthcare system (meaning that all health insurance is covered through the government, and everyone is covered) to a more hybrid approach that doesn’t exclude private healthcare companies (half of the American population is currently enrolled in private plans).

At least according to her stance in the past, Harris favors the latter, hybrid approach—and it’s quite different from what Biden has proposed. What is her take, and how may her stance have shifted?

As a presidential candidate, Harris proposed Medicare for All.

The issue is personal for Harris. Citing her mother’s terminal cancer diagnosis, she’s said that her interest in improving coverage comes from that relationship: “She got sick before the Affordable Care Act became law, back when it was still legal for health insurance companies to deny coverage for pre-existing conditions. I remember thanking God she had Medicare…As I continue the battle for a better health care system, I do so in her name.”

The details can vary, but the basics of Medicare for All would be to vastly expand the government’s role to include everyone’s healthcare needs. By making Medicare more robust, the program would work to reduce costs for the insured, increase coverage to include those who were previously excluded, and expand upon existing plans in an effort to allow people to keep their existing doctors. But unlike other, more extreme proposals, Harris’ plan would subsequently allow private insurers to participate—in a similar way to the current framework of Medicare Advantage. “Essentially, we would allow private insurance to offer a plan in the Medicare system, but they will be subject to strict requirements to ensure it lowers costs and expands services,” she explained.

The candidates’ stances have had to incorporate what governmental influence would do to the private market, and Harris didn’t favor a plan that would abolish private insurance. She had initially expressed support for something along that lines, but then changed that stance; her perspective on the subject has evolved. She’s also proposed a decade-long “phase-in” period for this new Medicare plan to be put in place.

When they were both presidential candidates, Biden and Harris clashed over healthcare—she said his plan would leave Americans without coverage, he dismissed her plan as nonsensical.

Biden’s take on healthcare is vastly different.

Biden worked with President Obama on the Affordable Care Act (ACA), and thus his plans for healthcare would be to expand upon and further develop the ACA, while protecting it from current attacks. People could choose a public plan (i.e., they wouldn’t be mandated to join Medicare) and the government would provide tax benefits. “It would also cap every American’s health-care premiums at 8.5 percent of their income and effectively lower deductibles and co-payments. Biden recently said he also wants to lower the Medicare enrollment age by five years, to 60.”

The plan would separately take on exorbitant pharmaceutical pricing, which is another hot-button issue that hasn’t had any resolution. Multiple bills have been debated in Congress but the House’s recently passed bill is heavily opposed by Republicans.

Harris wasn’t the only one to criticize Biden on his plan, which may still exclude many from coverage. But now that the two are running mates, they may need to come up with a cohesive strategy that incorporates both of their stances (or, Harris may have to adopt a more moderate approach).

Harris has proposed several healthcare solutions for COVID-19.

Harris has been active in proposing economic relief towards individuals, families, and businesses during the pandemic, and healthcare is no exception. She’s proposed the COVID-19 Racial and Ethnic Disparities Task Force Act, which (among other things) would be designed to address barriers to equitable health care and medical coverage. This is one of the area’s in which she’s pledged to act towards racial justice—and it may be another area in which her stance impacts the Biden-Harris platform.

It’s crucial to get a flu shot this year amid the coronavirus pandemic, doctors say

I just received my yearly flu vaccination this past Wednesday and I have been advising all my patients to get their flu shots now! Adrianna Rodriquez that the message to vaccinate is not lost on Americans calling their doctors and pharmacists to schedule a flu shot appointment before the start of the 2020-2021 season. 

Experts said it’s crucial to get vaccinated this year because the coronavirus pandemic has overwhelmed hospitals in parts of the country and taken the lives of more than 176,000 people in the USA, according to Johns Hopkins data.

It’s hard to know how COVID-19 will mix with flu season: Will mask wearing and social distancing contain flu transmission as it’s meant to do with SARS-CoV-2? Or will both viruses ransack the nation as some schools reopen for in-person learning? 

“This fall, nothing can be more important than to try to increase the American public’s decision to embrace the flu vaccine with confidence,” Centers for Disease Control and Prevention Director Robert Redfield told the editor of JAMA on Thursday. “This is a critical year for us to try to take flu as much off the table as we can.”

Here’s what doctors say you should know about the flu vaccine as we approach this year’s season: 

Who should get the vaccine?

The CDC recommends everyone 6 months and older get a flu vaccine every year. State officials announced Wednesday the flu vaccine is required for all Massachusetts students enrolled in child care, preschool, K-12 and post-secondary institutions.

“It is more important now than ever to get a flu vaccine because flu symptoms are very similar to those of COVID-19, and preventing the flu will save lives and preserve health care resources,” said Dr. Lawrence Madoff, medical director of the Bureau of Infectious Disease and Laboratory Sciences at the Massachusetts Department of Public Health.

When should I get my flu shot? 

Dr. Susan Rehm, vice chair at the Cleveland Clinic’s Department of Infectious Diseases, said patients should get the influenza vaccine as soon as possible.

CVS stores have the flu vaccine in stock, and it became available Monday at Walgreens.

“I plan to get my flu shot as soon as the vaccines are available,” Rehm said. “My understanding is that they should be available in late August, early September nationwide.”

Other doctors recommend that patients get their flu shot in late September or early October, so protection can last throughout the flu season, which typically ends around March or April. The vaccine lasts about six months.

The CDC recommends people get a flu vaccine no later than the end of October – because it takes a few weeks for the vaccine to become fully protective – but encourages people to get vaccinated later rather than not at all.

Healthy people can get their flu vaccine as soon as it’s available, but experts recommend older people and those who are immunocompromised wait until mid-fall to get their shots, so they last throughout the flu season.

What is the high-dose flu shot for seniors? 

People over 65 should get Fluzone High-Dose, or FLUAD, because it provides better protection against flu viruses.

Fluzone High-Dose contains four times the antigen that’s in a standard dose, effectively making it a stronger version of the regular flu shot. FLUAD pairs the regular vaccine with an adjuvant, an immune stimulant, to cause the immune system to have a higher response to the vaccine. 

Research indicates that such high-dose flu vaccines have improved a patient’s protection against the flu. A peer-reviewed study published in The New England Journal of Medicine and sponsored by Sanofi, the company behind Fluzone High-Dose, found the high-dose vaccine is about 24% more effective than the standard shot in preventing the flu.

An observational study in 2013 found FLUAD is 51% effective in preventing flu-related hospitalizations for patients 65 and older. There are no studies that do a comparative analysis between the two vaccines.

Is the flu vaccine safe?

According to the CDC, hundreds of millions of Americans have safely received flu vaccine over the past 50 years. Common side effects for the vaccine include soreness at the injection spot, headache, fever, nausea and muscle aches.

Dr. William Schaffner, professor of infectious diseases at the Vanderbilt Medical Center in Nashville, Tennessee, emphasized that these symptoms are not the flu because the vaccine cannot cause influenza.

“That’s just your body working on the vaccine and your immune response responding to the vaccine,” he said. “That’s a small price to pay to keep you out of the emergency room. Believe me.”

Some studies have found a small association of the flu vaccine with Guillain-Barré syndrome (GBS), but Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, said there’s a one in a million chance of that happening.

Not only is the flu vaccine safe, but the pharmacies, doctors offices and hospitals administering it are also safe.

Horovitz and Schaffner said hospitals take all the necessary precautions to make sure patients are protected against COVID-19. Some hospitals send staff out to patients’ cars for inoculation while others allow them to bypass the waiting room. Doctors offices require masks and social distancing, and they are routinely disinfected.

“Call your health care provider to make sure you can get in and out quickly,” Schaffner advised. “It’s safe to get the flu vaccine and very important.”

Will it help prevent COVID-19?

Experts speculate any vaccine could hypothetically provide some protection against a virus, but there’s little data that suggests the flu vaccine can protect against the coronavirus, SARS-CoV-2, which causes COVID-19.

“We don’t want to confuse people of that … because there’s simply no data,” Schaffner said. “Flu vaccine prevents flu; we’re working on a coronavirus vaccine. They’re separate.”

A study in 2018 found that the flu vaccine reduces the risk of being admitted to an ICU with flu by 82%, according to the CDC.

“People perhaps forget that influenza is something that we see every year,” Rehm said. “Tens of thousands of people die of influenza ever year, including people who are very healthy, and hundreds of thousands of people are hospitalized every year.”

Doctors said it will be even more hectic this year because some flu and COVID-19 symptoms overlap, delaying diagnosis and possibly care.

What can we expect from this year’s flu season and vaccine?

“Even before COVID, what we say about the flu is that it’s predictably unpredictable,” Rehm said. “There are some years that it’s a light year and some years that it’s horrible.”

Flu experts said they sometimes look at Australia’s flu season to get a sense of the strain and how it spreads, because winter in the Southern Hemisphere started a few months ago. 

According to the country’s Department of Health surveillance report, influenza has virtually disappeared: only 85 cases in the last two weeks of June, compared with more than 20,000 confirmed cases that time last year.

“Australia has had a modest season, but they were very good at implementing COVID containment measures, and of course, we’re not,” Schaffner said. “So we’re anticipating that we’re going to have a flu season that’s substantial.”

The CDC said two types of vaccines are available for the 2020-2021 season: the trivalent and quadrivalent. Trivalents contain two flu A strains and one flu B strain and are available only as high-dose vaccines. Quadrivalents contain those three strains plus an additional flu B strain, and they can be high- or standard-dose vaccines. I made sure that I received the quadrivalent vaccine.

Though some doctors may have both vaccines, others may have only one, depending on their supply chain. Natasha Bhuyan, a practicing family physician in Phoenix, said people should get whatever vaccine is available.

“Vaccines are a selfless act. They’re protecting yourself and your friends through herd immunity,” she said. “Any vaccine that you can get access to, you can get.”

Horovitz said vaccine production and distribution have been on schedule, despite international focus on coronavirus vaccine development. He has received his shipment to the hospital and plans to administer the vaccine with four strains closer to the start of the season.

“I don’t think anything suffered because something else was being developed,” he said. “(The flu vaccine) has been pretty well established for the last 20 to 30 years.”

Producers boosted supplies of the flu vaccine to meet what they expect will be higher demand. Vaccine maker Sanofi announced Monday that it will produce 15% more vaccine than in a normal year.

Redfield told JAMA the CDC arranged for an additional 9.3 million doses of low-cost flu vaccine for uninsured adults, up from 500,000. The agency expanded plans to reach out to minority communities.

What about the nasal spray instead of the shot? 

After the swine flu pandemic in 2009, several studies showed the nasal spray flu vaccine was less effective against H1N1 viruses, leading the CDC and the Advisory Committee on Immunization Practices to advise against it.

Since the 2017-2018 season, the advisory committee and the CDC voted to resume the recommendation for its use after the manufacturer used new H1N1 vaccine viruses in production.

Though agencies and advisory committees don’t recommend one vaccine over the other, some pediatricians argue the nasal spray is easier to administer to children than a shot.

Other doctors prefer the flu shot because some of the nasal spray side effects mimic respiratory symptoms, including wheezing, coughing and a runny nose, according to the CDC. Horovitz said anything that presents cold symptoms should probably be avoided, especially among children who are vectors of respiratory diseases.

“Giving them something that gives them cold (symptoms) for two or three days may expel more virus if they’re asymptomatic with COVID,” he said.

So, get vaccinated!!

Pandemic fears are boosting demand for trustworthy news; And What Have We Learned from Sweden’s Experience?

During these last few months of the pandemic one of my concerns is the lack consistent reliable data with which the media pundits of all sorts deliver their predictions and many times with false knowledge and predictions. Question, what is the correct social distancing length? Studies keep on changing! One of the key features of the web is its ability to turn regular people into citizen journalists. The cost of publishing text on the web is almost nil. The barriers to entry in the media industry are low, too. And many readers are not picky about where their news comes from: the stories that go viral can come from amateur scribes or veteran ones, media startups or established outfits. But this is not always the case. New research suggests that when a crisis hits, readers turn to reliable sources.

In 2018 Paul Resnick and James Park, two researchers at the University of Michigan, devised a pair of tools for measuring the popularity of English-language news stories on Facebook and Twitter. The first, dubbed the “Mainstream Quotient”, measured the proportion of highly-shared links that came from mainstream news sources, such as the New York Times, the BBC and, yes, The Economist. The second, the “Iffy Quotient”, measured the share originating from less trustworthy sources, based on ratings provided by NewsGuard, a company that tracks misinformation published online.

Both indices have shifted significantly during the pandemic. Beginning in February, when the coronavirus started to spread outside China, traffic to traditional media outlets and news sites surged, whereas dodgier sites attracted fewer readers. The Mainstream Quotient rose steadily during this period, a phenomenon Messrs Resnick and Park call a “flight to quality”. The Iffy Quotient, meanwhile, tumbled. The drop was particularly steep during March, when many countries instituted lockdown measures (see chart).

The researchers argue that consumers seek out reliable news sources during times of uncertainty, in the same way that fearful investors turn to gold. Whether these patterns will last remain unclear. The Iffy Quotient has already started to creep back up, for both Facebook and Twitter. And recent efforts by social-media platforms to crack down on fake news may prove only temporary. Once the pandemic subsides, demand for unreliable news may return to pre-covid levels. For now, at least, the flight to quality has taken off.

Pandemic Spike in Telehealth Levels Off

Crystal Phend of MedPage pointed out that Telehealth’s early bonanza during the pandemic has given way to persistently elevated use in primary care, a Department of Health and Human Services (HHS) report showed.

Analysis of Medicare fee-for-service (FFS) data showed an increase in Medicare primary care visits from 0.1% of all primary care in February to 43.5% in April, representing an increase from about 2,000 to 1.28 million telehealth visits per week.

Meanwhile, there was a “precipitous” drop in in-person visits for primary care in mid-March as COVID-19 took hold in the U.S., then a rise from mid-April through May, according to the report from the Office of the Assistant Secretary for Planning and Evaluation.

Use of telehealth in primary care “declined somewhat but appears to have leveled off at a persistent and significant level by the beginning of June,” the report noted. It still accounted for 22.7% of Medicare beneficiaries’ primary care visits as of June 3rd.

Overall, weekly primary care visit rates have not yet returned to pre-pandemic levels.

“Based on early experience with Medicare primary care telehealth at the start of the COVID-19 public health emergency, there is evidence that Medicare’s new telehealth flexibilities played a critical role in helping to maintain access to primary health care services — when many beneficiaries and providers were concerned with transmission of COVID-19,” the authors noted. “The stable and sustained use of telehealth after in-person primary care visits started to resume in mid-April suggests there may be continued demand for telehealth in Medicare, even after the pandemic ends.”

The findings overall match those from healthcare provider databases suggesting a 60% to 70% drop in health care office visits, partially offset by telehealth visits, with the start of the pandemic. Drug market research firm IQVIA has reported from physician surveys that about 9% of patient interactions were via telehealth prior to the pandemic but 51% during the shutdown, with expectation of a 21% rate after the pandemic, the HHS report noted.

There have been calls for Medicare to make the loosened rules around telemedicine permanent, and some legislative movement in that direction, but private insurers have signaled the opposite.

Fred Pelzman, MD, an internal medicine physician at Weill Cornell Medicine in New York City (and MedPage Today columnist), said an informal survey of his patients indicated they would be willing to do up to 50% of their care via video tools.

“We went from a handful of video visits in our practice to several thousand over the course of the months,” he said. “It’s a great way to take care of people, kept a lot of people safe, we think. What has happened is that as we started to open our practice back up again and offer appointments, the floodgates have opened and patients are declining video visits.”

Those patients opting for in-person visits tend to be older, braving what feels like a quiet time in the pandemic for the state to take care of necessary visits, he noted. “I think ultimately that we’ll plateau. It will probably come down a little more.”

The study included Medicare FFS Part B claims from January through May 2020 for primary care services along with preliminary Medicare Part B primary care claims data up to June 3. Primary care services included evaluation and management, preventive services, and advance care planning.

Telehealth usage increased most in urban counties early in the pandemic and saw smaller declines in May compared with rural counties across the country. Among cities, Boston had the greatest proportion of primary care visits by telehealth (73.1%) and Phoenix the lowest (37%).

Notably, the rate “was not strongly associated with differences in COVID-19 severity across cities as measured by rate of hospitalizations per thousand Medicare FFS beneficiaries,” the report pointed out.

I read an article predicting that telehealth visits are the future of medicine. This is truly worrisome due to the many incorrect diagnoses as well as poor control of chronic diseases that I have seen coming through my office alone. Physical diagnosis is made by looking at the patient, listening to the patient, hearing what the patient is really saying, touching the patient and using the different diagnostic tools such stethoscopes, ophthalmoscopes, otoscopes, percussion hammers, etc. to make the correct diagnoses and to follow our patients. How is that done virtually? The only ones benefitting the most from these virtually visits are the practices and the electronic medical record companies selling the practices additional software to utilize telehealth. And patients are finding that not all telehealth “visits” are paid for by their insurance companies.

How Did Sweden Flatten Its Curve Without a Lockdown?

One expert credits a “good-enough strategy”; others worry that it won’t last. Who is correct?

Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage reported that

Despite never implementing a full-scale lockdown, Sweden has managed to flatten its curve, prompting its health leadership to claim victory — but others question the cost of the strategy, as the country has a far higher death toll than its Scandinavian neighbors.

In late July, Sweden’s 7-day moving average of new cases was about 200, down from a peak of around 1,140 in mid-June. Its daily death totals have been in the single digits for two weeks, well below its mid-April peak of 115 deaths in a single day.

However, on a per-capita basis, Sweden far outpaces its Scandinavian neighbors in COVID deaths, with 567 deaths per million people compared with Denmark’s 106 deaths per million, Finland’s 59 deaths per million, and Norway’s 47 deaths per million. The Swedish figure is closer to Italy’s 581 deaths per million.

While the positive trends have led Anders Tegnell, PhD, chief epidemiologist at the Swedish Public Health Agency and architect of Sweden’s coronavirus strategy, to state that the “Swedish strategy is working,” others have criticized the approach, including two dozen Swedish academics who published a recent USA Today editorial.

“In Sweden, the strategy has led to death, grief, and suffering,” they wrote. “On top of that, there are no indications that the Swedish economy has fared better than in many other countries. At the moment, we have set an example for the rest of the world on how not to deal with a deadly infectious disease.”

The Swedish Public Health Agency has not openly stated that herd immunity was its goal, though many suspect that this was the intention. Tegnell told reporters last week he thought the recent trends indicated that immunity was now widespread in the country. But with rates of antibody positivity around 10%, that seems impossible. (Officials at the agency did not respond to MedPage Today‘s request for comment.)

So how has Sweden managed to get its outbreak under control?

Behavior Change

While Sweden didn’t officially lock down, many in the country have described a locked-down “feeling” that has eased in the summer months.

At the start of the outbreak, only high schools and universities closed; daycare and elementary schools have been open. Businesses have also remained open, but typically at reduced hours, and restaurants have functioned at reduced capacity.

Swedes have been asked to keep their distance in public, refrain from non-essential travel, and work from home when possible. Gatherings of more than 50 people are also banned. People age 70 and over are advised to stay away from others as much as possible.

Masks were never required and aren’t commonly worn.

This response hasn’t changed over time, through the June surge and into today’s decline, so there’s no definitive explanation for the flattening, though, and experts have several theories.

“Swedes in general have changed their behavior to a great extent during the pandemic and the practice of social distancing as well as physical distancing in public places and at work has been widespread,” said Maria Furberg, MD, PhD, an infectious diseases expert at Umea University Hospital in northeastern Sweden.

“During the months of March to early June, all shops were practically empty, people stopped dining with friends, and families stopped seeing even their closest relatives,” Furberg told MedPage Today. “A lock-down could not have been more effective. Handwashing, excessive use of hand sanitizers, and staying home at the first sign of a cold became the new normal very quickly.”

Mozhu Ding, PhD, an epidemiologist at the famed Karolinska Institute, said the decline is “likely to be a combination of measures taken by individuals, businesses and a widespread information campaign launched by the government.”

“Even without a strict lockdown order, many businesses allowed employees to work from home, and universities are offering distance courses to the students,” Ding told MedPage Today. “Individuals are also taking personal hygiene more seriously, as items like hand sanitizers and single-use gloves are often sold out in pharmacies and grocery stores.”

Immunity

Experts told MedPage Today there weren’t clear data to prove Tegnell’s assertion of widespread immunity in Sweden.

Furberg said there is likely “some sort of unspecific immunity that protects parts of the population from contracting COVID-19” but it’s not necessarily secondary to SARS-CoV-2 exposure.

For instance, a study by the Karolinska Institute and Karolinska University Hospital recently found that about 30% of people with mild or asymptomatic COVID showed T-cell-mediated immunity to the virus, even though they tested negative for antibodies.

“This figure is [more than] twice as high as the previous antibody tests, meaning that the public immunity to COVID-19 is probably much higher than what antibody studies have suggested,” Ding told MedPage Today. “This is of course very good news from a public health perspective, as it shows that people with negative antibody test results could still be immune to the virus at a cellular level.”

Indeed, T-cell immunity is coming into focus as a potentially important factor in COVID infection. A paper published in Nature in mid-July found that among 37 healthy people who had no history of either the first or current SARS virus, more than half had T cells that recognized one or more of the SARS-CoV-2 proteins.

Another 36 people who had mild-to-severe COVID-19 were all found to have T-cell responses to several SARS-CoV-2 proteins, and another 23 people who had SARS-CoV-1 (the virus responsible for the SARS outbreak in 2003) all had lasting memory T cells — even 17 years later — that also recognized parts of SARS-CoV-2.

It could be that T cell immunity is the result of a previous infection with common cold coronaviruses, but this hasn’t yet been established; nor is it certain that T cell immunity is driving Sweden’s decline in COVID cases.

Path Forward

Summertime is another factor that may account for the decline, which began around late June — not directly because of the weather, but social factors related to it.

Swedes are “outdoors more, and students are not at school,” said Anne Spurkland, MD, a professor of immunology at the University of Oslo in Norway.

Also, “perhaps Sweden has finally gotten better control over the disastrous spread of the virus in nursing homes which to some extent can explain their relatively high death rates,” Spurkland told MedPage Today. About half of Sweden’s 5,730 deaths occurred among those in elder care homes.

Norway is still requiring that Swedes quarantine for 10 days when coming into Norway, and Denmark has not fully reopened its borders to its neighbor yet either.

That doesn’t bode well for the Swedish economy. If the goal of avoiding a lockdown was to spare economic woe, its success has been limited.

According to Business Insider, “international tourism and trade are decimated. … Sweden’s National Institute of Economic Research predicts Sweden’s GDP will fall 5.4% in 2020, after predicting a 1% rise [in] December 2019. It also expects unemployment to rise around three percentage points, to 9.6%, between the end of 2019 and the end of 2021.”

Spurkland said it’s still “too early yet to conclude whether the Swedish approach was the wisest over all,” as it remains to be seen whether Norway and other countries that did lock down will avoid a second wave of infections in the fall.

Yet she cautions that choosing to take on a higher case load may have health consequences far beyond the immediate infection.

“What we have learned these months is that COVID-19 is not only about death, it is also about ill health,” Spurkland said. “Quite a number of people going through the infection have long-term symptoms, that may be stopping them from resuming their daily life. We do not know yet how large a proportion of those who get the virus will fall into this category, but it is certainly a concern.”

“So, when deciding on taking a herd immunity approach to handle a totally new virus we do not know anything about,” she said, “the Swedish government has also unknowingly put the general population at risk for much long-term ill-health caused by the virus.”

Furberg doesn’t see it that way: “I am very proud of the way Swedes have adapted to the restrictions and regulations and I believe the Public Health Agency of Sweden has picked a good-enough strategy for our country.”

What Americans Need to Understand About the Swedish Coronavirus Experiment

Sweden made headlines for never shutting down. Here’s what’s really happening there.

Matthew Zeitlin pointed out that Tooutsiders, life in Stockholm, Sweden, appears perfectly normal: Walk down a cobblestone street, and you may see two friends sitting at a cafe enjoying the spring air or a group of kids kicking a soccer ball in the park. Cars and bicyclists may zip by; a family may walk past you on their afternoon stroll.

Whereas most of the Western world has been in lockdown for weeks, Sweden has opted to forgo any sort of shelter-in-place policy in response to the coronavirus and instead allow businesses and parks to stay open and groups of under 50 to gather.

That’s not to say the country hasn’t been proactive at all. The policy in effect in Sweden is similar to what had been implemented in much of the United States before shelter-in-place orders were issued — and the one that will soon be in place in states that reopen. The Swedish government has recommended that people wash their hands frequently, maintain social distance, work from home if they can, and those who are elderly or more susceptible to Covid-19 stay home. The government recommended that universities switch to online teaching; they quickly followed course. Social distance is required by law in restaurants, and bar service is banned. The government changed its sick leave rules to encourage anyone who is feeling symptoms to stay home. “Instead of saying ‘close down all of society,’ we have looked at society and closed down… aspects of society,” where the disease is most likely to spread, Anders Tegnell, the epidemiologist at Sweden’s Public Health Agency in charge of recommending policy to the government, told The Daily Show. “I think that’s had a great effect.”

Sweden may not be so much an alternative, as a glimpse of the future.

Sweden’s approach has been hailed by critics of American and European pandemic policies as a less restrictive — and less economically devastating — alternative to state or national shutdowns, but it’s also been lambasted by others as an unnecessarily risky strategy that has led Sweden to have the highest Covid-19 death toll among the Nordic nations. As more and more areas of the United States reopen, Sweden may not be so much an alternative as a glimpse of the future.

As of Sunday afternoon, the country had 25,921 confirmed cases and3,220deaths, according to the Johns Hopkins Coronavirus Resource Center. These are much higher figures than those of the country’s neighbors, but lower than those in some other wealthy Western European countries on both an overall and population-adjusted basis. Sweden also has suffered problems familiar to residents of countries that have had more severe outbreaks and stricter policies. Nursing homes have been hard hit, and Tegnell described Sweden’s failure to protect nursing home residents as its greatest shortcoming so far. Immigrant and ethnic minority communities also have suffered, due in part to their larger households. Just over half of all households in Sweden in 2016 consisted of only one person, while immigrants were substantially more likely than native-born residents to live in overcrowded conditions or multigenerational household.

Even with the less aggressive containment measures, the economic effects of the virus have been severe for the country. Sweden’s National Institute for Economic Research projected that gross domestic product would contract by 7% in 2020 and the unemployment rate would rise to just over 10%. The large fall in consumer and business confidence, the institute said in a release, point “to a rapid and severe downturn, not least in large parts of the service sector.”

“The economy will shrink both due to a drop in exports and is already contracting due to lower consumption. But the underlying causes differ: The export sector is mostly affected by the international situation, whereas the drop in consumption is directly related to the government’s recommendation of social distancing,” said Lina Maria Ellegård, an economist at Lund University.

In the first three months of the year, the Swedish economy contracted by less than 1% — less than the United States’ fall — but the production of both goods and services declined in March. The car industry — one of Sweden’s major export sectors — along with real estate, hospitality, and restaurants led the way.

That’s because even without lockdowns or orders, the behavior of Swedes still changed — to an extent. According to data collected by Google and Apple, Swedes have cut back on their travel to places like stores and restaurants and decreased their use of transit-like buses substantially, though not as dramatically as their Nordic neighbors in Denmark. Still, travel over the Easter holiday fell by 90%, Tegnell said on The Daily Show.

Multiple experts in Sweden I spoke to agreed that because a recommendation made by Swedish leadership is culturally viewed as more of a demand, the freedoms allowed have not resulted in free-for-alls. “There’s a basic misconception that there’s one big huge after-ski party,” said Lars Trägårdh, a Swedish historian. “That’s not true.”

Sweden’s voluntary restrictions policy is made possible by the high levels of trust throughout Swedish society. “We have a lot of social trust and a lot of trust in the institutions, and the institutions have confidence in the citizens,” said Trägårdh. “That’s why we decided to have this voluntary approach as opposed to one that’s more hardcore.”

The photos circulating online don’t fully represent the broader reality on the ground either. “I’ve seen pictures in the newspapers and news media of what looks to be crowded restaurants in Stockholm. What I’ve seen is mostly pretty sparse restaurants. Every other table is empty, and there’s very little business,” said Bo Becker, an economist at the Stockholm School of Economics. “Life doesn’t go on as usual, but maybe the lockdown is less severe than in other countries.”

But even if Sweden’s policy of allowing businesses to open and people to move out and about is not that different from some policies American states have or will soon implement, there’s been one major difference: the schools. Schools for children up to age 15 have remained open, all the way down to daycares and preschool. “That makes a world of difference,” Trägårdh told me. “It’s a gender issue.”

Sweden has one of the highest rates of female participation in the labor force for rich countries. Forcing young children to stay home would put many mothers in a bind or even knock them out of the workforce entirely.

“Closing down schools works well if you are in a well-to-do, middle-class family that has a house and a garden and can afford to have one person staying at home,” Trägårdh said. “That may not look like a doable proposition if you are a single parent or do not make a lot of money.”

Shutting down daycare and schools could increase risk as well, Erik Angner, a philosopher and economist at Stockholm University, explained, by leading working parents to turn to their own parents for help. “If you close daycares, then either one parent has to stop working or grandma or grandpa shows up,” he said. But since the elderly are most at risk, it was even more important to keep schools and daycares open

As other countries work through their peak infections, they will have to figure out how to reach a new status quo where the disease’s spread is still slow but restrictions can be lightened. “Now that everybody else is starting to shift toward opening up, people are talking about Sweden,” said Trägårdh. “Other Nordics are realizing you can’t keep schools closed forever. We’re in the long run here. It’s not a 60-meter race, it’s more like a marathon.”

While Sweden has a higher death rate than its Nordic neighbors and other wealthy European nations like Germany, it has been lower than rates in the Netherlands, France, and the United Kingdom. According to the Financial Times’ figures, Sweden has seen an 18% jump in excess deaths since the start of the outbreak, while Denmark has seen a 5% rise. Excess deaths in England and Wales are up 37%.

“The data out of Finland, Norway, and Denmark looks much better,” said Angner. “But everything will hinge on what will happen next.”

There’s some evidence that Sweden has managed to take the heaviest blow from the virus already — about a fourth or fifth of the population of Stockholm may have been infected, which would put the infection rate at a level similar to that found in New York City, which has had many more deaths and been under a near-total lockdown for almost two months. On Tuesday, health officials in Stockholm said the number of new deaths linked to Covid-19 was slowly decreasing from one week to the next.

The Swedish example carries both optimistic and pessimistic tidings for the United States as it embraces a partial, scattered reopening cheered on by the White House. It suggests that, even without punitive mandates, people can and will take measures to keep themselves safe from the disease. But even though people are protecting themselves without formal orders, the economy will be only slightly better off than it was under lockdown. Meanwhile, the American push to reopen is being driven by distrust of the government combined with the absence of robust safety-net programs to stem the economic bleeding. In the American context, Sweden’s example may be no example at all.

As a paper that was just accepted for publication, written by this author and two coauthors, we need reliable data to evaluate our progress as well as our failures to predict, based on appropriate statistical models and in order to lead us all in the correct path for future strategies for this pandemic and future crises.

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?