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.
As the terrible fires continue to burn and Nancy Pelosi says that Mother Nature is angry with us and the political atmosphere is all about hate, I sometimes don’t know who to believe, especially when it comes to the media. Andrew Romano reported that earlier this week, Iowa Republican Sen. Joni Ernst became the first member of “the world’s greatest deliberative body” to embrace a false online conspiracy theory that seeks to minimize the danger of COVID-19 by claiming only a few thousand Americans have died from the virus — not the 185,000 reported by state and local health agencies and hospitals.
Ernst, who described herself as “so skeptical” of the official death toll, even went so far as to echo the nonsense argument spread by QAnon and other right-wing conspiracy-mongers that medical providers who have risked their own lives and health to treat COVID-19 patients have been attributing non-COVID deaths to the virus to rake in extra cash from the federal government.
“These health-care providers and others are reimbursed at a higher rate if COVID is tied to it, so what do you think they’re doing?” Ernst, who is facing a tight reelection race, said Monday at a campaign stop near Waterloo, Iowa, according to a report by the Waterloo-Cedar Falls Courier.
“They’re thinking there may be 10,000 or less deaths that were actually singularly COVID-19,” Ernst added in an interview with the paper. “I’m just really curious. It would be interesting to know that.”
Since Ernst is “really curious,” here are the facts.
Yes, Medicare pays hospitals more for treating COVID-19 patients — 20 percent more than its designated rate, to be exact. Incidentally, this additional payment was approved 96-0 in the U.S. Senate — including by Joni Ernst. The reason Ernst (and all of her Senate colleagues) voted for it is simple: It helped keep U.S. hospitals open and operating during a worldwide emergency.
“This is no scandal,” Joseph Antos, a scholar in health care at the conservative American Enterprise Institute, explained in a recent PolitiFact fact-check. “The 20 percent was added by Congress because hospitals have lost revenue from routine care and elective surgeries that they can’t provide during this crisis, and because the cost of providing even routine services to COVID patients has jumped.”
In other words, no one is getting rich by misclassifying COVID-19 deaths.
It’s also fair to say that fewer than 185,000 Americans have died “singularly,” as Ernst put it, from COVID-19. According to a recent update by the Centers for Disease Control and Prevention, 94 percent of patients whose primary cause of death was listed as COVID-19 were also judged to have comorbidities — secondary conditions like diabetes that often exacerbate the virus’s effects. For the remaining 6 percent, COVID-19 was the only cause listed in conjunction with their deaths.
On Sunday, President Trump retweeted a QAnon backer who falsely claimed this meant that only 6 percent of reported COVID-19 deaths — that is, 10,000 or so — were actually caused by the virus. Perhaps this “report” is what Ernst was referring to when she agreed Monday with an audience member who theorized that COVID-19 deaths had been overcounted. “I heard the same thing on the news,” she said.
Yet Twitter quickly removed the tweet for spreading false information, and for good reason.
Despite all the innuendo, there’s nothing unusual about the way the government is counting coronavirus deaths, as we have previously explained. In any crisis — whether it’s a pandemic or a hurricane — people with preexisting conditions will die. The standard for attributing such deaths to the pandemic is to determine whether those people would have died when they did if the current crisis had never happened.
When it comes to the coronavirus, the data is clear: COVID-19 is much more likely to kill you if your system has already been compromised by some other ailment, such as asthma, HIV, diabetes mellitus, chronic lung disease or cardiovascular disease. But that doesn’t mean patients with those health problems would have died this week (or last week, or next month) no matter what. The vast majority of them probably wouldn’t have. COVID-19 was the cause of death — the disease that killed them now, and not later.
A closer look at the CDC data, meanwhile, reveals that many of the comorbidities listed by medical providers are complications caused by COVID-19 rather than chronic conditions that predated infection: heart failure, renal failure, respiratory failure, sepsis and so on.
Feverishly creating a baseless fiction from two threads of unrelated information — the additional Medicare payments and the CDC update about comorbidities — is a classic conspiracy-theorist move. But that doesn’t make it true.
“Let there not be any confusion,” Dr. Anthony Fauci, the nation’s top infectious disease expert, said Tuesday. “It’s not 9,000 deaths from COVID-19. It’s 180,000-plus deaths.”
“The point that the CDC was trying to make was that a certain percentage of [deaths] had nothing else but COVID,” Fauci continued. “That does not mean that someone who has hypertension or diabetes who dies of COVID didn’t die of COVID-19. They did.”
In reality, it’s more likely that the U.S. is undercounting rather than overcounting COVID-19 deaths. According to a recent New York Times analysis of CDC estimates, at least 200,000 more people than usual died in the U.S. between March and early August — meaning that the official COVID-19 death count, which hit 140,000 over the same period, is probably too low.
In the Hawkeye State, COVID-19 had killed at least 1,125 as of Wednesday afternoon. Over the past week, the state has reported an average of 1,177 cases per day, an increase of 124 percent from the average two weeks earlier. Its positive testing rate has risen from 10 percent to 18.5 percent since then.
So while Republican lawmakers such as Ernst seek to downplay the lethality of the virus, Theresa Greenfield, Iowa’s Democratic Senate candidate, seized on her opponent’s baseless claim to underscore the gravity of the situation in one of the only states in America where the pandemic is getting worse.
“It’s appalling for you to say you’re ‘so skeptical’ of the toll this pandemic has on our families and communities across Iowa,” Greenfield tweeted Tuesday, addressing the senator. “We need leaders who will take this seriously.”
Why a herd immunity approach to COVID-19 could be a deadly disaster
Reporter Rebecca Corey noted that since the coronavirus pandemic began, herd immunity has been floated by some experts as a possible solution to the deadly virus that has so far killed over 865,000 people worldwide.
Herd immunity is possible when enough people have contracted and become immune to a virus, providing community-wide protection by limiting the number of people who can spread it. And while the strategy is considered controversial and even downright dangerous by many public health experts, it is also reportedly gaining momentum in the White House.
According to a report by the Washington Post, herd immunity is a strategy being pushed by Dr. Scott Atlas — a neuroradiologist with no background in infectious diseases or epidemiology who recently joined the White House as a pandemic adviser.
Atlas denied that he had encouraged the White House to adopt a herd immunity strategy, and on Wednesday White House coronavirus task force coordinator Dr. Deborah Birx and top infectious disease expert Dr. Anthony Fauci dismissed the idea that herd immunity was under consideration. An administration official, however, told CNN that the policies being promoted by Atlas are indeed akin to a herd immunity approach.
Ordinarily, herd immunity would be acquired through a majority of the population being vaccinated — not through immunity acquired by natural infection.
“Normally, when we talk about herd immunity, we talk about how much of the population needs to be vaccinated,” World Health Organization (WHO) COVID-19 technical lead Dr. Maria Van Kerkhove said on Aug. 27. “If we think about herd immunity in a natural sense of just letting a virus run, it’s very dangerous because you would need a lot of people to be infected.”
It’s still uncertain what percentage of a population would need to be immune to the virus in order to attain herd immunity. According to Johns Hopkins University, in general, the answer is 70 to 90 percent of a population, depending on how contagious the infection is. But a model published last month in the magazine Science found that the threshold needed for coronavirus herd immunity could be as low as 43 percent.
Proponents of herd immunity have looked to emulate Sweden’s more hands-off approach; unlike most countries in Europe, the Nordic country opted out of a nationwide lockdown and kept most businesses open.
But Sweden’s strategy didn’t entail a total return to normalcy. The Swedish government implemented a ban on gatherings of 50 people or more, and many Swedes voluntarily followed social distancing guidelines.
Former FDA Commissioner Scott Gottlieb noted in an op-ed published on Aug. 30 that in addition to being much larger than Sweden (a country with a population the same size as North Carolina’s), the U.S. has a high rate of citizens with preexisting conditions, which can lead to a higher rate of COVID-19 complications; about 10 percent of Americans have diabetes, and 40 percent are considered obese.
Moreover, Sweden’s pursuit of natural herd immunity doesn’t appear to be working. A study released in June by the country’s Health Agency showed that only 6 percent of Swedes had developed antibodies to the coronavirus — though a recent study from Sweden’s Karolinska Institute and Karolinska University Hospital suggests that immunity in Sweden may be higher than antibody tests indicate.
The role of antibodies and how much of an impact they have on long-term immunity is still questionable. A U.K. study, which had not yet been peer-reviewed, found that antibodies may start to decline 20 to 30 days after the onset of COVID-19 symptoms. And a Chinese study found that antibody levels in patients who had recovered from COVID-19 fell sharply within two to three months after infection.
Falling antibody counts may not necessarily mean waning immunity; other immune responses such as T-cells could also affect how long immunity lasts. But the case for natural herd immunity is made even more improbable by reports of coronavirus reinfections in Hong Kong, Europe and the U.S. If natural immunity is as short-lived as a few months, that wouldn’t be stable enough to provide community or nationwide protection.
Yahoo News Medical Correspondent Dr. Dara Kass says waiting to reach the minimal number of infections needed for natural herd immunity to work would not only take longer than waiting for a vaccine (which could come before the end of the year, according to the CDC) but would also likely cost more lives. Even if only 40 percent of the U.S. population needed to contract and recover from COVID-19 to reach natural herd immunity, Kass argues, that would mean another 126 million more Americans would still need to be infected.
“It’s taken us six months to get to 6 million infections,” Kass says. “What if we just said, let’s live life like normal? Let’s not wear masks, let’s not socially distance, let’s ride the subways and go to work. How fast could we get to 126 million infections? One year? Two years? Three years? We don’t know. But what we know is, the faster we infect people, the more people will die.”
“We’ve seen so far 185,000 Americans die of this coronavirus with 6 million people infected,” Kass continues. “If we want to intentionally infect another 126 million Americans, that means that over 1 million more Americans would die of this virus before we infected enough people to get to any possible natural herd immunity.”
According to a Gallup poll conducted in late July, 35 percent of Americans said they would not get a coronavirus vaccine even if it were FDA-approved and available to them at no cost. But Kass says a vaccine will likely be the key to any workable herd immunity strategy.
“The bottom line is, will herd immunity be the answer to this coronavirus pandemic? And the answer will be yes — but not natural herd immunity. We will get to herd immunity hopefully with the development of a safe, effective vaccine,” Kass says.
“Until we have a safe and effective vaccine that is available to the hundreds of millions of Americans that still need to be exposed and recovered from this virus, we just need to continue to do the hard work, which means wear a mask, be socially distanced from people you don’t know, wash your hands multiple times a day and listen to the science.”
College Students Are Already Itching to Sue Frats Over COVID-19
So, is anyone surprised at the stupidity of college students returning to campus after this long imposed “lock-down?” Are you surprised at the number of positive COVID-19 tested students after all of their large parties?
Emily Shugerman reported that across the country, as college students return to campus with masks and hand sanitizer, fraternities and sororities are doing what they’ve always done: drinking and partying.
At the University of Washington this summer, 137 students living in frat houses tested positive for the coronavirus after hosting raucous parties that violated their own internal guidelines. At the University of Alabama, students completed an entirely virtual rush process that ended with new members showing up in person to sorority houses, packing themselves together to take photos and then crowding the neighboring bars. The next week, the university announced more than 500 cases on campus.
For responsible students and their families, who could fall ill or have their classes canceled due to their classmates’ Greek Life antics, it all seems ripe for a lawsuit, right?
Two attorneys who specialize in litigation against frats told The Daily Beast they have received multiple inquiries from concerned students or parents wondering what their legal rights are when it comes to potential super-spreader events on their campus.
Attorney Douglas Fierberg said filing a lawsuit is absolutely an option, arguing that violating public health rules around coronavirus is no different than violating other safety rules, like a speed limit.
“The violation of [safety rules] by someone with no excuse or justification renders them responsible for the harm that’s caused,” he told The Daily Beast. “That precedent has been around since the dawn of American jurisprudence.”
But David Bianchi, an attorney who helped draft Florida’s anti-hazing law, said it isn’t so simple. In order to win such a suit, the plaintiff would have to prove not only that the defendant acted negligently, but that the negligent behavior directly caused them harm. And in a pandemic—where the virus could be picked up anywhere from a frat house to a grocery store parking lot—that could be difficult to prove.
“The defense lawyer will have a field day asking questions of the plaintiff about every single place they went for the seven days before the fraternity party, the seven days after the fraternity party, and they’re going to come up with a list of 50 places,” he said. “How do you prove that that’s not where they got it from?”
Bianchi said half a dozen parents called his office asking about the possibility of filing a lawsuit, and he told them not to bother.
“I call ’em like I see ’em, and I just don’t see it here,” he said.
Lawsuits against Greek organizations, for everything from wrongful death to sexual assault, are big business for personal injury attorneys. (In 2018, the parents of a freshman at Northern Illinois University won a historic $14 million settlement after their son died at a fraternity party.)
And there’s no question that some are bracing for suits against fraternal organizations: Holmes Murphy, an independent insurance brokerage with a specialty in frats, wrote a blog post on how clients could avoid trouble.
“We’ve received many questions about whether or not a house corporation has a duty to do anything,” the post said. “This is a question that will ultimately be tested after a case and spread within a house occurs. There is certainly no shortage of lawsuits as a result of the pandemic. Ultimately, doing the right thing comes first. Start with the basics. That may be all you can do. But it is better than doing nothing.”
What’s hazier is the prospect for coronavirus lawsuits in general. Thousands of suits have been filed since the pandemic started—against schools, businesses, prisons, and pretty much anywhere else you can pick up a virus—but few have been decided. Some legislators have also pushed for laws giving businesses widespread legal immunity, in hopes of getting the economy back up and running.
On college campuses, Fierberg said, legal actions may not happen right away—classes have only just started, and it takes time for someone to get infected, suffer a grievous injury, and find a lawyer. He predicted a rash of such suits in the next six months to a year.
“The time period that this is incubating is now,” he said. “What’s gonna happen in that experiment is yet to entirely show itself. If it comes out as Frankenstein then that’s one thing. If it comes out as something nice… well that’s a different thing.”
Why a Vaccine Won’t Be a Quick Fix for COVID-19
Medscape’s Brenda Goodman noted that nine months into the COVID-19 pandemic, we are all exhausted, stressed out, and looking for the exit, so hopes for a vaccine are high. Not only are we all stressed out but with the election only weeks away there is pressure to have a vaccine so that President Trump sees a bump in his numbers for re-election possibilities.
Numerous efforts are underway around the world to test, manufacture, and distribute billions of doses. A table maintained by the World Health Organization (WHO) lists 33 vaccines against SARS-CoV-2, the virus that causes COVID-19, currently being tested in people, with another 143 candidates in preclinical testing and I just reviewed an article which noted that there were actually 210 vaccines being studied.
The effort is so critical, the U.S. government is spending billions to make doses of vaccine that may be wasted if clinical trials don’t show them to be safe and effective. The goal of this massive operation, dubbed Warp Speed, is to deliver 300 million doses of safe and effective vaccines by January 2021.
As important as a vaccine will be, some experts are already trying to temper expectations for how much it will be able to do.
“We all hope to have a number of effective vaccines that can help prevent people from infection,” Tedros Adhanom Ghebreyesus, director-general of the World Health Organization, said at an Aug. 3 news briefing. “However, there is no silver bullet at the moment, and there might never be.”
Barry Bloom, PhD, an expert in infectious diseases and immunology at the Harvard T.H. Chan School of Public Health, is even more direct: The idea that a vaccine will end the pandemic just isn’t realistic.
“That’s not going to happen,” he says. First, not enough people will get the vaccine. Second, for those who do take it, the vaccine may only offer partial protection from the virus.
“I am worried about incomplete availability, incomplete protection, unwillingness of a portion of a country to be vaccinated,” Bloom says.
At least at first, not enough people will get the vaccine for the world to achieve herd immunity, or community protection. Community protection robs the virus of the chance to spread easily. It occurs when enough people become immune, either because they’ve recovered from the infection or been vaccinated against it. This high level of immunity in a population cuts the chances that someone without immunity ― say an infant or someone who can’t be vaccinated for medical reasons ― will be exposed to the virus and get sick.
Typically, the herd immunity threshold for an infection is somewhere between 70% and 90% of the population. We don’t yet know where the threshold is for COVID-19 because there are still big unanswered questions about how our bodies respond to the virus or a vaccine against it: Do most people respond in a way that protects them in the future? If so, how long does that protection typically last?
Even at the low end of the typical range for community protection ― 70% ― we’re still far short of that mark.
Recent studies checking blood samples submitted to commercial labs suggest that 5% to 10% of the population has recovered from a COVID-19 infection in the U.S. That’s just an average. The real number varies widely across the U.S., ranging from a low of about 1% in San Francisco to a high of about 20% in New York City, according to CDC data. Most of the country is still in the 3%-5% range ― still a long way from community protection against the virus.
So, most of the immunity needed to reach a level that would provide community protection would have to come from a vaccine.
“It’s not just getting a vaccine. It’s using it and using it appropriately,” Bloom says. “Vaccines don’t prevent anything. Vaccination does.”
Getting enough doses to enough people will take a while, even after a vaccine becomes available, for several reasons.
When vaccines against COVID are first approved, supplies will be tight. Initially, there may be enough doses for 10 million to 15 million people in the U.S. The first shots will be reserved for the people who need them most.
Just this week, the National Academy of Sciences came up with a draft plan for how to fairly distribute the vaccine, which would unfold in four phases. Those phases will take time to execute.
The first phase recommends that the first doses go to health care workers and first responders, with the next batch going to people with health conditions that put them at highest risk of dying from COVID, and to seniors living in group homes. Those groups make up just 15% of the population, according to the report.
Phase two, which covers about 30% of the population, calls for vaccination of essential workers at “substantially high risk of exposure,” teachers, people with health conditions that put them at moderate risk from the disease, people living in close contact with others (like prisoners and those staying in homeless shelters), and seniors who weren’t covered in phase one.
The largest chunk of the population, including children, who can be infected but may show few signs of illness, aren’t a priority until phase three, which also includes other essential workers. Phase three accounts for about 40% of the population. The last phase, everyone else, makes up about 5%.
Among those who are eligible for vaccination, not everyone is likely to agree to get one.
A recent poll by Gallup found that 35% of Americans ― or about one in three ― don’t plan on getting a COVID-19 vaccine, even if it’s free. Among the two-thirds of Americans who say they will be immunized, a large number plan to wait. A recent survey by STAT found that 71% will wait at least 9 months to get their shots.
Those numbers align with a recent poll by WebMD, which found that 73% of readers said they would wait at least 3 months to get a vaccine when one becomes available.
“I don’t find that shocking. I would think for people who are rational, wouldn’t you want to see what the data are on safety and efficacy before you made a decision?” Bloom says. “I’m worried about the 25% who, no matter what happens, won’t take the vaccine. Those are the people who really worry me.”
Vaccine hesitancy ― fear of getting any vaccine ― is growing. The WHO recently listed it as one of the top threats to global health, pointing to the recent resurgence in measles. Many countries have recently seen large outbreaks of measles. These outbreaks have been caused by an increasing number of parents refusing to vaccinate their kids.
Experts are worried that vaccine hesitancy will play a large role in whether the U.S. and other countries reach herd immunity thresholds. The Gallup poll found Republicans are less likely to be vaccinated than Democrats, and nonwhite Americans ― the group being disproportionately affected by COVID-19 infections ― are less likely to be vaccinated than whites.
Bloom and others believe that right now, we should be working on a way to overcome vaccine hesitancy.
“Policymakers have to start focusing on this,” says Robert Litan, PhD, JD, a nonresident senior fellow at the Brookings Institute.
He thinks we shouldn’t try to overcome hesitancy by forcing people to take the vaccine. Instead, he wants the government to pay people to take it ― $1,000 each, or $4,000 for a family of four.
“That’s a lot of money,” especially now with the economy sagging and so many people out of work, Litan says. “I think a thousand dollars would get a lot of people to take the shot who would otherwise not take it.”
Litan ran the numbers, looking at various scenarios of how many people would take it and how effective the vaccine might be. He says he realized not enough people would be protected to fully reopen the country.
He says he’s not sure $1,000 is the right sum, but it should be generous because if people think the amount could go up, they will wait until it does, which would defeat the purpose of the incentive.
“I can’t think of anything else,” he says. “You either have carrots or sticks, and we can’t use sticks. It won’t work.” How Well Will It Work?
Getting enough people to take it is only one piece of the puzzle. We still don’t know how well any of the shots might work, or for how long that protection lasts.
Researchers have now confirmed at least four cases of COVID-19 reinfection, proving that the virus infected the same person twice.
We still don’t know how common reinfection is, but these cases suggest that some people may need a booster dose of vaccine before they’re fully protected against the virus, says Gregory Poland, MD, an expert in immunity and vaccine responses at the Mayo Clinic in Rochester, MN.
That’s similar to the way we dole out vaccines for seasonal flu, with people urged to get the shot every year, he says.
That’s another reason it could take a while to reach herd immunity.
It’s also not clear how effective a vaccine may be.
The FDA and WHO have said that a vaccine should be at least 50% more effective than a placebo to be approved. But that could mean that a shot merely decreases how bad an infection is but doesn’t stop it. That would be an important effect, Bloom says, but it could mean that even vaccinated people would continue to spread the infection.
“If it prevents disease, but doesn’t prevent growth in the upper respiratory tract, there is a possibility there will be a group of people who will be infected and not get sick because of the vaccine but still have the virus in their respiratory tract and be able to transit,” Bloom says. “That would not be the ideal for a vaccine, but it would protect against disease and death.”
He says the first studies will probably measure how sick vaccinated people get and whether or not they need to be hospitalized.
Longer studies will be required to see if vaccinated people are still able to pass the virus to others.
How effective any vaccine may be will also depend on age. In general, older adults ― the ones who most need protection against COVID-19 ― don’t respond as well to vaccines.
Our immune systems get weaker as we get older, a phenomenon called immunosenescence.
Seniors may need specially formulated vaccines ― with added ingredients, called adjuvants ― to get the same response to vaccines that a younger person might have.
Lastly, there’s the problem of reintroduction. As long as the virus continues to spread anywhere in the world, there’s a risk that it could reenter the U.S. and reignite infections here.
That’s what happens every year with measles. In most states, more than 90% of people are vaccinated against measles. The measles vaccine is one of the most effective ever made. It gives people substantial and long-lasting protection against a highly contagious virus that can stay in the air for long periods. You can catch it by walking through the same room an infected person was in hours before.
Every year, travelers come to the U.S. carrying measles. If they go to a crowded place, like a theme park, it increases the chances that initial infection will touch off many more. As vaccine hesitancy has increased in the U.S. and around the world, those imported cases have sparked outbreaks that have been harder and harder for public health officials to extinguish, raising the risk that the measles virus could become endemic again in countries like the U.S.
For the world to be rid of COVID-19, most of the world has to be vaccinated against it. There’s an effort underway ― called COVAX ― to pay for vaccinations for poorer countries. So far, 76 of the world’s wealthier countries have chipped in to fund the effort. The U.S. has not. The Trump administration says it won’t join because of the WHO’s involvement in the effort, a move that may place the plan in jeopardy.
For all these reasons, it will probably be necessary to continue to spread out, wear masks, and be vigilant with hand hygiene to protect yourself and others for the foreseeable future.
“For now, stopping outbreaks comes down to the basics of public health and disease control,” Tedros said.
We may get a vaccine, but we will still need to be able to test enough people for the virus, warn their contacts, and isolate those who are infectious to keep the epidemic under control, or, as Tedros has urged, “Do it all.”
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 we saw Wednesday the WHO declared the Corona Virus/COID-19 a pandemic. We also heard the President role out plans for travel restrictions, increased testings and economic assistance. But what really gets me angry is that the Democrats in Congress are still making this a political battleground. Shame on them all! This is not the time for partisan politics so that they can embarrass the President and get their wishes and show the evilness of the political hate out there. Grow up Congress and let’s all get in on this battle to keep us all healthy and limit the death toll!! Philip Verhoef of USA Today reported that Congress is grappling with the problem of surprise medical bills, but will its Band-Aid approaches make a difference? As a physician, I’m trained to look beyond superficial symptoms to diagnose the underlying ailment. When patients pay thousands of dollars each year for “good” private insurance, how does a health care system allow them to walk away from a single hospital visit with debilitating medical debt? These concerns have become even more pressing with the spread of the new coronavirus and the costs associated with prevention, testing and treatment.
Most Americans assume that a commercial insurance card in their wallet protects them from unexpected medical bills. They pay their premiums and deductibles, scour the pages of insurance fine print and keep up with the revolving door of “in-network” doctors and hospitals.
However, going to the “in-network” hospital is no guarantee that the emergency room doctor, radiologist or anesthesiologist will be “in-network.” Today, many hospitals no longer directly employ physicians but instead contract with physician staffing firms such as TeamHealth, which employs more than 16,000 clinicians at 3,300 medical facilities.
Caught unaware in a medical crisis
These agencies are extremely profitable, which is why private equity firms are so hungry to buy them. Contract physicians operate outside of insurance coverage agreements — they’re not part of any “network” — and can act like free agents, billing patients directly for services not covered by insurance, called “balance billing.”
What does this mean for patients? Imagine you’re having a heart attack and call 911. Paramedics transport you to the nearest emergency room, which may or may not be in your insurer’s network. And because that hospital — or the ER doctor on duty — does not have a contractual relationship with your insurer, they can essentially name their price and “balance bill” you for the amount the insurance company won’t cover.
Here in Hawaii, many critically ill patients must use air ambulances for transportation from their home island to one that can provide emergency specialty services. For one of my patients, an air ambulance was a life-or-death necessity but deemed “out of network” by their insurance. Weeks later, the family received a balance bill for more than $25,000. They were forced to file bankruptcy and then enroll in Medicaid to cover subsequent health care costs — all with an insurance card in their wallet.
If this hasn’t happened to you, it’s just a matter of time. Over 40% of privately insured patients face surprise medical bills after visiting emergency rooms or getting admitted to hospitals. These bills punch a major hole in most family budgets: The average surprise hospital bill is $628 for emergency care and $2,040 for inpatient admission. That’s on top of the more than $20,000 families pay in premiums and deductibles each year just for the insurance policy.
If faced with a surprise $500 medical bill, half of Americans would either have to borrow money, go into debt or wouldn’t be able to pay it at all. Medical bills are a key contributor in two-thirds of personal bankruptcies, and yet the vast majority of households filing for medical bankruptcy have insurance.
Medicare for All is the only solution-Really??
What is the value of commercial insurance if it can’t protect us from financial ruin?
Lawmakers are considering a number of policies that would prohibit balance billing, cap the amount patients pay at out-of-network facilities and implement baseball-style arbitration when providers and insurance companies can’t agree on a payment. But surprise bills are not the real problem — they are merely one symptom of a dysfunctional system based on private insurance. And insurance companies only turn a profit by restricting patient choice, denying claims and passing costs onto enrollees.
The only policy that can end this scourge for good is single-payer Medicare for All, which would cover everyone in the nation for all medically necessary care. Medicare for All would eliminate out-of-network bills, because every doctor and hospital would be covered. Patients would never see a medical bill again, because Medicare for All would pay doctors and hospitals directly, with no deductibles, co-pays or insurance paperwork to get in the way.
Right now the current Medicare system is covering the costs of coronavirus testing, protecting patients just as it was designed to do. This health emergency is another argument for expanding such protections to all Americans.
Working in various hospitals across the country, I have met so many patients who delay or avoid needed care for fear of surprise bills and financial catastrophe. That’s risky for them and, in the face of a threat like coronavirus, for all of us. It doesn’t have to be this way. As a doctor, I prescribe Medicare for All.
We are forgetting the huge cost of Medicare for All and the ineffectiveness and short comings of Medicare for All , which I have attempted to point out these last few weeks. Doesn’t any one read my posts?
America’s Health System Will Likely Make the Coronavirus Outbreak Worse
Abigail Abrams noted that as government officials race to limit the spread of the new coronavirus, fundamental elements of the U.S. health care system—deductibles, networks, and a complicated insurance bureaucracy—that already make it tough for many Americans to afford medical care under normal conditions will likely make the outbreak worse.
More than 140 cases of the coronavirus have been confirmed in the United States so far, according to a Johns Hopkins University tracker. But as the CDC makes the test for the virus more widely available, the structure of the U.S. health care system is complicating the response.
For one, people must actually choose to get tested—a potentially expensive prospect for millions of Americans. While the government will cover the cost of testing for Medicaid and Medicare patients, and for tests administered at federal, state and local public health labs, it’s unclear how much patients will be charged for testing at academic or commercial facilities, or whether those facilities must be in patients’ insurance networks. Just recently, a Miami man received a $3,270.75 bill after going to the hospital feeling sick following a work trip to China. (He tested positive for the seasonal flu, so did not have the new coronavirus, and was sent home to recover.)
Those who test positive for COVID-19 possibly face an even more financially harrowing path forward. Seeking out appropriate medical care or submitting to quarantines—critical in preventing the virus from spreading further—both come with potentially astronomical price tags in the U.S. Last month, a Pennsylvania man received $3,918 in bills after being released from a mandatory U.S. government quarantine after he and his daughter were evacuated from China. (Both the Miami and Pennsylvania patients saw their bills decrease after journalists reported on them, but they still owe thousands.)
More than 27 million Americans currently do not have health insurance of any kind, and even more are underinsured. But those who do have adequate health insurance are hardly out of the woods. Many current health plans feature massive deductibles—the amount you have to spend each year before your insurance kicks in. In 2019, 82% of workers with health insurance through their employer had an annual deductible, up from 63% a decade ago, according to a report from the Kaiser Family Foundation. The average deductible for a single person with employer insurance has increased 162% in that time, from $533 in 2009 to $1,396 last year.
More than one quarter of employees, and nearly half of those at small companies, have an annual deductible of at least $2,000. Those who are covered by Obamacare marketplace plans face an even bigger hurdle: the average deductible for an individual bronze plan last year was $5,861, according to Health Pocket, a site that helps consumers shop for health insurance.
For many Americans, paying down an unexpected bill of that size is almost unthinkable. Nearly 40% of U.S. adults say they wouldn’t be able to cover a $400 emergency with cash, savings or a credit card they could easily pay off, according to the Federal Reserve.
Research has shown that even in non-outbreak situations, high deductibles lead people to reduce their spending on health care and delay treatment or prescription drugs, which can pose particularly tough problems for patients with chronic illness or diseases that need early detection. The timing of the new coronavirus at the beginning of the year makes the outlook even worse: because most deductibles reset each January, millions of Americans will be paying thousands out of pocket before their insurance companies pay a cent.
“Most likely most people haven’t started paying down their deductible,” explains Adrianna McIntyre, a health policy researcher at Harvard. “For care they seek, unless it’s covered as zero dollar coverage before the deductible, they could be on the hook for the full cost of their visit, the diagnostic testing and other costs related to seeking care or diagnosis of coronavirus.”
Half of Americans report that they or a family member have put off care in the past because they couldn’t afford it. Others have gone without care because they couldn’t find an in-network provider, or couldn’t determine how much care would cost in advance, so decided not to risk seeking medical attention.
“When patients try to go to a doctor or hospital, they often don’t know how much it’s going to cost, so they get a bill that’s way more than expected,” says Christopher Whaley, a health economist at the RAND Corporation. “On a normal basis, that’s chaotic and challenging for patients. But when you add on top this situation where you have a potential pandemic, then that’s even worse.”
In the face of that kind of uncertainty, many patients may simply decide not to go to the doctor, he added, which is “exactly the opposite of what we want to happen in this type of situation.”
Public health experts and Democrats have also criticized the Trump administration’s decision to allow people to sidestep the Affordable Care Act’s rules and buy limited, short-term health insurance coverage. Such “junk plans,” said Senator Patty Murray, speaking at a Senate Health, Education, Labor and Pensions Committee hearing on Wednesday, are not required to cover diagnostic tests or vaccines.
The Trump administration’s embrace of such barebones plans “makes it much harder for people to get the care they need to keep this crisis under control,” she said. A large group of health, law and other experts also released a letter this week urging policymakers to “ensure comprehensive and affordable access to testing, including for the uninsured.”
Insurance industry trade group America’s Health Insurance Plans issued guidance on the coronavirus last week, but it did not recommend that insurance companies eliminate out-of-pocket costs related to the virus. It said insurers would be working with the CDC and “carefully monitoring the situation” to determine “whether policy changes are needed to ensure that people get essential care.”
New York Governor Andrew Cuomo issued a directive on Monday requiring New York health insurers to waive cost sharing for testing of the coronavirus, including emergency room, urgent care and office visits. This could help New Yorkers who receive coverage through Medicaid and other state-regulated plans, but it won’t apply to the majority of employer-based health insurance, which is regulated by the federal government. Other states have similar limitations on the insurance plans they can regulate, according to McIntyre.
The federal government, on the other hand, could step in. The Trump Administration is considering using a national disaster recovery program to reimburse hospitals and doctors for treating uninsured COVID-19 patients. And even Republicans, who have traditionally opposed health care paid for by the government, are warming to the idea. “You can look at it as socialized medicine,” Florida Rep. Ted Yoho, who has vocally opposed the Affordable Care Act, told HuffPost this week. “But in the face of an outbreak, a pandemic, what’s your options?”
But even if the federal government takes steps to eliminate deductibles or other cost-sharing related to the coronavirus, experts say that Americans should brace themselves for long wait times to see providers, or for having to see doctors who are out-of-network, due to the limited capacity of providers and hospitals.
Those who don’t need to be treated at a hospital may still be impacted. The CDC has recommended that people maintain a supply of necessary medications in case they are quarantined, for example. But many insurance companies do not allow patients to refill prescriptions until they are almost out. The CDC also recommends that people to stay home from work if they experience symptoms of respiratory illness, but a lack of federally mandated sick leave makes it impossible for many workers to afford to take time off.
These consequences of the country’s fragmented health care system become more visible in times of stress, says Whaley. “In a pandemic type situation, that’s harmful both for patients,” he says, “and also for the members of society.
”Coronavirus: US ‘past the point of containment’ in battle to stop outbreak spreading
Tim Wyatt reported that America is “past the point of containment” in its battle against the coronavirus, senior health officials have admitted.
There are now more than 550 confirmed cases of the virus in the United States and at least 22 deaths linked to the outbreak.
Now, the government’s strategy had to change from trying to hold the virus at bay to actively seeking to minimise its impact and slow its spread, experts said.
Speaking on US television, the former commissioner of the Food and Drug Administration Dr Scott Gottlieb, said everything had changed.
“We’re past the point of containment. We have to implement broad mitigation strategies. The next two weeks are really going to change the complexion in this country.
“We’ll get through this, but it’s going to be a hard period. We’re looking at two months, probably, of difficulty.”
A similar message came from the Surgeon General Jerome Adams who warned it was time to consider cancelling large gatherings, including sporting events, and closing schools.
Each community might take a different approach to mitigating Covid-19, but inaction was not longer an option he cautioned while speaking to CNN. “Communities need to have that conversation and prepare for more cases so we can prevent more deaths,” he said.
Those in the most at-risk groups, including the elderly or unwell, should refrain from spending time in confined spaces with large numbers of the public, Dr Adams added.“Average age of death for people from coronavirus is 80. Average age of people who need medical attention is age 60. “We want people who are older, people who have medical conditions, to take steps to protect themselves, including avoiding crowded spaces, including thinking very carefully about whether or not now is the time to get on that cruise ship, whether now is the time to take that long haul flight,” he said.
Dr Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, echoed this advice. “If you are an elderly person with an underlying condition, if you get infected, the risk of getting into trouble is considerable,” he told NBC.“So it’s our responsibility to protect the vulnerable. When I say protect, I mean right now. Not wait until things get worse. Say no large crowds, no long trips. And above all, don’t get on a cruise ship.”
A swathe of conferences, including many tech-focused events in California, have already been cancelled over fears flying in thousands of delegates from across the country and world would exacerbate the spread of Covid-19. Some schools in the US are already closing, with major sporting events such as the Indian Wells tennis tournament being cancelled.
The comments from senior Trump administration health officials marks a shift from an earlier tone of calm. Several people, including the president, had sought to downplay fears about the coronavirus, insisting it probably would not turn into a full-blown epidemic in America.
Dr Fauci even suggested limited lockdowns could be imposed on regions or towns where a serious outbreak occurs, saying the government was ready to take “whatever action is appropriate” to try and mitigate the crisis.’We’re gearing up for something extremely significant’:
Top hospitals across the US told us how they’re preparing for the coronavirus outbreak
Lydia Ramsey and Zachary Tracer reviewed the U.S. hospitals preparation for this pandemic. Hospitals around the US are preparing for the novel coronavirus outbreak, which has sickened more than 200 people in the US and 100,000 worldwide.
They want to make sure workers and equipment are ready to go in the event of a worst-case scenario. “We’ve not yet seen an epidemic or pandemic in our lifetimes of this size and scope,” said Becca Bartles, the executive director of infectious disease prevention at Providence St. Joseph Health System. “We’re gearing up for something extremely significant.”
When the first case of novel coronavirus showed up in the US in January, Becca Bartles was ready for it.
As the executive director of infectious disease prevention at Providence St. Joseph Health System, she had been preparing for years. Bartles helps prepare Providence, which runs 51 hospitals across the West Coast, for potential outbreaks by keeping an eye out for new pathogens that could hit the communities the health system serves.
“We’ve not yet seen an epidemic or pandemic in our lifetimes of this size and scope,” Bartles said. “We’re gearing up for something extremely significant.”
Hospitals and healthcare workers are already starting to feel the effects of the coronavirus outbreak as it hits communities around the US. The US has reported more than 200 cases of the novel coronavirus, which causes the disease known as COVID-19. More than 100,000 people have come down the virus worldwide, mainly in China.
And they’re preparing for the outbreak to get worse. Some of the hospitals Bartles works with are in the Seattle area and are already treating coronavirus patients. She said the virus is positioned to be the biggest outbreaks we’ve seen in recent US history.
‘It will stretch our capacity to provide healthcare overall in the US’
“I don’t think we can appreciate, based on what we’ve seen in our lifetimes, how big that’s going to be,” Bartles said. “That does cause me significant concern.” “It will stretch our capacity to provide healthcare overall in the US,” she added.
According to the US Centers for Disease Control and Prevention, reported symptoms related to the novel coronavirus include fever, cough, and shortness of breath, appearing within 14 days of exposure to the virus.
In a presentation hosted by the American Hospital Association, which represents thousands of hospitals and health systems, one expert projected there could be as many as 96 million cases in the US, 4.8 million hospitalizations, and 480,000 deaths associated with the novel coronavirus. The American Hospital Association said the webinar reflects the views of the experts who spoke on it, not its own.
Preparing for the worst
Health systems like Providence perform drills and trainings in anticipation of outbreaks like the novel coronavirus. The goal is to make sure employees, especially those working in the emergency department or who might care for critically ill patients, are trained correctly and have the right protective equipment.
And they’re ramping those up now. In Philadelphia, Jefferson Health has been conducting extra protective-equipment trainings, focused on intensive care unit clinicians who might treat people with the coronavirus.
The 14-hospital system also started a coronavirus task force this week and is readying its outbreak plans. The idea is to prepare for a worst-case scenario.
“We’re saying, look, let’s plan as if there’s going to be a lot of cases, it’s going to be overwhelming to our hospital,” said Dr. Edward Jasper, an emergency medicine physician who leads the task force. “We don’t think that’s going to happen. And then whatever else comes, it’s going to be nothing compared to that. So we’re prepared.”
For now, Jasper said he’s not expecting the worst. “We watch it so closely and right now it’s not triggering keeping me awake at night,” he said.
At Providence, Bartles said leaders within the organization are now meeting multiple times a day to discuss issues like making sure the hospitals have enough supplies on hand, especially protective equipment for those working in emergency departments.
The goal of the meetings is also to inform other hospitals across Providence’s network of what’s going on in Washington, which has been hit hard with the virus.
How the largest health system in New York is preparing
The senior leadership at New York’s Northwell Health System, which operates 23 hospitals, has been meeting continuously for the last several weeks, chief quality officer Dr. Mark Jarrett told Business Insider. The discussions cover what happens if one individual comes in with symptoms all the way to a pandemic.
Northwell’s relying on some of the preparation it did in advance of the SARS epidemic in 2003, and its response to the H1N1, or Swine Flu pandemic in 2009. But, Jarrett said, the hospital has changed a lot since then. Northwell, New York’s largest health system by revenue and the state’s largest private employer, has been steadily moving more of its services outside the four walls of a hospital.
That means the health system will have to account for patients showing up for care in places other than the main hospital in a community — places like urgent care centers and primary care clinics.
Readying hospitals for a surge of patients
Should the outbreak intensify, hospitals are grappling with how to prepare for the surge in coronavirus patients while also keeping other patients safe. At first, hospitals will isolate patients with the coronavirus, but if lots of patients come down with the virus, hospitals will probably put them in rooms together, said Kelly Zabriskie, Jefferson’s director of infection prevention.
Dr. Kathleen Jordan, a vice president at CommonSpirit Health, a 142-hospital health system and chief medical officer at the system’s Saint Francis Memorial Hospital, told Business Insider that the health system is having conversations about what might happen if they’re confronted with an influx of patients.
That might include setting up tents, building out larger emergency rooms or adding more beds for patients who need to stay at the hospital. For now, the health system has a few cases of the novel coronavirus under investigation. Eventually, hospitals might have to consider reducing or pausing elective procedures to make room for the surge in patients, Northwell’s Jarrett said. Hospitals are also thinking about staff being out, either due to the virus itself, or in the event that they have to care for their family.
Northwell on Tuesday told its employees that it’s restricting travel for business both internationally and domestically through the end of March. That’s a move other hospitals are making as well. “These updated travel guidelines are designed to help us remain in good physical health so we can most effectively care for the patients and families we serve,” Northwell said in an email to employees.
But you shouldn’t rush to the emergency room if you start having flu symptoms. Bartles said the plan is to focus on following CDC recommendations. As the virus continues to spread in communities, it will be harder to distinguish what might be flu from coronavirus.
Jan Emerson-Shea, a spokeswoman for the California Hospital Association, said hospitals are encouraging patients to call ahead or use an online doctor visit, rather than show up to an emergency room with potential coronavirus. That can help prevent them from infecting others, and let hospitals focus their resources on the most serious cases.
And lastly, few have mentioned that in China they are already taking down some of the temporary housing for the quarantined patients as the infection rate decreases. Important to note as we prepare for the worst!
And next week we should discuss the economic issues resulting from the pandemic!
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!
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!
Why aren’t more people interested in the severity of the vaping complications in our youth? We are now up to 19 deaths, and this is just the reported deaths. We haven’t figured the long-term severity of chronic vaping inhalation, a form of COPD-chronic obstructive pulmonary disease!
The death toll in the United States from illnesses linked to e-cigarette use has risen to at least 19, health authorities say, as more than 1,000 others have suffered lung injuries probably linked to vaping.
Officials have yet to identify the cause for the outbreak, which dates back to March and is pursuing multiple lines of investigation.
A report by clinicians in North Carolina last month pointed to the inhalation of fatty substances from aerosolized oils, but a new study by the Mayo Clinic published this week found patients’ lungs had been exposed to noxious fumes.
The Centers for Disease Control and Prevention said Thursday that 18 deaths in 15 states had now been positively linked to vaping, from a total of 1,080 cases of people sickened —a jump of 275 since last week.
Connecticut officials also announced the first death in the state, bringing the total to at least 19.
The CDC attributed the sharp increase to a combination of new patients becoming ill in the past two weeks and recent reporting of previously identified patients.
“I think we really have the feeling right now that there may be a lot of different nasty things in e-cigarette or vaping products, and they may cause different harms in the lung,” Anne Schuchat, a senior official with the Centers for Disease Control and Prevention (CDC), said in a call with reporters.
Among a group of 578 patients interviewed on substances they had used, 78 percent reported using tetrahydrocannabinol (THC), the primary psychoactive substance of marijuana, with or without nicotine products.
Another 37 percent reported exclusive use of THC products, and 17 percent said they had only used nicotine-containing products.
About 70 percent of patients are male, and 80 percent are under 35 years old.
E-cigarettes have been available in the US since 2006.
It is not clear whether the outbreak is only happening now—or if there were cases earlier that were wrongly diagnosed.
Initially conceived as a smoking cessation device, e-cigarette use has skyrocketed among teens, with preliminary official data for 2019 showing more than a quarter of high school students using e-cigarettes in the past 30 days.
They were until recently perceived as a less harmful alternative to smoking because they do not contain the 7,000 chemicals in cigarettes, dozens of which are known to cause cancer.
Only one case of lung injury has been reported abroad, making the outbreak more mysterious still.
Canadian authorities said in September a youth had been hospitalized, but so far no other countries have reported anything similar.
Public and political opinion appears to be hardening, however, with the administration of US President Donald Trump announcing in September that it would ban in the coming month’s flavored e-cigarette products, which are particularly attractive to young people.
India has issued an outright ban on all e-cigarette products, as has the US state of Massachusetts.
E-cigarettes: five things to know about vaping linked deaths and illnesses in the U.S.
E-cigarettes have become hugely popular in the past decade but a rash of vaping-linked deaths and illnesses in the United States is feeding caution about a product, already banned in some places.
Here are five things to know about electronic cigarettes.
Around for two decades
Early designs for an electronic cigarette were drawn up in the United States in the 1960s but Chinese pharmacist Hon Lik is acknowledged as the inventor of a viable commercial version in the early 2000s.
Hon, who was trying to quit his own pack-a-day habit, took out patents between 2003 and 2005. But his devices would soon be overtaken as the international market exploded.
How do they work?
A battery powers a coil that heats a liquid containing various amounts of nicotine as well as propylene glycol and vegetable glycerin, which mimic tobacco smoke when heated.
This “e-juice” can also contain flavorings and other substances, such as THC, or tetrahydrocannabinol, the psychoactive ingredient in marijuana.
E-cigarettes are mostly draw-activated, with the puffing releasing vapor.
They do not produce tar or carbon monoxide—two of tobacco’s most noxious elements and associated with cancer and cardiovascular disease.
Harmful to health?
E-cigarettes were initially touted as less damaging than tobacco, which causes around eight million deaths a year.
In 2015 public health authorities in England said best estimates showed they were 95 percent less harmful than tobacco.
“Even if it is difficult to quantify precisely the long-term toxicity of electronic cigarettes, there is evidence that it is significantly lower than traditional cigarettes,” the French Academy of Medicine said the same year.
However, concern has been growing.
On October 3, 2019, US health authorities reported 18 vaping-related deaths and more than 1,000 cases of damage since March, the cause of which had not been identified.
The US Centers for Disease Control and Prevention said on September 2019 that many of the cases involved the use of black-market marijuana products.
In July 2019 the World Health Organization (WHO) warned that electronic smoking devices were “undoubtedly harmful and should, therefore, be subject to regulation”.
Another worry is that the vaping flavors are particularly attractive to teenagers and an enticement to pick up the habit.
The number of vapers worldwide has leaped from seven million in 2011 to 41 million in 2018, according to leading market researcher Euromonitor International.
By comparison, there were 1.1 billion tobacco smokers on the planet in 2016, according to the latest WHO figures on its website.
The largest markets for e-cigarettes are the United States followed by Britain, France, Germany, and China.
The increase in vaping has been particularly dramatic among teenagers.
Moving towards regulation
In September 2019 India became the latest country to ban the import, sale, production, and advertising of e-cigarettes, citing in particular concerns about its youth.
The devices are already banned in several places, such as Brazil, Singapore, Thailand and the US state of Massachusetts, but elsewhere legislations are inconsistent.
In June 2019 San Francisco became the first major US city to effectively ban the sale and manufacture of electronic cigarettes.
In September New York followed Michigan in banning flavored e-cigarettes.
Trump woos seniors with an order to boost Medicare health program
Reporter Jeff Mason pointed out that U.S. President Donald Trump sought to woo seniors on Thursday with an executive order aimed at strengthening the Medicare health program by reducing regulations, curbing fraud, and providing faster access to new medical devices and therapies.
The order, which Trump discussed during a visit to a retirement community in Florida known as The Villages, is the Republican president’s answer to some Democrats who are pushing for a broad and expensive expansion of Medicare to cover all Americans.
Trump referred to such proposals as socialist and pledged to prevent them from coming to fruition, a political promise with an eye toward his 2020 re-election campaign in which healthcare is likely to be a major issue.
“They want to raid Medicare to fund a thing called socialism,” Trump told an enthusiastic crowd in Florida, a political swing state that is critical to his goal of keeping the White House.
The executive order follows measures his administration rolled out in recent months designed to curtail drug prices and correct other perceived problems with the U.S. healthcare system. Policy experts say the efforts are unlikely to slow the tide of rising drug prices in a meaningful way.
Trump suggested that drug companies were backing impeachment efforts in Washington, which he considers a “hoax,” as a way to sabotage his efforts to make prescriptions affordable.
“We’re lowering the cost of prescription drugs, taking on the pharmaceutical companies. And you think that’s easy? It’s not easy… I wouldn’t be surprised if the hoax didn’t come from some of the people that we’re taking on,” he said.
Medicare covers Americans who are 65 and older and includes traditional fee-for-service coverage in which the government pays healthcare providers directly and Medicare Advantage plans, in which private insurers manage patient benefits on its behalf.
Seniors are a key political constituency in America because of a high percentage of the vote.
The order pushes for Medicare to use more medical telehealth services, which is care delivered by phone or digital means, leading to cost reductions by reducing expensive emergency room visits, an administration official told Reuters ahead of the announcement.
The order directs the government to work to allow private insurers that operate Medicare Advantage plans to use new plan pricing methods, such as allowing beneficiaries to share in the savings when they choose lower-cost health services.
It also aims to bring payments for the traditional Medicare fee-for-service program in line with payments for Medicare Advantage.
Trump’s plans contrast with the Medicare for All program promoted by Bernie Sanders, a Democratic socialist who is running to become the Democratic Party’s nominee against Trump in the 2020 presidential election.
Sanders’ proposal, backed by left-leaning Democrats but opposed by moderates such as former Vice President Joe Biden, would create a single-payer system, effectively eliminating private insurance by providing government coverage to everyone, using the Medicare model.
“Medicare for All is Medicare for none,” said Seema Verma, the administrator of the U.S. Centers for Medicare and Medicaid Services, on a conference call with reporters, calling the proposal a “pipe dream” that would lead to higher taxes.
Sanders has argued that Americans would pay less for healthcare under his plan.
The White House is eager to show Trump making progress on healthcare, an issue Democrats successfully used to garner support and take control of the House of Representatives in the 2018 midterm elections. Trump campaigned in 2016 on a promise to repeal and replace the Affordable Care Act, his predecessor President Barack Obama’s signature healthcare law also known as “Obamacare.” So far he has not repealed or replaced it.
In July, the U.S. Department of Health and Human Services (HHS) said it would propose a rule for imports of cheaper drugs from Canada into the United States. A formal rule has not yet been unveiled.
The administration also issued an executive order in June demanding hospitals and insurers make prices they charge patients more transparent. Another in July encouraged novel treatments for kidney disease.
Trump considered other proposals that did not reach fruition.
A federal judge in July shot down an executive order that would have forced drugmakers to display list prices in advertisements, and Trump scrapped another planned order that would have banned some rebate payments drugmakers make to payers.
The administration is mulling a plan to tie some Medicare reimbursement rates for drugs to the price paid for those drugs by foreign governments, Reuters reported.
Targeting ‘Medicare For All’ Proposals, Trump Lays Out His Vision For Medicare
Faced with the pressure from the Democrats and their proposal for health care, Medicare for All President Trump gave a speech and signed an executive order on health care Thursday, casting the “Medicare for All” proposals from his Democratic rivals as harmful to seniors.
His speech, which had been billed as a policy discussion, had the tone of a campaign rally. Trump spoke from The Villages, a huge retirement community in Florida outside Orlando, a deep-red part of a key swing state.
His speech was marked by cheers, standing ovations and intermittent chants of “four more years” by an audience of mostly seniors.
Trump spoke extensively about his administration’s health care achievements and goals, as well as the health policy proposals of Democratic presidential candidates, which he characterized as socialism.
The executive order he signed had previously been titled “Protecting Medicare From Socialist Destruction” on the White House schedule but has since been renamed “Protecting and Improving Medicare for Our Nation’s Seniors.”
“In my campaign for president, I made you a sacred pledge that I would strengthen, protect and defend Medicare for all of our senior citizens,” Trump told the audience. “Today I’ll sign a very historic executive order that does exactly what — we are making your Medicare even better, and … it will never be taken away from you. We’re not letting anyone get close.”
The order is intended, in part, to shore up Medicare Advantage, an alternative to traditional Medicare that’s administered by private insurers. That program has been growing in popularity, and this year, premiums are down and plan choices are up.
The executive order directs the Department of Health and Human Services to develop proposals to improve several aspects of Medicare, including expanding plan options for seniors, encouraging innovative plan designs and payment models and improving the enrollment process to make it easier for seniors to choose plans.
The order includes a grab bag of proposals, including removing regulations “that create inefficiencies or otherwise undermine patient outcomes”; combating waste, fraud, and abuse in the program; and streamlining access to “innovative products” such as new treatments and medical devices.
The president outlined very little specific policy in his speech in Florida. Instead, he attacked Democratic rivals and portrayed their proposals as threatening to seniors.
“Leading Democrats have pledged to give free health care to illegal immigrants,” Trump said, referring to a moment from the first Democratic presidential debate in which all the candidates onstage raised their hands in support of health care for undocumented migrants. “I will never allow these politicians to steal your health care and give it away to illegal aliens.”
Health care is a major issue for voters and is one that has dominated the presidential campaign on the Democratic side. In the most recent debate, candidates spent the first-hour hashing out and defending various health care proposals and visions. The major divide is between a Medicare for All system — supported by only two candidates, Sen. Bernie Sanders and Sen. Elizabeth Warren — and a public option supported by the rest of the field.
Trump brushed those distinctions aside. “Every major Democrat in Washington has backed a massive government health care takeover that would totally obliterate Medicare,” he said. “These Democratic policy proposals … may go by different names, whether it’s single-payer or the so-called public option, but they’re all based on the totally same terrible idea: They want to raid Medicare to fund a thing called socialism.”
Toward the end of the speech, he highlighted efforts that his administration has made to lower drug prices and then suggested that drugmakers were helping with the impeachment inquiry in the House of Representatives. “They’re very powerful,” Trump said. “I wouldn’t be surprised if … it was from some of these industries, like pharmaceuticals, that we take on.”
Drawing battle lines through Medicare may be a savvy campaign move on Trump’s part.
Medicare is extremely popular. People who have it like it, and people who don’t have it think it’s a good thing too. A recent poll by the Kaiser Family Foundation found that more than 8 in 10 Democrats, independents and Republicans think of Medicare favorably.
Trump came into office promising to dismantle the Affordable Care Act and replace it with something better. Those efforts failed, and the administration has struggled to get substantive policy changes on health care.
On Thursday, administration officials emphasized a number of its recent health care policy moves.
“[Trump’s] vision for a healthier America is much wider than a narrow focus on the Affordable Care Act,” said Joe Grogan, director of the White House’s Domestic Policy Council, at a press briefing earlier.
The secretary of health and human services, Alex Azar, said at that briefing that this was “the most comprehensive vision for health care that I can recall any president putting forth.”
He highlighted a range of actions that the administration has taken, from a push on price transparency in health care to a plan to end the HIV epidemic, to more generic-drug approvals. Azar described these things as part of a framework to make health care more affordable, deliver better value and tackle “impassable health challenges.”
Without a big health care reform bill, the administration is positioning itself as a protector of what exists now — particularly Medicare.
“Today’s executive order particularly reflects the importance the president places on protecting what worked in our system and fixing what’s broken,” Azar said. “Sixty million Americans are on traditional Medicare or Medicare Advantage. They like what they have, so the president is going to protect it.”
Sanders presidential campaign pivots health scare to Medicare for All message
And now Bernie Sander’s health becomes an issue! Simon Lewis reported that Bernie Sanders’ 2020 presidential election campaign on Wednesday sought to use news the candidate had a heart procedure to highlight the benefits of his trademark Medicare for All healthcare plan.
Sanders’ campaign canceled campaign events and pulled TV ads after the 78-year-old U.S. senator had two stents inserted into an artery after he experienced discomfort during a campaign visit to Nevada on Tuesday.
The candidate would rest for a few days after the relatively common procedure, his campaign for the November 2020 presidential election said.
Sanders’ speechwriter, David Sirota, said in a daily newsletter that the unexpected medical procedure was “a perfect example of why the United States needs to join the rest of the world and pass Bernie’s Medicare for All legislation.”
Sirota cited a 2018 paper by researchers at the London School of Economics that found cardiac implant devices cost up to six times more in the United States than in some European countries with government-run healthcare systems.
Sanders advocates an approach that would extend the existing Medicare program for Americans aged over 65 to all Americans and largely eliminate the private insurance industry.
Sirota argued the gulf in price was in part due to the U.S. healthcare system’s “complex web of payers – rather than a single-payer Medicare for All system that can negotiate better prices.”
As many as 1 million Americans a year get stents, a procedure that involves inserting a balloon-tipped catheter to open the blockage and deploy tiny wire-mesh tubes to prop open the artery.
“I’m feeling good. I’m fortunate to have good health care and great doctors and nurses helping me to recover,” Sanders tweeted on Wednesday afternoon, his first public statement since the procedure.
“None of us know when a medical emergency might affect us. And no one should fear going bankrupt if it occurs. Medicare for All!”
News of Sanders’ health scare sparked mean-spirited jokes pointing out the U.S. senator was treated by the healthcare system he wants to overhaul.
“Any bets on whether he’ll be going to Cuba for their great communist medical care? Get well soon Bern. #SocialismSucks!” tweeted Ben Bergquam, a right-wing California radio host.
Sanders’ supporters also took to social media to post #GetWellBernie messages.
The senator from Vermont’s campaign manager, Faiz Shakir, retweeted one message from a supporter that read, “take my heart, Bernie!!”
Another issue, which his campaign manager refuses to point out is did Bernie used his Medicare insurance to cover his diagnostic studies, his stenting procedure or his post-op care? As they are touting Medicare for All after Bernie had a quick diagnosis and stenting of his coronary artery disease we should all remember that Bernie, as well as all of the candidates for the presidency, don’t have Medicare for their health care insurance. No, they all have Congressional Blue Cross and Blue Care. So, don’t fall for their politicization of healthcare. Again, I point out, how can you promote Medicare for all when you all have no idea of the impact on patients of being insured under Medicare and the multiple restrictions and the true expense of Medicare insurance!
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!
Let us first remember Pearl Harbor Day and the men and women who lost their lives and the battles that followed. Now, let’s continue with the second edition of the suicide post. I am interested in the discussion of the epidemic and those who are left behind to suffer who someone commits suicide. The Editorial Board at USA TODAY noted that though suicide is the 10th leading cause of death, efforts to understand and prevent it falls short. But this could be changing.
If a killer roaming America left 47,000 men, women and children die each year, you can bet society would be demanding something be done to end the scourge.
Well, such a killer exists. It’s called suicide, and the rate of it has steadily risen.
Yet the national response has been little more than a shrug, apart from raised awareness whenever celebrities — fashion designer Kate Spade and renowned chef Anthony Bourdain, to name two this year — are tragically found dead by their own hand.
USA TODAY’s comprehensive look at this public health crisis and its ripple effect, published Wednesday, includes a daughter’s heart-wrenching narrative of losing a mother to suicide, as told by former Cincinnati Enquirer Managing Editor Laura Trujillo.
Although suicide is the 10th leading cause of death in America, efforts to understand and prevent it fall dismally short. The National Institutes of Health, by far the world’s largest underwriter of biomedical study, spent $68 million last year on suicide — a relatively small amount compared with NIH funds devoted to other leading killers.
NIH and NIMH: We’re deeply committed to reducing suicide
Kidney disease leaves about as many dead, yet it receives nine times the research funding. Indeed, the NIH spent more than twice the suicide research sum to better understand inflammatory bowel syndrome and even more on dietary supplements.
Suicide rates across the U.S. (Photo: USA TODAY)
The NIH says that it spends billions on mental health research and that this indirectly prevents suicide, but that’s misleading: Millions of Americans suffer emotional problems and relatively few resorts to suicide. Society needs to know why this is, and only further study can answer the question.
Federal government priorities often mirror what matters to politicians and, ultimately, the general public, which for too long has seemed mired in complacency about suicide. There have been no concerted campaigns similar to those targeting leading killers such as HIV or breast and prostate cancers.
This could be changing.
A new survey funded by the American Foundation for Suicide Prevention shows that 94 percent of Americans believe that suicide is preventable, and the foundation is advocating an increase in NIH suicide funding, to $150 million.
“The public is starting to get it,” says foundation CEO Robert Gebbia.
Even limited investments have borne fruit:
►The military and the Department of Veterans Affairs invested hundreds of millions of dollars after suicide rates tripled in the Army during recent wars, then kept climbing among a generation of young veterans. The VA has developed an algorithm to identify the most at-risk patients as a way to focus more intensive care. Preliminary results have been encouraging, with lower mortality rates.
►Studies show that reducing access to lethal means saves lives, and states with stronger gun control laws now see reduced rates of suicide. Construction began this year on a massive, stainless steel net slung under the Golden Gate Bridge to end that San Francisco landmark’s dark history as a prime site for suicide.
►With proven benefits of intervention, President Donald Trump this year signed a bill to examine the feasibility of creating a 911-style, three-digit emergency number for more easy access to the National Suicide Prevention Lifeline (1-800-273-8255).
Scientists have established that the self-destructive urge is often fleeting. Where counseling, better coping skills and reduced access to a lethal means help the distraught to endure this moment, people can survive. It’s one of the reasons why nine out of 10 people who attempt suicide, studies show, do not ultimately kill themselves.
Where there is life, there is hope.
We need to talk about suicide more
USA TODAY has published an extensive story by Laura Trujillo on her mother’s suicide. Editor Nicole Carroll explains why and the precautions are taken.
I called Laura the minute I heard.
We had worked together in Phoenix for more than a decade, and she had recently moved to Cincinnati.
She answered, sobbing.
“Oh, Laura, I’m so sorry.”
My heart was broken for Laura, her mom, her family. And over the following years, I watched as Laura tried to absorb, understand and even explain her mother’s suicide. She began writing about it in spurts on Facebook.
“It can feel impossible to understand,” she once posted. “And you can’t until you can. Until you, too, have felt alone in a way so overwhelmingly strong that you would do anything to escape it. It can be gone and return, consuming you. But sometimes there is luck. Good doctors and medicine. Time, people and faith.”
Laura and I talked about how someday when she was ready, she should share her story more widely.
Because every time Laura told her story, others would tell theirs.
And we need to talk about suicide.
On average, there are 129 suicides each day, according to new data from the Centers for Disease Control and Prevention. And for every person who dies, about 29 more attempt it. It’s the 10th leading cause of death in the United States.
We all know someone touched by suicide. Myself included.
I lived with my grandparents until I was 2. I stayed close to my grandfather; he never stopped looking out for me, even as I started college, work, a family. Then, in 2001, he killed himself. It wasn’t a secret, but no one ever talked about it.
That was 17 years ago. And still today, we just don’t talk about suicide.
The media rarely share stories of suicide, in part because we don’t want to make things worse. The practice in newspapers for decades was not to write about suicide at all unless it was done in public or was a public figure.
When the media cover high-profile suicides, especially when they include specific details of the death, the exposure can lead to suicide contagion. In the months after Robin Williams’ death in 2014, suicides rose 10 percent higher than expected, according to a Columbia University study.
But the answer can’t be to ignore suicide and the effect it has on so many. In addition to Laura’s personal essay, we felt it important to explore suicide as a broader public health problem. In our reporting, we learned that while suicide rates are up 33 percent over the past 18 years in the USA, funding for it lags behind that of all other top causes of death, leaving suicide research well behind the nation’s other top killers.
There is much about suicide we don’t know. And in an effort to protect people, news organizations have allowed misconceptions to persist, including the belief that there’s nothing you can do to help someone who is contemplating suicide.
So we know we need to report on suicide, but we must do it carefully. Because when we write about suicide responsibly, we can help save lives.
We’ve talked about this – constantly – in the writing and editing of Laura’s story.
We shared the story with two psychologists who study suicide. They advised us on language to avoid, details to omit and ways to offer support. Stories of survival help, they said. Make sure to include the suicide lifeline number with every story. Talk about warning signs.plans.
Not all psychologists agree on exactly how we should or shouldn’t write about suicide. And we didn’t do everything those experts suggested. We felt it was unrealistic to avoid talking about how Laura’s mother killed herself and to avoid every detail of where it took place. We did, however, avoid descriptions of the method in our other reported stories on suicide. Our intent is to inform, not to sensationalize, and we felt these stories were compelling without them.
We discussed language to use on social media if vulnerable readers reached out to us and how to keep the conversation going after this story published.
We then shared the story with Kelly McBride, senior vice president at the Poynter Institute and an expert on responsible media coverage of suicide. She reviewed the story, headlines, and photos, giving further advice on sensitive phrasing, and suggestions for more details of Laura’s personal journey that could help.
Because the goal of Laura’s story is to help.
Help those who’ve been touched by suicide.
Those who’ve considered suicide.
And those who are worried – right now – that someone they love is thinking about suicide.
So let’s not be afraid. Let’s find ways to share our stories.
After a suicide, here’s what happens to the people left behind
To me, this is the most important part of this post. I consider suicide a loser’s way to solve their problems and I have been through it with fellow physicians and friends who have lost family members. The people who suffer are those left behind to wonder what they did wrong or what they could have done to prevent the suicide.
Loss survivors – the close family and friends left behind after a suicide – number six to 32 for each death, according to the Centers for Disease Control and Prevention, meaning that in 2017 alone, as many as 1.5 million people unwillingly became part of this group.
They are forced to cope with the loss of a loved one and navigate uncertain futures, often caring for confused children as they struggle to accept they may never know “why.”
Suicide can affect a wider community of individuals, including members of a person’s church or school. One study estimates roughly 425 people are exposed to each suicide in this way.
After a loved one’s death, those left behind face an increased risk of suicide themselves. According to a report in 2015 from the Action Alliance for Suicide Prevention:
Losing any first-degree relative to suicide increased the mourner’s chance of suicide by about threefold.
Young people appear to be particularly vulnerable after the suicide of a peer, which can lead to a phenomenon sometimes referred to as suicide clusters or contagion.
Men who have a spouse die by suicide have a 46-fold increase in their chances of dying by suicide. Women have a 16-fold increase.
Kim Ruocco, whose husband, Marine Corps Maj. John Ruocco, died by suicide in 2005, said she never seriously considered killing herself, but she often wondered how she would make it through each day.
“After his death, I cannot say that I was suicidal, but I can remember being in so much emotional pain that I would think, ‘I really don’t want to wake up,'” Ruocco said. “Because you can’t figure out how to live your life with this kind of grief.”
‘My whole world turned upside down’
When Ruocco’s husband died, she said, she lost her sense of reality.
“My whole world was turned upside down,” she said. “What I thought I knew to be true may not have been true. … It made me question everything in my life, from my spirituality to my instincts, to my decision-making, to my marriage, to my family relationships.”
Grief, she learned, was not linear. Some days were terrible. Some were OK, even good. She had to learn, she said, to embrace it all.
“It’s not one feeling, it’s a whole bunch of feelings, and I think the advice for anybody who’s experiencing grief is that whatever you are feeling, it’s OK, it’s normal, and it’s going to come,” she said. “I let it come, I look at it, I feel it, I express it, and then I try to let it go.”
Stories of hope:
Stepping back from the ledge
Suicide never entered his mind. Then 9/11 happened.
Young, transgender and fighting a years-long battle against suicidal thoughts
She worked in suicide prevention. Then one day she had to save herself.
When Debbie Baird lost her 29-year-old son, Matthew, to suicide in 2009, she didn’t think she would ever let go of her grief.
Debbie Baird said she didn’t think she would ever recover from the grief over her son Matthew’s suicide. (Photo: Debbie Baird)
“If you had told me in the early days that I would feel better again, I would never have believed you,” she said.
She went to counseling, found a support group and journaled for years, which the Suicide Prevention Lifeline recommends as a way to process things you weren’t able to say before your loved one’s death. Slowly, Baird said, she began to heal. She could see it in the pages.
“I kept thinking if I could write a letter to him, maybe he’d write back to me. Maybe he’d let me know the reason why this happened. I felt like I needed to find a way to connect with him,” she said. “It went from wanting to know why, and how hurt and sad I felt and how my heart was broken and all the physical pain that I was going through and my depression and how I was feeling too, ‘Hey, Jen’s going to have another baby.’ I could see my life changing.”
Baird is now a community educator and support specialist for loss survivors at the National Alliance on Mental Illness.
The American Psychological Association said that after a suicide, it’s important for survivors to:
Accept your emotions.
Not worry about what you “should” feel or do. There’s no standard timeline for grieving and no single right way to cope.
Care for yourself. Do your best to get enough sleep and eat regular, healthy meals. Taking care of your physical self can improve your mood and give you the strength to cope.
Draw on support systems.
Talk to someone. There is often stigma around suicide, and many loss survivors suffer in silence. Speaking about your feelings can help.
Join a group.
Talk to a professional.
How to help
The bereaved can heal, suicide prevention experts said, but their pain is often underestimated. The stigma around suicide creates an additional burden. Loss survivors commonly experience a range of emotions as they grieve, including shock, fear, shame, and anger. As they work to cope with these feelings, many simultaneously deal with the pressure to keep their loved one’s suicide a secret or with the mistaken belief that they did something to cause their loved one’s death.
Thomas Joiner, who lost his father to suicide and went on to become a leading suicide researcher, wrote in his book “Why People Die by Suicide” that some people’s inability to intellectually make sense of suicide kept them from showing sympathy after his dad’s death.
“To some people … understanding didn’t matter and wasn’t a barrier to acting with a real generosity of spirit,” he wrote. “To others, the lack of understanding seemed an insurmountable barrier, so that instincts toward compassion were short-circuited.”
According to the American Association of Suicidology and the National Suicide Prevention Lifeline, people can help loss survivors by:
Listening without judgment
Using the lost loved one’s name to show that person is not forgotten
Accepting the loss survivor’s feelings, which can include shock, shame, and abandonment
Avoiding phrases such as “I know how you feel,” unless you, too, are a loss survivor
Avoiding telling them how they should act or feel
Being sensitive during holidays and anniversaries
“People need the education to understand that it is OK to talk about their loved one,” Baird said. “It is OK to mention their name. It is OK to say, ‘I’m sorry.’ ”
Loss survivors should be encouraged to get help for themselves. Grief counselors, faith leaders, social workers, and doctors may be trained in how to respond to suicide.
Ruocco became vice president of suicide prevention and postvention at the Tragedy Assistance Program for Survivors (TAPS) after her husband’s death. “Postvention” describes efforts to prevent suicide among loss survivors and help them heal. Ruocco said postvention doesn’t just decrease risk, it can help survivors find a new purpose.
“They can really have post-traumatic growth and make meaning out of this kind of loss,” Ruocco said.
It’s impossible for survivors to return to the way things were before their loved one’s death. Ruocco said she misses her husband every day, but she’s managed to build a life for herself that, although not what she imagined is full of joy.
“You look at the world in a different way,” she said. “Not only did I have meaning in my life because of his death, but I also cherished the world in a different way. My relationships with my children were more intense, more purposeful. I was more present and connected to the outside world, whether that’s nature or other people. I found joy in little things and appreciated little things and moments with people that I may not have discovered prior to my husband’s death, and I was able to honor his life lived by telling other people about him and preventing suicide in honor of him.”
Suicide Lifeline: If you or someone you know may be struggling with suicidal thoughts, you can call the U.S. National Suicide Prevention Lifeline at800-273-TALK (8255)any time of day or night or chat online.
If you have lost a loved one to suicide, visitAlliance of Hopeto find support resources.
If you are grieving the death of a loved one who served, you can contact the Tragedy Assistance Program for Survivors (TAPS)at800-959-8277.
U.S. teens now spend 6 hours, 40 minutes per day using screens for entertainment. Fifty percent report they feel “addicted” to their devices.
Working in the world of child and adolescent psychiatry as an advanced practice nurse, I frequently hear about symptoms of irritability, anger, isolation and poor sleep from my patients. These symptoms are common to many childhood psychiatric disorders. These disruptive symptoms baffle parents, teachers and clinicians alike, and can lead to incorrect diagnoses for these children with dysregulated moods.
I have been a steadfast believer in the importance of good diet, exercise and adequate sleep as being elementary steps one can take to improve moods. I now also consider the fourth tenet for youth mood regulation to be limited electronic screen exposure.
Excessive screen time stresses the brain, and electronic devices of all types have taken over our modern everyday life by storm in an insidious manner. The typical U.S. teen now spends 6 hours, 40 minutes per day using screens for entertainment. Fifty percent of U.S. teens say they feel “addicted” to their devices.
Recently, I saw a 12-year-old male in my office who presented with symptoms of isolation, nightmares, anxiety, anger, academic decline and poor sleep. What followed my evaluation was a discussion about how electronic devices tend to produce mood disturbances. Excessive screen time can disrupt the production of melatonin, which helps to regulate sleep-wake cycles. Light at night has been linked to depression and/or suicide in numerous studies.
Typical gaming and social media interfaces induce stress reactions with hyperarousal, provoking a “wired and tired” state. Gaming interfaces desensitize the brain’s reward system and release the “feel-good” chemical dopamine. Dopamine is critical in regulating focus and moods. Brain scans have shown that those playing video games are similar to those using cocaine.
Screen time overloads the senses
Screen time overloads the senses, fractures attention and depletes mental reserves. Emotional meltdowns can then become a coping mechanism. And lastly, excessive screen time reduces a time for “green time” — physical activity outdoors in a natural setting, which can reduce stress and restore attention.
“Pervasive design” is the practice of combining psychology and technology to change behavior. The pervasive design is increasingly employed by social media and video gaming companies to pull users onto their sites and keep them there for as long as possible. Several Google and Facebook executives have voiced their concerns about social media sites negatively affecting human psychology.
Utilizing an “electronic fast” for children in my practice has shown drastic improvement in psychiatric symptoms. I suspect those without underlying psychiatric disorders may show an even more marked improvement. As parents/guardians of children, please consider the negative impact screen time may be impacting your child.
And it is my impression after reviewing all the data that this increased screen time and social media may be the reason for this increase in suicide rates. Whether you believe President’s Trump’s tweets and outlandish suggestions that the media lies, kids and adults are measuring themselves to impossible comparisons in behavior, aesthetics, levels of social measures etc.