What a confusing time and how disappointed can one be when one candidate running for President convinces a group of physicians to complain about Trump’s response to the Pandemic. I am embarrassed to say that they are in the same profession that I have been so proud to call my own. Can you blame the President for the pandemic as all the other countries that are experiencing the increased wave of COVID? Can you blame Trump for the lack of PPE’s when former President Obama and yes, Vice President Biden refused to restock the PPE’s used for the other SAR’s viruses? What a pathetic situation where the average American is so hateful and, yes, the word is stupid, and with no agreement in our Congress except to make us all hate them. Where is the additional financial support, the stimulus package promised, for the poor Americans without jobs and huge debts? This is a difficult situation when we have such poor choices for the most important political office and can’t see through the media bias.
I just had to get all that off my chest as I am like many very frustrated. How did we get here and who do we believe as we hear more about Biden’s connection with his son’s foreign dealings?
Thomas J. Bollyky and Stewart M. Patrick reported that the winner of the presidential election, whether that is Donald Trump or Joe Biden, will need to overcome the COVID-19 pandemic — the worst international health emergency since the 1918 influenza outbreak — and also begin preparing the United States and the world for the next pandemic.
Think it is too soon to worry about another pandemic? World leaders have called the coronavirus outbreak a “once-in-100-year” crisis, but there is no reason to expect that to be true. A new outbreak could easily evolve into the next epidemic or a pandemic that spreads worldwide. As lethal as this coronavirus has been, a novel influenza could be worse, transmitting even more easily and killing millions more people.
Better preparation must begin with an unvarnished assessment of what has gone wrong in the U.S. and in the global response to the current pandemic and what can be done to prepare for the next one when it strikes, as it inevitably will.
Preparedness needs to start with investment. Despite multiple recent threats, from SARS (2003) to H5N1 (2007) to H1N1 (2009) to Ebola (2013-2016); many blue ribbon reports and numerous national intelligence assessments; international assistance for pandemic preparedness has never amounted to more than 1% of overall international aid for health.
The United States devoted an even smaller share of its foreign aid budget in 2019 — $374 million out of $39.2 billion — to prepare for a pandemic that has now cost the country trillions of dollars. Meanwhile, funding for the Centers for Disease Control and Prevention’s support to states and territories has fallen by more than a quarter since 2002. Over the last decade, local public health departments have cut 56,360 staff positions because of lack of resources.
Preparation isn’t only about investing more money. It is also about embracing the public health fundamentals that allowed some nations to move rapidly and aggressively against the coronavirus. The United States has been hard hit by this pandemic, but all countries were dealt this hand.
But we can do better. Here are four measures, outlined in a new report from the Council on Foreign Relations, that would make Americans and the rest of the world safer.
First, the United States must remain a member of the World Health Organization, while working to reform it from within. The agency is hardly perfect, but it prompted China to notify the world of the coronavirus and it has coordinated the better-than-expected response to the pandemic in developing nations. Yet, the agency has no authority to make member states comply with their obligations and less than half of the annual budget of New York-Presbyterian Hospital. The WHO needs more dedicated funding for its Health Emergencies Program and should be required to report when governments fail to live up to their treaty commitments.
Second, we need a new global surveillance system to identify pandemic threats, one that is less reliant on self-reporting by early affected nations. An international sentinel surveillance network, founded on healthcare facilities rather than governments, could regularly share hospitalization data, using anonymized patient information. Public health agencies in nations participating in this network, including the CDC, can assess that data, identify unusual trends and more quickly respond to emerging health threats.
The U.S. should take the lead in forming a coalition to work alongside the WHO to develop this surveillance network. We should also work with like-minded G-20 partners, as well as private organizations, in this coalition to reduce unnecessary trade and border restrictions; increase the sharing of vaccines, therapeutics and diagnostics; and work with international financial institutions to provide foreign aid and debt relief packages to hard-hit nations.
Third, responding to a deadly contagion requires a coordinated national approach. Too often in this pandemic, in the absence of federal leadership, states and cities competed for test kits and scarce medical supplies and adopted divergent policies on reopening their economies. The next administration needs to clarify the responsibilities of the federal government, states and 2,634 local and tribal public health departments in pandemic preparedness and response. Elected leaders, starting with the president, must also put public health officials at the forefront of communicating science-based guidance and defend those officials from political attacks.
Finally, the U.S. must do better by its most exposed and vulnerable citizens. More than 35% of deaths in the U.S. from COVID-19 have been nursing home residents. Many others have been essential workers, who are disproportionately Black and Latinx and from low-income communities. Federal, state and local governments should direct public health investments to these groups as a matter of social justice and preparedness for future threats.
All of this will require leadership and marshaling support at home and abroad. The next president need not be doomed to replay this current catastrophe — provided he acts on the tragic lessons learned from the COVID-19 pandemic.
In search of President Trump’s mysterious health care plan
Hunter Walker responded to questions about President Trump’s healthcare plan noting that President Trump’s health care plan has become one of the most highly anticipated, hotly debated documents in Washington. And depending on whom you ask, it might not exist at all.
The contents — and the whereabouts — of the health plan have been a growing mystery since 2017, when efforts to pass a White House-backed replacement for Obamacare stalled in the Senate. Since then, Trump has repeatedly vowed to unveil a new health plan. In July, it was said to be two weeks away. On Aug. 3, Trump said the plan would be revealed at the end of that month. Last month, White House press secretary Kayleigh McEnany said it would be released within two weeks. At other points, Trump has suggested the plan is already complete. That shifting schedule has lent Trump’s health plan an almost mythical status.
Let me state here that if President Trump doesn’t win this election his lack of a healthcare plan as well as the blame for the pandemic will be the deciding reason that even previous GOP supporters will vote for Biden. Hard to believe, right? In fact, weeks to months ago I related the need for the President to release his healthcare plan to further prove to the voters that he is fulfilling his promises.
The mystery surrounding the president’s vision for health care has added urgency because the Supreme Court is currently scheduled to hear oral arguments in a case that could decide the future of former President Barack Obama’s signature health care law on Nov. 10, exactly one week after the election. That case was brought by Republican attorneys general and joined by the Trump administration. The argument that Obamacare is unconstitutional could lead to the current health care framework being struck down, but Trump has yet to present an alternative.
With both the election and the court date looming, questions about Trump’s health care plan have intensified on the campaign trail. And the White House’s answers have only added to the uncertainty.
During the first presidential debate last month, Trump was pressed by Fox News moderator Chris Wallace about the fact he has “never in these four years come up with a plan, a comprehensive plan, to replace Obamacare.”
“Yes, I have,” Trump replied. “Of course, I have.”
He was apparently referring to the Republican tax bill passed in 2017 that eliminated the tax penalty for individuals who did not purchase health insurance, or obtain it through their jobs or government assistance. That so-called individual mandate was a critical part of the Affordable Care Act, more commonly known as Obamacare, meant to ensure that even healthy people would buy health insurance and spread the costs out across the population. Other parts of the Affordable Care Act remain in place, but the Republican lawsuit argues that without the mandate the entire program should be overturned.
That could end the most popular feature of Obamacare: the requirement that insurance companies provide affordable coverage for preexisting conditions. While Trump has repeatedly insisted, he wants to maintain that protection, any details of his plan or evidence of how he would do it have remained elusive.
During the final debate last week, Democratic nominee Joe Biden argued that the administration “has no plan for health care.”
“He’s been promising a health care plan since he got elected. He has none,” Biden said of Trump. “Like almost everything else he talks about, he does not have a plan. He doesn’t have a plan. And the fact is, this man doesn’t know what he’s talking about.”
The issue also came up during the vice-presidential debate on Oct. 7, when Vice President Mike Pence said, “President Trump and I have a plan to improve health care and protect preexisting conditions for every American.”
“Obamacare was a disaster, and the American people remember it well,” Pence said.
But Trump seemed to admit during last week’s debate that his plan is more of a dream than a concrete proposal.
“What I would like to do is a much better health care, much better,” he said, adding, “I’d like to terminate Obamacare, come up with a brand-new, beautiful health care.”
However, by the end of last weekend, the idea of a written, completed Trump health plan was back on the table — literally.
During the president’s contentious “60 Minutes” interview that aired on Sunday, host Lesley Stahl asked Trump about his repeated promises of a health plan coming imminently.
“Why didn’t you develop a health plan?” Stahl asked.
“It is developed,” Trump responded. “It is fully developed. It’s going to be announced very soon.”
And after Trump ended the interview and walked out on Stahl, McEnany, the White House press secretary, came in and handed the “60 Minutes” correspondent a massive binder.
“Lesley, the president wanted me to deliver his health care plan,” McEnany said. “It’s a little heavy.”
Indeed, Stahl struggled with the huge book. The situation seemed reminiscent of other instances where Trump tried to dissuade debate by presenting massive piles of paper that didn’t stand up to scrutiny, and it sparked speculation that the contents of the massive binder were blank. However, the conservative Washington Examiner newspaper subsequently reported it contained more than 500 pages comprising “13 executive orders and 11 other pieces of healthcare legislation enacted under Trump.”
Stahl was unimpressed. After perusing the gigantic tome, she declared, “It was heavy, filled with executive orders, congressional initiatives, but no comprehensive health plan.”
McEnany took issue with that assessment and shot back with a tweet that declared, “@60Minutes is misleading you!!”
“Notice they don’t mention that I gave Leslie 2 documents: a book of all President @realDonaldTrump has done & a plan of all he is going to do on healthcare — the America First Healthcare Plan which will deliver lower costs, more choice, better care,” the press secretary wrote.
McEnany had implied one of Washington’s most wanted documents was printed, bound and ready for review. It even had a name! Were we really this close to seeing the Trump health plan?
After Yahoo News requested a copy of the “health care plan” that she presented to Stahl, McEnany provided a statement detailing the contents of the enormous binder.
“The book contains all of the executive orders and legislation President Trump has signed,” McEnany said.
She credited those actions with “lowering health care premiums and drug costs” compared with where they were under Obama and Vice President Biden. Trump has previously claimed premiums and costs have gone down during his administration, but these assertions aren’t entirely backed up by the data. And many of Trump’s executive orders on health care have been largely symbolic.
McEnany also provided us with a copy of the second document that she described on Twitter and Stahl had supposedly ignored. It was a 10-page report (including front and back covers) with a large-print, bullet-pointed list of highlights from Trump’s previous actions on health care and slogans making promises for the future.
“The America First Healthcare Plan lays out President Trump’s second term vision animated by the principles that have brought us lower cost, more choice and better care,” McEnany said.
The White House’s immense binder clearly didn’t contain Trump’s “health care plan” as McEnany declared during the dramatic on-camera delivery. But it did hold a fragment of the president’s policy vision.
Perhaps more pieces of the puzzle could be found on Capitol Hill. After all, in April 2019, Trump proclaimed on Twitter that “the Republicans … are developing a really great HealthCare Plan.” That comment followed reports that a group of Republican senators including Mitt Romney of Utah, John Barrasso of Wyoming, Rick Scott of Florida and Bill Cassidy of Louisiana were working on drafting a proposal. Trump said this plan would “be far less expensive & much more usable than ObamaCare.” The president further suggested it would be complete and ready to be voted on “right after the election.”
So, is there a finished plan floating around Capitol Hill ready to make its debut in a matter of weeks? No.
A Republican Senate source who has been privy to the talks told Yahoo News that a group of GOP senators including Romney, Barrasso, Lindsey Graham of South Carolina and Senate Health Committee Chairman Lamar Alexander of Tennessee have been “exploring” an alternative to Obamacare “over the course of the past year and a half.” However, with the coronavirus pandemic and a Supreme Court confirmation dominating the agenda, the source, who requested anonymity to discuss the deliberations, suggested the planning had stalled.
“I don’t think they’ve talked about this stuff for months now due to other pressing issues,” the source said of the health care planning.
The source predicted that activity on health care would not resume until the outcome of the election and the Supreme Court’s Obamacare case are clear.
“Depending on how things in November shake out and … what the Supreme Court does with the ACA, maybe those discussions will be revived,” the source said. “But there really has not been much going on of late.”
Nevertheless, the source contended that, even though there is no finished plan, Trump and his Republican allies on the Hill have made some real progress toward “a potential plan that would preserve private insurance but also seek to lower costs.” They suggested Senate efforts to lower drug prices and end surprise medical billing are part of the “frameworks,” as are some of the executive orders issued by Trump.
“There have been sort of piecemeal efforts in this area. … The executive branch has done what they can do within their authority to try to lower costs,” the source said. “There just hasn’t been … a wholesale piece of legislation or framework that everyone has coalesced around. That’s just something that has not come together.”
In the end, perhaps the truest answer to the ongoing mystery of Trump’s proposed Obamacare replacement came from the president himself during the “60 Minutes” interview. In the conversation, Trump suggested that his health plan exists in a realm beyond the bounds of space and time.
“A new plan will happen,” he said. “Will and is.”
As you can tell from the lead in to this post, that many of us who can really think and put enough words together to make a understandable sentence our choices are not good but it is really important for us all to go and turn out to vote, either in person, with masks in place and socially distancing or by mail in or drop off ballots.
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.
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.
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!
Richard Orange noted that Sweden, in deference to the rest of the countries believing in the strategy to lockdown their populace, decided not to use stay-at-home or lockdowns except for the elderly. Sweden’s opposition has attacked the government for its handling of the coronavirus pandemic, with the stubbornly high death rate fueling questions over the decision not to impose a lockdown.
Jimmie Akesson, the leader of the populist Sweden Democrats, first called for Anders Tegnell, the architect of Sweden’s less restrictive coronavirus strategy, to resign. The attacks continued in heated televised leaders’ debate on Sunday night.
“The strategy in Sweden was not to try to hold back the infection, but instead to try to limit it at the same time as protecting risk groups,” Mr Akesson wrote in a debate article in the Dagens Nyheter newspaper.
“By that measure, it has failed miserably. Anders Tegnell should therefore resign. Only then will he show the Swedish people that he takes responsibility for the mistakes FHM [Public Health Agency of Sweden] has made.”
During a party leaders’ debate on Sunday evening, Ebba Busch-Thor, leader of the Christian Democrat party, blamed Sweden’s strategy – and by extension the government that allowed it – for some of the 4,659 deaths due to the virus.
“What we can say about Sweden is that many of those who are mourning over those they have lost this spring are doing so because Sweden knowingly and deliberately allowed a large spread of the infection,” she said.
Ulf Kristersson, the leader of the Moderate Party, the biggest party on the Centre-Right, held back from joining Mrs. Busch-Thor’s attack on the strategy, instead attacking the implementation of it.
“I had no problem with the strategy. It was a bit slow but, when it was in place, I had nothing against it,” he said. “But the government didn’t put any power behind the words.”
The Prime Minister, Stefan Lofven, continued to back Sweden’s strategic decision not to impose a lockdown, instead laying the blame for the death rate on failures within elderly care.
“I think the strategy is the right one,” he said. “But it has transpired that that very many people, in certain areas, have died in elderly care. There’s no doubt that elderly care needs to be improved.”
Mr Akesson faced an immediate counter-attack from Johan Carlsson, the director of FHM, who dismissed his call as “almost pathetic”.
Dagens Nyheter’s political commentator Ewa Stenberg wrote on Sunday that the debate marked an end to the “borgsfred”, or “castle truce”, in Sweden.
“The tone was harsh and quite contrary to how it was when the virus hit the country. Then all the parties backed the government’s decision to let the Public Health Authority take the lead,” she wrote.
However, the return of political opposition does not yet seem to reflect a loss of support for the government among the public.
Kids During Lockdown: Is Another Epidemic About to be Revealed?
Ingrid Walker-Descartes noted that even in non-pandemic years, the summertime “back-to-school” rush of appointments in many pediatric practices can be a logistical challenge. This year could be even more hectic after many families delayed routine appointments during quarantine. Hoping to return to their routines, children and teens will need vaccines, physical exams for sports clearances and school forms, and all the regular developmental and emotional surveillance that is so important to keep them healthy.
As pediatricians, we should be adding another layer to our checklists in these visits this year. For many children, this visit may be the first time in weeks or months that someone outside their immediate family has had eyes on them.
We must be careful to listen, very carefully, to what the children and parents tell us, both in their words and in other signs. How has the family coped with the stress of being stuck at home? Are there financial struggles? Food insecurity? Other stresses? As a child abuse pediatrician, I know all of these things can put tremendous stress on a family, and ultimately can lead to a child being maltreated or abused. We have a real opportunity right now to intervene and provide critical support to families, and to protect children.
Sadly, we know from previous disasters that during these times of intense emotional and economic stress, rates of child abuse and neglect increase. Injuries and deaths among infants due to abusive head trauma increase during times of economic stress, and scattered reports among physicians at children’s hospitals in various states are reporting that is happening now, too. For example, a hospital in Fort Worth, Texas, and a hospital in Philadelphia, are reporting an increase in the number of severe physical abuse cases. Many times, this abuse occurs when a parent or caregiver is frustrated or at the “end of their rope,” and in a moment of anger, makes a devastating choice that injures a child.
For the past few months, during sheltering in place, children have lacked many of the people who often step forward as protectors — the aunt they may confide in, a teacher who sees a bruise, or a physician who notices an injury where there reasonably should be none. Reports to child abuse hotlines and child protective services have declined during the pandemic, but this is not necessarily because fewer children are being injured. We know that teachers and school counselors are the most frequent reporters of suspected abuse, and for months children have not had access to these trusted protectors. Many of them have not seen their pediatrician, either. These combined realities have left some of our most vulnerable children without several much-needed layers of protection.
As a pediatrician who specializes in diagnosing abuse and protecting children from further abuse, I am well versed in talking with children to understand what happened to cause their injuries. Some may convey lessons learned from their choices made due to curiosity or naivete. Others struggle to elaborate on marks or scars made in anger by a caregiver. Post COVID-19, it will be important for all pediatricians to have a careful approach as they are talking with families, listening and observing to understand what children experienced during the pandemic, and how we can help them and their families be safe and healthy.
Some families may benefit from a referral to a nutrition program, caregiver support program, parental counseling, or other resources. In other cases, a pediatrician may notice a sign of potential abuse that should be reported to the relevant child protection agencies. This is always difficult, but it can be the first step to making sure a child is safe and protected while a family gets the support they need.
The American Academy of Pediatrics (AAP) recently provided a webinar guide on how to identify child abuse during the pandemic, and additional resources are provided on the AAP website, including a list of child abuse programs across the country to help support you in this difficult role.
The stress on families and children will not end when the stay-at-home orders lift. Let’s be prepared to help all our children emerge healthy and strong, and ready to learn.
CDC wants states to count ‘probable’ coronavirus cases and deaths, but most aren’t doing it
Reinhard, Emma Brown Reis Thebault and Lena H. Sun reported that fewer than half the states are following federal recommendations to report probable novel coronavirus cases and deaths, marking what experts say is an unusual break with public health practices that leads to inconsistent data collection and undercounts of the disease’s impact.
A Washington Post review found that the states not disclosing probable cases and deaths include some of the largest: California, Florida, North Carolina and New York. That is one reason government officials and public health experts say the virus’s true toll is above the U.S. tally as of Sunday of about 1.9 million coronavirus cases and 109,000 deaths — benchmarks that shape policymaking and public opinion on the pandemic.
The U.S. Centers for Disease Control and Prevention works closely with a group of health officials called the Council of State and Territorial Epidemiologists to issue guidelines for tracking certain illnesses. The guidelines are voluntary, though states generally comply. The goal: solid comparisons between states and accurate national statistics that inform public health decision-making.
In April, as coronavirus infections multiplied and laboratory testing was limited, the CSTE and the CDC advised states to count both probable cases and deaths — where symptoms and exposure pointed to infection — along with those confirmed by tests.
Yet weeks after the guidance was handed down to standardize coronavirus reporting, a Post review found states as of early June counting cases and deaths in all sorts of ways.
At least 24 states are not heeding the national guidelines on reporting probable cases and deaths, despite previously identifying probable cases in other national outbreaks, including H1N1 flu during the country’s last pandemic in 2009.
The failure of many states to document probable coronavirus cases and deaths is “historic in many ways because there are lots of probable case classifications and probables are regularly and normally reported on,” said Janet Hamilton, the CSTE executive director. “We are definitely concerned about the undercounting of covid-19 deaths and cases.”
New Jersey says it began reporting probable cases and deaths to the CDC on May 15 but does not disclose them publicly on its website. Georgia says it tracks the information internally but is not reporting those numbers on its website or to the CDC.
“We do have intentions of sharing them but not yet,” said Nancy Nydam, a spokeswoman for the Georgia Department of Public Health, who said as of late May the department had tracked 1,658 probable cases and potentially dozens of probable deaths.
Officials in Montana, Rhode Island and the District of Columbia say they haven’t reported any probable cases or deaths because they have not had any, citing low numbers or the wide availability of testing.
Seven states did not respond to The Post’s requests for a breakdown of cases and death counts. Five of those are not reporting probable cases or deaths, according to data the CDC began publishing June 2. South Dakota reports probable deaths but not cases.
Officials in the remaining 17 states say they are reporting probable and confirmed coronavirus cases and deaths on their websites and to the CDC. Some states distinguish between probable and confirmed while others group them.
In some states not reporting probable cases, officials cite the demands of an unprecedented crisis in which Americans press for daily updates from public health data systems that are chronically underfunded and outdated.
In Washington state, where many of the nation’s first deaths occurred, health department spokeswoman Lisa Stromme Warren said documenting probable cases and deaths “is one of many urgent priorities.” The state has identified about 100 people whose death certificates list covid-19 but were never tested, so they are not included in the public death count or reported to the CDC.
“We suspect that we are actually more likely to be undercounting deaths than overcounting them,” Katie Hutchinson, the health department’s health statistics manager, said during a recent briefing.
CDC spokeswoman Kristen Nordlund said that the agency is working with health departments to improve the flow of data. “In pandemic circumstances, such as with covid-19, collecting complete information on each case is challenging,” Nordlund said. “The current case and deaths counts reported to CDC are likely an undercount.”
During the H1N1 flu pandemic, states initially counted probable and confirmed cases individually. But about three months into the outbreak, the CDC said those individual counts represented “only a fraction of the true burden” of the disease. The agency stopped collecting individual case reports and instead began publishing estimates based on hospitalizations, symptoms and other data.
The CDC is planning to come up with similar estimates for the coronavirus but has no immediate plans to stop counting individual cases. “CDC is actively working on a model to address and assess the true burden of covid-19 in the U.S.,” Nordlund said.
All eyes on numbers
For government officials assessing how quickly to reopen the economy and individuals deciding what risks to take, their daily judgment calls are based, in part, on the case and death counts publicized on television and computer screens.
That has propelled the pandemic counts into the contentious political arena, where some allies of President Trump and conservative voices on social media have claimed that the covid-19 death toll is inflated. The debate over whether counts of probables are crucial or misleading extends beyond the nation’s capital.
In Illinois, two Republican lawmakers and three businesses have sued the Democratic governor over coronavirus disaster orders. A spokeswoman for the health department, Melaney Arnold, said the state is not divulging probable deaths on its website “because there is concern from the public that the number of deaths is being inflated. . . . We need the public to have confidence in the data and therefore are reporting only those deaths that are laboratory confirmed.”
The state website lists about 5,700 deaths as of June 5, excluding the approximately 185 probable deaths tracked internally as of that day and reported to the CDC.
But a resident looking at a state chart and then turning to the CDC might not find the same numbers. The newly posted CDC table does not reflect the probables that officials in some states said they have reported. Officials say that’s because the reports sent to the CDC include those with confirmed cases in one figure and because the national update can run slightly behind state websites.
Since the 1950s, CSTE has recommended which diseases states should track and what those reports to the federal government should look like. The CDC works closely with the epidemiologists’ council and adopts its guidelines to “enable public health officials to classify and count cases consistently across reporting jurisdictions,” according to the CDC website.
States usually follow these recommendations and report the incidence of dozens of different diseases to the CDC, with some exceptions. A state may not report cases of a disease that does not occur within its borders, yet may track another illness found only in its part of the country.
Hawaii, for example, does not report Lyme disease, as every other state does, but it does report hallucinogenic fish poisoning.
“It’s more of a handshake agreement between the states and CDC that we will send you the data in this way so that you can then aggregate it,” said Kathy Turner, Idaho’s deputy epidemiologist. “In general, there’s no argument. We all do it because we realize the importance of being able to look at a disease on a national level.”
Some reportable diseases rarely result in deaths, so CSTE directives have typically focused on how to count cases, not fatalities. Then came the coronavirus and a mushrooming death toll. The CDC acknowledged in early April that the death count was an “underestimation” because it included only fatalities in which the virus was laboratory confirmed. Testing shortages, people dying at home or in nursing homes, and spotty postmortem testing meant victims were overlooked.
“When the outbreak first started and we were all just counting lab-confirmed cases by default, it became clear that we were not going to be able to describe the burden of the pandemic because so many people were not being tested,” said Turner, lead author of the CSTE statement on covid-19.
“We usually don’t approach a death separately from a case, but in this situation, we decided it was needed,” she said.
The CSTE recommended reporting probable and confirmed cases and deaths on April 5. The CDC’s written response to the recommendations, which was shared with The Post, said the agency “concurs” and that adoption by states is “very important” for covid-19 record-keeping. On April 14, the CDC noted on its website that the national tally includes probables, although the agency did not at that time provide a state-by state breakdown. The CDC also modified the form states use for coronavirus reports, adding boxes that can be checked to indicate a “lab-confirmed” case or “probable” case.
Probable cases were defined as showing symptoms and having contact with an infected person, or meeting one of those criteria and testing positive for coronavirus antibodies, rather than for the virus itself. Probable deaths meant those who were never tested for the virus but whose death certificates listed covid-19 as the cause of death or a significant condition contributing to death.
The CSTE statement also says that confirmed and probable counts should be included in the tallies “released outside the public health agency,” which could mean a state website or written report, according to the organization.
“When states are using different approaches, it always begs the question: ‘Why does one state choose one over another? Why a more conservative approach over a more sensitive one?’’’ asked Lorna Thorpe, director of the division of epidemiology at NYU Grossman School of Medicine. “That’s the reason we have standards and guidance that are technically sound.”
The erratic reporting of coronavirus cases and deaths means that what residents can learn about the extent of the pandemic in their community varies widely.
Ohio was one the first states to begin disclosing probable cases and deaths in early April. “It usually is a given when CSTE makes a recommendation like that,” said Brian Fowler, chief data officer for the Ohio Department of Health. “When they made that recommendation, we looked at it and said, okay, well this is what we need to use.”
As of June 5, Ohio’s website showed 2,117 confirmed deaths and 222 probables. By breaking out the numbers separately, Fowler said, “you can’t be accused of hiding information and you can’t be accused of inflating numbers — it’s all out there.”
The transition to counting probables was not “a huge lift,” Fowler said. Epidemiologists at the health department were already reviewing all suspected coronavirus cases.
Some health officials were candid about how adding probable deaths would boost the overall tally. “I want to make sure that everyone understands that these are not new deaths,” Indiana Health Commissioner Kristina Box said at an April 20 news conference. “Rather, we are capturing the deaths that have occurred really since this pandemic began.” Box suggested other states would do the same: “Indiana — like every other state — will include these deaths in our reporting in order to better capture the toll that covid-19 has truly taken.”
One week earlier, Michigan officials had said they intended to begin disclosing probable cases and deaths. When the state finally began doing that on June 5, more than 5,000 cases and 200 deaths were added to coronavirus totals.
California’s state health department is reviewing the process to track probable deaths and “working to provide as much data as possible about COVID 19 while ensuring that the data are valid and useful for understanding the pandemic,” according to a May 20 email to The Post.
Hilda Solis, a supervisor in Los Angeles County who represents a heavily Hispanic and impoverished district, said she was surprised that the state is not following national recommendations on counting coronavirus deaths. She has called for more post-mortem testing by the medical examiner. “A lot of people are dying at home. Poor people are dying at home. Homeless people are dying,” said Solis, a former U.S. labor secretary under President Barack Obama. “I do believe covid-19 is being underreported and that we need to take more responsibility.”
The scale of undercounting that results from reporting only confirmed cases became clear when New York City on April 14 added more than 3,700 probable deaths to its numbers, sending the city’s tally over 10,000.
The city that sits at the epicenter of the pandemic in the United States still is not counting probable cases, however. New York Gov. Andrew M. Cuomo, a Democrat praised for his command of daily news briefings during the pandemic, has indicated skepticism about recording probable cases. “Probable is different than confirmed,” he said at a news conference in late May. “Probable is ‘probable, but I have to check, I don’t know, I have to do further testing.’ We’ve had many cases that were probable coronavirus and turned out not to be coronavirus and that’s why they call them probable.” Covid-19 websites for New York and New Jersey include probable deaths at nursing homes, but those numbers are not included in the states’ overall death totals. A spokesperson for North Carolina’s health department said the state is not reporting probables because of wariness about the reliability of antibody tests, and because of concerns that the CSTE’s definition of a probable case is overly broad. Officials in Florida did not respond to repeated requests for comment about why the state isn’t following federal guidelines.
People behind ‘probables’
Behind each probable death is a person. Barnes O’Neal, 83, checked into the Brightmoor Nursing Center in Georgia in March to recover from a 10-day hospitalization. Less than a month into his stay at the facility about 40 miles south of Atlanta, a coronavirus outbreak forced a lockdown. O’Neal developed a fever and pneumonia. His daughter, Natalie Turner, pleaded with her father’s caretakers and the state health department for a coronavirus test. She said she wanted his illness on the record.
On April 20, just hours after Turner had spoken with him by phone, O’Neal died. He was never tested, but Turner said his doctor told her there was “zero doubt” it was covid-19 and wrote it on her father’s death certificate.
Still, her father, a frequent volunteer at the local soup kitchen, would not be included in the death toll on the state website because he was never tested. “It’s just important to me because my dad’s life counted,” Turner said. “I feel like there’s a face behind every statistic, and that’s forgotten many times.”
And now the pandemic’s overall death toll in U.S. has exceeded 100,000, but what are the real numbers?
Second U.S. Virus Wave Emerges as Cases Top 2 Million
Emma Court and David Baker noted that a second wave of coronavirus cases is emerging in the U.S., raising alarms as new infections push the overall count past 2 million Americans.Texas on Wednesday reported 2,504 new coronavirus cases, the highest one-day total since the pandemic emerged. A month into its reopening, Florida this week reported 8,553 new cases — the most of any seven-day period. California’s hospitalizations are at their highest since May 13 and have risen in nine of the past 10 days.
A fresh onslaught of the novel coronavirus is bringing challenges for residents and the economy in pockets across the U.S. The localized surges have raised concerns among experts even as the nation’s overall case count early this week rose just under 1%, the smallest increase since March.
“There is a new wave coming in parts of the country,” said Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security. “It’s small and it’s distant so far, but it’s coming.”
Though the outbreaks come weeks into state reopenings, it’s not clear that they’re linked to increased economic activity. And health experts say it’s still too soon to tell whether the massive protests against police brutality that have erupted in the past two weeks have led to more infections.
In Georgia, where hair salons, tattoo parlors and gyms have been operating for a month and a half, case numbers have plateaued, flummoxing experts.
Puzzling differences show up even within states. In California, which imposed a stay-at-home order in late March, San Francisco saw zero cases for three consecutive days this week, while Los Angeles County reported well over half of the state’s new cases. The White House Coronavirus Task Force has yet to see any relationship between reopening and increased cases of Covid-19, Food and Drug Administration Commissioner Stephen Hahn said on a podcast.
But in some states, rising numbers outpace increases in testing, raising concerns about whether the virus can be controlled. It will take a couple of weeks to know, Toner said, but by then “it’s going to be pretty late” to respond.
Since the pandemic initially swept the U.S. starting early this year, 2 million people have been infected and more than 112,000 have died.
After a national shutdown that arrested the spread, rising illness had been expected as restrictions loosened. The trend has been observed across 22 states in recent weeks, though many increases are steady but slow.
In New York, the state hardest hit by Covid-19, Governor Andrew Cuomo only recently started reopening by region. New York City, the epicenter, began the first of four phases Monday.
“We know as a fact that reopening other states, we’re seeing significant problems,” Cuomo said Tuesday. “Just because you reopen does not mean you will have a spike, but if you are not smart, you can have a spike.”
Experts see evidence of a second wave building in Arizona, Texas, Florida and California. Arizona “sticks out like a sore thumb in terms of a major problem,” said Jeffrey Morris, director of the division of biostatistics at University of Pennsylvania’s Perelman School of Medicine.
Arizona’s daily tally of new cases has abruptly spiked in the last two weeks, hitting an all-time high of 1,187 on June 2.
This week, its Department of Health Services urged hospitals to activate emergency plans. Director Cara Christ, told a Phoenix television station that she was concerned about the rising case count and percentage of people tested who are found to be positive.
Valleywise Health, the public hospital system in Phoenix, has seen an increase in Covid-19 cases during the past two weeks. It’s expanded its intensive-care capacity and those beds are 87% full, about half with Covid patients, according to Michael White, the chief medical officer.
White said Valleywise has adequate protective gear for staff, but hospitals aren’t getting their entire orders. A surge in Covid cases could put that supply under stress, he said.
The increase in transmission follows steps to resume business and public life as well as the riots and protests.
“Within Phoenix, we’ve been more relaxed than I’ve seen in some of the other parts of the country,” White said, with some people disregarding advice to wear masks and maintain six feet of distance from others. “People are coming together in environments where social distancing is challenging.”
Texas on Wednesday reported a 4.7% jump in hospitalizations to 2,153, the fourth consecutive daily increase. The latest figures showing an escalation came as Governor Greg Abbott tweeted a public service announcement featuring baseball legend Nolan Ryan urging Texans to wash their hands and to not be “a knucklehead.”
Abbott was criticized for an aggressive reopening last month. Mobile-phone data show activity by residents is rebounding toward pre-Covid levels, according to the Children’s Hospital of Philadelphia’s PolicyLab.
That could reflect a perception that the virus wasn’t “ever a big threat,” said Morris, who recently moved to Philadelphia after 20 years in Houston.
Florida’s health department said in a statement that it attributes the increase in cases to “greatly expanded efforts in testing,” and noted that overall positivity rates remain low, at about 5.5%.
Bucking the trend is Georgia, which was the first U.S. state to reopen. Covid cases there have plateaued. Despite local outbreaks in the state, “their sea levels did not rise,” said David Rubin, director of the PolicyLab, which has been modeling the virus’ spread. “They’ve kind of held this fragile equilibrium.”
California was the earliest state to shut down its economy over the coronavirus, after one of the nation’s first outbreaks in the San Francisco Bay Area. It has been slower than most to reopen.
Even so, the state has also seen the number of people hospitalized with Covid-19 rebound in the past two weeks, as commerce accelerates. Case counts are climbing too, although officials attribute that to increased testing and say it’s a sign of preparation.
In part, rising numbers represent the virus spreading into places that largely avoided the first round of infections, including rural Imperial County in California’s southeastern desert. Yet the contagion remains present in places that bore the brunt of the first wave, including Los Angeles County. Hospitalizations there are lower than at the start of May, but deaths remain stubbornly high, with 500 in the past week alone.
Barbara Ferrer, Los Angeles County public health director, said the region has likely not seen the end of the first wave. And despite concerns about infections coming out of mass demonstrations in the sprawling city, she thinks the reopening of the economy will have a bigger impact.
“We’re not at the tail end of anything,” Ferrer said. “We never had a huge peak. We’ve kind of been within this band. We’re not in decline, we’re kind of holding our own in ways that protect the health-care system.” But, she added, “go to Venice and see the crowds, and you’ll understand why I have concerns.”
The U.S. has long been bracing for another wave, but future outbreaks are likely to take a different shape. Social distancing and mask-wearing, as well as careful behavior by individuals, are likely to have staying power even as economies reopen.
Experts are steeling for autumn, when changes in weather and back-to-school plans could have damaging repercussions.
“The second wave isn’t going to mirror the first wave exactly,” said Lance Waller, a professor at Emory University’s Rollins School of Public Health in Atlanta. “It’s not snapping back to exactly the same thing as before, because we’re not exactly the way we were before.”
Daniel Lucey, a fellow at the Infectious Diseases Society of America, compared the virus’ new paradigm with a day at the beach: The U.S. has been bracing for another “high tide” like the one that engulfed New York City. Today is a low tide, but “the waves are always coming in.”
As a physician I only stopped seeing my patients for two weeks during the pandemic. Why? I considered my patients cancer care a necessary demand. My cancer patients needed surgical procedures and the hospital didn’t consider those procedures urgent. So, I offered to do their surgical procedures in my office surgical suite under local anesthesia. If I didn’t the tumors would continue to grow and possibly metastasize or spread reducing their chances for cure. This brings up the important consideration that this pandemic is allowing our regular medical and surgical patient to result in delayed diagnoses and treatment. Victor Garcia reported that the Coronavirus lockdowns may be “killing” just as many people as the virus because as I mentioned, many people with serious conditions unrelated to the virus have been skipping treatment, Hoover Institution senior fellow Dr. Scott Atlas said Saturday on “Fox Report.”
“I think one thing that’s not somehow receiving attention is the CDC just came out with their fatality rates,” Atlas said. “And lo and behold, they verify what people have been saying for over a month now, including my Stanford epidemiology colleagues and everyone else in the world who’s done this analysis — and that is that the infection fatality rate is less than one-tenth of the original estimate.”
Even White House coronavirus task force member Dr. Anthony Fauci is acknowledging the harm caused by the lockdown, Atlas said. “The policy itself is killing people. I mean, I think everyone’s heard about 650,000 people on cancer, chemo, half of whom didn’t come in. Two thirds of cancer screenings didn’t come in. 40 percent of stroke patients urgently needing care didn’t come in,” Atlas said. “And now we have over half the people, children in the United States not getting vaccinations. This is really what [Fauci] said was irreparable harm.”
More on Dr. Fauci later in this post.
“And I and my colleagues from other institutions have calculated the cost of the lockdown in terms of lives lost,” Atlas said. “Every month is about equal to the entire cost of lives lost during the COVID infection itself. This is a tragic, misguided public policy to extend this lockdown, whether or not it was justifiable in the beginning.”
Many states are currently reopening their economies slowly, while a few have pledged to extend the lockdowns through the summer.
The doctor also argued against keeping children out of schools, saying there’s no reason they can’t go back. “There’s no science whatsoever to keep K-through-12 schools closed, nor to have masks or social distancing on children, nor to keep summer programs closed,” Atlas said. “What we know now is that the risk of death and the risk of even a serious illness is nearly zero in people under 18.”
Lockdown measures have kept nearly 80 million children from receiving preventive vaccines
Caitlin McFall of Fox News reported that the coronavirus pandemic has resulted in stay-at-home orders that are putting young children at risk of contracting measles, polio and diphtheria, according to a report released Friday by the World Health Organization (WHO).
Routine childhood immunizations in at least 68 countries have been put on hold due to the unprecedented spread of COVID-19 worldwide, making children under the age of one more vulnerable.
More than half of 129 counties, where immunization data was readily available, reported moderate, severe or total suspensions of vaccinations during March and April.
“Immunization is one of the most powerful and fundamental disease prevention tools in the history of public health,” said WHO Director-General Tedros Adhanom Ghebreyesus. “Disruption to immunization programs from the COVID-19 pandemic threatens to unwind decades of progress against vaccine-preventable diseases like measles.”
The WHO has reported the reasons for reduced immunization rates vary. Some parents are afraid to leave the house due to travel restrictions relating to the coronavirus, whereas a lack of information regarding the importance of immunization remains a problem in some places.
Health workers are also less available because of COVID-19 restrictions.
The Sabin Vaccine Institute, the United Nations Children’s Fund (UNICEF) and GAVI, The Vaccine Alliance also contributed to the report.
Experts are worried that worldwide immunization rates, which have progressed since the 1970s, are now being threatened.
“More children in more countries are now protected against more vaccine-preventable diseases than at any point in history,” said Gavi CEO Dr. Seth Berkley. “Due to COVID-19 this immense progress is now under threat.”
UNICEF has also reported a delay in vaccine deliveries because of coronavirus restrictions and is now “appealing to governments, the private sector, the airline industry, and others, to free up freight space at an affordable cost for these life-saving vaccines.”
Experts say that children need to receive their vaccines by the age of 2. And in the case of polio, 90 percent of the population need to be immunized in order to wipe out the disease. Polio is already making a comeback in some parts of the world, with more than a dozen African countries reporting polio outbreaks this year.
“We cannot let our fight against one disease come at the expense of long-term progress in our fight against other diseases,” said UNICEF’s Executive Director Henrietta Fore. “We have effective vaccines against measles, polio and cholera,” she said. “While circumstances may require us to temporarily pause some immunization efforts, these immunizations must restart as soon as possible or we risk exchanging one deadly outbreak for another.”
Six Social Health System Teams to Encourage People to Seek Healthcare
Alexandra Wilson Pecci noted that the campaign, which aims to encourage people to get healthcare when they need it, comes as providers across the country have seen a dramatic drop in visits and revenue during the COVID-19 pandemic.
Six of Los Angeles County’s largest nonprofit health systems with hospitals, clinics, and care facilities are teaming for BetterTogether.Health, a campaign that aims to encourage people to get healthcare when they need it, despite the current pandemic.
The campaign, from Cedars-Sinai, Dignity Health, Providence, UCLA Health, Keck Medicine of USC, and Kaiser Permanente, comes as hospitals and healthcare provider offices across the country have seen a dramatic drop in visits and revenue.
“We know many patients who in the past dialed 911 for life-threatening emergencies are now not accessing these vital services quickly,” Julie Sprengel, President, Southwest Division of Dignity Health Hospitals, CommonSpirit Health, said in a statement. “We are instead seeing patients that delayed, postponed or cancelled care coming to emergency departments with serious conditions that should have been treated far earlier.”
Indeed, outpatient hospital visits experienced a record one-week 64% decline during the week of April 5-11, compared to pre-COVID-19 volumes, according to research from TransUnion Healthcare. In addition, hospital visit volumes further declined 33%-62% between the weeks of March 1-7 and April 12-18.
Those stats were echoed in a Medical Group Management Association (MGMA) survey last month showing that physician practices reported a 60% average decrease in patient volume and a 55% average decrease in revenue since the beginning of the public health emergency.
In addition, nearly two-thirds of hospital executives expect full year revenues will decline by at least 15% due to the coronavirus disease 2019 (COVID-19) outbreak, according to a Guidehouse analysis of a survey conducted by the Healthcare Financial Management Association (HFMA).
The campaign’s website and PSAs communicate messages like “Life may be on pause. Your health isn’t.,” “Thanks L.A. for doing your part.,” and “Get care when you need it.”
In addition to lost revenue, healthcare providers are warning of a “silent sub-epidemic” of those who are avoiding getting medical care when they need it, which could result in serious, negative health consequences that could be avoided.
“There is concern that patients with serious conditions are putting off critical treatments,” Tom Jackiewicz, CEO of Keck Medicine of USC, said in a statement. “We know that seeking immediate care for heart attacks and strokes can be life-saving and may minimize long-term effects. Our hospitals and health care providers are ready and open to serve your needs.”
The BetterTogether.Health public service effort combines those health systems’ resources to create a joint message that will include multi-language television and radio spots, and billboards, messages in newspapers, magazines, digital, and social media; online information, and links to healthcare resources.
It’s reminding people to seek care for things ranging from heart attack symptoms to keeping up with children’s immunization schedules.
“Receiving timely treatment by skilled medical professionals is essential to helping us achieve for our patients and communities the best possible outcomes,” Tom Priselac, President and CEO of Cedars-Sinai Health System. “Please do not delay getting your health care. We encourage you to call a trusted health care provider like your doctor’s office, hospital or urgent care center.”
Doctors raise alarm about health effects of continued coronavirus shutdown: ‘Mass casualty incident’
Furthermore, Tyler Olson reported something that most of us physicians realized as this pandemic continued that and that more than 600 doctors signed onto a letter sent to President Trump Tuesday pushing him to end the “national shutdown” aimed at slowing the spread of the coronavirus, calling the widespread state orders keeping businesses closed and kids home from school a “mass casualty incident” with “exponentially growing health consequences.”
The letter what I stated in the beginning of this post, which outlines a variety of consequences that the doctors have observed resulting from the coronavirus shutdowns, including patients missing routine checkups that could detect things like heart problems or cancer, increases in substance and alcohol abuse, and increases in financial instability that could lead to “poverty and financial uncertainty,” which “is closely linked to poor health.”
“We are alarmed at what appears to be the lack of consideration for the future health of our patients,” the doctors say in their letter. “The downstream health effects … are being massively under-estimated and under-reported. This is an order of magnitude error.”
The letter continues: “The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.
“Because the harm is diffuse, there are those who hold that it does not exist. We, the undersigned, know otherwise.”
The letter comes as the battle over when and how to lift coronavirus restrictions continues to rage on cable television, in the courts, in protests and among government officials. Those for lifting the restrictions have warned about the economic consequences of keeping the shutdowns in effect. Those advocating a more cautious approach say that having more people out and about will necessarily end with more people becoming infected, causing what National Institute of Allergy and Infectious Diseases Director Dr. Anthony Fauci warned in a Senate hearing last week would be preventable “suffering and death.”
But these doctors point to others that are suffering, not from the economy or the virus, but simply from not being able to leave home. The doctors’ letter lists a handful of patients by their initials and details their experiences.
“Patient E.S. is a mother with two children whose office job was reduced to part-time and whose husband was furloughed,” the letter reads. “The father is drinking more, the mother is depressed and not managing her diabetes well, and the children are barely doing any schoolwork.”
“Patient A.F. has chronic but previously stable health conditions,” it continues. “Her elective hip replacement was delayed, which caused her to become nearly sedentary, resulting in a pulmonary embolism in April.”
Dr. Mark McDonald, a psychiatrist, noted in a conversation with Fox News that a 31-year-old patient of his with a history of depression who was attending school to get a master’s degree in psychology died about two weeks ago of a fentanyl overdose. He blames the government-imposed shutdown.
“She had to stay in her apartment, essentially in-house arrest as most people here in [Los Angeles] were for weeks and weeks, she could not see her therapist — she could speak to the therapist over the phone but she couldn’t see her in person. She could not attend any of her group meetings, which were helping to maintain her abstinence from opiates … and she relapsed into depression.
“She was just too withdrawn to ask for help,” McDonald continued before noting that due to regulations only six people could be at her funeral. “She was simply trying to escape from her pain… I do blame these actions by the government for her death.”
Fox News asked McDonald, as well as three other doctors who were involved with the letter, if they thought the indirect effects of the shutdowns outweighed the likely direct consequences of lifting them — the preventable “suffering and death” Fauci referred to in last week’s Senate hearing. All four said that they believe they do.
“The very initial argument … which sounded reasonable three months ago, is that in order to limit the overwhelmed patient flux into hospitals that would prevent adequate care, we needed to spread out the infections and thus the deaths in specific locales that could become hotspots, particularly New York City… It was a valid argument at the beginning based on the models that were given,” McDonald said. “What we’ve seen now over the last three months is that no city — none, zero — outside of New York has even been significantly stressed.”
McDonald is referring to the misconception that business closures and stay-at-home orders aimed at “flattening the curve” are meant to reduce the total number of people who will fall ill because of the coronavirus. Rather, these curve-flattening measures are meant largely to reduce the number of people who are sick at any given time, thus avoiding a surge in cases that overwhelms the health care system and causes otherwise preventable deaths because not all patients are able to access lifesaving critical care.
McDonald said that “hospitals are not only not overwhelmed, they’re actually being shut down.” He noted that at one hospital in the Los Angeles area where Dr. Simone Gold, the head organizer of the letter, works “the technicians in the ER have been cut by 50 percent.”
Gold also said the effects of the shutdown are more serious for the vast majority of people than the potential virus spread if it is quickly lifted.
“When you look at the data of the deaths and the critically ill, they are patients who were very sick to begin with,” she said, “There’s always exceptions. … But when you look at the pure numbers, it’s overwhelmingly patients who are in nursing homes and patients with serious underlying conditions. Meaning, that that’s where our resources should be spent. I think it’s terribly unethical… part of the reason why we let [the virus] fly through the nursing homes is because we’re diverting resources across society at large. We have limited resources we should put them where it’s killed people.”
People of all ages, of course, have been shown to be able to catch the coronavirus. And there have been reported health complications in children that could potentially be linked to the disease. Fauci also warned about assuming that children are largely protected from the effects of the virus.
“We don’t know everything about this virus … especially when it comes to children,” Fauci said in a Senate hearing last week. “We ought to be careful and not cavalier.”
Newport Beach, Calif., concierge doctor Dr. Jeffrey Barke, who led the letter effort with Gold, also put an emphasis on the disparity in who the virus effects.
“There are thousands of us out there that don’t agree with the perspective of Dr. Fauci and [White House coronavirus response coordinator] Dr. Deborah Birx that believe, yes, this virus is deadly, it’s dangerous, and it’s contagious, but only to a select group of Americans,” he said. “The path forward is to allow the young and healthy, the so-called herd, to be exposed and to develop a degree of antibodies that both now is protective to them and also prevents the virus from spreading to the most vulnerable.”
Dr. Scott Barbour, an orthopedic surgeon in Atlanta, reflected the comments the other doctors made about how the medical system has been able to handle the coronavirus without being overwhelmed, but also noted that the reported mortality rates from the coronavirus might be off.
“The vast majority of the people that contract this disease are asymptomatic or so minimally symptomatic that they’re not even aware that they’re sick. And so the denominator in our calculation of mortality rate is far greater than we think,” he said. “The risk of dying from COVID is relatively small when we consider these facts.”
Gold, an emergency medicine specialist based in Los Angeles, led the letter on behalf of a new organization called A Doctor a Day.
A Doctor a Day has not yet formally launched but sent the letter, with hundreds of signatures from physicians nationwide, to the White House on Tuesday. Gold and the group’s co-founder, Barke, said they began the organization to advocate for patients against the government-imposed coronavirus shutdowns by elevating the voices of doctors who felt that the negative externalities of the shutdowns outweigh the potential downside of letting people resume their normal business.
To gather signatures for the letter, Gold and Barke partnered with the Association of American Physicians and Surgeons (AAPS), a doctors’ group that advocates for less government interference in the relationship between doctors and patients, and notably has taken part in legal challenges against the Affordable Care Act and advocated to allow doctors to use hydroxychloroquine on themselves and their patients.
Gold, in a conversation with Fox News, lamented that the debate around hydroxychloroquine has become politicized, noting that it is taken as a preventative measure for other diseases and that the potentially harmful effects of the drug mainly affect people with heart issues.
The drug is approved to treat malaria, lupus and rheumatoid arthritis, but the Food and Drug Administration has said that “hydroxychloroquine and chloroquine have not been shown to be safe and effective for treating or preventing COVID-19.”
The FDA has also warned health professionals that the drug should not be used to treat COVID-19 outside of hospital or research settings.
Gold said she has direct knowledge of physicians who are taking hydroxychloroquine and said that although “we will see” about its efficacy as it is studied more, there have been some indicators that it could be effective at preventing or mitigating COVID-19 and she could therefore understand why doctors might take the drug themselves or prescribe it to their patients.
There is also other research that appears to indicate hydroxychloroquine is not an effective treatment for the coronavirus, which has largely informed the consensus that the risks of the drug outweigh the potential benefits.
Gold, who is a member of the national leadership council for the Save Our Country Coalition — an assortment of conservative groups that aim “to bring about a quick, safe and responsible reopening of US society” — also said she was concerned that her message about the harms of shutdowns is becoming politicized. She said that she agreed with the general principles of the coalition and decided to sign on when asked, but hasn’t done much work with it and is considering asking to have her name removed because people are largely associating her message on reopening the country with a conservative political point of view.
“I haven’t done anything other than that,” she said. “It’s causing a big misunderstanding about what I’m doing so I actually think I’m just going to take my name off because it’s not really supposed to be political.”
Gold also said she is not associated with the Trump reelection campaign in any way, referring to her inclusion in an Associated Press story about the Trump campaign’s efforts to recruit doctors to support the president’s message on lifting coronavirus restrictions. The AP story details a call organized CNP Action, also part of the Save Our Country Coalition, which involved a senior Trump campaign staffer and was aimed at recruiting “extremely pro-Trump” doctors to make television appearances calling for the reopening of the economy as quickly as possible.
Fauci says extended stay-home orders could cause ‘irreparable damage’
Just recently Dr. Fauci changed his view on stay-home orders. Dom Calicchio reported that stay-home orders that extend too long could cause the U.S. “irreparable damage,” Dr. Anthony Fauci finally warned Friday.
Strict crackdowns on large gatherings and other orders, such as for home quarantines, were needed when the coronavirus first hit the nation, but those rules can now begin to be lifted in many parts of the country, Fauci said during an interview on CNBC.
“I don’t want people to think that any of us feel that staying locked down for a prolonged period of time is the way to go,” the member of the White House coronavirus task force said.
“But now is the time, depending upon where you are and what your situation is, to begin to seriously look at reopening the economy, reopening the country to try to get back to some degree of normal.” He warned, however, against reckless reopenings and called for the use of “very significant precautions” as restrictions are lifted.
Fauci told CNBC that staying closed for too long could cause “irreparable damage.” He said the US had to institute severe measures because #Covid19 cases were exploding “But now is the time, depending upon where you are and what your situation is” to open.
“In general, I think most of the country is doing it in a prudent way,” he said. “There are obviously some situations where people might be jumping over that. I just say, ‘Please, proceed with caution if you’re going to do that.’”
Fauci’s comments came one day after two top Republicans – Sen. Rand Paul of Kentucky and Rep. Andy Biggs of Arizona – wrote in an op-ed that Fauci’s initial safety recommendations had “emasculated” the nation’s health care system and “ruined” its economy.
“Fauci and company have relied on models that were later found to be deficient. He even has suggested that he can’t rely, on any of the models, especially if the underlying assumptions are wrong,” the pair wrote in USA Today. “Yet, Fauci persists in advocating policies that have emasculated the medical care system and ruined the economy.”
They also pointed to Fauci’s testimony last week before a Senate committee that opening too soon would “result in needless suffering and death.”
“What about the countless stories of needless suffering and death produced by Fauci’s one-size-fits-all approach to public health?” Paul and Biggs asked.
They called for policies based on trusting the risk assessment of the American people rather than a federal government mandate.
Earlier Friday, Fauci said it was “conceivable” that the U.S. could begin to distribute a coronavirus vaccine by December. “Back in January of this year when we started the phase 1 trial, I said it would likely be between a year and 18 months before we would have a vaccine,” Fauci said during an interview on NPR. “I think that schedule is still intact.
“I think it is conceivable,” he continued, “if we don’t run into things that are, as they say, unanticipated setbacks, that we could have a vaccine that we could be beginning to deploy at the end of this calendar year, December 2020, or into January, 2021.”
My question is what does the future of medicine look like going forward from this pandemic and how do we plan for a better healthcare system and assist in the recovery of our economy?
Dr. Sarah-Anne Schumann, UnitedHealthcare’s chief medical officer for employer and individual health care plans in North Texas and Oklahoma, says telehealth visits are soaring.
The growth of telemedicine is apparent at UnitedHealthcare’s sister company, Optum, which went from 1,000 telemedicine-trained care providers to 5,000 in a matter of weeks. That number is expected to grow to 10,000 providers by the end of April.
In the interview that follows, Schumann, who is a family doctor in addition to her role with UnitedHealthcare, gives us a look at the growth of telemedicine during the coronavirus from the viewpoint of both the insurer and the physician.
How has the acceptance and reliance on telehealth grown given the COVID-19 pandemic?
Telehealth has been around for a long time, and basically what telehealth does is it allows people to see a doctor anywhere and anytime on a mobile device or computer. It’s available 24 hours a day, seven days a week. People can get their medical conditions diagnosed and treated that way. With the coronavirus, now that there’s a lot of risk with going into a doctor’s office — a risk of you exposing other people or you being exposed to coronavirus — more and more doctors’ practices have very quickly scaled up their technology to allow their doctors to provide telehealth.
Can you quantify the growth?
I have some statistics. Seventy-six percent of hospitals can connect patients and care providers using digital and other technology. On the employer side, nearly nine out of 10 employers offer telemedicine to their employees.
When did UnitedHealthcare start allowing for telehealth visits?
We did allow for telehealth before COVID, but our policies have changed. We have much broader coverage since COVID. Our policy now is we are covering telehealth with no cost-sharing at all. That started on March 31. As of now through June 18, we are waiving all cost-sharing for in-network health visits for our Medicaid, Medicare Advantage and our fully insured individual and group health plans. For self-funded employers, they can opt in to telehealth with no cost-sharing.
That’s not just for COVID-related visits, but for absolutely any telehealth visits. It’s not just primary care and urgent care, but also for outpatient behavioral health and physical therapy, occupational therapy and speech therapy.
Did UnitedHealthcare broaden the coverage because of the COVID-19 pandemic?
Yes. Some primary care offices are closed right now both for safety and because there’s decreased volume for a lot of the businesses. This is a very safe way to get people assessed when they’re feeling sick but not sick enough to go to an emergency room.
It’s my understanding that insurance won’t pay the same for a telehealth visit vs. an in-person doctor visit. Is that true with UnitedHealthcare?
They are covered at a different rate, but there are many ongoing conversations. Right now, with COVID, for the doctors’ practices that have moved over to provide telehealth, they are being reimbursed at the same rate as an in-person visit. Another change, because the doctor’s offices had to pivot so quickly to start offering this, right now, there can even be phone-only visits that are covered.
Typically, do you Facetime or how do the providers get the visuals from the patient?
If you have a smartphone, which most people have, or a tablet or computer, that’s usually how it works. But right now, you can do phone-only visits.
How does a patient find out if their existing doctor is signed up and licensed to practice telemedicine?
Call the practice or go on their website. It’s best to try your own doctor first, but if that doesn’t work, try your (insurance company’s) website and it will connect you with a national provider.
What should employers know about telehealth?
Telehealth, of course, is not for everything. But for simple, urgent medical issues like allergy symptoms or pink-eye or rashes or fever, telehealth is a great way for their employees to access care. It reduces the burden on the health care system and it reduces cost and improves accessibility to care. Another thing for employers to think about is, right now while people are at home, there’s a lot of increased stress and anxiety, and virtual visits can be a way to connect with a therapist or psychologist or psychiatrist.
Do you think the COVID-19 pandemic will cause permanent changes in how people access health care?
A lot of the changes that we are experiencing in society because of the pandemic are going to be permanent changes. Things like people working from home. Some people are more productive when they’re working from home. It’s the same thing with telemedicine. Now that people are introduced to this, I think in the cases where telemedicine is a good substitute, waiting to see the doctor for urgent-care type visits where you don’t need to have a blood test done or get IV medication or things like that, people are going to see that telemedicine is a great substitute.
How to reopen the US, according to Johns Hopkins and Harvard: Test 20 million people a day, hire an army of contact tracers, and expand healthcare coverage
Hilary Bruek reported that experts from Harvard and Johns Hopkins, as well as the former FDA commissioner, have each released their plans for how to reopen the country safely.
The plans suggest the US will need to massively ramp-up its disease testing and tracing capabilities to allow people to return to work and school.
Collectively, the reports suggest the US will need: around 5 million tests a day by July, 100,000 public health workers to contact trace, and a “national infectious disease forecasting center.”
Most Americans are still stuck at home, but a trio of reports, out from Harvard, Johns Hopkins, and former US Food and Drug Administration Commissioner Scott Gottlieb, are starting to lay a foundation for what reopening the country might look like, if done safely.
Though staying inside is certainly keeping more infections at bay right now, it’s not without its costs.
Aside from the strain stay-at-home orders are putting on families, friends and communities, the newfound national quiet means the US is “hemorrhaging $100 billion to $350 billion a month,” according to the new Harvard analysis, which was released on Monday.
A hasty, careless reopening would be a deadly disaster, though.
If everyone rushed back into the streets, hugging, kissing, shaking hands, and entirely abandoning social distancing measures, more than 300,000 people nationwide could die, according to federal documents from the Department of Health and Human Services, first released in a report from the Center for Public Integrity on Tuesday.
That’s why any thoughtful plan to reopen the country must involve massive additional investments in public health, especially the testing and tracing of US coronavirus cases.
Here are the key topline suggestions from the experts for not only emerging from the coronavirus crisis successfully and safely, but also, as the Harvard report put it, becoming a “pandemic resilient” nation.
Harvard’s Roadmap to Pandemic Resilience says more testing is fundamental to recovery
Broadly, the Harvard report suggests the task ahead of us is “bigger than most people realize.”
“We need to massively scale-up testing, contact tracing, isolation, and quarantine—together with providing the resources to make these possible for all individuals,” the authors write.
In the coming months, the US should rapidly ramp up its capacity to test for the coronavirus, eventually testing upwards of 2 to 6% of the population on any given day. (Currently, the US tests around 150,000 people per day, or about 0.04% of the population.) The plan starts with: 5 million tests per day by early June, and continues trending upward towards 20 million tests a day nationwide, by late July. That kind of widespread testing would be on a scale larger than Germany (testing 0.06% of the country per day, with more than 50,000 coronavirus tests), and would even surpass South Korea, which so far has tested more than 1.1% of the country, overall, for COVID-19.
But “even this number may not be high enough to protect public health,” the report authors warn.
“Given that 40% of the economy is already open,” the report says, “our first priority for a massively scaled up pandemic testing program should be to stabilize the essential workforce.” Policy makers should listen to worker voices, the report also said, “because workers have expert knowledge about how to make their jobs safe and when safety-related rules are not being followed.”
Tests will eventually also be needed for others, including:
Everyone with coronavirus symptoms, and their close contacts.
People with presumed exposure (healthcare workers, essential workers, etc.)
Nursing home residents and staff.
Companies and schools.
“Those who have tested negative within a very recent window and those who show immunity in reliable antibody tests (assuming these prove feasible) should be free to return to work,” the report said.
The authors were cautious about the idea of immunity cards or passports, though. “Certificates of immunity should be used only in contexts where people have equal access to testing and where a recent negative test result provides the same access to mobility as immunity,” the report says. “Any other use of immunity certificates would be likely to violate constitutional equal protection requirements.”
In order to be able to follow 14-day quarantine orders successfully, people will need to be supported with more job protectionand healthcare, the report added.
The cost of testing and tracing at this scale is an estimated $50 – 300 billion over two years, which, the authors write is still far cheaper than “the economic cost of continued collective quarantine,” at $100 to 350 billion a month.
A Pandemic Testing Board should also be established by the federal government, the report suggests, with a National Director of Testing Supply appointed to help ramp up testing efforts. “In virtually every successful historical example of such rapid coordination, a central authority has set goals and ensured that each part of the chain meets the interlocking goals required for the chain to succeed,” the report authors add.
There’s just one problem, though: the Harvard approach relies on all coronavirus tests being accurate, but some are not
Claudio Furlan/LaPresse noted that the swab-the-nose-and-throat coronavirus testing delivers about 30% false negatives, which means that roughly 3 in 10 people who have the virus could wrongly assume they don’t after they’re tested, and then could go on to infect others at work or at school.
Coronavirus blood tests, which are meant to determine whether a person has been infected in the past with the coronavirus and developed disease-fighting antibodies, have so far performed much worse than the swab tests, with some operating at just 30% accuracy, the New York Times recently reported.
Johns Hopkins’ ‘National Plan to Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the US’ adds an army of contact tracers to the Harvard testing plan
The goal of deploying thousands of contact tracers across the US, the report authors write, is to “find every COVID-19 case in the midst of a national epidemic … and then work quickly to contain spread through intensive case and contact tracing interventions,” by warning others who might’ve been exposed to those sick people to stay home.
“This entire operation has never been done before,” New York Governor Andrew Cuomo said Wednesday, as he announced during a news conference that his state would be partnering with Johns Hopkins to roll out a new army of contact tracers in the tri-state area, to the tune of $10 million.
“You’ve never heard the words testing, tracing, isolate before,” Cuomo said. “No one has. We’ve just never done this.”
Here’s how the plan could work, nationwide:
Hire “an extra 100,000 contact tracers across the United States,” the report says. “While this figure may be stunning, it is still the equivalent of less than half the number [of contact tracers] employed in Wuhan,” the authors point out.
Contact tracers will need to be trained by existing state and territorial public health departments on: disease transmission, principles of case isolation and quarantine, ethics of public health data collection and use, risk communication, cultural sensitivity, and more.
The plan could provide jobs for: former government employees, retired public health and public safety workers & medical personnel, medical and public health students, Medical Reserve Corps or Peace Corps members, community health workers, and others “seeking employment—especially those who have lost their jobs due to COVID-19.” People with good communication and interviewing skills would be especially well-qualified for the task.
The new workforce will cost the US an estimated $3.6 billion, and the report authors urge Congress to fund this idea in its fourth stimulus package.
The cost of not tracing is also high: “It is estimated that each infected person can, on average, infect two to three others,” the authors write. “This means that if one person spreads the virus to three others, that first positive case can turn into more than 59,000 cases in 10 rounds of infections.”
Apple and Google have also released their own plans to make contact tracing and surveillance happen more automatically on our phones
Apple and Google are both working on new apps and other press-of-a-button opt-in functionalities for phones that would harness Bluetooth technology to track where we’ve been, and then warn others who’ve been near us, in the event we get sick with the coronavirus, in a new brand of push notification-friendly contact tracing.
The companies promise that “user privacy and security” will be paramount in any forthcoming app design.
Other countries have already tried out similar Bluetooth-reliant tracing techniques, but they’re not always very successful, as you need a large percentage of the population to use them in order to have any major impact on transmission.
Scott Gottlieb’s ‘Road Map to Reopening’ from the American Enterprise Institute adds in the element of a weather forecasting service for pandemics
James Gathany reviewed that Scott Gottlieb reviewed the “Road Map to Reopening” from the American Institute and reported that Gottlieb calls it a “National Infectious Disease Forecasting Center,” and says “this permanent federal institution would function similarly to the National Weather Service, providing a centralized capability for both producing models and undertaking investigations to improve methods used to advance basic science, data science, and visualization capabilities.”
Gottlieb also cautioned that we should not rush to return the US to business-as-usual, even as some restrictions are lifted. As schools and businesses reopen, “teleworking should continue where convenient” he said, and “social gatherings should continue to be limited to fewer than 50 people wherever possible.”
‘It’s going to be brutal,’ billionaire Mark Cuban says of economy’s recovery from coronavirus, and ‘there’s no way to sugarcoat it’
‘It’s going to be brutal. There’s no way to sugarcoat it at all.’
That is outspoken billionaire and Dallas Mavericks owner Mark Cuban, who has been increasingly visible as the National Basketball Association has been temporarily suspended due to the deadly COVID-19 pandemic.
Reporter DeCambre reviewed an interview with Mark Cuban with Maria Bartiromo. Cuban, speaking with Fox Business anchor Maria Bartiromo, explained why he thought the recovery from the economic fallout wrought by the illness caused by a novel coronavirus strain could be a long and ugly one for the average American and small businesses in particular.
“It’s going to be brutal. There’s no way to sugarcoat it at all. And when we get to the other side, companies are going to be operating differently,” Cuban said on the business network.
The entrepreneur, who boasts a net worth of $4.3 billion, according to Forbes, says that challenges for businesses are manifold and include additional costs that will be incurred to sanitize and retrofit spaces as nearly shutdown economies attempt to reboot after a virus-imposed hibernation.
“Companies are going to have to be agile … Companies are going to have to build from the bottom up,” Cuban said.
The “Shark Tank” star said he remains confident that some normalcy will return in two to three years but predicts that investors and business owners will need to endure some pain to get to the other side.
His comments came as Robert Redfield, director of the Centers for Disease Control and Prevention, was quoted in the Washington Post as saying in an interview published on Tuesday that “there’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through.”
The deadly contagion that was first identified late last year in Wuhan, China, has, infected more than 2.6 million people globally and killed about 179,000, according to data aggregated by Johns Hopkins University, as of Wednesday morning.
On Thursday, investors and others will be watching for a House vote on a nearly $500 billion aid package for small businesses amid the coronavirus pandemic, after the Senate passed the measure on Tuesday.
The passage of the bill and the possibility of restarting stalled economies may be conferring some optimism on markets, with the Dow Jones Industrial Average DJIA, +1.10%, the S&P 500 SPX, +1.39% and the Nasdaq Composite Index COMP, +1.64% all closing sharply higher Wednesday.
That said, Cuban believes that small businesses may require at least a third installment of funds to operate through the crisis, and he is looking to invest in companies that sit outside the criteria for obtaining government-backed loans.
“We haven’t talked about those companies that are 501 and up. They are suffering the most,” he said, referring to language that stipulates that businesses need to have 500 or fewer employees to qualify for the small-business recovery funding.
So, when do we really reopen the economy and back to the “new” normal and do we use scientific data? I think as we can see we need data based on more testing, but the testing has to be accurate and more sensitive and then we need comprehensive contact tracing and case follow-up tracing. Also, what technology will we use for contact tracing and could it be the use of APPS on our phones or other home health and fitness wearables or other real time monitors?
This technology needs to integrate multiple longitudinal electronic medical records across all sources including healthcare providers and healthcare facilities, labs, clinics, pharmacies, long-term care facilities, etc. with nationwide coverage and interoperability and more important it needs to be HIPPA compliant to respect personal information.
Big wishes and needs, which will lead the way to solutions and attaining our goals of defeating COVID-19 and also prepare the US for whatever the next possible pandemic may raise its ugly head!
This is a lengthy post but with all the fear regarding COVID-19 I thought that it would be worth the time. I became more aware as we traveled to the West Coast for a half marathon at Napa Valley. There were many people on our planes wearing masks and my wife was so worried about our planned trip to Europe in April. The cruise companies now our offering to either give one hundred percent refund or hold the paid fees for 2 years to allow rescheduling of the cruises. Can you imagine what the Corona Virus scare is doing to economies around the world>
Sarah Midkiff reported that as the deadly coronavirus outbreak approaches pandemic status, the U.S. government remains in the midst of approving legislation for a $7.5 billion emergency spending bill. Meanwhile, coronavirus continues its spread in the U.S. — with 100 confirmed cases and six deaths across 15 states — so the need for these funds is more imperative than ever. The emergency bill will allocate money to the Department of Health and Human Services for vaccine development, protective and medical equipment, and aid for state and local governments affected by an outbreak, according to the Washington Post.
But, what legislators have yet to mention is whether subsidizing treatment or funding low-cost and free clinics will be part of the plan. The bill may address availability of vaccine development, but it does not directly address affordability of testing or treatment, which is of the utmost importance during a pandemic.
A report published by America’s Health Insurance Plans (AHIP) on Thursday stated that the Centers for Disease Control and Prevention (CDC) is currently the only facility equipped to test for COVID-19. The CDC is not billing for testing, but the test itself isn’t the only line item on a possible medical bill. There is the cost of the doctor’s visit; other tests they might run in conjunction with COVID-19, such as standard flu tests; treatment and medication, as well as getting the vaccine when it becomes available. And, medical bills can grow astronomically high if someone requires in-patient care, like an overnight stay in the hospital.
Stories have already begun to emerge of Americans seeking testing only to find that their insurance was insufficient to the tune of thousands of dollars in medical bills. One such example is a man in Florida who faces a $3,270 medical bill after he went through his insurance when he was concerned he might have been exposed to coronavirus. He was confirmed negative for COVID-19 after testing positive for the flu via a standard flu test rather than the more expensive CT scan which has been proven to be the most consistent test in diagnosing coronavirus.
Others have undergone government-mandated treatment and found that, despite the procedure being required, they were the ones left to foot bills that totaled thousands of dollars. Experiences like this make it easy to see why a 2018 national poll conducted by West Institute and NORC at the University of Chicago found that 44% of Americans declined to see a doctor due to cost.
Notably, the U.S. is alone among other developed countries as the only one that doesn’t offer federally mandated paid sick leave. This makes it particularly difficult to follow the CDC’s current advice that people experiencing even mild respiratory symptoms should stay home, other than when getting medical care. Between a lack of mandated paid sick leave and approximately 27 million Americans currently without health insurance, the coronavirus outbreak is at risk of exhausting our already failing public health system.
Even among people with health insurance, 29% are underinsured, according to results from a 2018 Commonwealth’s Fund survey, meaning that even though they technically have an insurance plan, the copays and deductibles make seeking care unaffordable in relation to their income. Cases of the virus could go undetected and untreated simply because Americans cannot afford to be saddled with medical debt or go without pay to take sick leave (or both), thus encouraging a rapid spread of the virus as people attempt to “power through” in spite of symptoms.
And then there are the approximately 11 million undocumented U.S. residents: Many of these people are un- or under-insured, and also have to grapple with the justified fear of coming into contact with federal authorities, therefore preventing them from seeking medical care.
If further evidence is needed that our health care system has been crippled by privatization, government officials are not debating whether or not pharmaceutical companies should be allowed to profit from a vaccine, but are just figuring out by how much. Last week, the Department of Health and Human Service secretary, Alex Azar, would not commit to price controls on a coronavirus vaccine. “We need the private sector to invest… price controls won’t get us there,” said Azar.
House Speaker Nancy Pelosi responded directly to Azar’s comments. “This would be a vaccine that is developed with taxpayer dollars…We think that should be available to everyone—not dependent on ‘Big Pharma,’” she said in a press release on February 27. She described the vaccine as needing to be “affordable,” but what does that even mean? What is affordable to some is not affordable to all.
Still, a vaccine – affordable or not – is a ways off. In a coronavirus task force briefing with Donald Trump on Monday, experts estimated that it would take a year to a year-and-a-half before a vaccine would be effective and safe for the public, reports CNN. Until then, the economic inequality that runs rampant in America is bound to be reflected in who can afford to survive this epidemic, and who can’t.
US may pay for uninsured coronavirus patients
Washington (AFP) – The US may invoke an emergency law to pay for uninsured patients who get infected with the new coronavirus, a senior health official said Tuesday.
Public health experts have warned that the country’s 27.5 million people who lack health coverage may be reluctant to seek treatment, placing themselves at greater risk and fueling the spread of the disease.
Robert Kadlec, a senior official with the Health and Human Services department told the Senate on Tuesday that talks were underway to declare a disaster under the Stafford Act, which would allow the patients’ costs to be met by the federal government.
Under this law, their health care providers would be reimbursed at 110 percent of the rate for Medicaid, a government insurance program for people with low income, he added.
“We’re in conversations, initial conversations with CMS (Centers for Medicare & Medicaid Services) to understand if that could be utilized in that way and be really impactful,” Kadlec told a Senate committee.
President Donald Trump also touched on the issue as he headed to a briefing on the coronavirus outbreak at the National Institutes of Health in Washington on Tuesday.
“We’re looking at that whole situation. There are many people without insurance,” Trump told reporters.
The number of Americans without health insurance began falling from a high of 46.5 million in 2010 following the passage of Obamacare (the Affordable Care Act).
It climbed again to 27.5 million in 2018, or 8.5 percent of the population, from 25.6 million the year before.
The reasons include policies by Trump’s administration that made it harder to enroll in Medicaid — such as adding requirements to work — or to sign up for insurance under the marketplaces created by Obamacare.
The Republican-held Congress also repealed a penalty on people who lack insurance, which may have led people to voluntarily drop out.
The Centers for Disease Control and Prevention (CDC) has said patients who are advised by their health care providers to stay at home should do so for at least two weeks, but a work culture that emphasizes powering through while sick could compound the problem further.
The US is alone among advanced countries in not offering any federally mandated paid sick leave. While some states have passed their own laws, 25 percent of American workers lacking any whatsoever, according to official data.
Maia Majumder, an epidemiologist at Harvard, told AFP she was particularly concerned by low-wage workers in the service and hospitality sector, who cannot afford to take time off but could act as vectors to transmit the spread of the disease.
The latest coronavirus death rate is 3.4% — higher than earlier figures. Older patients face the highest risk.
The global death rate for the novel coronavirus based on the latest figures is 3.4% — higher than earlier figures of about 2%.
In contrast, the seasonal flu kills 0.1% of those infected.
A patient’s risk of death from COVID-19 varies depending on age and preexisting health conditions.
Though the latest numbers mark an increase in mortality, experts have predicted that the fatality rate of COVID-19 could decrease as the number of confirmed cases rises.
The latest global death rate for the novel coronavirus is 3.4% — higher than earlier figures of about 2%.
The coronavirus outbreak that originated in Wuhan, China, has killed more than 3,100 people and infected nearly 93,000 as of Tuesday. The virus causes a disease known as COVID-19.
Speaking at a media briefing, the World Health Organization’s director-general, Tedros Adhanom Ghebreyesus, noted that the death rate was far higher than that of the seasonal flu, which kills about 0.1% of those infected.
The death rate is likely to change further as more cases are confirmed, though experts predict that the percentage of deaths will decrease in the longer term since milder cases of COVID-19 are probably going undiagnosed.
“There’s another whole cohort that is either asymptomatic or minimally symptomatic,” Anthony Fauci, the director of the US National Institute of Allergy and Infectious Diseases, said at a briefing last month. “We’re going to see a diminution in the overall death rate.”
‘It is a unique virus with unique characteristics’
Tedros noted differences between the novel coronavirus and other infectious diseases like MERS, SARS, and influenza. He said the data suggested that COVID-19 did not transmit as efficiently as the flu, which can be transmitted widely by people who are infected but not yet showing symptoms.
He added, however, that COVID-19 caused a “more severe disease” than the seasonal flu and explained that while people around the world may have built up an immunity to the flu over time, the newness of the COVID-19 meant no one yet had immunity and more people were susceptible to infection.
“It is a unique virus with unique characteristics,” he said.
Tedros said last week that the mortality rate of the disease could differ too based on the place where a patient receives a diagnosis and is treated. He added that people with mild cases of the disease recovered in about two weeks but severe cases may take three to six weeks to recover.
Older patients face the highest risk
A patient’s risk of dying from COVID-19 varies based on several factors, including where they are treated, their age, and any preexisting health conditions.
COVID-19 cases have been reported in at least 76 countries, with a vast majority in China.
A study conducted last month from the Chinese Center for Disease Control and Prevention showed that the virus most seriously affected older people with preexisting health problems. The data suggests a person’s chances of dying from the disease increase with age.
Notably, the research showed that patients ages 10 to 19 had the same chance of dying from COVID-19 as patients in their 20s and 30s, but the disease appeared to be much more fatal in people ages 50 and over.
About 80% of COVID-19 cases are mild, the research showed, and experts think many mild cases haven’t been reported because some people aren’t going to the doctor or hospitals for treatment.
CDC reports 108 cases of coronavirus, including presumed infections; 4 more deaths
The Centers for Disease Control and Prevention (CDC) on Tuesday confirmed 17 new cases of the coronavirus and four more deaths due to the outbreak, bringing the total number of U.S. cases to 108, including among repatriated citizens.
Coronavirus is making some Republicans reconsider the merits of free health care
Tim O’Donnell reported that the Coronavirus has a lot of people re-thinking things. That apparently includes Republicans and government-funded health care.
With the possibility of an outbreak of the respiratory virus in the United States looming, the government is still trying to piece together its response. And it sounds like free testing could be on the table. Rep. Ted Yoho (R-Fla.), at least, thinks it’s really the only option. Yoho is normally known for opposing the Affordable Care Act, and certainly doesn’t seem likely to advocate for Medicare-for-All anytime soon. But he’s willing to blur the lines when an unforeseen circumstance like coronavirus comes to town and is even ok if you want call it “socialized medicine.”
Truly stunning to hear some Republicans advocate for free Coronavirus testing and treatment for the uninsured.
Rep. Ted Yoho (R-Fla.), one of the most anti-ACA members:
“You can look at it as socialized medicine, but in the face of an outbreak, a pandemic, what’s your options?”
The Trump administration, meanwhile, is contemplating funding doctors and hospitals so they can care for people who don’t have insurance should they become infected with the virus, a person familiar with the conversation told The Wall Street Journal. Read more at The Wall Street Journal.
The Coronavirus Outbreak Could Finally Make Telemedicine Mainstream in the U.S.
Time’s reporter, Jamie Ducharme noted that for years, telemedicine has been pitched as a way to democratize medicine by driving down costs, increasing access to care and making appointments more efficient. It sounds great—until you look at the data, and find that only about 10% of Americans have actually used telemedicine to make a virtual visit, according to one 2019 survey.
An outbreak of the novel coronavirus COVID-19 could change that. If extreme measures like mass quarantines come to pass, telehealth could finally have its bittersweet moment in the spotlight, potentially generating momentum that proponents hope will continue once life returns to normal.
“Something like having to stay home could springboard telehealth tremendously, because when we get over this—and we will—people will have had that experience, and they’ll be saying, ‘Well, why can’t I do other aspects of my health care that way?’” says Dr. Joe Kvedar, president-elect of the American Telemedicine Association (ATA).
As of March 3, more than 92,000 people worldwide have been sickened by the virus that causes COVID-19, including more than 100 in the U.S. As both numbers trend upward, the U.S. Centers for Disease Control and Prevention (CDC) has warned that increased person-to-person spread in U.S. communities is likely, and that containment measures may become increasingly disruptive to daily life. If the situation reaches the point where public health officials are encouraging or requiring people to stay home, the health care system may have to offer many medical appointments via telehealth services, the CDC’s Dr. Nancy Messonnier said during a Feb. 26 press briefing.
Kvedar says telehealth tools offered by health plans, private companies and pharmacies are ready and waiting for that possibility. There are some limitations to telehealth’s utility for COVID-19 testing—you can’t take a chest x-ray or collect a sample for lab testing remotely, after all—but Kvedar says it could be used for initial symptom assessment and questioning, as well as non-virus-related appointments that couldn’t happen in person due to precautions. If a patient turned up at an emergency room with possible COVID-19 symptoms, doctors could also do initial intake via virtual platforms, while keeping the patient in isolation to minimize spread within the vulnerable health care environment, he says.
Telehealth giants like Amwell and Teladoc are now advertising their availability for coronavirus-related appointments, and Teladoc’s stock prices spiked in late February. XRHealth, a company that makes health-focused virtual reality applications, is this week providing Israel’s Sheba Medical Center with VR headsets that will both allow doctors to monitor COVID-19 patients remotely, and enable quarantined patients to “travel” beyond their rooms using VR, says XRHealth CEO Eran Orr. The company will next week begin working with hospitals to deploy the technology in the U.S., Orr says.
All of these solutions seem logical. But in practice, there’s a “thicket of state laws and regulations that make telemedicine very complex…to implement broadly,” says Dr. Michael Barnett, an assistant professor of health policy and management at the Harvard T.H. Chan School of Public Health. Insurers—especially Medicare—don’t always cover telehealth visits, and, since medical licenses are state-specific, there could be legal issues if a doctor is located in a different state than the patient they’re treating, Barnett says. Drug prescription and privacy laws can also complicate regulation, according to the American Hospital Association.
These regulatory issues, as well as a lack of patient awareness, have kept telehealth from being as widely adopted as it could be, Barnett says. COVID-19 could be “a good use case” for telemedicine, he says, but it will partially depend on lawmakers’ willingness to relax, or at least streamline, regulation.
The wheels are already in motion. On Feb. 28, telehealth groups including the ATA, the Personal Connected Health Alliance and the eHealth Initiative sent a letter to Congressional leaders, urging them to expand access to telehealth and to grant the Department of Health and Human Services the power to let Medicare cover telemedicine appointments during emergency situations. On March 3, Arizona Rep. Ruben Gallego announced he was introducing a bill that would allow Medicaid to cover all COVID-19-related charges, including virtual appointments.
That’s a good step, but Julia Adler-Milstein, director of the University of California, San Francisco’s Center for Clinical Informatics and Improvement Research, says there are still logistical challenges.
She says larger health systems that have invested heavily in telehealth, like Kaiser Permanente, have seen benefits from it, but providers with a less built-out infrastructure will have to grapple in real-time with questions like, “How do we know which patients are well-suited to telehealth?” and “How do we get their information into the doctor’s hands?” These issues are especially salient for patients with complex medical histories, who may have choose between seeing their regular doctor in person, potentially risking infection, or seeing a doctor virtually who does not have access to their medical records, she says.
Kvedar acknowledges that widespread adoption of telehealth during the COVID-19 outbreak may require some goodwill on the part of companies and doctors. Companies like CVS and Walgreens could waive fees for the use of their telemedicine services during the crisis, Kvedar suggests, or doctors could offer to see patients virtually for free for a few hours a week. “People pull together for all sorts of things,” he says.
Barnett is less optimistic that providers can seamlessly overcome regulations, but says patients and doctors will find a way through the outbreak with or without telemedicine, even if it means conducting many appointments over the old-fashioned telephone. “We have more pressing needs in this epidemic,” he says, “than telehealth availability.”
15 Italian tourists test positive for Covid-19, India springs into battle mode
Niharika Sharma reported that fifteen Italian tourists in India have been reportedly tested positive for the dreaded coronavirus, perhaps finally bringing home the full scale of the seriousness of the global health crisis to the country.
This is besides the six others who have been diagnosed with Covid-19 across the country, prompting India to take massive preventive measures.
The Italian tourists have been quarantined at a camp of the paramilitary, Indo-Tibetan Police Force, media reports said.
Fear and anxiety gripped India’s national capital region (NCR) after a 45-year-old man was diagnosed with the novel coronavirus infection in the city yesterday (March 3). This prompted authorities to step up the vigil.
Over 40 people in Delhi NCR, who came in contact with the patient, are under surveillance. Another 13 people have been screened in Uttar Pradesh’s Agra where he visited his family.
The man who self-reported at Delhi’s Ram Manohar Lohia Hospital had organised his son’s birthday party at Hyatt Regency on Feb. 28. The five-star hotel has asked staffers, who were on duty that day, to stay at home. “The hotel has also started to conduct daily temperature checks for all colleagues and contractors when they enter and exit the building,” the hotel said in a statement yesterday (March 3).
The school in Noida where the infected man’s son attended classes has been shut for the rest of the week, and five students are being screened.
Besides the Delhi man, an Italian tourist, and a person in Hyderabad, who travelled from Dubai to Bengaluru on Feb. 20 on an IndiGo flight, have also tested positive for the virus. ”We’re following all prescribed Airport Health Organisation guidelines,” IndiGo said in a statement yesterday. The airline has asked its four cabin crew who were on the aircraft to stay at home.
Authorities appear to be working overtime to track the footprints of all the patients and screen everyone who came in contact with them. “Our officers even visit the homes individually, taking necessary precautions, to check listed people for symptoms,” an official of the Integrated Disease Surveillance Programme (IDSP) under the health ministry told Hindustan Times on condition of anonymity. “For asymptomatic people, home quarantine for a stipulated period of time is good enough, but those who develop symptoms are moved to a hospital as per protocol.”
But the process could be tedious as the 69-year-old Italian tourist, who was tested positive in Jaipur on March 3,had travelled to six districts in India before arriving at Rajasthan. He and his wife, who has also tested positive, were part of a 21-member group, which landed in Delhi on Feb. 21. The rest of the group is in Agra, according to a Hindustan Times report.
The health ministry has now issued a travel advisory, suspending all regular visas/e-visas granted on or before March 3 to nationals of Italy, Iran, South Korea, and Japan, who have not yet entered India. The advisory also suspends visa on arrival issued until March 3 to Japanese and South Korean nationals who have not yet entered India.
The government has also made it mandatory for passengers entering India from other countries affected by coronavirus to fill forms with personal details and travel history to the health and immigration officials at 21 airports across the country and 12 major and 65 minor seaports.
Aviation watchdog Directorate General of Civil Aviation has also asked carriers to ensure that adequate protective gears like surgical masks and gloves are available in flight for passengers.
In Delhi, the Kejriwal government has reserved 230 beds in isolation wards at 25 hospitals and also sent advisories to schools mentioning precautions to tackle the situation.
On March 3, the information ministry asked all private radio and TV channels to give “adequate publicity” to the travel advisory issued by the health ministry in the wake of the coronavirus outbreak.
The health ministry has also launched a series of TV commercials as part of its awareness program against the outbreak.
Here’s what you must keep in mind:
In addition, the Narendra Modi government has asked the army, the navy and the air force to prepared quarantine facilities for over 2,500 in coming days, as per the sources quoted by various media reports.
Several events, where foreign delegates were expected to participate, have been cancelled or postponed.
The Indian Navy called off a multilateral naval exercise that was scheduled from March 18 in Visakhapatnam due to coronavirus. Around 30 countries were expected to take part in the event.
On March 3, Chinese smartphone maker Xiaomi said it is cancelling all upcoming on-ground launch events in India to reduce exposure risk in the wake of Covid-19.
Italy could have more than 100,000 coronavirus cases, expert warns
Reporter Will Taylor of the Yahoo News noted that Italy could have more than 100,000 cases of coronavirus, an expert has revealed.
Professor Neil Ferguson, of Imperial College London’s faculty of medicine, said he estimates there are “at least” 50,000 to 100,000 cases of the virus in the country, which is one of the worst affected by the virus.
Italy has 2,500 confirmed cases and has suffered 79 deaths.
Prof Ferguson told the BBC’s Today programme that he expects to see measures to tackle the virus rolled out in a matter of days.
“[Italy has] I think it’s over 50 deaths now,” he said, “so those people were probably infected three weeks ago, and for every person who dies we think there might be 100, maybe even 200 people infected.
“The lethality of this virus is not completely determined but it’s in that order… so the epidemic is probably doubling every week or so in Italy, so when you put those numbers together, we’d estimate somewhere between 50,000 and 100,000 cases at the moment in Italy.
“At least, it could even be higher, cases may still be being missed even in severe cases.”
He said the UK is “several weeks” behind Italy and is in an earlier stage of an epidemic.
Authorities will be looking to slow the spread of the virus to try to relieve pressure on health systems and the UK government yesterday announced measures to tackle the virus.
Prof Ferguson said screening air passengers is imperfect and pointed out that Spanish flu spread around the world in the days before commercial air travel.
His figures mean the total number of Italy’s cases could outstrip the total number confirmed worldwide. Just over 93,000 have been reported globally as of Wednesday morning.
After mainland China – where the virus originated – South Korea is the next worst hit with 5,328 confirmed cases and 28 deaths.
Iran reports 77 deaths from its 2,300 officially reported cases.
A Coronavirus Guide for Older Adults (And Their Family Advocates)
Jeffrey Kluger noted that it’s hard enough getting old, what with all of the creeping ailments—diabetes, COPD, dementia, heart disease—that come along with age. Now add a novel coronavirus to the mix. There are more than 91,000 COVID-19 cases and 3,100 deaths as of writing, but the virus doesn’t hit all demographics equally hard—and seniors are the most vulnerable.
A late February study in the Journal of the American Medical Association showed that children 10 and under accounted for just 1% of all COVID-19 cases, for example, while adults in the 30-79 age groups represented a whopping 87%. The World Health Organization (WHO) found something similar in China, with 78% of patients falling between the ages of 30 and 69.
The older you get, the likelier you are not only to contract a SARS-CoV-2 infection (the virus that causes COVID-19), but to suffer a severe or fatal case. One study out of China found that the average age of COVID-19 patients who developed acute respiratory distress syndrome—a severe shortness of breath often caused by fluid in the lungs and requiring a ventilator—is 61. As early as January, Chinese health authorities were already reporting that the median age range for people who died of the disease was 75.
“Older people are more likely to be infected, especially older people with underlying lung disease,” says Dr. Teena Chopra, medical director of infection prevention and hospital epidemiology at Wayne State University. “For this population, mortality rates for COVID-19 are about 15%.”
In this sense, COVID-19 behaves a lot like seasonal flu. From 70% to 85% of all flu deaths and 50% to 70% of flu-related hospitalizations occur among people in the 65-plus age group, according to the United States Centers for Disease Control and Prevention (CDC). The 2002-2003 SARS outbreak similarly proved lethal for more than 50% of people over 60 who contracted the disease..
None of this is a surprise of course. With their higher risk of underlying health conditions, older people are already under physical stress, and their immune systems, even if not significantly compromised, simply do not have the same “ability to fight viruses and bacteria,” says Dr. Steven Gambert, professor of medicine and director of geriatrics at the University of Maryland School of Medicine.
What’s more, seniors’ risk of exposure to any pathogen is often higher than that of other adults. There are 48 million seniors overall in the U.S., and while only about 3% of them reside in assisted living facilities, that still factors out to more than 1.4 million already at-risk people living in communal environments in which disease can spread quickly.
“People living in long care facilities have common meetings, they share common rooms,” says Chopra. Common meetings and common rooms can too often mean common pathogens.
In the event of coronavirus infection in a residential facility, Gambert says, those living there should avoid communal rooms and even meals, and, if possible, eat in their own rooms.
Even older people living at home face communal risks, since many of them regularly visit community senior centers, which are great places for socialization and provide a means to stay active and engaged, but can serve as pathogenic petri dishes. Gambert recommends being proactive in these situations, asking the staff of the senior center if they have had any cases of coronavirus, and if so, avoid those facilities.
The health system itself may be playing a significant role in putting seniors at risk. People with multiple medical conditions typically visit multiple specialists, and every such visit means entering a health care environment that can be teeming with viruses and bacteria. For now, Chopra advises older patients to postpone doctor visits that aren’t absolutely essential, like “their annual eye visit. Dental cleaning can be avoided too.” Telemedicine—conducting doctor visits that don’t require hands-on treatment online—can be helpful too, as can e-prescribing, with drugs being delivered straight to patients, sparing them exposure to pharmacies.
Staying current on vaccines—especially flu and pneumonia—can also be critical. Patients—or their family advocates—should ask doctors if they are up to date on their vaccines, or if they need a booster, especially since vaccine formulations change and improve over time. “If you haven’t had a pneumonia vaccine now is the time to get one,” says Gambert. “Even if you have had one in the past, ask your primary care provider if you need a newer one.”
Finally, it’s important to remember that the way COVID-19 presents itself in a younger person is not always the way it presents itself in someone who’s older. “Old people may not get a fever so just checking their temperature may not reveal the infection,” says Gambert.
Instead, he says, families and seniors should be alert for “atypical presentation” of COVID-19. A fall or forgetfulness, for example, might be a sign of infection, even if other, more common symptoms aren’t in evidence. “Any reason you don’t feel the same as you usually do should not be dismissed,” Gambert says.
The coronavirus epidemic is not going away any time soon. That means continued vigilance for our own health and special vigilance for that of seniors. The people who looked after us when we were younger need the favor returned now that they are older.
AOC says that ensuring access to free coronavirus testing and treatment is ‘absolutely’ an ‘argument for Medicare for All’
According to Joseph Zeballos-Roig AOC told the Huffington Post that the government is taking steps to guarantee free coronavirus testing and medical treatment.
“What this crisis has taught us is that, our health care system and our public health are only as strong as the sickest person in this country,” she told the outlet.
Concerns are increasing that the expensive nature of American healthcare could discourage people from seeking medical treatment if they are infected with the coronavirus.
Democratic Rep. Alexandria Ocasio-Cortez said in an interview published Tuesday that ensuring free coronavirus testing and medical treatment is “absolutely” an “argument for Medicare for All.”
The New York congresswoman told the Huffington Post that if the government took steps to guarantee public access to testing and treatments by paying for it, “then what makes coronavirus different from so many other diseases, particularly ones that are transmissible?”
“What this crisis has taught us is that, our health care system and our public health are only as strong as the sickest person in this country,” she told the outlet.
Medicare for All is the signature plan of Sen. Bernie Sanders, a leading Democratic presidential candidate that Ocasio-Cortez has thrown her support behind. It would provide comprehensive health coverage and do away with deductibles, premiums, and other out-of-pocket spending. Private insurance would be eliminated as well.
As of Wednesday, the coronavirus has infected more than 94,000 people in at least 80 countries beyond China, its point of origin. The death toll from the respiratory disease it causes, COVID-19, has killed more than 3,200 people, mostly in China. There are at least 128 confirmed cases in the US.
Over the last week, concerns have mounted that the skyrocketing costs of healthcare could form a barrier discouraging people from getting tested and receiving treatment for the virus.
Business Insider recently analyzed the medical bill of a Miami resident who tested negative for the coronavirus but still racked up a $1,400 in costs, though he was insured. The majority of it came from an emergency room visit.
The Trump administration announced on Monday it was reviewing what products and services it would cover for coronavirus under Medicare and Medicaid, the two biggest federal health insurance programs.
Vice President Mike Pence said a day later the programs would insure diagnostic testing, making it free for patients. But it was not immediately clear what additional medical care would be paid for by the government.
“People who are subject to cost sharing — they are less likely to use medical care, even if they need it,” John Cogan, a health-law expert at the University of Connecticut, previously told Business Insider.
The White House is also reportedly considering reimbursing hospitals and doctors for treating uninsured coronavirus patients. In 2018, 27.5 million Americans had no health insurance, an increase from 25.2 million the year before.
The Most Common Coronavirus Symptoms to Look Out for, According to Experts Coronavirus symptoms are similar to those associated with the flu.
Unless you get a lab test, you can’t really distinguish between coronavirus COVID-19 and a typical cold or the flu. Dr. Wesley Long, Houston Methodist Director of Diagnostic Microbiology The severity of coronavirus
symptoms varies from person to person, Dr. Long notes. In more serious cases, the infection may lead to pneumonia, severe acute
respiratory syndrome, kidney failure, and even death, says Dr. Neal Shipley. Those most at risk of severe illness from coronavirus include the very young, the very old, and people with generally weakened or impaired immune systems. It’s difficult to pinpoint how long it takes
for coronavirus symptoms to appear. “The generally accepted window from exposure to onset of symptoms is 2-14 days,” says Dr. Long. To be clear, there’s still a lot that experts don’t know about COVID-19. And, you can only contract it if you’ve come into contact with someone who already has it.
So, rather than cause continual promotion of more fear we should all be prepared using good hand washing, cleaning surfaces with appropriate products, if you are sick seek assistance with your medical physician or nurse practitioner offices regarding the need to be tested, etc. The question looms out there, not if you will become sick with this virus, but when and how you care for yourself!
As Michael Bloomberg continues to attempt to buy the Primaries and the Elections let us look at Trump’s new budget and its effect on health care. University of Pennsylvania Assistant Professor of Public Policy, Simon F. Haeder reported that the Trump administration recently released its budget blueprint for the 2021 fiscal year, the first steps in the complex budgetary process.
The final budget will reflect the input of Congress, including the Democratic House of Representatives, and will look significantly different.
However, budget drafts by presidential administrations are not meaningless pages of paper. They are important policy documents highlighting goals, priorities and visions for the future of the country.
As a health care expert, I find the vision brought forward by the Trump administration deeply concerning. Cuts to virtually all important health-related programs bode ill for nations future. To make things worse, ancillary programs that are crucial for good health are also on the chopping block. To be sure, most of the proposed damage will find it hard to pass muster with Congress. Yet given the nation’s ever-growing debt Congress may soon be amenable to rolling back the nation’s health safety net.
Rolling back the ACA and the safety net
To no one’s surprise, some of the biggest cuts in the proposed budget focus on health care programs. The budget document uses a number of terms to disguise its true intentions. Yet a closer look indicates that terms like “rightsizing government,” “advancing the President’s health reform vision,” “modernizing Medicaid and the Children’s Health Insurance Program,” and “reforming welfare programs” all come down to the same end result: cuts to the safety net.
One of the main targets remains the Affordable Care Act, or ACA. In 2017, after several failed attempts to repeal and replace the ACA, the Trump administration has scaled back its open hostility. Instead of asking directly to repeal the ACA, this year’s budget proposal calls for initiatives to “advance the president’s health reform vision,” by cutting more than half a trillion dollars from the budget.
These initiatives come on top of actions the Trump administration has already taken to roll back the Affordable Care Act, including the repeal of the individual mandate penalty, severely limiting outreach and enrollment efforts, and creating a parallel insurance market by expanding the roles of short-term, limited duration and association health plans.
The Trump administration has also targeted Medicaid, the nation’s largest safety net program serving mostly low-income Americans, pregnant women, children, the disabled and those in need of long-term care, as well as its cousin, the Children’s Health Insurance Program. Overall “modernization” for these two programs alone would entail cuts of almost US$200 billion.
Medicare, the program serving America’s seniors, technically would not undergo significant restructuring. However, “streamlining” and “eliminating waste” would reduce the program by more than half a trillion dollars or 6%. All put together, cuts to the ACA, Medicaid and Medicare will exceed a trillion dollars over a decade. Coverage losses, mostly affecting lower-income Americans, would range in the millions of dollars.
Health is more than just medical care
In the U.S, we often equate health with access to medical care. However, researchers have long recognized that medical care contributes only about 10% to 20% to the health of individuals.
One crucial component of good health is access to education. However, the Trump budget includes cuts of more than $300 billion across the entire education spectrum from Head Start to grants that support college education. This just doesn’t make any sense!
Access to food and nutrition also plays a major role in maintaining good health. However, two programs providing important food security to millions of Americans would face significant cuts. For one, the Supplemental Nutrition Assistance Program (SNAP), which supplements food budgets for 34 million Americans with an annual budget of $58 billion, is slated for $22 billion in cuts over a decade. There are also cuts exceeding $2 billion over a decade to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), which reaches more than 6 million Americans with an annual budget of $6.4 billion.
Cuts to nutritional benefits would be further compounded by a 15.2% reduction to the Department of Housing and Urban Development. The department provides a range of housing assistance programs to needy individuals. Moreover, the Temporary Assistance for Needy Families (TANF) program which provides cash benefits to needy families, faces 10% in cuts. Again, this doesn’t make any sense!
A healthy environment and access to clean air and water unquestionably are crucial to living a healthy life. However, the proposed budget would trim spending on the agency tasked with protecting the nation’s environment, the Environmental Protection Agency, by more than 40%, or $36 billion.
A myriad of public health crises has been slowly but steadily harming communities all across the country. Much of the attention has been garnered by the devastating opioid crisis. More recently, the coronavirus and the seasonal flu epidemic have caught the headlines. Yet, there are countless other epidemics harming communities around the country including syphilis, hepatitis C and gonorrhea. Yet the nation’s major public health agency, the Centers for Disease Control, would see its budget decline by 9%.
The Trump administration is also proposing to significantly reduce funding for health-related research programs. One target is the National Science Foundation, which would see a reduction by 6.5%. Moreover, the National Institutes of Health, the nation’s premier medical research agency, is set for 7.2% in cuts. Both agencies play crucial roles in positioning the nation to tackle current and future health challenges. Do any of these budget cuts make any sense?
A blueprint for the future?
Since the Kennedy administration, taxes have generally been cut and only rarely increased. Particularly large tax cuts under the George W. Bush administration, without commensurate budget cuts, have created a systemic imbalance in the federal budget. This imbalance was further exacerbated by the recent tax cuts under the Trump administration.
So far, we have been able to stall the eventual reckoning because of strong economic growth and our ability to borrow heavily. Eventually, it seems inevitable that this massive imbalance will catch up with us.
Faced with the choice to either raise taxes or cut programs, Congress may choose the latter. With defense spending largely untouchable, health programs and other social support systems will likely bear the brunt.
Democrats Get Personal on Healthcare
Shannon Firth reported that the Democratic presidential candidates engaged in one of the most brutal and bruising fights to date, attacking each other’s integrity and physical fitness while still reserving time to tear into each other’s healthcare plans.
The debate took place in Las Vegas, with caucuses in Nevada only a few days away, and was broadcast by NBC/MSNBC.
Ahead of the debate, Sen. Bernie Sanders of Vermont, was leading nearly every poll according to RealClearPolitics.
In addition to Sanders, participants included former New York City Mayor Mike Bloomberg, Sen. Elizabeth Warren of Massachusetts, former Vice President Joe Biden, former South Bend, Indiana, Mayor Pete Buttigieg, and Sen. Amy Klobuchar of Minnesota.
Sanders’ health came under scrutiny in the wake of his October 2019 heart attack and stent placements.
When asked whether he would offer voters “full transparency” around his medical records, he was quick to point out that Bloomberg also has two stents. Sanders then said he had released the “full report” of his heart attack and decades of records from the attending physicians on Capitol Hill. (Last month, though, cardiologist Anthony Pearson, MD, noted that the recent report didn’t include Sanders’ left ventricular ejection fraction, a key indicator of cardiac function.)
In addition, two “leading Vermont cardiologists” had also released reports stating that he is “more than able to deal with the stress and the vigor of being president of the United States,” Sanders said, challenging anyone who doubts his stamina to “follow me around the campaign trail.”
Buttigieg quipped that Sanders was in “fighting shape,” but continued to stress the need for transparency.
When President Obama was in office the standard, he was to release “the read out” after a physical. While President Trump lowered that bar, Buttigieg said it should be raised.
“I am certainly prepared to get a physical, put out the results,” he said, “and I think everybody here should be willing to do the same.”
‘A PowerPoint,’ a ‘Post-It,’ and a ‘Good Start’
When it came to healthcare reform plans, Warren took aim at each of the other candidates.
Buttigieg has a “slogan” dreamed up by consultants, she said. “It’s not a plan, it’s a PowerPoint,” referring to Buttigieg’s “Medicare for All Who Want It.”
Buttigieg’s plan, which includes a public option, would initially preserve the role of private insurers, but later serve as a “glide path to Medicare for All.”
She likened Klobuchar’s plan, which also involves a public option, to a “a Post-It Note, ‘Insert plan here,'” then she took aim at Sanders’ more comprehensive plan. Although she had endorsed it in the first debate, this time she called it merely “a good start” that leaves gaping holes in how it would be implemented.
As candidate’s hands shot, with each rebuke, signaling a request to defend themselves, Warren shared her own vision for healthcare reform.
“[W]e need as much help for as many people as quickly as possible and bring in as many supporters as we can. And if we don’t get it all the first time,” presumably here she’s referring to a complete transition to a single-payer system, “… take the win and come back into the fight and ask for more,” Warren said.
Medicare for All has been a particular point of contention in Nevada, where the powerful Culinary Workers Union has been vocal in opposing any plan that takes away its members’ negotiated healthcare coverage. (The union declined to endorse any candidates in the state’s caucuses.) Asked about it in Wednesday’s debate, Sanders said, “I will never sign a bill that will reduce the healthcare benefits that they have, we will only expand it for them, for every union in America and for the working class of this country.”
Buttigieg, however, suggested that Sanders hadn’t been listening. “This idea that the union members don’t know what’s good for them is the exact kind of condescension and arrogance that makes people skeptical of the policies we’ve been putting forward.”
At another point, Biden took a shot at Bloomberg for having attacked the Affordable Care Act during a 2010 speech.
Bloomberg countered that he was in fact “a fan” of the landmark law. “I was in favor of it, I thought it didn’t… go as far as we should,” he said.
Now, his position is that Obamacare should be preserved and strengthened. “We shouldn’t just walk away and start something that is totally new, untried. People depend on this,” he said. One of his first moves as president would be to “bring back those things” that President Trump eliminated.
Other features of Bloomberg’s plan include a public option, caps on healthcare prices, and elimination of “surprise medical bills.” The overall goal is to achieve universal coverage while preserving private insurance.
Bloomberg To Grieving Family: Elderly Cancer Patients Are Too Expensive
Peter Hasson of the National Interest reported that Billionaire and Democratic presidential candidate Michael Bloomberg said in a 2011 video that elderly cancer patients should be denied treatment in order to cut health care costs.
“All of these costs keep going up, nobody wants to pay any more money, and at the rate we’re going, health care is going to bankrupt us,” said Bloomberg, who was then New York City’s mayor.
“We’ve got to sit here and say which things we’re going to do, and which things we’re not, nobody wants to do that. Y’know, if you show up with prostate cancer, you’re 95 years old, we should say, ‘Go and enjoy. Have a nice [inaudible]. Live a long life. There’s no cure, and we can’t do anything.’ If you’re a young person, we should do something about it,” Bloomberg said in the video.
“Society’s not ready to do that yet,” he added.
Bloomberg made the comments while visiting a grieving family whose brother had died after reportedly waiting 73 hours in an emergency room.
His presidential campaign didn’t return a request for comment.
The New York billionaire has faced increased scrutiny over past statements as he has continued to rise in Democratic primary polls.
Fake Facts Are Flying About Coronavirus. Now There’s A Plan to Debunk Them
We have been hearing all sorts of information regarding the Corona Virus and I thought that I would share some of the Fake Facts and some of the truths. Malaka Gharib reported that the coronavirus outbreak has sparked what the World Health Organization is calling an “infodemic” — an overwhelming amount of information on social media and websites. Some of it’s accurate. And some is downright untrue.
The false statements range from a conspiracy theory that the virus is a man-made bioweapon to the claim that more than 100,000 have died from the disease (as of this week, the number of reported fatalities is reported at 2,200-plus).
WHO is fighting back? In early January, a few weeks after China reported the first cases, the U.N. agency launched a pilot program to make sure the facts about the newly identified virus are communicated to the public. The project is called EPI-WIN — short for WHO Information Network for Epidemics.
“We need a vaccine against misinformation,” said Dr. Mike Ryan, head of WHO’s health emergencies program, at a WHO briefing on the virus earlier this month.
The Coronavirus Outbreak What you should know
Where the virus has spread
While this is not the first health crisis that has been characterized by online misinformation — it happened with Ebola, for example — researchers are especially concerned because this outbreak is centered in China. The world’s most populous country has the largest market of Internet users globally: 21% of the world’s 3.8 billion Internet users are in China.
And fake news can spread quickly online. A 2018 study from Massachusetts Institute of Technology found that “false news spreads more rapidly on the social network Twitter than real news does.” The reason, say the researchers, may be that the untrue statements inspire strong feelings such as fear, disgust and surprise.
This dynamic could cause fake coronavirus cures and treatments to fan out widely on social media — and as a result, worsen the impact of the outbreak, says Bhaskar Chakravorti, dean of global business at the Fletcher School at Tufts University. Over the past decade, he has been tracking the effect of digital technology on issues such as global health and economic development.
The rumors offer remedies that have no basis in science. One untrue statement suggests that rubbing sesame oil on the skin will block the coronavirus.
If segments of the public turn to false treatments rather than follow the advice of trusted sources for avoiding illness (like frequent hand-washing with soap and water), it could cause “the disease to travel further and faster than it ordinarily would have,” says Chakravorti.
There could be a political agenda behind the fake coronavirus news as well. Countries that are antagonistic toward China could try to hijack the conversation in hopes of creating chaos and eroding trust in the authorities, says Dr. Margaret Bourdeaux, research director for Harvard Belfer Center’s Security and Global Health Project.
“Disinformation that specifically targets your health system or your leaders who are trying to manage an emergency is a way of destroying, undermining, disrupting your health system,” she says.
In the instance of vaccines, Russian bots have been identified as fueling skepticism about the effectiveness of vaccination for childhood diseases in the U.S.
The World Health Organization’s EPI-WIN team believes that the countermeasure for misinformation and disinformation is simply to tell the truth.
It works rapidly to debunk unjustified medical claims on social media. In a series of bright blue graphics posted on Instagram, EPI-WIN states categorically that neither sesame oil nor breathing in the smoke of fire or fireworks will kill the new coronavirus.
Part of this truth-telling strategy involves enlisting large-scale employers.
The approach, says Melinda Frost, an officer on the EPI-WIN team, is based on the idea that employers are the most trusted institution in society, a finding reflected in a 2020 study on global trust from the public relations firm Edelman: “People tend to trust their employers more than they trust several other sources of information.”
Over the past few weeks, Frost and her team have been organizing rounds of conference calls with representatives from Fortune 500 companies and other multinational corporations in sectors such as health, travel and tourism, food and agriculture, and business.
The company representatives share questions that their employees might have about the coronavirus outbreak — for example, is it safe to go to conferences? The EPI-WIN team gathers the frequently asked questions, has their experts answer them within a few days, and then sends the responses back to the companies to distribute in internal newsletters and other communication.
Because the information is coming from their employer, says Frost, the hope is that people will be more likely to believe what they hear and pass the information on to their family and community.
Bourdeaux at Harvard calls this approach a “smart move.”
It borrows from “advertising techniques from the 1950s,” she adds. “They’re establishing the narrative before anybody else can. They are going on offense, saying, ‘Here are the facts.’ “
WHO is also collaborating with tech giants like Google, Twitter, Facebook, Pinterest and TikTok to limit the spread of harmful rumors? It’s pursuing a similar tactic with Chinese digital companies such as Baidu, Tencent and Weibo.
“We are asking them to filter out false information and promote accurate information from credible sources like WHO, CDC [the U.S. Centers for Disease Control and Prevention] and others. And we thank them for their efforts so far,” said Dr. Tedros Adhanom Ghebreyesus, director-general of WHO, in a briefing earlier this month.
Google and Twitter, for example, now actively bump up credible sources such as WHO and the CDC in search results for the term “coronavirus.” And Facebook has deployed fact-checkers to remove content with false claims or conspiracy theories about the outbreak. Kang-Xing Jin, head of health at Facebook, wrote in a statement about one such rumor that it has eliminated from its platform: that drinking bleach cures coronavirus.
Chakravorti applauds WHO’s coordination with the digital companies — but says he’s particularly impressed with Facebook’s efforts. “This is a radical departure from Facebook’s past record, including its controversial insistence on permitting false political ads,” he wrote in an op-ed in Bloomberg News.
[Facebook and Twitter did not respond to requests from NPR for comments. Facebook is one of NPR’s financial sponsors.]
Still, there is no silver bullet to fighting health misinformation. It has become “very, very difficult to fight effectively,” says Chakravorti of Tufts University.
A post making a false claim about coronavirus can just “jump platforms,” he says. “So you might have Facebook taking down a post, but then the post finds its way on Twitter, then it jumps from Twitter to YouTube.”
In addition to efforts by WHO and other organizations, individuals are doing their part.
On Wednesday, The Lancet published a statement from 27 public health scientists addressing rumors that the coronavirus had been engineered in a Wuhan lab: “We stand together to strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin …. Conspiracy theories do nothing but create fear, rumors and prejudice that jeopardize our global collaboration in the fight against this virus.”
Dr. Deliang Tang, a molecular epidemiologist at Columbia University’s Mailman School of Public Health, says his friends from medical school and his research colleagues in China find it difficult to trust Chinese health authorities, especially after police reprimanded the eight Chinese doctors who warned others about a pneumonialike disease in December.
As a result, Tang’s network in China has been looking to him and others in the scientific community to share information.
Since the outbreak began, Tang says he has been answering “30 to 50 questions a night.” Many want to fact-check rumors or learn about clinical trials for a potential cure.
“My real work starts at 7 p.m.,” he says — morning in China.
And the latest news on the Corona virus: Coronavirus update: 80,238 cases, 2,700 deaths; CDC warns Americans to prepare for disruption
And:Harvard scientist predicts coronavirus will infect up to 70 percent of humanity
Dr. Daniel E. Choi announced that ”Hey man, just wanted you to be one of the first to know that I put in my 90-day resignation notice at the hospital. Planning to pursue exec MBA…”
I did a double take at this shocking text from an orthopedic surgery colleague who was also a close friend. What? He was quitting?
We had just slaved through 5 years of orthopedic surgery residency, 1 year of fellowship, and just passed our oral boards. We were now supposed to be living the dream. All of that delayed gratification: throwing away our 20s holed up in the library, taking call endlessly on weekends and holidays. We did it for the ultimate privilege of being attending surgeons for our patients one day.
I called him right away and he confirmed my suspicions about why he quit. As an employed physician in a hospital system, he felt that he was sadly just becoming a cog in the machine, a “provider” generating relative value units. Administrators who had never done a day of residency or even stepped foot in his clinic wanted to provide “guidance” on how he should practice medicine. Overall, he felt that medicine was a sinking ship on which doctors were losing autonomy quickly and that this was a path leading straight to burnout.
I felt I had to let the Twitterverse know.
This tweet went viral and it was clear that I was on to something. I had struck a nerve with many of my physician colleagues. Surprisingly, many physicians empathized with my friend and didn’t blame him for looking elsewhere in finding a fulfilling career. Some physicians even thought he was doing the right thing.
I was getting really curious. I followed up with a Twitter poll: “Physicians, are you actively making plans for early retirement or considering how to possibly exit medicine in the near future?” Sixty-five percent of physicians who replied were considering an early exit from medicine.
This poll result was consistent with my own observation that early retirement online physician groups are burgeoning. Physician Side Gigs on Facebook, which seeks to help “physicians interested in pursuing opportunities outside of traditional clinical medicine…as a way to supplement or even replace their clinical income,” has over 50,000 members. Another Facebook group, Physicians on FIRE, aims to help physicians reach “Financial Independence. Retire Early” and has over 4000 members.
It is difficult to determine whether these physicians seeking early retirement are just wishfully complaining or actually planning an exit strategy. Many physicians answering the Twitter poll clarified that they loved treating and helping their patients but that the system had just become too difficult to deal with. Did this many physicians really want to leave the practice of medicine? What does that mean for our impending physician shortage? Why do so many of us feel the urge to get out?
Many discussions with disenchanted physicians ensued after that poll. In these discussions, I have found several common reasons that have pushed my colleagues to leave medicine.
Devaluation of Physicians on All Fronts
Devaluation appears to be happening on many fronts, according to my discussions with doctors online. There is the use of the term “provider” to replace “physician,” which more of us are finding offensive.
Mid-level providers who are cheaper for health systems to hire are replacing physicians. Reimbursements from commercial payers are declining. Health policy “experts” unfairly blame rising healthcare costs on physicians and have pushed legislators to find ways to lower physician compensation further. There are fewer physician meeting spaces in hospitals, such as doctors’ lounges or physician dining rooms, which used to serve as important spaces for physicians to commiserate and collaborate.
Overall, I sense great disappointment and anger among physicians about what many perceive to be increasing disregard for the tremendous amount of sacrifice physicians have made to complete their training. Physicians increasingly regret all of that time away from family or dropping their personal interests and hobbies during medical school and residency.Most shocking to me, however, is that physicians who speak out about such devaluation are often labeled “greedy doctors” by health policy “experts,” the press, and even fellow physicians (usually in the later stages of their career).
Loss of Autonomy and Independent Physician Opportunities
Personally, I’ve always wanted to be my own boss and I knew fairly early on in training that I wanted to enter private practice. I thought private practice would allow me to insulate myself from many of the forces that pushed my orthopedic surgery colleague to quit.
Mine is not the popular path, however, as the number of millennial physicians who are entering private practice has rapidly declined over the past decade. According to Medscape’s Residents Salary & Debt Report 2019, 22% of residents say they anticipate becoming either a practice owner or partner. According to a survey by the Physicians Foundation and Merritt Hawkins, only 31.4% of physicians identified as independent practice owners or partners in 2018. In 2012, independent physicians made up 48.5% of all doctors.
The survey even revealed that 58% of doctors do not think that hospital employment is a positive trend and concluded that “many physicians are dubious about the employed practice model even though they have chosen to participate in it, perhaps fearing that employment by hospitals will lead to a loss of clinical and administrative autonomy.”
I used to wonder why more of my millennial physician colleagues did not choose private practice as a career path and why so many were choosing hospital-based employment. A line I saw on Twitter sums it up: “Private practice is no longer about profitability. It’s about financial sustainability.” With greater consolidation within healthcare, independent doctors have lost much of their leverage when trying to negotiate fair rates with commercial payers.
In addition, the costs of purchasing an electronic health record and running a staff to deal with authorization and billing issues have made private practice extremely difficult. If more private practice opportunities existed, I am sure that my millennial colleagues would absolutely take them to maintain their independence. However, such independent practice opportunities continue to diminish, and millennial physicians may be pressured to take the only available positions: hospital employment with possible restrictions on autonomy.
Is Your Career Worth Your Own Life?
On average, one doctor a day in the United States ends his or her own life. Physicians commit suicide at a rate twice that of the general population, and over 1 million patients will lose their doctors to suicide every year. Pamela Wible, MD, who studied 1363 physician suicides, points out that “assembly-line medicine kills doctors” and that “pressure from insurance companies and government mandates further crush the souls of these talented people who just want to help their patients.”
Just a couple of months ago, my fellowship director forwarded me an email about a young orthopedic surgeon who had committed suicide, Thomas Fishler. He was known to be a brilliant surgeon whom colleagues and patients loved, and is survived by his young daughter. My fellowship director included in his email, “I know you have an awareness of the risks that those in our profession often face.”
Many physicians are crying for help and nobody is listening. Some sadly feel that the only way out is to end their lives.
Physician suicide is heartbreaking and screams crisis. What is driving brilliant doctors to the edge? I believe it’s further evidence of compounding external pressures that are making the practice of medicine increasingly intolerable. Many physicians are crying for help and nobody is listening. Some sadly feel that the only way out is to end their lives.
I get chills as I push the thought quickly out of my mind: Am I being subjected to this risk? All physicians have their tough days but I have never been anywhere close to being suicidal. But seriously—is it really worth it if I am at even a small risk of becoming that miserable?
Is There an Impending Crisis?
The average millennial physician completes training, looks around, and sees his or her profession in complete shambles. Burnout is rampant. Doctors are committing suicide daily. Many seem to be miserable over their lack of autonomy and loss of standing. The physician starts to take a hard look at the career they are about to embark on and begins to have serious doubts. Then the physician remembers that student loan debt. The average medical student loan debt in 2018, according to AAMC , was $198,000. There’s really no way out at this point; even if your job is going to make you miserable, you are going to push through because you’re on the hook.
And this is where I start to get seriously worried. We will have an entire generation of graduating physicians who will be subjected to forces that have never been present in medicine before. And these forces are actively causing distress and misery among some of my colleagues.
I know that my millennial colleagues have tremendous resilience and grit, as every generation of physicians has in the past. But how long will they put their heads down and fight against these ominous forces before they decide that they’ve had enough and jump ship just like my orthopedic colleague did?
Hope in Advocacy to Avert Crisis
Don’t get me wrong—practicing medicine is still the greatest privilege, and I know that every one of my millennial physician colleagues loves their patients dearly. I am honored that my patients entrust me to take away their pain and suffering in the operating room. I’ve studied and trained for 14 years to become an attending orthopedic spine surgeon; I’m not giving up this privilege that easily. And neither are most millennial physicians.
Millennials may be viewed as entitled, but many of us see that as “ comfort in advocating for themselves and questioning the status quo.” I believe that millennial physicians will not quietly accept the current state of affairs.
I see many impassioned millennial physician advocates becoming active in organizations like the Medical Society of the State of New York or the American Medical Association. These organizations already do excellent advocacy work, and I predict that millennial physicians will become a powerful force within such organizations to protect their profession. Through a unified voice, organized medicine is truly our strongest hope in enacting systemic changes that can prevent further physician demoralization and burnout.
We’re not giving up just yet. The crisis can be averted. Our patients and profession depend on it.
America’s healthiest and unhealthiest states
Cortney Moore noted that when it comes down to the popular saying that “health is wealth,” the states that have high revenue streams and median household incomes also have populations that are wellness-focused. Particularly, the states with the healthiest people are concentrated in the northern half of the U.S. and West Coast, according to America’s Health Rankings annual report conducted by the United Health Foundation.
The United Health Foundation analyzed the 50 states on five core categories, including model behaviors, community and environmental factors, public policies for health care and preventative care, clinical care and the overall health outcomes that result from the previous four.
America’s Health Rankings used a composite index of over 30 metrics to create its annual snapshot of statewide healthy populations, which ultimately helped the organization determine the healthiest to the unhealthiest.
Moreover, the report cited the World Health Organization’s definition of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” in addition to individual genetic predispositions to disease.
The healthiest state is Vermont, which has moved up from 20th place in 1990 to first place in 2019, according to America’s Health Rankings data. In the past 15 years, the state has decreased its air pollution by 47 percent – with fine particles per cubic meter going down from 9.7 to 5.1 micrograms. Additionally, Vermont’s disparity in health status decreased from 49 percent to 17.4 percent in the past year. Other strengths the report noted include low incidences of chlamydia, violent crime and the percentage of uninsured residents.
For the 2019 fiscal year, with the exception to the month of December (which data has yet to be released for at the time of publication), the state of Vermont made over $955 million in revenue from general funds, according to the Agency of Administration. More than $113 million came from health care taxes and assessments that were collected between January 2019 and November 2019.
The median household income in Vermont is $60,076, according to data from the U.S. Census Bureau, which is close to the national median of $61,937. Moreover, average employee health care premium contributions for a family in the state is said to be $4,996, according to independent researchers at the Commonwealth Fund.
When it comes down to those who have government-funded health insurance plans, the Centers for Medicare and Medicaid Services do not have up-to-date figures since it is collected on a quinquennial basis. However, the agency found that Vermont reported a little over $5.7 million in 2015 for health care expenditures, as noted in an infographic by the Kaiser Family Foundation.
Outside the Green Mountain State, the other states that rounded out America’s Health Rankings top 10 are Massachusetts, Hawaii, Connecticut, Utah, New Hampshire, Minnesota, New Jersey, Washington and Colorado.
The unhealthiest state is Mississippi, which has maintained close to 50th place from 1990 to 2019, according to America’s Health Rankings data. Since 1993, low birthweight in Mississippi increased from 9.6 percent to 21 percent of live births. In the past five years, premature death increased by seven percent from 10,354 to 11,043 years lost to people who died before age 75. Premature mortality has increased on a national scale in addition to diabetes and obesity. Other challenges the report noted include a high cardiovascular death rate and percentage of children in poverty.
For the fiscal year of 2019, the state of Mississippi made $166 million in revenue collections, according to the Mississippi Legislative Budget Office, which surpassed the state’s estimate by $30.5 million.
The median household income in Mississippi is $43,567, according to data from the U.S. Census, which is $18,370 less than the national median. Average employee health care premium contributions for a family in the state is $5,133, according to the Commonwealth Fund, which is only $137 more than the premiums employees in Vermont are paying. But, when coupled with Mississippi’s lower median income, the cost of health coverage is substantial.
Mississippi also surpassed Vermont in spending on government-funded health insurance plans. The Centers for Medicare and Medicaid Services found that Mississippi reported over $21.5 million in 2015 for health care expenditures.
The other states that rounded out America’s Health Rankings bottom 10 were primarily in the South, including, South Carolina, Kentucky, Tennessee, West Virginia, Oklahoma, Alabama, Arkansas and Louisiana. Indiana was the only Midwestern state to land on the lower one-fifth of the unhealthiest states list.
On a national scale, American health is a mixed bag. Since 2012, smoking among adults has decreased from 24 percent to 16.1 percent, however, obesity among adults increased to 30.9 percent from 11 percent while diabetes among adults increased to 15 percent from 9.5 percent.
In the past three years, drug-related deaths have increased by 37 percent from 14 to 19.2 deaths per 100,000 people. When compared to America’s Health Rankings data from 2007, that is a 104 percent increase.
Environmental conditions have improved as air pollution decreased by 36 percent since 2003 and violent crime decreased by 50 percent since 1993. In the past four years, frequent mental distress increased from 11 percent to 13 percent, which has resulted in an increase of mental health providers, according to the report.
Infant mortality has decreased by 43 percent from 10.2 to 5.8 deaths per 1,000 live births in the past 29 years. However, low birth weight has increased by four percent from eight to 8.3 percent in the past three years, which also happens to be a 19 percent increase from 1993.
The average American spends more than $11,000 per year on health care and accounted for 17.7 percent of the U.S. GDP, according to estimates from the Centers for Medicare and Medicaid Services. With spending projected to grow at an average rate of 5.5 percent per year, the U.S. will reach nearly $6 trillion in health care spending by 2027.
Buttigieg’s health care plan would save money while Warren and Sanders plans would cost trillions, analysis finds
Associate Editor Adriana Belmont reported that Health care has been a contentious topic among the Democratic presidential candidates: Sens. Bernie Sanders (I-VT) and Elizabeth Warren (D-MA) support Medicare for All while Mayor Pete Buttigieg (D-IN) and former Vice President Joe Biden offer alternatives to universal health care.
A new analysis from the Committee for a Responsible Federal Budget (CRFB) took a look at the different plans and found that while each proposal would reduce the number of uninsured Americans, the least costly would be Buttigieg’s plan.
“Mayor Buttigieg’s plan would reduce deficits by $450 billion,” according to CFRB, adding that the policy would also “increase gross spending by $2.85 trillion, reduce costs by $1.2 trillion, and raise $2.1 trillion through direct and additional offsets.”
Through Buttigieg’s Medicare for All Who Want It plan, everyone would automatically be involved in universal health care coverage for those who are eligible. The policy would also expand premium subsidies for low-income individuals, cap out-of-pocket costs for seniors on Medicare, and limit what health care providers change for out-of-network care at double what Medicare pays for the same service. At the same time, those who still want to stay on private insurance can do so.
“This is how public alternatives work,” Buttigieg said. “They create a public alternative that the private sector is then forced to compete with.
CRFB estimated that the Indiana mayor’s plan would reduce the number of uninsured by between 20 to 30 million “by improving affordability and implementing auto-enrollment as well as retroactively enrolling and charging premiums to those who lack coverage.”
‘Building on Obamacare’
Joe Biden’s health care plan, described as “building on Obamacare,” has an estimated gross cost of $2.25 trillion and would add $800 billion to deficits over 10 years. The CRFB also found that “it would reduce costs by $450 billion” and “raise $1 trillion through direct and additional offsets.”
Biden’s plan would reduce the number of uninsured by 15 to 20 million Americans and reduce national health expenditures by 1%.
Some of his biggest revenue drivers in his plan include coverage expansion revenue feedback, which would create a public option, and end deductibility of prescription drug advertising. Additionally, his capital gains tax and “tax at death” would generate $550 billion.
‘Federal health expenditures would increase somewhat more’
Sen. Sanders, one of the original proponents of Medicare for All, has a plan that’s projected to add $13.4 trillion to deficits over a decade at a gross cost of $30.6 trillion. It would also raise $12.5 trillion in revenue through direct offsets and raise another $3 trillion through additional offsets.
His proposals to eliminate medical debt would cost $100 billion and would raise $1.7 trillion by reducing the costs of prescription drugs. To generate more money for the plan, Sanders would establish a 4% income surtax (projected to raise $4 trillion) and 7.5% employer payroll tax (estimated $4 trillion added). One significant cost in his plan, though, is offering universal long-term care — which would cost $29 trillion.
“The reality is that Medicare for All will save American families thousands of dollars a year because they will no longer be paying premiums, deductibles and co-payments to greedy private health insurance companies,” Warren Gunnels, senior advisor for the Sanders campaign, told Yahoo Finance in a statement.
“If every major country on earth can guarantee health care to all and achieve better health outcomes, while spending substantially less per capita than we do, it is absurd for anyone to suggest that the United States of America cannot do the same.”
Overall, between 2021 to 2030, the CFRB estimated that Sanders’ plan would increase national health expenditures by 6%, “meaning that federal health expenditures would increase somewhat more than non-federal health spending would fall.”
‘Magical math’ or ‘the biggest middle class tax cut ever’?
Sen. Warren’s plan closely resembles Sanders’ in terms of cost. She stated her plan would cost $20.5 trillion in federal spending over a decade. CFRB found that the plan “would add $6.1 trillion to deficits over ten years under our central estimate.”
Experts disagree over the cost of Warren’s numbers, with one calling it “magical math” and another referring to Warren’s plan as “the biggest middle class tax cut ever.”
According to CRFB, the plan would increase gross spending by $31.75 trillion, reduce costs by $4.7 trillion, raise $14.2 trillion in revenue through direct offsets, and raise another $6.75 trillion through additional offsets. Her health care plan is estimated to increase costs by about 3%, but “the magnitude of these increases would decline over time.”
A major way to fund the plan would be through tax reform. By essentially eliminating tax breaks with private health insurers and requiring employers to contribute to her Medicare for All, she’s projected to generate an estimated $14.2 trillion. Other means of generating revenue for her plan include her wealth tax and a tax on bonds, stocks, and derivatives.
Both the Warren and Sanders plans would reduce the number of uninsured Americans by 30 to 35 million and “nearly eliminate” average premiums and out-of-pocket costs.
Patients can’t afford for doctors to misunderstand the healthcare business
Caroline Yao reported that When I was in medical school, my teachers started a lot of their stories with the same phrase:
“Back in my day, I still helped patients who couldn’t pay.”
“Back in my day, we didn’t have 100 checklists.”
“Back in my day, I didn’t need permission from insurance companies to do my job.”
“Back in my day, a yelp review couldn’t ruin my reputation.”
It happened so often that I wondered if I had shown up to the medical profession 30 years too late. Had I signed up for a sham fairytale?
I had thought doctors were autonomous, benevolent masters with kind voices and encyclopedic knowledge. After entering the field, I’ve found most young doctors struggle to balance convention versus empowerment, and doing good versus doing well. Doctors are the ugly stepchild of healthcare reform; too privileged to warrant help, but too powerless to do our jobs better.
I performed more than 2,500 surgeries during my residency training, and I am embarrassed to say that I do not know what a single one of my patients paid for their operations.
I later learned at the public hospital, surgeons were reimbursed $35 for each emergency appendectomy performed. Where did all that money go? Why didn’t the doctors question the system, or try to regain some control?
The provider will see you now
Somewhere along the way, my title as a doctor has been reduced to “provider,” and my worth dictated by administrators, insurance companies—and the government. The Hippocratic Oath I earnestly recited upon starting medical school is challenged everyday by a system of perverse incentives, where hospitals are paid more for treating the sick than keeping the patient well.
In 2013, 87% of graduating doctors felt uncomfortable with their knowledge of the business of medicine; 81% felt they lacked an understanding of healthcare legislation.
Is the answer that doctors should participate more in determining patient fees and reimbursement schedules? History shows that when doctors controlled payments more directly, graduated systems based on ability to pay were subtle but more ubiquitous. In the era of Aristotle, wealthy physicians did not accept payment, while poorer ones requested them. When 9th-century physician and scholoar Ishaq bin Ali al-Ruhawi wrote the first book of medical ethics, he described physicians as business owners who provided free services during times of patronage from caliphs and sultans. Throughout medieval Europe and during the Ottaman Empire, doctors treated the poor with the help of subsidies from royal courts and churches. Notable physicians such as Sir William Osler, legendary French surgeon and anatomist Guillaume Dupuytren, and physician and founder of Dickinson College, Benjamin Rush also charged rich and poor patients based on a self-made sliding scale.
Today, governments, universities, religious groups, and philanthropists are essentially modern-day barons who fund healthcare for the indigent through public hospitals, grants, and charitable work.
In the US, some physicians are granted partial and full student debt forgiveness from the government for working in underserved or rural communities. However, the majority of physicians who volunteer at free clinics, teaching hospitals, charities, or medical missions often do so only because their practice is flexible or lucrative enough to allow them both time away from paying jobs and the financial means to offer free services.
While physicians in private practice have autonomy over who they treat and how much they charge, physicians who work in hospital systems are more and more removed from managing the whole patient.
In 1983, 76% of doctors owned their own practice versus only 47% in 2016. Young physicians today are fundamentally unaware of the business side of medicine, and that’s bad news for everyone. As is the fact that medical students and residents are consistently and idealistically mentored to ignore the costs of materials and treatments we recommend.
We are taught to deliver care based on strict scientific evidence: the “gold standard” of care. Said gold standard, however, does not account for price, diminishing returns, convenience, or pain. The treatment that works best for a lab rat in a cage does not always translate to the most appropriate care for a person who has far more complex needs.
The cost of your health
A more pragmatic physician understands that patients who are underinsured, uninsured, or improperly educated will often forgo procedures, clinic visits, and medications when those interventions are too expensive or inconvenient.
Cost-conscious surgeons know that using instruments to tie stitches instead of hand-tying stitches can often result in a 10-fold cost savings without sacrificing quality.
I did not know how prohibitively expensive everyday surgical consumables cost until I went on humanitarian missions abroad and worked with surgical teams that could not afford these luxuries. I learned that hemostatic fabric we used like disposable napkins in the US cost $40 for a post-it sized square. A five-inch silicone band-aid costs $20. Bioengineered skin substitutes cost $10,000 for a palm-sized sheet.
My lack of price-awareness is fairly common. Many doctors have stopped accounting for the cost portion of a cost-benefit analysis.
And where doctors have leaned away from understanding cost, others have stepped in. Hospital administrators, governments, and insurance companies now manage the costs of healthcare. Correspondingly, physician compensation is estimated to be under 10% of total US national healthcare spending today. Overhead, administration, ancillary staff, malpractice insurance, and pharmaceuticals account for the majority of costs. For an appendectomy and associated care in 2018, the Medicare allowable compensation for a surgeon’s work is $394; meanwhile, healthcare watchdog organizations quote $13,000 as the fair price for hospitals to charge a patient and US hospitals bill an average of $31,000.
Most surgeons working in large hospitals are unaware of these numbers. They are therefore unable to tell patients how much they will be billed for a given operation. A surgeon in the 1830s in the company of the likes of Dr. Dupuytren would know these numbers.
Patients are often dismayed or surprised that their doctor cannot earnestly explain the cost-benefits of different treatments. A 2013 survey by the Journal of the American Medical Association found that 87% of graduating doctors felt uncomfortable with their knowledge of the business of medicine and 81% felt they lacked an understanding of healthcare legislation. As surgeons, we have slowly let ourselves become exclusively technicians. Just like Aristotle and Plato said.
By turning our noses up at the business of medicine, we have lost ownership over our patients, and the agency to advocate for them. As Osler said, “The good physician treats the disease. The great physician treats the patient who has the disease.”
We as physicians and surgeons need to recover our identity and learn the business skills that our teachers have forgotten, but our forefathers stood up for.
As China’s Coronavirus Cases Rise, U.S. Agencies Map Out Domestic Containment Plans
Richard Harris reported that China has reported a large surge of cases of the novel coronavirus — upping its count from under 3,000 to over 4,500 as of Tuesday morning. More than 100 deaths have been reported. It is spreading rapidly in many provinces, and sporadic cases have now been reported in 18 other locations outside of China, including Australia, France and Canada.
In the United States, the case count remains at five — all people who had recently returned from Wuhan, China. And at a news conference Tuesday, top U.S. health officials reiterated that the disease — while serious — is not currently a threat to ordinary Americans.
“At this point, Americans should not worry for their own safety,” said Alex Azar, health and human services secretary, at the press briefing Tuesday.
While risk to most Americans remains low, Dr. Nancy Messonnier, the director of the National Center for Immunization and Respiratory Diseases at the Centers for Disease Control and Prevention, noted that “risk is dependent on exposure” and that health care workers or others who know they have been in contact with a person exposed to the virus should take precautions.
The federal government continues to adjust its approach to preventing the disease from taking hold in the U.S. On Monday night, the CDC and the State Department announced that a travel advisory recommending that Americans avoid travel to China when at all possible.
Airport screening is also being expanded from five airports to 20, with the goal of screening all passengers returning from China and letting people know what they should do if they fall ill after they get home.
The CDC is conducting contact investigations of people known to have been in contact with the five patients with confirmed infections, monitoring them for symptoms and testing them if concerning symptoms emerge.
Officials at the CDC are eager to get into China in order to help scientists there answer key questions — such as whether the virus can spread from people who don’t show any symptoms of illness. Azar said at the news conference that he had been pressing his counterpart in China for permission to send investigators.
That plea has been answered, at least to a certain extent. On Tuesday, the World Health Organization announced that it had the green light to send outside experts to China. It was not immediately clear whether that will include scientists from the CDC.
Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, explained that federal agencies are taking a three-pronged approach to respond to the novel coronavirus: developing and improving diagnostic tests, investigating experimental antiviral drugs, and working to develop a vaccine.
He said if it turns out that the virus can spread from someone who is not showing any symptoms, there would be some changes in the public health response. Similar coronaviruses from past outbreaks — severe acute respiratory syndrome and Middle East respiratory syndrome — did not spread in the absence of symptoms, but that doesn’t mean the new one will behave the same way. Viruses such as measles and influenza can be spread from people who aren’t showing signs of disease.
“Even if there is some asymptomatic transmission, in all the history of respiratory-borne viruses of any type, asymptomatic transmission has never been the driver of outbreaks,” Fauci said. “The driver of outbreaks has always been a symptomatic person.”
And lastly condolences go out to the Bryant family and the other members of the helicopter crash in southern California. Kobe will be sure missed but loss of kids really upsets a father like me the most!
What a horrible week with the burning or Notre Dame, the Democrats all piling on to tear apart the Mueller report and threaten to impeach the President and the tragedy in Sri Lanka. But the thing that really annoyed me is the increasing number of patients with measles, now over 500 in this country due to non vaccinated children, etc.. These anti-vaxers are spoiled and selfish. But I bet that when their children get really sick they will demand the best care from any and all hospitals, physicians and nurses out there or threaten to sue them. So, the Single-payer healthcare discussion will have to wait a week!
The NIH/National Institute of Allergy and Infectious Diseases pointed out that in 2000, measles was declared to be eliminated in the United States when no sustained transmission of the virus was seen in this country for more than 12 months. Yes, you read that right; it was declared to have been eliminated. What happened then?
Today, however, the United States and many other countries that had also eliminated the disease are experiencing concerning outbreaks of measles because of declines in measles vaccine coverage. Without renewed focus on measles vaccination efforts, the disease may rebound in full force, according to a new commentary in the New England Journal of Medicine by infectious diseases experts at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and the Penn State University College of Medicine’s Milton S. Hershey Medical Center.
Measles is an extremely contagious illness transmitted through respiratory droplets and aerosolized particles that can remain in the air for up to two hours. Most often seen in young children, the disease is characterized by fever, malaise, nasal congestion, conjunctivitis, cough, and a red, splotchy rash. Most people with measles recover without complications within a week. However, for infants, people with immune deficiencies, and other vulnerable populations, the consequences of measles infection can be severe. Rare complications can occur, including pneumonia, encephalitis, other secondary infections, blindness, and even death. Before the measles vaccine was developed, the disease killed between two and three million people annually worldwide. Today, measles still causes more than 100,000 deaths globally each year.
Measles can be prevented with a vaccine that is both highly effective and safe. Each complication and death related to measles is a “preventable tragedy that could have been avoided through vaccination,” the authors write. Some people are reluctant to vaccinate their children based on widespread misinformation about the vaccine. For example, they may fear that the vaccine raises their child’s risk of autism, a falsehood based on a debunked and fraudulent claim. A very small number of people have valid medical contraindications to the measles vaccine, such as certain immunodeficiencies, but almost everyone can be safely vaccinated.
When levels of vaccine coverage fall, the weakened umbrella of protection provided by herd immunity—indirect protection that results when a sufficiently high percentage of the community is immune to the disease—places unvaccinated young children and immunocompromised people at greater risk. This can have disastrous consequences with measles. The authors describe a case in which a single child with measles infected 23 other children in a pediatric oncology clinic, with a fatality rate of 21 percent.
Now, look at the situation in New York City.
If vaccination rates continue to decline, measles outbreaks may become even more frequent, a prospect the authors describe as “alarming.” This is particularly confounding, they note since measles is one of the most easily prevented contagious illnesses. In fact, it is possible to eliminate and even eradicate the disease. However, they say, achieving this goal will require collective action on the part of parents and healthcare practitioners alike.
New York Declares Measles Emergency, Requiring Vaccinations in Parts of Brooklyn
New York City on Tuesday declared a health emergency following a measles outbreak in the Orthodox Jewish community in Brooklyn. Demetrius Freeman for The New York Times reported.
Tyler Pager and Jeffery Mays reported that for months, New York City officials have been fighting a measles outbreak in ultra-Orthodox Jewish communities in Brooklyn, knowing that the solution — the measles vaccine — was not reaching its target audience.
They tried education and outreach, working with rabbis and distributing thousands of fliers to encourage parents to vaccinate their children. They also tried harsher measures, like a ban on unvaccinated students from going to school.
But with measles cases still on the rise and an anti-vaccination movement spreading, city health officials on Tuesday took a more drastic step to stem one of the largest measles outbreaks in decades.
Mayor Bill de Blasio declared a public health emergency that would require unvaccinated individuals living in Williamsburg, Brooklyn, to receive the measles vaccine. The mayor said the city would issue violations and possible fines of $1,000 for those who did not comply.
“This is the epicenter of a measles outbreak that is very, very troubling and must be dealt with immediately,” Mr. de Blasio said at a news conference in Williamsburg, adding: “The measles vaccine works. It is safe, it is effective, it is time-tested.”
The measure follows a spike in measles infections in New York City, where there have been 285 confirmed cases since the outbreak began in the fall; 21 of those cases led to hospitalizations, including five admissions to the intensive care unit.
City officials conceded that the earlier order in December, which banned unvaccinated students from attending schools in certain sections of Brooklyn, was not effective. Mr. de Blasio said on Tuesday that the city would fine or even temporarily shut down yeshivas that did not abide by the measure.
“There has been some real progress in addressing the issue, but it’s just not working fast enough and it was time to take a more muscular approach,” Mr. de Blasio said.
To enforce the order, health officials said they did not intend to perform random spot checks on students; instead, as new measles cases arose, officials would check the vaccination records of any individuals who were in contact with those infected.
“The point here is not to fine people but to make it easier for them to get vaccinated,” Dr. Oxiris Barbot, the city’s health commissioner, said at the news conference.
If someone is fined but still refuses to be vaccinated, Dr. Barbot said that would be handled on a “case-by-case basis, and we’ll have to confer with our legal counsel.”
Across the country, there have been 465 measles cases since the start of 2019, with 78 new cases in the last week alone, the Centers for Disease Control and Prevention said on Monday.
In 2018, New York and New Jersey accounted for more than half of the measles cases in the country, and the continuing outbreak has led to unusual measures.
In Rockland County, N.Y., a northern suburb of New York City, county health officials last month barred unvaccinated children from public places for 30 days. Last week, however, a judge ruled against the order, temporarily halting it.
“This is the epicenter of a measles outbreak that is very, very troubling and must be dealt with immediately,” Mayor Bill de Blasio said on Tuesday.
“This is the epicenter of a measles outbreak that is very, very troubling and must be dealt with immediately,” Mayor Bill de Blasio said on Tuesday.CreditJohn Taggart for The New York Times
Despite the legal challenge to Rockland County’s efforts, Mr. de Blasio said the city had consulted its lawyers and felt confident it was within its power to mandate vaccinations.
“We are absolutely certain we have the power to do this,” Mr. de Blasio said. “This is a public health emergency.”
[In Rockland County, an outbreak spread fear in an ultra-Orthodox community.]
Dr. Paul Offit, a professor of pediatric infectious diseases at Children’s Hospital of Philadelphia, said there was the precedent for Mr. de Blasio’s actions, pointing to a massive measles outbreak in Philadelphia in 1991. During that outbreak, officials in that city went even further, getting a court order to force parents to vaccinate their children.
“I think he’s doing the right thing,” Dr. Offit said about Mr. de Blasio. “He’s trying to protect the children and the people of the city.”
He added: “I don’t think it’s your unalienable right as a United States citizen to allow your child to catch and transmit a potentially fatal infection.”
Nonetheless, the resistance to the measles vaccine remains among some ultra-Orthodox in Brooklyn.
Gary Schlesinger, the chief executive of Parcare, a health and medical center with locations in Williamsburg and Borough Park, called the public health emergency a necessary “step in the right direction.”
“Any mother that comes in and says that they don’t want to vaccinate, our providers will tell them please go find another health center,” Mr. Schlesinger said.
He said he often reminded Orthodox parents that there was no religious objection to getting vaccinated. “Any prominent rabbi will say that you should vaccinate,” he said.
Just outside the public library where Mr. de Blasio held his news conference, some Hasidic mothers raised concerns about the emergency declaration.
“I don’t think it’s up to the city to mandate anything. We all have constitutional rights,” said a woman who only identified herself by Gitty. She refused to give her last name for fear of being harassed for her rejection of vaccinations.
She said she had five children and that none had been or would be vaccinated, an action she called “a medical procedure by force.”
“We are marginalized,” she said. “Every minority that has a different opinion is marginalized.”
In nearby South Williamsburg, reaction to the emergency order was mixed. Some agreed with the need for vaccinations, but did not believe the law should require them; others agreed with the mayor.
“He’s right,” said Leo Yesfriedman, a 33-year-old father of four who said he had his family vaccinated.
He said he had followed news of the measles outbreak. Of people in his community opposed to vaccinations, he said, “It’s a very, very little percentage of crazy people.”
Measles Outbreak: Yeshiva’s Preschool Program Is Closed by New York City Health Officials
The program is the first one to be closed as part of the city’s escalating effort to stem the country’s largest measles outbreak in decades.
Children leaving a yeshiva’s preschool program in Williamsburg on Monday. It is the first to be closed by New York City officials for violating a Health Department order.
The New York Times John Taggart reported that New York City closed a preschool program at a yeshiva in Brooklyn on Monday for violating a Health Department order that required it to provide medical and attendance records amid a measles outbreak.
The preschool at United Talmudical Academy, which serves 250 students between the ages of 3 and 5 in the Williamsburg area, is the first program to be closed by the city, as it escalates efforts to stem the country’s largest measles outbreak in decades.
New York City has confirmed 329 measles cases since the outbreak began in the fall, and the cases have largely been confined within the ultra-Orthodox Jewish community. The outbreak began after unvaccinated individuals returned from celebrating Sukkot, a Jewish harvest festival, in Israel.
The closing of the preschool comes as tensions have risen in the ultra-Orthodox community over increased scrutiny and fears of an anti-Semitic backlash. On the one hand, most in the ultra-Orthodox community are vaccinated, and the vast majority of prominent rabbis have urged people to vaccinate their children. However, the city’s response to the outbreak has caused vaccine skeptics to double down on their opposition to immunization. The anti-vaccination movement’s well-coordinated and sophisticated messaging campaign, highlighted by magazines, hotlines, and conference calls, has convinced some parents that vaccines are dangerous and that diseases, like measles, are not.
In December, the city issued exclusion orders, barring unvaccinated students from attending school in certain neighborhoods. The city issued violations to 23 yeshivas and day care centers for breaking that order. But, last month, the city said it would no longer issue violations; rather, it would immediately close yeshivas.
“The challenge has been with this particular school that they have been unable and/or unwilling to provide documentation as required when we visit,” Dr. Oxiris Barbot, the city’s health commissioner, said at a news conference on Monday. “So we have visited on a number of occasions and offered support, but in spite of all of that it’s been to no avail.”
The Health Department said the preschool would not be allowed to reopen until its staff had “submitted a corrective action plan approved by the department.”
At the news conference, health officials said two students associated with the school had contracted measles, though they did not know for sure whether the students had been infected with the virus at the school or elsewhere.
Last week, Mayor Bill de Blasio declared a public health emergency, requiring all individuals living in certain ZIP codes of Brooklyn to be vaccinated against measles or face a $1,000 fine. On Monday, a group of parents filed a lawsuit against the order, arguing it was unjustified because of “insufficient evidence of a measles outbreak or dangerous epidemic.”
“Our attempts at education and persuasion have failed to stop the spread of measles,” Nick Paolucci, a spokesman for the city’s Law Department, said in a statement. “We had to take this additional action to fulfill our obligation to ensure that individuals do not continue to put the health of others at risk. We are confident that the city’s order is within the health commissioner’s authority to address the very serious danger presented by this measles outbreak.”
A judge declined to issue an emergency injunction against the city on Monday, and the parties will appear in court on Thursday.
There have been no deaths associated with this outbreak, but 25 individuals have been hospitalized. Two patients remain in the intensive care unit.
90 New Cases of Measles Reported in the U.S. as Outbreak Continues Record PaceApril 15, 2019
“This outbreak will continue to worsen, and the case count will grow if child care programs and schools do not follow our direction,” Dr. Barbot said in a statement. “It’s crucial in this outbreak that child care programs and schools maintain up-to-date and accurate immunization and attendance records. It’s the only way we can make sure schools are properly keeping unvaccinated students and staff out of child care centers to hasten the end of this outbreak.”
A teacher at United Talmudical Academy, who declined to give his name, said that all students who were not vaccinated were sent home weeks ago.
“It was a few kids who didn’t take the shots,” he said, as he exited the building. “They’re not coming back.”
A 68-year-old community member, who declined to give his name, said he did not think the school should be closed down.
“The parents should be held accountable,” he said.
He added that the community will be “very angry” that the school was shut down.
Measles outbreaks have also been reported in Rockland and Westchester Counties, suburbs of New York. Since January, 555 cases of measles have been reported in the United States, the Centers for Disease Control and Prevention said on Monday, noting the outbreak is on pace to be the largest since the country declared measles eradicated in 2000.
Exemptions Surge As Parents And Doctors Do ‘Hail Mary’ Around Vaccine Laws
Barbara Feder Ostrov noted that at two public charter schools in the Sonoma wine country town of Sebastopol, more than half the kindergartners received medical exemptions from state-required vaccines last school year. The cities of Berkeley, Santa Cruz, Nevada City, Arcata, and Sausalito all had schools in which more than 30% of the kindergartners had been granted such medical exemptions.
Nearly three years ago, with infectious disease rates ticking up, California enacted a fiercely contested law barring parents from citing personal or religious beliefs to avoid vaccinating their children. Children could be exempted only on medical grounds if the shots were harmful to health.
Yet today, many of the schools that had the highest rates of unvaccinated students before the new measure continue to hold that alarming distinction. That’s because parents have found end-runs around the new law requiring vaccinations. And they have done so, often, with the cooperation of doctors — some not even pediatricians. One prolific exemption provider is a psychiatrist who runs an anti-aging clinic.
Doctors in California have broad authority to grant medical exemptions to vaccination and to decide the grounds for doing so. Some are wielding that power liberally and sometimes for cash: signing dozens — even hundreds — of exemptions for children in far-off communities.
“It’s sort of the Hail Mary of the vaccine refusers who is trying to circumvent SB 277,” the California Senate bill signed into law by Gov. Jerry Brown in 2015, said Dr. Brian Prystowsky, a Santa Rosa pediatrician. “It’s really scary stuff. We have pockets in our community that is just waiting for measles to rip through their schools.”
The number of California children granted medical exemptions from vaccinations has tripled in the past two years.
Medical Exemptions On The Rise
The number of California children with medical vaccine exemptions has tripled in the two years since California enacted a 2016 law banning exemptions based on personal beliefs.
Across the nation, 2019 is shaping up to be one of the worst years for U.S. measles cases in a quarter-century, with major outbreaks in New York, Texas, and Washington state, and new cases reported in 12 more states, including California. California’s experience underlines how hard it is to get parents to comply with vaccination laws meant to protect public safety when a small but adamant population of families and physicians seems determined to resist.
When Senate Bill 277 took effect in 2016, California became the third state, after Mississippi and West Virginia, to ban vaccine exemptions based on personal or religious beliefs for public and private school students. (The ban does not apply to students who are home-schooled.)
In the two subsequent years, SB 277 improved overall child vaccination rates: The percentage of fully vaccinated kindergartners rose from 92.9% in the 2015-16 school year to 95.1% in 2017-18.
But those gains stalled last year due to the dramatic rise in medical exemptions: More than 4,000 kindergartners received these exemptions in the 2017-18 school year. Though the number is still relatively small, many are concentrated in a handful of schools, leaving those classrooms extremely vulnerable to serious outbreaks.
Based on widely accepted federal guidelines, vaccine exemptions for medical reasons should be exceedingly rare. They’re typically reserved for children who are allergic to vaccine components, who have had a previous reaction to a vaccine, or whose immune systems are compromised, including kids being treated for cancer. Run-of-the-mill allergies and asthma aren’t reasons to delay or avoid vaccines, according to the U.S. Centers for Disease Control and Prevention. Neither is autism.
Before California’s immunization law took effect, just a fraction of 1% of the state’s schoolchildren had medical exemptions. By last school year, 105 schools, scattered across the state, reported that 10% or more of their kindergartners had been granted medical exemptions. In 31 of those schools, 20% or more of the kindergartners had medical exemptions.
As of July 2016, California no longer allows parents to exempt their children from state-required vaccinations based on personal beliefs. Many of the same schools that once had the highest percentage of students with personal belief exemptions now lead the state in student medical exemptions.
Credit: Harriet Blair Rowan/California Healthline
Source: California Department of Public Health Get the data created with Datawrapper
The spike in medical exemptions is taking place amid a politically tinged, often rancorous national conversation over vaccines and personal liberty as measles resurges in the U.S. and worldwide. At least 387 cases of measles had been reported nationwide through March 28, according to the CDC. In California, 16 cases had been reported, two of them requiring hospitalization.
The problem in California, state officials say, is how the immunization law was structured. It removed the ability of parents to cite “personal belief” as a reason for exempting their children from vaccine requirements in daycare and schools. A licensed physician who provides a written statement citing a medical condition that indicates immunization “is not considered safe” now must authorize exemptions.
But the law does not specify the conditions that qualify a student for a medical exemption, nor does it require physicians to follow federal guidelines.
The wording has led to a kind of gray market in which parents share names of “vaccine-friendly” doctors by word of mouth or in closed Facebook groups. And some of those doctors are granting children blanket exemptions — for all time and all vaccines — citing a range of conditions not supported by federal guidelines, such as a family history of eczema or arthritis.
Amid growing concerns about suspect exemptions, the California Department of Public Health recently launched a review of schools with “biologically unlikely” numbers of medical exemptions, said the agency’s director, Dr. Karen Smith. Doctors who have written questionable exemptions will be referred to the Medical Board of California for a possible investigation.
The medical board, which licenses doctors, has the authority to levy sanctions if physicians have not followed the standard medical practice in examining patients or documenting specific reasons for an exemption.
In recent years, however, the board has sanctioned only one doctor for inappropriately writing a medical vaccine exemption in a case that made headlines. Since 2013, the board has received 106 complaints about potentially improper vaccine exemptions, including nine so far this year, said spokesman Carlos Villatoro.
One pending case involves Dr. Ron Kennedy, who was trained as a psychiatrist and now runs an anti-aging clinic in Santa Rosa.
Medical board investigators took the unusual step of subpoenaing 12 school districts for student medical records after receiving complaints that Kennedy was writing inappropriate exemptions. They found that Kennedy had written at least 50 exemptions, using nearly identical form letters, for students in multiple communities, including Santa Rosa, Fremont, and Fort Bragg, saying that immunizations were “contraindicated” for a catchall list of conditions including lupus, learning disability, food allergies and “detoxification impairment.”
Dr. Dean Blumberg, chief of pediatric infectious diseases at UC Davis Children’s Hospital and the medical board’s expert witness, said that the exemptions issued by Kennedy appear to have been provided “without appropriate evaluation,” according to court documents.
Kennedy has refused to respond to the board’s subpoenas seeking the medical records of three of his patients, according to court documents. The board has yet to file a formal accusation against Kennedy, and he continues to practice.
Like Kennedy, many of the doctors granting unorthodox exemptions cite their belief in parental rights or reference concerns not supported by conventional medical science. Kennedy is suing the medical board and its parent agency, the California Department of Consumer Affairs, saying the state did not have the legal right to subpoena school districts for his patients’ medical records without first informing him so he could challenge the action in court. The case is ongoing.
Kennedy declined to comment to Kaiser Health News. “I don’t want to be out in the open,” he said in a brief phone exchange. “I’ve got to go. I’ve got a business to run.”
In Monterey, Dr. Douglas Hulstedt is known as the doctor to see for families seeking medical exemptions. In a brief phone interview, he said he was worried about being targeted by the state medical board. “I have stuck my neck way out there just talking with you,” he said. Hulstedt does not give exemptions to every child he examines, he said, but does believe vaccines can cause autism — a fringe viewpoint that has been debunked by multiple studies.
In March, the online publication Voice of San Diego highlighted doctors who write medical exemptions, including one physician who had written more than a third of the 486 student medical exemptions in the San Diego Unified School District. District officials had compiled a list of such exemptions and the doctors who provided them.
State Sen. Richard Pan (D-Sacramento), a pediatrician who sponsored California’s vaccine law, has been a vocal critic of doctors he says are skirting the intent of the legislation by handing out “fake” exemptions. Last month, he introduced follow-up legislation that would require the state health department to sign off on medical exemptions. The department also would have the authority to revoke exemptions found to be inconsistent with CDC guidelines.
“We cannot allow a small number of unethical physicians to put our children back at risk,” Pan said. “It’s time to stop fake medical exemptions and the doctors who are selling them.”
8 Common Arguments Against Vaccines And why they don’t make any sense at all
Gid M-K noted that because whilst vaccines have been accepted by public health organizations the world over as the most important medical innovation of the 20th century, and one of the most lifesaving interventions that we’ve ever come up with, there is a small minority of people who are convinced that vaccines are bad for their child’s health.
A small, very vocal, minority but this minority is causing real problems for others as well as their own kids.
One would like not to criticize parents. Because it’s very important to note that most parents want the best for their kids. They are trying to look out for their children, and occasionally in this pursuit, they get misled. And make no mistake, the people who sell vaccine fear are professionals in the art of deception. They know exactly how to convince a worried parent that the most dangerous thing in the world for their child is the vaccine, rather than, say, the measles.
It’s not the parents who are spreading vaccine denial. They are victims of professionals. If you are a parent who is worried about vaccination: don’t stress. You are a good parent. You have just been lied to. Have a read of this article, and maybe go have a chat with your doctor about why immunization is important and why it’s a good thing for your kids.
Whenever you talk vaccines, the anti-vax professionals come up with the same arguments time and again. Let’s look at my top 8, and why they make no sense whatsoever:
Vaccines Cause Autism. I’m not really going to go into this, because it has been refuted time and again. Virtually every study involving a) humans, b) more than 10 participants, and c) researchers who haven’t been convicted of fraud, has shown that there is no link between vaccines and autism. It was a valid concern in the early 90s, but we have 30 years of evidence showing that autism is in no way linked to vaccines.
VACCINES DO NOT CAUSE AUTISM ALL REPUTABLE STUDIES HAVE SHOWN THIS FOR DECADES
There Hasn’t Been Much Research. This is always a bit of a weird one because people are usually claiming that on the one hand there hasn’t been enough research done on vaccines to prove them safe, but on the other, they know the truth because they’ve done their research and it shows vaccines to be basically poison.
It’s a strange argument to make, but it comes up all the time.
This is simply a lie told by vaccine-deniers to make parents scared. Vaccines are one of the most well-researched interventions of all time. We have data from literally millions of children across the world demonstrating their safety. There has been more research on vaccines than almost any other medical intervention.
The research has been done. Time and again. Vaccines are safe and effective.
Vaccines Are Enormously Profitable. This is also a weird one, because…so what? So are any number of things. The international flour market is gigantic, but that doesn’t make every bread advert a missive from the devil. Flour millers have actually been influential in protecting babies worldwide by fortifying their products with macronutrients and preventing neural tube defects.
It’s also untrue. Pharma companies make far more money from so-called ‘blockbuster’ drugs than vaccines — for example, AstraZeneca’s Nexium, despite being no more effective than cheaper options for gastrointestinal problems, has made them more than $50 billion. The yearly earnings have been somewhere between 2 and 5 times as much as the flu vaccine. In fact, if you look at the top 20 earners for pharma companies, not one of them is a vaccine.
Vaccines Cost Loads. Perhaps more importantly than this, however: vaccines don’t cost much at all. Take the whooping cough vaccine. A full 3 doses costs around 100 USD. That seems like quite a bit until you remember that a single case of whooping cough can easily top $10,000if it requires significant treatment.
Vaccines are actually cost-saving. What this means is that for every dollar you spend on vaccines, you get about seven dollars back because you stop people from getting sick and dying from their illnesses. Generally speaking, it would be much more profitable for the medical industry to not vaccinate, because the disease tends to be really expensive.
The CDC Is Lying. This is one of my favorite red herrings because it is just so easy to disprove. Whenever someone brings up the CDC, my response is…so what? Let’s say the CDC is evil, awful, in the pocket of Big Pharma. It’s not — the people who work at the CDC are dedicated, honest, and usually incredibly good at public health — but for the sake of argument, let’s say the CDC is corrupt.
People who focus on the CDC ignore one glaring truth: the US isn’t the only country in the world. If the CDC is corrupt, what about every other public health organization in the world that recommends vaccines. Australia. France. The UK. Japan. China. The list goes on. Forget about the CDC. Have a look at the Australian Department of Health on vaccines. Or the Japanese immunization schedule. Or one of the hundreds of other countries that all choose to vaccinate. Either there’s a global conspiracy including countries that are literally at war with one another — a bit unlikely — or immunization is a good thing no matter what you think of the CDC.
The US Is Special. This is another one that I love because it’s so easily disprovable. No, the US doesn’t give a uniquely high number of immunizations. Much of the OECD has a virtually identical vaccine schedule to the US, bar a few minor differences. The US also has significantly less punitive laws in terms of vaccination than other countries — for example, in France, you can go to jail for failing to vaccinate your kids.
So no. The US isn’t special. It’s just another country, trying to stop nasty diseases like polio, diphtheria, and measles from killing children.
Vaccine Manufacturers Can’t Be Sued For Making Kids Sick. This is actually a very simple lie. You can sue whoever you want, even in the US. What the 1986 National Childhood Vaccine Injury Act actually does is make it much easier to get compensation for children who have suffered vaccine injuries. If you can demonstrate that you had a vaccine and suffered a recognized issue — let’s say anaphylaxis — there is a reasonably simple method of gaining access to compensation in the US.
Elsewhere in the world, for example, Australia, often all you can do is sue in civil courts. And even if you’ve suffered genuine harm from vaccination, proving this in a court of law is next to impossible, meaning that people who do suffer injuries are almost never compensated.
It’s also worth noting that saying “vaccine manufacturers can’t be sued” is again a uniquely American piece of nonsense. There are hundreds of other countries. Most of them allow anyone to try and sue anyone. And yet, the UK court system isn’t flooded with cases of vaccine manufacturers being successfully sued.
I wonder why?
Vaccine Injury Is Common/People Are Getting Sicker. Last but not least, the most common one of the bunch. Forget the CDC, forget the pharmaceutical companies, this is the real evil.
Every year, people are getting sicker. And it’s all down to vaccines.
There are two parts to this story. Firstly, we aren’t getting sicker. Not even a little bit. Life expectancy is marching steadily upward, with some people predicting that we will be living past 100 in this century. Not only that, but infant and child mortality is at record lows, and is only heading swiftly down. This isn’t just true for wealthy countries mind you — the entire world is getting stubbornly healthier.
Secondly, vaccine injury is an amazingly well-researched field. We know the rate of injuries associated with vaccines all too well. It’s a roughly 1 serious problem for every million vaccinations given. This is a number that has been replicated worldwide, from Japan to Thailand to Australia to Finland and yes, to the US.
There’s not really much more to say. These are common arguments, mostly just based on simple lies. Vaccines are safe and effective, not because pharmaceutical companies say it’s so or because the CDC has proclaimed it, but because thousands of dedicated researchers the world over have spent decades checking to make sure that they are.
So go and get your kids vaccinated. It’s good for society, it will save us all money, but most of all it might save their life.
It’s as simple as that. So, stop all your chest beating complaining about your constitutional rights being trampled on! Vaccinations are for the benefit of the children yours and those who will come in contact with non-vaccinated people and get severely sick. Cut it out and get vaccinated or suffer the consequences!!
I don’t know whether you all remember my last few sentences of last week’s post but I was so encouraged this week because it seems that maybe some of the politicians are reading my blog (yeah right!?!?) or they recognize the severity of the measles problem today. So, I want to continue the discussion starting with a number of States who get the message.
Patti Neighmond wrote that all U.S. states require most parents to vaccinate their children against some preventable diseases, including measles, mumps, rubella, and whooping cough, to be able to attend school. Such laws often apply to children in private schools and day care facilities as well as public schools.
At the same time, beyond medical exemptions, most states also allow parents to opt out of this vaccination requirement for religious reasons. And 17 states permit other exemptions — allowing families to opt out of school vaccination requirements for personal or philosophical reasons.
Michelle Mello, a professor of law and health research and policy at Stanford University, says the bar for claiming an exemption from vaccine requirements has been very low in many states. “You can believe that vaccines don’t work or that they are unsafe or they simply fly in the face of your parenting philosophy,” she says.
But this winter’s outbreaks of measles across the nation are resulting in challenges to many exemptions: At least eight states, including some that have experienced measles outbreaks this year, want to remove personal exemptions for the measles vaccine. And some states would remove the exemption for all vaccines.
Most of this year’s measles cases have been among children who were not vaccinated against the virus.
Once considered eradicated in the U.S., measles has sickened at least 159 people since the start of 2019, according to the Centers for Disease Control and Prevention, in outbreaks ranging from Washington and Oregon to Texas and New York. Last year, there were 372 reported cases of measles nationwide.
The move among state legislatures to tighten vaccine requirements is good news to Diane Peterson, the associate director for immunization projects with the pro-vaccine advocacy group Immunization Action Coalition.
“Measles is not like a common cold,” Peterson says. “Children get very, very sick and can be hospitalized,” she says, adding that measles can even lead to death.
The virus is highly contagious, airborne and easily spreads. It can survive in the air for a couple of hours.
“A patient with measles can go to the doctor, cough in the exam room and two hours later another patient coming into the same exam room can be infected,” Peterson says.
The virus is spreading fast this winter, she says, because of the “pockets of children who have not been vaccinated, mostly due to parents who have decided not to vaccinate them.”
This leaves not only those unvaccinated school children vulnerable to the virus but also many adults who have suppressed immune systems and infants who are not old enough to be vaccinated.
According to the Association of State and Territorial Health Officials, bills to restrict exemptions are now pending in a growing number of states.
None of this sits well with activists who want their states to maintain personal and philosophical exemptions.
“Nobody should sit in judgment of another person’s religious and spiritual beliefs,” says Barbara Loe Fisher, a spokesperson for the National Vaccine Information Center, a group that lobbies against mandatory vaccination and thinks parents should have a choice. “No person should be allowed to force someone to violate their conscience when they’re making a decision about the use of a pharmacological product that carries a risk of harm.”
The scientific consensus about any risk from vaccines is that serious side effects are extremely rare. A suggestion that immunization might be tied to severe consequences like autism was debunked years ago after findings supporting that link were proved fraudulent.
Mello, the Stanford law professor who has been following the exemption debate, notes that the courts have repeatedly held that when a public health intervention is necessary to safeguard the public, individuals generally can be required to give up some personal liberty, particularly if that liberty is tied to a government benefit like school.
So far, only three states — Mississippi, West Virginia and California — prohibit nearly all vaccine exemptions, including the one exempting families who say their religious belief conflicts with vaccination. (All states allow medical exemptions when, for example, a child has a compromised immune system.)
The California state Legislature made that decision in 2015, less than a year after the state experienced a significant measles outbreak that got its first foothold among unvaccinated children visiting Disneyland.
A measles outbreak in the US has triggered debate on the ease with which parents can opt out of mandatory vaccine rules.
I noted last week that a total of 159 people have come down with the disease in 10 states since January, but one small area, in particular, Clark County in Washington State, has illustrated the dangers of these exemptions, which are sought for religious, personal or philosophical reasons.
Just north of Portland, Oregon, Clark County accounts for 65 measles cases, 47 of them among children under age 10. In almost all 65 cases, patients had not been vaccinated.
Fifteen years ago, 96 percent of school children aged five in Clark County got measles shots. But in 2017-2018, the proportion was down to 84 percent.
In some schools, mainly private ones, the rate of use of the so-called MMR vaccination against measles, mumps, and rubella was only 20 to 30 percent. In some of the schools, more than half the students had received exemptions.
Local lawmakers in Washington State have responded to the outbreak by advancing legislation that would do away with exemptions on personal or philosophical grounds. Opt-outs for religious reasons would still be allowed.
Such exemptions are widely available in the United States. Only three of the 50 states—California, Mississippi, and Virginia do not allow them.
California did away with exemptions for personal reasons in 2015. In the most populous US state, exemptions are permitted only for medical reasons.
In recent years other states have toughened their laws. Connecticut, for instance, requires parents claiming an exemption for religious reasons to provide a yearly, notarized statement to this effect. Since 2015, Delaware has allowed schools to temporarily exclude non-vaccinated kids.
Vermont wants to get rid of religious exemptions, after eliminating those sought for philosophical reasons four years ago, according to The Washington Post. Arizona, Iowa, Minnesota are also debating stricter laws.
The US Congress will hold a hearing Wednesday on the issue of vaccinating children.
Overall, the vaccination rate of kids in the US has remained stable, according to the Centers for Disease Control and Prevention, which monitors such trends closely.
It reports that in the 2017-2018 school year, around 95% of American kindergarteners were vaccinated against MMR, chicken pox and diphtheria, tetanus and whooping cough.
But the national rate masks wide disparities from state to state and even from one school to the next, as the case of Clark County illustrates.
And health authorities are alarmed because the previous school year was the third in a row in which requests for exemptions from vaccination increased, even though the rises were small.
And the proportion of kids reaching age two without having received any kind of vaccination is also growing, albeit slowly: 0.9 percent of children born in 2011 to 1.3 percent among those born in 2015. Vaccination-free kids were practically unheard of at the turn of the century.
Exemptions alone do not explain why children are not vaccinated. Many vaccines are recommended for American children in their first two years of life—the CDC advises they be used for 14 diseases—and this is hard for parents to keep up with, especially for vaccines that require three or four shots.
Another problem is access to health insurance. Children in families without such insurance make up a disproportionate amount of those who go without shots, according to the CDC.
In Congress, the measles outbreak has prompted lawmakers to act.
The disease routinely infected American kids before a vaccine was introduced in 1963. Before that, it killed 400 to 500 people a year in the US. In 2000 it was declared eliminated. But since then, over the years anywhere from 50 to 600 cases have been reported annually.
Two US senators recently called on the CDC to explain what it is doing in response to what they called “pockets of unvaccinated people.”
‘We Need to Get to Zero’ on Measles: NIAID Chief to House Panel
I think we all agree and members from both parties express support for measles, mumps, and rubella vaccine
Our friend Joyce Frieden, the News Editor of MedPage Today, reported that the views that some House committee members expressed Wednesday in favor of vaccination brought to mind a line from a character on a British television show: “I am unanimous in this.”
“It wasn’t until the development of the MMR [measles, mumps, and rubella] vaccine that we as a country were able to stop this horrific illness,” said Rep. Diana DeGette (D-Colo.), chairman of the House Energy & Commerce Subcommittee on Oversight and Investigations, at a hearing on recent measles outbreaks in the U.S. “But despite that success, here we are again 20 years later.”
Rep. Greg Walden (R-Ore.), a ranking member of the full Energy & Commerce Committee, noted that one in four people diagnosed with measles will end up being hospitalized. “If we don’t reverse the downward trend in vaccination, we risk bringing back measles in full force,” he said.
DeGette called the recent measles outbreaks “a real cause for national concern” and pointed out that the national measles vaccination rate for children stands at 91%.
“That may seem high to some, but it’s well below the 95% vaccination rate required to protect communities and give them herd immunity,” she said. “And while the overall national rate of MMR vaccines is currently at 91%, the rate in some communities is much lower — some as low as 77%. Outbreaks like the one we’re seeing with measles remind us of just how interconnected our communities are … As a nation, to stop the spread of deadly diseases, we have to address the root cause of the problem and we have to define concrete steps … We need to support additional research into vaccine safety to further increase consumer confidence in these vaccines.”
Nearly 160 Cases This Year
Once again the numbers are important and so from Jan. 1, 2019 to Feb. 21, 2019, there have been 159 confirmed measles cases in 10 states, Nancy Messonnier, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases, told the committee. The states reporting outbreaks include California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New York, Oregon, Texas, and Washington. In 2018, 372 people in 25 states and the District of Columbia were reported to have measles; most of those cases involved unvaccinated people, she added.
Although measles was officially eliminated in the U.S. in 2000, and the rate of measles vaccination coverage is fairly high nation-wide, “there are pockets of people who are vaccine hesitant who delay or even refuse to vaccinate themselves and their children,” which can cause outbreaks, Messonnier said. Many of those live in close-knit communities where they share the same religious beliefs or ethnic backgrounds as their neighbors. Others simply have a strong personal belief against vaccination.
“In the past 5 years, there have been 26 measles outbreaks of more than five cases, 12 of which were in close-knit communities, including a Somali community in Minnesota in 2017 and Orthodox Jewish communities in New York City and New York state in 2018; these 12 outbreaks account for over 75% of cases in the past 5 years,” she said, adding that “Vaccine hesitancy is the result of a misunderstanding of the risk and seriousness of disease combined with misinformation regarding the safety and effectiveness of vaccines. However, the specific issues fueling hesitancy vary by community” and must be attacked locally with the help of the CDC.
The federal government’s Vaccines for Children (VFC) program is a “critical component” of the fight against vaccine-preventable diseases, Messonnier said. “Because of VFC, we have seen significant decreases in disparities in vaccination coverage … For each dollar invested [in the program], there are $10 of societal savings and $3 in direct medical savings.”
‘I Am a Measles Survivor’
Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases (NIAID) in Bethesda, Maryland, said that measles was “one of the most contagious pathogens we know of” and explained that since the virus has been well sequenced, “we can tell, when the virus is reintroduced into our country, from where it comes.” For example, researchers were able to determine that a measles virus that led to an outbreak among a community of Hasidic Jews in Brooklyn in New York City came from Israel.
“I consider it really an irony that you have one of the most contagious viruses known to man, juxtaposed against one of the most effective vaccines that we have, and yet we don’t do and have not done what could be done — namely, completely eliminate and eradicate this virus.” Fauci showed a slide delineating the recent outbreaks. “This slide is really unacceptable; this is a totally vaccine-preventable disease … What we all should strive for, that measles in the United States, we need to get to zero.”
A few hearing participants shared their own experience with the disease. “I am a measles survivor,” said Rep. Michael Burgess, MD (R-Texas). “I was at an age where the measles vaccine was not available. Even though I was very young when that happened, I still remember … the heart-shaking chills, the muscle pain, and the rash that’s [emblematic] of measles.” Fauci said he also had the disease and that it was “very uncomfortable and very scary.” Rep. Brett Guthrie (R-Ky.), the subcommittee’s ranking member said that one of his close childhood friends “was essentially born without a hand” after the friend’s mother contracted rubella during her pregnancy. “I’ve always thought of measles and how devastating it can be.”
Guthrie also asked Fauci whether people could “self-medicate” with vitamin A to prevent measles. Fauci responded that children with vitamin A deficiency who get measles “have a much more difficult course, so vitamin A [supplements] can actually protect you from some of the toxic and adverse effects,” but that doesn’t apply in developed countries where such deficiencies are rare. “It doesn’t prevent measles, but it’s important in preventing complications in societies in which vitamin A deficiency might exist,” he said.
The Thimerosal Question
Burgess asked about whether thimerosal — a mercury-containing preservative often mistakenly claimed to cause problems with vaccines — was in the measles vaccine. “No, it’s preservative-free,” said Fauci. Burgess asked whether there was ever any evidence that mercury or thimerosal was unsafe. Messonnier said thimerosal had been removed from vaccines “out of an abundance of caution at a time when there wasn’t enough evidence, but evidence since then has been very conclusive” that thimerosal is safe.
The hearing was also marked by a few disruptions, including some shouts from the audience when Fauci, responding to a question, said that the measles vaccine couldn’t cause encephalitis. DeGette told the audience that such disruptions were in violation of House rules; Messonnier then said that the vaccine doesn’t cause brain swelling or encephalitis in healthy children.
Guthrie remarked that whether or not parents choose to vaccinate their children, they do so with the best of intentions. “Whatever decisions they’re making, they’re making it in the love and best interest of their child,” he said. “So I think it’s important we do have the science … and people with credentials and reputations to present this evidence, and hopefully people have the opportunity to see it and read it.”
Measles cases soar worldwide, UN warns of ‘complacency’
Outside of the U.S., I think it is necessary to see how this disease is affecting other countries. I brought up the statistics regarding the incidence and the deaths in the Philippines but on a broader scale Cynthia Goldsmith reviewed the statistics with regard of the measles problem in the world and noted that just 10 countries were responsible for three-quarters of a global surge in measles cases last year, the UN children’s agency said Friday, including one of the world’s richest nations, France.
Ninety-eight countries reported more cases of measles in 2018 compared with 2017, and the world body warned that conflict, complacency and the growing anti-vaccine movement threatened to undo decades of work to tame the disease.
“This is a wakeup call. We have a safe, effective and inexpensive vaccine against a highly contagious disease—a vaccine that saved almost a million lives every year over the last two decades,” said Henrietta Fore, executive director of UNICEF.
“These cases haven’t happened overnight. Just as the serious outbreaks we are seeing today took hold in 2018, lack of action today will have disastrous consequences for children tomorrow.”
Measles is more contagious than tuberculosis or Ebola, yet it is eminently preventable with a vaccine that costs pennies.
But the World Health Organization last year said cases worldwide had soared nearly 50 percent in 2018, killing around 136,000 people.
Ukraine, the Philippines, and Brazil saw the largest year-on-year increases. In Ukraine alone, there were 35,120 cases—nearly 30,000 more than in 2017.
Brazil saw 10,262 cases in 2018 after having none at all the year before, while the Philippines reported 15,599 cases last year compared to 2,407 in 2017.
Taken together, the ten nations accounting for 75 percent of the increase from 2017 to 2018 account for only a tenth of the global population.
The countries with the highest rate of measles last year were Ukraine (822 cases per million people), Serbia (618), Albania (481), Liberia (412), Georgia (398), Yemen 328), Montenegro (323) and Greece (227).
While most of the countries that experienced large spikes in cases are beset by unrest or conflict, France saw its caseload jump by 2,269.
In the United States, there was a 559 percent year-on-year increase in cases from 120 to 791.
Misinformation and mistrust
The resurgence of the disease in some countries has been linked to medically baseless claims linking the measles vaccine to autism, which have been spread in part on social media by members of the so-called “anti-vax” movement.
The WHO last month listed “vaccine hesitancy” among the top 10 most pressing global health threats for 2019.
“Almost all of these cases are preventable and yet children are getting infected even in places where there is simply no excuse,” Fore said.
“Measles may be the disease, but all too often the real infection is misinformation, mistrust and complacency.”
In war-torn Yemen, where health services in many regions have collapsed, UNICEF and the World Health Organization joined with local authorities last month in a campaign to vaccinate some 13 children aged six months to 15 for measles and rubella.
UN officials estimated that 92 percent of the targeted children were jabbed during the one-week push, which ended on February 14.
Yemen also figured on UNICEF’s “top 10” list of countries showing the largest increases last year in measles cases with a 316 percent hike, from 2,101 cases in 2017 to 8,742 cases in 2018.
Other countries with huge jumps last year compared to 2017 are Venezuela (4,916 more cases, up 676 percent), Serbia (4,355 more cases, up 620 percent), Madagascar (4,307 more cases, up 5,127 percent), Sudan (3,496 more cases, up 526 percent) and Thailand (2,758 more cases, up 136 percent).
A few countries saw declines in the number of confirmed cases of measles.
In Romania, reported cases dropped 89 percent from 8,673 to 943, and in Indonesia, the number declined by 65 percent from 11,389 to 3,995.
Nigeria, Pakistan, Italy, and China also saw drops of 35 to 55 percent.
So, the number of worldwide resurgence of cases of measles is huge and we as a community need to step up and push our healthcare community and the government to step up and demand that we protect our youth both here in the U.S.A. and yes, in the world. Also, we need to ignore the politics and the misinformation and mistrust and get the job done for our kids, and future generations!