Category Archives: Health Care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Broad brush

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

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

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

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

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

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

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

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

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

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

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

No luck.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

‘Warp Speed’ Officials Debut Plan for Distributing Free Vaccines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What happened with the last vaccine rush?

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

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

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

What else can go wrong when vaccines are rushed

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

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

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

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

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

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

Other issues with inadequately tested vaccines

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Not necessarily.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Medicare

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

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

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

Undocumented Immigrants

  • Allow undocumented immigrants to buy into a public option

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

Affordable Care Act

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

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

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

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

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

Prescriptions

  • Lower prescription drug pricing

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

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

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

Abortion

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

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

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

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

Surprise Billing

  • Stop surprise billing

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

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

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

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

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

As a presidential candidate, Harris proposed Medicare for All.

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

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

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

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

Biden’s take on healthcare is vastly different.

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

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

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

Harris has proposed several healthcare solutions for COVID-19.

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

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

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

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

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

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

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

Who should get the vaccine?

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

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

When should I get my flu shot? 

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

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

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

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

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

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

What is the high-dose flu shot for seniors? 

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

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

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

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

Is the flu vaccine safe?

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

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

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

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

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

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

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

Will it help prevent COVID-19?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What about the nasal spray instead of the shot? 

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

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

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

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

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

So, get vaccinated!!

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

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

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

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

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

Pandemic Spike in Telehealth Levels Off

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

How Did Sweden Flatten Its Curve Without a Lockdown?

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

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

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

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

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

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

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

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

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

Behavior Change

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

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

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

Masks were never required and aren’t commonly worn.

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

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

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

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

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

Immunity

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

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

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

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

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

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

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

Path Forward

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

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

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

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

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

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

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

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

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

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

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

What Americans Need to Understand About the Swedish Coronavirus Experiment

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More on Dr. Fauci later in this post.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Six Social Health System Teams to Encourage People to Seek Healthcare

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More on that in future posts.

Coronavirus: Top scientist who battled COVID-19 says we will never live normally without vaccine! Nursing Homes, Packed Coffee Houses, and When will it Be Over?

As anyone else noticed the advertisements on television? They are mainly auto dealerships who will delivery your new car to your home and more attorney companies who will sue whomever you want and will not get charged unless they will your case. One of my former professors during my MBA program is a federal judge who warned me that judges are expecting to see many cases of malpractice cases coming to the courts secondary to the COVID-19 cases. Unbelievable!

 Ross McGuinness reported that a top scientist who fell ill with COVID-19 has said the world will never return to normal unless there is a coronavirus vaccine.

Peter Piot, director of the London School of Hygiene & Tropical Medicine, spent a week in hospital after contracting the virus in March. The Belgian virologist, who led the Joint United Nations Program on HIV/AIDS between 1995 and 2008, said climbing a flight of stairs still leaves him breathless.

Last week, a World Health Organization (WHO) official warned there may never be a coronavirus vaccine.

Prof Piot, one of the discoverers of the Ebola virus, is currently a coronavirus adviser to European Commission president Ursula von der Leyen. In an interview with Belgian magazine Knack, later translated by Science Magazine, he warned that a vaccine is needed for people to live normally again.

“The Commission is strongly committed to supporting the development of a vaccine,” he said. “Let’s be clear: Without a coronavirus vaccine, we will never be able to live normally again. “The only real exit strategy from this crisis is a vaccine that can be rolled out worldwide.

“That means producing billions of doses of it, which, in itself, is a huge challenge in terms of manufacturing logistics. And despite the efforts, it is still not even certain that developing a COVID-19 vaccine is possible.”

Prof Piot criticized anti-vaxxers, saying: “Today there’s also the paradox that some people who owe their lives to vaccines no longer want their children to be vaccinated. “That could become a problem if we want to roll out a vaccine against the coronavirus, because if too many people refuse to join, we will never get the pandemic under control.”

He said he hoped the coronavirus pandemic can help ease political tensions, citing how polio vaccination campaigns have led to truces between countries. He said he hoped the WHO could be “reformed to make it less bureaucratic”, saying it too often resembles a “political battleground”.

According to Johns Hopkins University, the US is the worst-hit country by coronavirus, with more than 79,500 deaths, followed by the UK with more than 31,900 and Italy with more than 30,500.

On Sunday, British prime minister Boris Johnson announced a range of new measures to ease the UK out of its COVID-19 lockdown. However, his announcement of the government’s measures was criticized by scientists, opposition politicians and workers’ unions, who called it confusing.

The government was left scrambling on Monday to bring some kind of clarity to the new measures. A 50-page document outlining the easing of restrictions was published on Monday. From Wednesday, people will be able to meet one person from another household in a park as long as they stay two meters apart.

Covid-19: nursing homes account for ‘staggering’ share of US deaths, data show

Reporter Jessica Glenza noted that residents of nursing homes have accounted for a staggering proportion of Covid-19 deaths in the US, according to incomplete data gathered by healthcare researchers.

Privately compiled data shows such deaths now account for more than half of all fatalities in 14 states, according to the Kaiser Family Foundation. Only 33 states report nursing home-related deaths.

“I was on a phone call last week, where four or five patients came into our hospital just in one day from nursing homes,” said infectious disease specialist Dr Sunil Parikh, of Yale School of Public Health in Connecticut. “It’s just a staggering number day to day.”

Despite early warnings that nursing homes were vulnerable to Covid-19, because of group living settings and the age of residents, the federal government is only beginning to gather national data.

In Connecticut, 194 of 216 nursing homes have had at least one Covid-19 case. Nearly half the Covid-19 deaths in the state – more than 1,200 people – have been of nursing home residents. The proportion is higher elsewhere. In New Hampshire, 72% of deaths have been nursing home residents.

Parikh said limited testing and a lack of personal protective equipment such as masks hampered efforts to curb the spread of Covid-19 in care homes. Due to limited testing capacity, most state nursing homes are still only able to test residents with symptoms, even though the disease is known to spread asymptomatically.

“What I would like to see is the ability to test the entire nursing homes,” Parikh said. “This symptomatic approach is just not cutting it. Many states, including Connecticut, are starting to move in that direction … but I hope it becomes a national effort.”

Nursing homes have been closed to the public for weeks but a bleak picture has nonetheless emerged. In New Jersey, Governor Phil Murphy called in 120 members of the state national guard to help long-term care facilities, after 17 bodies piled up in one nursing home.

In Maine, a 72-year-old woman who went into a home to recover from surgery died just a few months later, in the state’s largest outbreak.

“I feel like I failed my mom because I put her in the wrong nursing home,” the woman’s daughter, Andrea Donovan, told the Bangor Daily News. “This facility is responsible for so much sadness for this family for not protecting their residents.”

Fifteen states have moved to shield nursing homes from lawsuits, according to Modern Healthcare.

Nursing home residents were among the first known cases of Covid-19 in the US. In mid-February in suburban Kirkland, Washington, 80 of 130 residents in one facility were sickened by an unknown respiratory illness, later identified as Covid-19.

Statistics from Kirkland now appear to tell the national story. Of 129 staff members, visitors and residents who got sick, all but one of the 22 who died were older residents, according to the US Centers for Disease Control and Prevention (CDC).

By early March, most Covid-19 deaths in the US could still be traced to Kirkland.

“One thing stands out as the virus spreads throughout the United States: nursing homes and other long-term care facilities are ground zero,” wrote Dr Tom Frieden, the former head of the CDC, for CNN on 8 March.

That day, Frieden called on federal authorities to ban visitors from nursing homes. US authorities announced new measures to protect residents several days later.

The CDC investigation into Kirkland was released on 18 March. It contained another warning: “Substantial morbidity and mortality might be averted if all long-term care facilities take steps now to prevent exposure of their residents to Covid-19.”

It was not until 19 April that the head of the Centers for Medicare and Medicaid Services promised to track all deaths in nursing homes. That requirement went into effect this Friday, but there is still a two-week grace period for compliance. During the period from 19 April to 8 May, 13,000 people died, according to an NBC News analysis.

“This is really decimating state after state,” said Parikh. “We have to have a very rapid shift [of focus] to the nursing homes, the veteran homes … Covid will be with us for many months.”

Texas begins to reopen after Covid-19 quarantine – but political controversy and health risks await

Three reporters contributed to this article, Erum Salam, Nina Lakhani and Oliver Laughland, where they noted that Tim Handren, the chief executive of Santikos Entertainment, a small cinema chain in San Antonio, admits his business is not essential. But while the giants of the industry keep their screens closed, he has taken a different approach.

Since last weekend, three of nine Santikos cinemas have reopened to the public, among the first in America to do so during the coronavirus pandemic.

“Take your mask off and relax,” Handren said in a recorded message to customers. “Breathe in some great buttery popcorn smells, watch a great movie, and just enjoy some time with your family.”

The reopening is among the starker examples in Texas, where one of the quickest and most expansive efforts to reignite the economy has drawn significant controversy.

On the one hand, some civil liberty advocates have argued that their right to drink at bars, have their hair cut and dine at restaurants has been curtailed. On the other, many public health experts warn thousands will become infected as the state reopens.

Handren, who is also the mayor of the small town of Boerne, said that although his cinemas would keep patrons 6ft apart and offer a reduced menu there remained debate in the community about whether the shutdown had been necessary at all.

“Unfortunately, I still interact with people that believe Covid-19 is a hoax concocted by the media after all this time. That’s the extreme on that side of the equation … ‘We should have never shut down’. Even the lieutenant governor said that. And then there are others who want to hunker down and hibernate for the next six months. I’ve had to, as a mayor, balance health and economics.”

Abbott, a Republican, last week ended a stay-at-home order and allowed businesses including barber shops and retail outlets to open. The move followed decisions in other southern states including Florida and Georgia, and earned praise from Donald Trump.

The president told reporters: “Texas is opening up and a lot of places are opening up. And we want to do it, and I’m not sure that we even have a choice. I think we have to do it. You know, this country can’t stay closed and locked down for years.”

In private, Abbott has acknowledged that his decision to reopen is likely to cause an increase in coronavirus cases. Leaked audio obtained by the Daily Beast captured comments during a private call with state lawmakers.

Abbott, who has sought to downplay the increased risk to the public, said: “The more that you have people out there, the greater the possibility is for transmission. The goal never has been to get transmission down to zero.”

Infectious disease experts predict the average daily Covid-19 positive test rate in Texas could rise from 1,053 at the beginning of May to up to 1,800 by June.

As of this weekend, Texas had an estimated 16,670 active cases and 1,049 deaths. With the occasional dip, the number of cases continues to rise even while testing lags behind other states.

Harris county, which includes Houston, has 157 coronavirus cases per 100,000 people – 31% higher than the state average. Last month, officials said African Americans accounted for two-thirds of Covid-19 deaths in the city despite making up only 22.5% of the population.

Harris county judge Lina Hidalgo, a Democrat, has attempted to enforce a mandatory mask order. Abbott has publicly criticized her.

Dr Andrew Miller, a pediatric ophthalmologist in Harris county, reopened his clinic last week with social distancing in place. He told the Guardian that even after his decision to reopen, because of the pressing needs of patients, he was experiencing significant anger from those who refuse to wear masks.

He said: “We’ve had some pushback from families because we won’t let them in without a mask. They’ve been ugly to the staff. While I respect their civil liberties, I am entitled to not see them.”

Last week, Abbott took power away from officials who arrest Texans for certain Covid-19 violations. The move was prompted by a conservative backlash against the arrest of a salon owner in Dallas – another hotspot – who opened up against local rules. In an act that exacerbated the divisions on the case, Texas senator Ted Cruz appeared at the salon to receive a haircut from the recently released owner.

Houston lies in a sprawling industrial region with more than 500 petrochemical facilities, a busy shipping channel, large highways and commercial railroads, and one of the highest densities of polluting industries in the country, if not the world.

Air quality, specifically particulate matter, which increases the risk of multiple lung and heart conditions also associated with Covid-19 complications, has been worse in some parts of the city despite the lockdown, leading environmentalists to criticize the decision to reopen so quickly.

“It’s a blind, uninformed decision based on optimism that everything will be better, even though the evidence points to the contrary,” said Elena Craft, senior director at the Environmental Defense Fund (EDF), which coordinates a local project tracking air quality.

The meatpacking industry is also linked to several emerging hotspots in the Texas panhandle, a semi-rural region of 26 northern counties where Trump won 79.9% of the vote in 2016 and the Republican party dominates every level of government.

Moore county has the highest infection rate in Texas. Its death rate is 28 per 100,000 people, almost 10 times higher than Harris county and the state average.

Moore, where around 55% of residents identify as Latino or Hispanic, is home to the massive Brazilian-owned JSB meatpacking plant, which employs mostly Hispanic and migrant workers, many bussed in on company shuttles from towns including Amarillo. Nationwide, industrial meat plants have emerged as incubators for coronavirus spread.

Amarillo, the region’s largest city, situated across Potter and Randall counties, had 1,304 cases as of last Wednesday, including at least 18 deaths. The infection rate is rapidly rising. Potter county has the second worst rate in Texas, with infections doubling every seven or eight days.

Just to the south, in the city of Odessa, a group of armed militia men were arrested last week as they protested alongside bar owner Gabrielle Ellison, who attempted to reopen in violation of an executive order which mandates bars should remain closed.

The six men were members of a militia named Open Texas, which according to reports has operated across the state, offering armed support to business owners.

Ellison, who was also arrested, told local news from jail: “I think some rights were taken away from us, which one of them was like a right to survive. We have to survive and I think those rights were stripped from us.”

But looked what happened in Colorado!

Customers in Packed Colorado Coffee Shop Ignore Mask and Distancing Advice

 We have many stupid people as this next story proves. Customers in a Colorado coffee outlet on Sunday, May 10, resisted official calls for people to wear face masks and gloves – and to distance from one another – when in public.

This video shows the crowded scene inside a C&C Coffee and Kitchen store in Castle Rock on Mother’s Day morning. Few customers appear to be wearing face masks or distancing from one another to the extent suggested by federal and state officials.

Colorado Gov Jared Polis’s ‘Safer at Home’ order, which encourages six feet of distance between people, remains in effect until May 27.

As of May 10, Colorado had reported 19,703 confirmed cases of the coronavirus and 971 deaths.

Opinion: The coronavirus is accelerating America’s decline

Arvind Subramanian reported that the federal government’s response to the pandemic exposes incompetence and decay. The consequences will play out over years to come.

The COVID-19 crisis augurs three watersheds: the end of Europe’s integration project, the end of a united, functional America, and the end of the implicit social compact between the Chinese state and its citizens.                                                                                                                    As a result, all three powers will emerge from the pandemic internally weakened, undermining their ability to provide global leadership.                                                           Europe                                                                                                                                                Start with Europe. As with the 2010-12 eurozone crisis, the bloc’s fault line today runs through Italy. Drained over decades of dynamism and fiscally fragile, it is too big for Europe to save and too big to let fail. During the pandemic, Italians have felt abandoned by their European partners at a moment of existential crisis, creating fertile ground for populist politicians to exploit. The images of Bergamo’s COVID-19 victims being carried in body bags by military convoy to their anonymous, unaccompanied burials, will long remain etched in the Italian collective psyche.                                                                                    Meanwhile, when addressing how to help pandemic-stricken member states, the European Union’s technocratic, ostrich-like elites lapse into the institutional alphabet soup — ECB, ESM, OMT, MFF and PEPP — that has become their default language. The continent’s leaders have faltered and dithered, from European Central Bank President Christine Lagarde’s apparent gaffe in March — when she said that the ECB was “not here to close spreads” between member states’ borrowing costs — to the bickering over debt mutualization and COVID-19 rescue funds and the reluctant, grudging incrementalism of the latest agreement.                                                                                                                          Suppose, as seems likely, that the successful economies of the EU core recover from the crisis while those on the bloc’s periphery falter. No political integration project can survive a narrative featuring a permanent underclass of countries that do not share their neighbors’ prosperity in good times and are left to their own devices when calamity strikes.                             U.S.                                                                                                                                                      The United States’ decline, meanwhile, is over-predicted and under-believed. Even before the COVID-19 crisis, key U.S. institutions signaled decay: the incontinent presidency of Donald Trump, a gerrymandered Congress, a politicized Supreme Court, fractured federalism and captured regulatory institutions (with the U.S. Federal Reserve being an outstanding exception).                                                                                                                          Deep down, however, many of those Americans who see the decay reject the thesis of decline. They remain convinced that the country’s thick web of non-state institutions and underlying strengths — including its universities, media, entrepreneurial spirit, and technological prowess, as well as the global supremacy of the dollar — provide the resilience America needs to maintain its pre-eminence.

But so far, the world’s richest country has been by far the worst at coping with the pandemic. Although the US has less than 5% of the world’s population, it currently accounts for about 24% of total confirmed COVID-19 deaths and 32% of all cases.

In rapid succession, therefore, America’s credibility and global leadership have been buffeted by imperial overreach (the Iraq war), a rigged economic system (the global financial crisis), political dysfunction (the Trump presidency), and now staggering incompetence in tackling COVID-19. The cumulative blow is devastating, even if it is not yet fatal.                                                                                                                                                              Many of these pathologies in turn stem from the deep and poisonous polarization in US society. Indeed, Trump is now goading his supporters into insurrection. Come November, even the basic democratic criterion of holding free and fair elections could end up being flouted.                                                                                                                                         This is a critical moment. Prepare for the trading day with MarketWatch’s Need to Know newsletter. Our flagship email guides investors to the most important, insightful items required to chart the trading a day ahead.                                                      Of course, it would be alarmist and premature to see America’s far-reaching failures in the face of the COVID-19 crisis as threatening U.S. democracy or nationhood. But clinging adamantly to American exceptionalism at such a time seems like dangerous denialism.    China                                                                                                                                         Finally, there is China. Since the time of Deng Xiaoping, the country has thrived on a simple, implicit agreement: citizens remain politically quiescent, accepting curbs on freedom and liberties, and the state — firmly under the control of the Communist Party of China — guarantees order and rising prosperity. But the COVID-19 crisis threatens that grand bargain in two ways.                                                                                         First, the Chinese authorities’ terrible initial handling of the pandemic, and in particular their catastrophic suppression of the truth about the COVID-19 outbreak in Wuhan, has called the regime’s legitimacy and competence into question. After all, the social contract looks less attractive if the state cannot guarantee citizens’ basic well-being, including life itself. China’s true COVID-19 death toll, which is almost certainly higher than the authorities are admitting, will eventually come to light. So, too, will the stark contrast with the exemplary response to the pandemic by the freer societies of Taiwan and Hong Kong.  Second, the pandemic could lead to an external squeeze on trade, investment, and finance. If the world deglobalizes as a result of COVID-19, other countries will almost certainly look to reduce their reliance on China, thus shrinking the country’s trading opportunities. Similarly, more Chinese companies will be blocked from investing abroad, and not just on security grounds — as India has recently signaled, for example. And China’s Belt and Road Initiative — its laudable effort to boost its soft power by building trade and communications infrastructure from Asia to Europe — is at risk of unraveling as its pandemic-ravaged poorer participants start defaulting on onerous loans.                              The COVID-19 crisis will therefore probably hurt China’s long-term economic prospects. Widespread internal rumblings have begun, even if they are less evident externally. Domestic disorder is unlikely, because President Xi Jinping could ratchet up repression even more ruthlessly and effectively than he already has. But the current social contract will seem increasingly Faustian to the average Chinese citizen.

Command of resources is a prerequisite for power. But, as international-relations theory reminds us, projecting power beyond one’s borders requires a modicum of cohesion and solidarity within them. Weak, fractured societies, no matter how rich, cannot wield strategic influence or provide international leadership — nor can societies that cease to remain models worthy of emulation.                                                                                                     We have been living for some time in a G-minus-2 world of poor leadership by the U.S. and China. Both have been providing global public “bads” such as trade wars and erosion of international institutions, instead of public goods such as stability, open markets, and finance. By further weakening the internal cohesion of the world’s leading powers, the COVID-19 crisis threatens to leave the world even more rudderless, unstable, and conflict-prone. The sense of three endings in Europe, America, and China is pregnant with such grim geopolitical possibilities.                                                                                                            And Now Wuhan reported its first new coronavirus case in more than a month                                                                                                                      Aly Song from Reuters reported that Wuhan reported their first new COVID case.

  • The central Chinese city of Wuhan has reported its first new coronavirus case in more than a month.
  • The Wuhan Municipal Health Commission said Sunday that an 89-year-old man was confirmed to have the virus on Saturday. His wife, along with several members of the community, were recorded as asymptomatic cases, which are not included in official case tallies.
  • On Sunday, the National Health Commission revealed that 14 new symptomatic cases were reported on Saturday, marking the largest increase since April 28.

The central Chinese city of Wuhan, where the coronavirus first appeared last year, reported its first new case in more than a month on Sunday. The Wuhan Municipal Health Commission announced Sunday an 89-year-old male with a history of various health problems, tested positive for the virus on Saturday after showing symptoms.

His wife, who tested positive without symptoms, has been recorded as an asymptomatic case. Several other members of the community were also recorded as asymptomatic cases. The health commission said the elderly man, who resides in the Dongxihu district, lived in an area where 20 other people previously tested positive for the virus. The risk level for his district was raised to medium on Sunday. The new case is, according to multiple outlets, the first case reported in Wuhan since April 3.

Wuhan, the Chinese city hardest hit by the virus, has reported a total of 50,334 coronavirus cases and at least 3,869 deaths. In mid-April, the city revised its death toll, increasing it by 50%. The numbers coming out of China have repeatedly been called into question, especially by US officials, including the president.

China has argued that numbers are low because it took decisive action. The strict quarantine of Wuhan, a sprawling city of 11 million people, began on Jan. 23 and ended on April 8. Similar action was taken in cities across China.

On Sunday, China’s National Health Commission announced that there were 14 new coronavirus cases reported nationwide on Saturday, marking the largest single-day increase since April 28, according to Reuters. The majority of the new cases were reported in Shulan, a city in China’s northeastern Jilin province. Local officials raised the risk level to high in response.

China also reported 20 new asymptomatic cases, which are not included in the total tally. The country has reported 82,901 cases and 4,633 deaths.

How a COVID-19 Testing Model No One Is Talking About Could Save Thousands of Lives

Andrea Galeotti noted that with solid data in short supply relating to the characteristics and spread of COVID-19, many governments and health officials are struggling to formulate suitable health and economic policies. As a consequence, some although not all, countries are effectively waging a war against the coronavirus based on the dynamics of a game of chance. This in turn is producing considerable anxiety about when lockdowns might end and the first steps towards economic activity might begin to occur.

This absence of data and resultant lack of concrete purpose is perhaps best illustrated in the U.S. where the federal government has left individual states to decide when to reopen in phases, without clarity on how widespread COVID-19 actually is. What state governments should be doing is formulating a reopening procedure that is based on selecting and testing a representative sample of the population.

There is now abundant evidence that asymptomatic individuals are the key diffusers of COVID-19 and as such firmly locating those individuals is the only way to stop further waves of contagion. Testing has always been of paramount importance, but this should not be seen as a mandate to test on a massive scale. That option is clearly not practicable and should urgently be substituted for well-designed testing strategies that determine the rate of infection in the local communities of individuals being tested, as well offering a firmer bearing on the general prevalence and diffusion of the virus within the greater population. Based on this information, contact tracing and smart containment strategies can be designed in order to ensure that contagion curve is kept flat and the health system can operate within its capacity.

COVID-19 has shown it can infect people regardless of age, race, gender, and geography, and therefore has proved unpredictable and difficult to contain. This unpredictability has been mirrored by the divergent testing strategies of different governments around the world. Countries such as Italy, U.K., and the U.S. have principally been testing patients with severe symptoms and have largely withheld testing asymptomatic individuals. By contrast, in countries such as Germany, Iceland and South Korea, the testing regimen has quickly expanded to mildly symptomatic cases, and to asymptomatic individuals who work in jobs where, should the become infected, have a high chance of spreading the virus to many others. That includes, for example, medical staff and workers in transportation hubs.

These different approaches may have been dictated by different logistical constraints, yet it is clear those countries that have employed intelligent testing and contact tracing strategies have in turn been more successful in containing COVID-19. For example, Iceland, South Korea, Australia, and Singapore all have strong testing and contact tracing initiatives and their infection and mortality numbers are a fraction of the U.S.’s.

A key piece of the exit strategy for countries like the U.S., Italy, and the U.K., then, seems simple: develop a serological testing program on a representative sample of the population, while also gathering information on demographic characteristics such as age, gender, number of children, type of working sector, skills, social and working associations.

Serological tests detect the presence of antibodies for COVID-19 and make sense for this purpose for a few reasons. PCR tests, which detect RNA evidence of a virus, can only reveal a current or recent infection. Antibody tests, on the other hand, can, in theory, identify someone who was exposed to the virus months ago. By testing with this method, governments will be able to capture a clear picture to what extent the virus has already spread and identify trends across geographical regions as well as across individual characteristics such as age, gender, working sectors and skills.

Gathering this representative sample would be relatively easy and cost-effective to implement. It is also easy because countries can use representative samples of the population that are regularly used for socio-economic surveys. For example, the U.S. Bureau of Labor Statistics’ “Labor Force Statistics from the Current Population Survey” could be adapted to run such tests. Secondly, the data collected can be analyzed though standard statistical methods, which will help to infer a body of valuable analysis related to the spread across the wider population.

There are aspects of the design of such test programs that will need to be very carefully managed. For example, they could be vulnerable to outcomes that wrongly indicate the presence of COVID-19 in a given region, or, conversely, identify regions that notionally suggest low infection rates. In both examples, test validation is critical.

Through the collection and statistical analysis of such data, governments will be in a position to make an informed choice and evaluate the advantages and the disadvantages that are inherent in any policy that will relax social distancing before a vaccine is available. Formulating an exit strategy without this information amounts to flipping a coin—the proverbial game of chance and is the new cases of COVID-19 a signal of what we could see in this country as we ease self-quarantine and the “severe” lock-down in states and cities?

We need a comprehensive collection of data using contact as well as post infection patient tracing to get a handle on this pandemic and the possible recurrent waves!

Telehealth use, Coverage by Insurers Soaring in Response to COVID-19; COVID Testing, Contact Tracing and How to Reopen the US and Pandemic Resilience?

Dr. Sarah-Anne Schumann, UnitedHealthcare’s chief medical officer for employer and individual health care plans in North Texas and Oklahoma, says telehealth visits are soaring.

The growth of telemedicine is apparent at UnitedHealthcare’s sister company, Optum, which went from 1,000 telemedicine-trained care providers to 5,000 in a matter of weeks. That number is expected to grow to 10,000 providers by the end of April.

In the interview that follows, Schumann, who is a family doctor in addition to her role with UnitedHealthcare, gives us a look at the growth of telemedicine during the coronavirus from the viewpoint of both the insurer and the physician.

How has the acceptance and reliance on telehealth grown given the COVID-19 pandemic?

Telehealth has been around for a long time, and basically what telehealth does is it allows people to see a doctor anywhere and anytime on a mobile device or computer. It’s available 24 hours a day, seven days a week. People can get their medical conditions diagnosed and treated that way. With the coronavirus, now that there’s a lot of risk with going into a doctor’s office — a risk of you exposing other people or you being exposed to coronavirus — more and more doctors’ practices have very quickly scaled up their technology to allow their doctors to provide telehealth.

Can you quantify the growth?

I have some statistics. Seventy-six percent of hospitals can connect patients and care providers using digital and other technology. On the employer side, nearly nine out of 10 employers offer telemedicine to their employees.

When did UnitedHealthcare start allowing for telehealth visits?

We did allow for telehealth before COVID, but our policies have changed. We have much broader coverage since COVID. Our policy now is we are covering telehealth with no cost-sharing at all. That started on March 31. As of now through June 18, we are waiving all cost-sharing for in-network health visits for our Medicaid, Medicare Advantage and our fully insured individual and group health plans. For self-funded employers, they can opt in to telehealth with no cost-sharing.

That’s not just for COVID-related visits, but for absolutely any telehealth visits. It’s not just primary care and urgent care, but also for outpatient behavioral health and physical therapy, occupational therapy and speech therapy.

Did UnitedHealthcare broaden the coverage because of the COVID-19 pandemic?

Yes. Some primary care offices are closed right now both for safety and because there’s decreased volume for a lot of the businesses. This is a very safe way to get people assessed when they’re feeling sick but not sick enough to go to an emergency room.

It’s my understanding that insurance won’t pay the same for a telehealth visit vs. an in-person doctor visit. Is that true with UnitedHealthcare?

They are covered at a different rate, but there are many ongoing conversations. Right now, with COVID, for the doctors’ practices that have moved over to provide telehealth, they are being reimbursed at the same rate as an in-person visit. Another change, because the doctor’s offices had to pivot so quickly to start offering this, right now, there can even be phone-only visits that are covered.

Typically, do you Facetime or how do the providers get the visuals from the patient?

If you have a smartphone, which most people have, or a tablet or computer, that’s usually how it works. But right now, you can do phone-only visits.

How does a patient find out if their existing doctor is signed up and licensed to practice telemedicine?

Call the practice or go on their website. It’s best to try your own doctor first, but if that doesn’t work, try your (insurance company’s) website and it will connect you with a national provider.

What should employers know about telehealth?

Telehealth, of course, is not for everything. But for simple, urgent medical issues like allergy symptoms or pink-eye or rashes or fever, telehealth is a great way for their employees to access care. It reduces the burden on the health care system and it reduces cost and improves accessibility to care. Another thing for employers to think about is, right now while people are at home, there’s a lot of increased stress and anxiety, and virtual visits can be a way to connect with a therapist or psychologist or psychiatrist.

Do you think the COVID-19 pandemic will cause permanent changes in how people access health care?

A lot of the changes that we are experiencing in society because of the pandemic are going to be permanent changes. Things like people working from home. Some people are more productive when they’re working from home. It’s the same thing with telemedicine. Now that people are introduced to this, I think in the cases where telemedicine is a good substitute, waiting to see the doctor for urgent-care type visits where you don’t need to have a blood test done or get IV medication or things like that, people are going to see that telemedicine is a great substitute.

How to reopen the US, according to Johns Hopkins and Harvard: Test 20 million people a day, hire an army of contact tracers, and expand healthcare coverage

Hilary Bruek reported that experts from Harvard and Johns Hopkins, as well as the former FDA commissioner, have each released their plans for how to reopen the country safely.

The plans suggest the US will need to massively ramp-up its disease testing and tracing capabilities to allow people to return to work and school. 

Collectively, the reports suggest the US will need: around 5 million tests a day by July, 100,000 public health workers to contact trace, and a “national infectious disease forecasting center.” 

Most Americans are still stuck at home, but a trio of reports, out from Harvard, Johns Hopkins, and former US Food and Drug Administration Commissioner Scott Gottlieb, are starting to lay a foundation for what reopening the country might look like, if done safely.

Though staying inside is certainly keeping more infections at bay right now, it’s not without its costs.

Aside from the strain stay-at-home orders are putting on families, friends and communities, the newfound national quiet means the US is “hemorrhaging $100 billion to $350 billion a month,” according to the new Harvard analysis, which was released on Monday.

A hasty, careless reopening would be a deadly disaster, though.

If everyone rushed back into the streets, hugging, kissing, shaking hands, and entirely abandoning social distancing measures, more than 300,000 people nationwide could die, according to federal documents from the Department of Health and Human Services, first released in a report from the Center for Public Integrity on Tuesday.

That’s why any thoughtful plan to reopen the country must involve massive additional investments in public health, especially the testing and tracing of US coronavirus cases.

Here are the key topline suggestions from the experts for not only emerging from the coronavirus crisis successfully and safely, but also, as the Harvard report put it, becoming a “pandemic resilient” nation.

Harvard’s Roadmap to Pandemic Resilience says more testing is fundamental to recovery 

Broadly, the Harvard report suggests the task ahead of us is “bigger than most people realize.”

“We need to massively scale-up testing, contact tracing, isolation, and quarantine—together with providing the resources to make these possible for all individuals,” the authors write. 

Here’s how:

In the coming months, the US should rapidly ramp up its capacity to test for the coronavirus, eventually testing upwards of 2 to 6% of the population on any given day. (Currently, the US tests around 150,000 people per day, or about 0.04% of the population.) The plan starts with: 5 million tests per day by early June, and continues trending upward towards 20 million tests a day nationwide, by late July. That kind of widespread testing would be on a scale larger than Germany (testing 0.06% of the country per day, with more than 50,000 coronavirus tests), and would even surpass South Korea, which so far has tested more than 1.1% of the country, overall, for COVID-19.

But “even this number may not be high enough to protect public health,” the report authors warn.

“Given that 40% of the economy is already open,” the report says, “our first priority for a massively scaled up pandemic testing program should be to stabilize the essential workforce.” Policy makers should listen to worker voices, the report also said, “because workers have expert knowledge about how to make their jobs safe and when safety-related rules are not being followed.” 

Tests will eventually also be needed for others, including:

  1. Everyone with coronavirus symptoms, and their close contacts.
  2. People with presumed exposure (healthcare workers, essential workers, etc.)
  3. Nursing home residents and staff.
  4. Incarcerated people.
  5. Companies and schools.
  6. Those who have tested negative within a very recent window and those who show immunity in reliable antibody tests (assuming these prove feasible) should be free to return to work,” the report said.
  7. The authors were cautious about the idea of immunity cards or passports, though. “Certificates of immunity should be used only in contexts where people have equal access to testing and where a recent negative test result provides the same access to mobility as immunity,” the report says. “Any other use of immunity certificates would be likely to violate constitutional equal protection requirements.” 
  8. In order to be able to follow 14-day quarantine orders successfully, people will need to be supported with more job protection and healthcare, the report added.
  9. The cost of testing and tracing at this scale is an estimated $50 – 300 billion over two years, which, the authors write is still far cheaper than “the economic cost of continued collective quarantine,” at $100 to 350 billion a month. 
  10. Pandemic Testing Board should also be established by the federal government, the report suggests, with a National Director of Testing Supply appointed to help ramp up testing efforts. “In virtually every successful historical example of such rapid coordination, a central authority has set goals and ensured that each part of the chain meets the interlocking goals required for the chain to succeed,” the report authors add.  

There’s just one problem, though: the Harvard approach relies on all coronavirus tests being accurate, but some are not

Claudio Furlan/LaPresse noted that the swab-the-nose-and-throat coronavirus testing delivers about 30% false negatives, which means that roughly 3 in 10 people who have the virus could wrongly assume they don’t after they’re tested, and then could go on to infect others at work or at school.

Coronavirus blood tests, which are meant to determine whether a person has been infected in the past with the coronavirus and developed disease-fighting antibodies, have so far performed much worse than the swab tests, with some operating at just 30% accuracy, the New York Times recently reported.

Johns Hopkins’ ‘National Plan to Enable Comprehensive COVID-19 Case Finding and Contact Tracing in the US’ adds an army of contact tracers to the Harvard testing plan

The goal of deploying thousands of contact tracers across the US, the report authors write, is to “find every COVID-19 case in the midst of a national epidemic … and then work quickly to contain spread through intensive case and contact tracing interventions,” by warning others who might’ve been exposed to those sick people to stay home.

“This entire operation has never been done before,” New York Governor Andrew Cuomo said Wednesday, as he announced during a news conference that his state would be partnering with Johns Hopkins to roll out a new army of contact tracers in the tri-state area, to the tune of $10 million.

“You’ve never heard the words testing, tracing, isolate before,” Cuomo said. “No one has. We’ve just never done this.”

Here’s how the plan could work, nationwide:

  • Hire “an extra 100,000 contact tracers across the United States,” the report says. “While this figure may be stunning, it is still the equivalent of less than half the number [of contact tracers] employed in Wuhan,” the authors point out. 
  • Contact tracers will need to be trained by existing state and territorial public health departments on: disease transmission, principles of case isolation and quarantine, ethics of public health data collection and use, risk communication, cultural sensitivity, and more. 
  • The plan could provide jobs for: former government employees, retired public health and public safety workers & medical personnel, medical and public health students, Medical Reserve Corps or Peace Corps members, community health workers, and others “seeking employment—especially those who have lost their jobs due to COVID-19.” People with good communication and interviewing skills would be especially well-qualified for the task.
  • The new workforce will cost the US an estimated $3.6 billion, and the report authors urge Congress to fund this idea in its fourth stimulus package.
  • The cost of not tracing is also high: “It is estimated that each infected person can, on average, infect two to three others,” the authors write. “This means that if one person spreads the virus to three others, that first positive case can turn into more than 59,000 cases in 10 rounds of infections.” 

Apple and Google have also released their own plans to make contact tracing and surveillance happen more automatically on our phones

Apple and Google are both working on new apps and other press-of-a-button opt-in functionalities for phones that would harness Bluetooth technology to track where we’ve been, and then warn others who’ve been near us, in the event we get sick with the coronavirus, in a new brand of push notification-friendly contact tracing.

The companies promise that “user privacy and security” will be paramount in any forthcoming app design.

Other countries have already tried out similar Bluetooth-reliant tracing techniques, but they’re not always very successful, as you need a large percentage of the population to use them in order to have any major impact on transmission. 

Scott Gottlieb’s ‘Road Map to Reopening’ from the American Enterprise Institute adds in the element of a weather forecasting service for pandemics 

James Gathany reviewed that Scott Gottlieb reviewed the “Road Map to Reopening” from the American Institute and reported that Gottlieb calls it a “National Infectious Disease Forecasting Center,” and says “this permanent federal institution would function similarly to the National Weather Service, providing a centralized capability for both producing models and undertaking investigations to improve methods used to advance basic science, data science, and visualization capabilities.” 

Gottlieb also cautioned that we should not rush to return the US to business-as-usual, even as some restrictions are lifted. As schools and businesses reopen, “teleworking should continue where convenient” he said, and “social gatherings should continue to be limited to fewer than 50 people wherever possible.”

‘It’s going to be brutal,’ billionaire Mark Cuban says of economy’s recovery from coronavirus, and ‘there’s no way to sugarcoat it’

‘It’s going to be brutal. There’s no way to sugarcoat it at all.’

That is outspoken billionaire and Dallas Mavericks owner Mark Cuban, who has been increasingly visible as the National Basketball Association has been temporarily suspended due to the deadly COVID-19 pandemic.

Reporter DeCambre reviewed an interview with Mark Cuban with Maria Bartiromo. Cuban, speaking with Fox Business anchor Maria Bartiromo, explained why he thought the recovery from the economic fallout wrought by the illness caused by a novel coronavirus strain could be a long and ugly one for the average American and small businesses in particular.

“It’s going to be brutal. There’s no way to sugarcoat it at all. And when we get to the other side, companies are going to be operating differently,” Cuban said on the business network.

The entrepreneur, who boasts a net worth of $4.3 billion, according to Forbes, says that challenges for businesses are manifold and include additional costs that will be incurred to sanitize and retrofit spaces as nearly shutdown economies attempt to reboot after a virus-imposed hibernation.

“Companies are going to have to be agile … Companies are going to have to build from the bottom up,” Cuban said.

The “Shark Tank” star said he remains confident that some normalcy will return in two to three years but predicts that investors and business owners will need to endure some pain to get to the other side.

His comments came as Robert Redfield, director of the Centers for Disease Control and Prevention, was quoted in the Washington Post as saying in an interview published on Tuesday that “there’s a possibility that the assault of the virus on our nation next winter will actually be even more difficult than the one we just went through.”

The deadly contagion that was first identified late last year in Wuhan, China, has, infected more than 2.6 million people globally and killed about 179,000, according to data aggregated by Johns Hopkins University, as of Wednesday morning.

On Thursday, investors and others will be watching for a House vote on a nearly $500 billion aid package for small businesses amid the coronavirus pandemic, after the Senate passed the measure on Tuesday.

The passage of the bill and the possibility of restarting stalled economies may be conferring some optimism on markets, with the Dow Jones Industrial Average DJIA, +1.10%, the S&P 500 SPX, +1.39% and the Nasdaq Composite Index COMP, +1.64% all closing sharply higher Wednesday.

That said, Cuban believes that small businesses may require at least a third installment of funds to operate through the crisis, and he is looking to invest in companies that sit outside the criteria for obtaining government-backed loans.

“We haven’t talked about those companies that are 501 and up. They are suffering the most,” he said, referring to language that stipulates that businesses need to have 500 or fewer employees to qualify for the small-business recovery funding. 

So, when do we really reopen the economy and back to the “new” normal and do we use scientific data? I think as we can see we need data based on more testing, but the testing has to be accurate and more sensitive and then we need comprehensive contact tracing and case follow-up tracing. Also, what technology will we use for contact tracing and could it be the use of APPS on our phones or other home health and fitness wearables or other real time monitors?

This technology needs to integrate multiple longitudinal electronic medical records across all sources including healthcare providers and healthcare facilities, labs, clinics, pharmacies, long-term care facilities, etc. with nationwide coverage and interoperability and more important it needs to be HIPPA compliant to respect personal information.

Big wishes and needs, which will lead the way to solutions and attaining our goals of defeating COVID-19 and also prepare the US for whatever the next possible pandemic may raise its ugly head!

When This War Is Over, Many of Us Will Leave Medicine and the Stresses of Healthcare Workers on All Fronts

One ER physician recounts the stress of constant intubations and PPE shortages

Michele Harper reviews the stress of our frontline healthcare workers and here is a case.

I couldn’t see. My face shield was blurred by a streaky haze. I tilted my neck back and forth in an effort to peer beyond it, beneath it, through it, whatever might work. Was it condensation? I started to raise my hands to my face to wipe it away before I remembered and yanked them back down: I cannot touch my face, can’t ever touch my face — neither inside this room nor outside it.

As I stood at the head of the patient’s bed in ER Room 3, her nurse, Kate, secured a mask over the patient’s face to deliver additional oxygen. I checked to ensure the oxygen was cranked up to the maximum flow rate while we waited for the respiratory therapist. Even with that increased oxygen, the patient was saturating 85% at best, and her blood pressure was dropping.

Ninety minutes earlier, the patient — a woman of 68 years with significant impairment from a stroke — had been fine. The nurse at her nursing home called to inform us they were sending the patient to the ER for evaluation of “altered mental status” because she was less “perky” than usual. Her oxygen level on arrival was normal with no shortness of breath. Her blood pressure was a little low, but her blood glucose read high. Nothing a little IV fluid couldn’t fix, and initially, it did.

I had requested a rectal temperature; it read 103 degrees. The combination of her being a nursing home resident and running a fever was a red flag during these coronavirus times. I placed her on respiratory isolation and asked Kate to be extra vigilant for any decline. I ordered broad-spectrum antibiotics to kill any likely source of infection while I awaited her chest X-ray, urine, and blood tests. Her portable chest X-ray was done first and revealed what I had already anticipated: diffuse atypical infiltrates, a presumed telltale sign of Covid-19. Although our understanding of this viral infection is ever-evolving, it seems the only observation we can reliably conclude is that we have not yet identified anything pathognomonic about it.

Seventy-five minutes later, another nurse, Charlene, called, “They need you in Room 3.”

“Okay,” I replied as I entered orders on the next chest pain patient with shortness of breath.

“Dr. Harper, they need you in Room 3 now,” Charlene called again.

“Room 3? The nursing home patient? I’ll be right there. What happened?”

“Her oxygen is at 67%.”

I asked the clerk to call respiratory therapy for intubation. I then turned back to Charlene to ask her to help Kate prepare for the procedure.

Then the personal protective equipment (PPE) sequence. I grabbed gloves to remove my N95 mask from its paper bag and placed it over my face, checking it was snug over my nose and lower jaw. After removing those gloves, I donned my face shield, then walked to the cart for a new gown. Lastly, a fresh set of gloves before entering the patient’s room.

I was scared, and I don’t get scared. Other doctors do, but not ER doctors. We don’t scare easily.

Now I waited for the respiratory therapist. It was good that she needed extra time to get the ventilator and then don her PPE because I had to figure out why I couldn’t see without manually manipulating my face shield. My thoughts were pierced by the sound of panting. I checked the patient who was taking the oxygen quietly, rapidly, ineffectively at regular intervals that didn’t register a sound. Her eyes remained closed—no flip of an eyelash, no wince of her forehead, no twitch in a limb. Despite her instability, the patient was in no visible distress. No heaving breath there. The nurse to my left was concentrating on the patient’s oxygen. I heard only the crinkle of her gown as she adjusted her stance. The panting wasn’t hers. The nurse to my right prepared to administer the intubation medications. He read out my orders — the name and dose of the medication in each syringe and the order in which they were to be pushed. His voice was steady. It wasn’t him hyperventilating. The nurse just outside of the room kept documentation of the procedure on scrap paper she used to carefully transcribe each detail onto her laptop. She was too far away to be heard unless she yelled, so that audible breathing certainly wasn’t hers.

The panting was my own.

A hailstorm of thoughts ensued. Was my breath the fog on my face shield? If so, my N95 mask had a leak. Unsuspecting, had I already inhaled the virus? Would I be intubated next?

The respiratory therapist had arrived with the ventilator and put on her face shield. She was almost ready, so there was little time to pull myself together.

Breathe in, I commanded myself: One, two, three. Breathe out. I obeyed: One, two, three, four.

Was I already short of breath? Had I not noticed my symptoms when I drove to work this morning? Yesterday? Last night?

Breathe in. One two, three. Breathe out. One, two, three, four.

I was scared, and I don’t get scared. Other doctors do, but not ER doctors. We don’t scare easily. We’re a type of special forces who step in when everything else has failed. Typically, we do our job anonymously then leave when the mission is complete. Any injury to ourselves incurred in the line of duty is dealt with after we’re off the clock.

Once in a while, however, there are circumstances when the capacity to compartmentalize is overwhelmed, when the chronic stress breaks through so that the fear works on you. Now, as I stood at the patient’s bed with the video laryngoscope blade in one hand and the endotracheal tube in the other, panic pushed its way through me in involuntary. forceful. rapid. shallow. breaths.

Breathe in on one, two, three. Breathe out on one, two, three, four.

The respiratory therapist slapped on her gloves and in moments was at my side. It was time for intubation.

Breathe in on three and out on four.

At last, my breathing was smooth, measured, sound.

I looked through my mask again. It wasn’t condensation. It was streaks from the sanitizing wipes because we had to reuse our equipment.

I adjusted my eyes to the clear spaces. Finally, I could see. My N95 mask fit. I could breathe.

The room was relatively quiet, what I like to call “ER calm.” All was still, save for the bagging of respiratory therapy, save for the swoosh of oxygen jetting from its port aerosolizing everything.

I requested that the intubation medications be administered then checked for a response. After visualizing the vocal cords easily with the video laryngoscope, I slid in the endotracheal tube, and respiratory connected it to the vent. The patient’s oxygen increased to 100% on the monitor.

Those of us who survive will return each day to battle. But when this war is over, this is why many of us will leave.

Doffing my gown and gloves, I put on new gloves to remove and sanitize my face shield. I couldn’t imagine there was a way to effectively clean the foam band across the forehead. I hoped to remove the streaks. I also hoped the impossible: to remove the virus, because it was the same shield I had to use repeatedly during my shift. I took off the N95. We’re now told that we can reuse it, too, numerous times before getting a new one due to the PPE shortages, so I put the contaminated mask back in the bag until I would need to do it again for the next patient.

This is how we get infected. This is how we die.

Those of us who survive will return each day to battle because we do not walk away from war until it’s done. But when this war is over, this is why many of us will leave.

I walked to the back of the ER to use the restroom in the seven minutes before the patient was ready for CT and saw my ER director standing in the lounge. I waved hello.

“How did it go?” she asked, her eyes gentle, her smile sympathetic.

“It went,” I replied.

“How did you feel in the PPE? Did you feel protected?”

I paused to regulate my answer. Her intentions were good. She was an ER doctor who did her best to walk the fine line between the docs on the front lines and the administrators who notified me that “doctors don’t get paid sick leave” and “thank you for your service,” which were graciously sent out in two separate emails. Just another reminder that we health care providers are regarded as more disposable than our PPE. But this wasn’t her fault, so I felt responsible, in that moment, for her feelings too.

I pulled in my tone. “No. That equipment doesn’t protect us. There’s no way that we’re not all covered in Covid, but we’re following the ‘guidelines.’”

She nodded and frowned.

“Honestly,” I continued, “and I hate to say this, but my feeling is that the majority of people will have contracted this virus. Most people will get through it, and others won’t. Many will die. I don’t want any of us to die, but many health care providers will. The thing is, it’s impossible to know which camp we’re in until it happens.”

She nodded again.

We smiled at each other, and I continued to the bathroom. I washed my hands, turning them over each other, lathering the soap along each finger, under each nail. As I dried my hands, I looked up at the mirror, noting that my breath was now imperceptible when my phone rang.

A FaceTime request from my nine-year-old nephew, Eli.

My policy used to be to not answer the phone at work unless it was critical. But this is a different era. Eli is sheltering-in-place at a military base in California while his mother, my sister, is away for deployment.

I swiped the phone to answer. “Hi, Eli!”

“Hello, Aunt,” he announced more softly than usual. His eyelids hovered low, and his eyes weren’t their typical bright.

“How are you, Eli?” I inquired, masking my concern.

“I’m good.” He smiled with sleepy eyes. “I just woke up.” He yawned; his bushy eyebrows raised high. Years ago, he said his eyebrows were the indisputable evidence that Frida Kahlo was his great, great grandmother so he had to meet her forthwith. Upon being told that she had already passed away, he cried for the woman he had decided was his long-lost ancestor. Now, as he yawned again, his thick eyelashes shut tight. His head drifted back and his mouth reeled open expelling the strongest exhale of the bravest lion cub.

Smiling to myself, I sighed easily.

He breathed.

I breathed.

Today we are OK.

Anxiety on the Frontlines of COVID-19 

It’s not just healthcare workers’ physical health but also their mental health that’s suffering

Richard van Zyl-Smit, M.D./PhD described to a friend this week the current feeling of being in the hospital with COVID-19, as like sitting under a 1,000V high-tension electricity cable: there is a constant humming above your head, which is unnerving and just does not go away.

Two years ago, he published a book called They Don’t Award Nobel Prizes to Dead People about my experience as an academic clinician with a stress-induced anxiety disorder. The context is very different now, but the lessons I learned in that time might be of help to those of you feeling this intangible “humming” — a sense of anxiety that is neither defined nor visible even with no COVID patient contact — and for those of you who are caring daily for COVID-19 patients.

The first and most important aspect of this time is to recognize that anxiety is real. This is not something you might have experienced before. For those of us who have previously or currently suffer from anxiety, it is easily recognizable for what it is, but you may never have experienced it quite like this. You are not losing your mind or losing control, you are experiencing a loss of control of your environment. In many ways, the daily changing updates, the ever-changing schedules and call rosters are unsettling at best and can be completely unnerving as we can’t be certain from one day to the next. There is not a lot you can do about it, except to acknowledge it and talk about it.

The second aspect relates directly to that gnawing “hum.”

I learned previously the benefit of and strongly believe in “downtime.” Getting away from the humming, which is not so easy anymore as we don’t have rugby or soccer scores to get excited or depressed about, we don’t have news about politics or current affairs — except COVID, COVID, COVID. I used to play Candy Crush to get my mind off work and to get away from the “hum,” but recognized that did not accomplish much — it just kept my mind going, and the anxiety was still there. I now try to be creative, to garden, draw, write, crochet (see below), paint, anything that I can do that takes the focus off my work.

Exercise is great too — but now restricted to indoors! I don’t look at the hundreds of WhatsApp group messages unless I am at work; the latest medical publication of how I should treat my ventilated COVID-19 patient on my next week on call is not important when I am at home.

I am convinced that switching off the social media, medical media, and media media when you are not working is vital for your mental health. For some, it might mean no social media, for others less, but getting out from under the electricity cable when you can, is an important way to ensure your own sustainability over the next few months.

The last aspect relates to relationships: physical distance is key — but find, and seek out the people who can support you; keep talking to each other, be kind to each other and to yourself, and talk about the anxiety, fears, worries, or stress. Professional services are available to those feeling very out of control, but simply talking with someone is a fantastic way to get the humming out of your head.

As much as we need to care for our COVID-19 patients and protect ourselves with PPE, we also need to look after ourselves and protect our mental health. It is not a sign of weakness but requires courage and bravery to ask for help.

“Asking for help is not giving up, it is refusing to give up.” — Charlie Mackesy

We are all in this together — we need to be kind to each other and to ourselves.

India coronavirus doctors: Notes on hope, fear and longing Reporter Vikas Pandey shows us how the Corona virus is affecting doctors in India. Dr Milind Baldi was on duty in a Covid-19 ward when a 46-year-old man was wheeled in  with severe breathing difficulty.

The man was scared for his life and kept repeating one question: “Will I survive?”

The question was followed by a plea: “Please save me, I don’t want to die.” Dr Baldi assured the man that he was going to do “everything possible to save him”.

These were the last words spoken between the two men. The patient was put on a ventilator, and died two days later. The doctor, who works in a hospital in the central Indian city of Indore, vividly remembers the 30 “terrifying minutes” after the patient was brought to his hospital.

“He kept holding my hands. His eyes were full of fear and pain. I will never forget his face.”

His death deeply affected Dr Baldi. “It ate away my soul from inside and left a lacuna in my heart.” Seeing patients die in critical care wards is not uncommon for doctors like him. But, he says, nothing can compare to the psychological stress of working in a Covid-19 ward.

Most coronavirus patients are kept in isolation, which means, if they become critically ill, doctors and nurses are the only people they see in their final hours.

“No doctor ever wants to be in this scenario,” says Dr A Fathahudeen, who heads the critical care department at Ernakulam Medical College in southern India.

Doctors say they usually share the emotional burden of treating someone with that person’s family. But Covid-19 doesn’t allow that. Dr Fathahudeen says he will never forget “the blankness in the eyes” of a Covid-19 patient who died in his hospital.

“He wasn’t able to talk. But his eyes reflected the pain and the fear he was experiencing.” Dr Fathahudeen felt helpless because the patient was going to die alone. But there was a tiny sliver of hope: the man’s wife was being treated for coronavirus in the same hospital.

So, Dr Fathahudeen brought her to the ward. She stood still and kept looking at him and said her goodbye. She never thought her 40-year marriage would end so abruptly.

The experienced doctor says the incident left him “emotionally consumed”. But, he adds, there was “some satisfaction that he didn’t die without seeing his wife”. “But that won’t always happen. The harsh truth is that some patients will die without saying goodbye to their loved ones.”

The emotional toll is made much worse as many doctors are themselves in a form of isolation – most are staying away from their families to protect them. As a result, Dr Mir Shahnawaz, who works at the Government Chest Hospital in Srinagar, says it’s “not just the disease we are fighting with”.

“Imagine not knowing when you will see your family next, add that to the constant fear that you may get infected and you will begin to understand what we are going through.”

Adding to the stress, is the fact that they also have to constantly deal with the emotional outbursts of patients. “They are very scared and we have to keep them calm – be their friend and doctor at the same time.”

And doctors also have to make phone calls to the families of patients, and deal with their fears too. The whole process, Dr Shahnawaz says, is emotionally draining.

“It hits you when you go back to your room in the night. Then there is the fear of the unknown – we don’t know how bad the situation will get.”

Doctors are used to saving lives, he adds, and “we will continue to do that no matter what”. “But the truth is that we are also human beings and we are also scared.” He says that the first coronavirus death in his hospital made his colleagues break down: it was when they realized that Covid-19 doesn’t afford the family a final glimpse of their loved one.

“Family members want to remember the final moments of a patient – a faint smile, a few last words, anything really to hold on to. But they can’t even give a proper burial to the dead.”

Dr Fathahudeen says such psychological pressure needs to be addressed and each hospital needs to have a psychiatrist – both for doctors and patients. “This is something I have done in my hospital. It’s important because otherwise the emotional scars will be too deep to heal. We are staring at cases of PTSD among frontline workers.”

Doorstep doctors

It is not just those working in Covid-19 wards who are on the front line, but also the doctors, community health workers and officials who are involved in contact tracing and screening suspected patients by going door-to-door in virus hotspots.

Dr Varsha Saxena, who works in the badly affected northern city of Jaipur, says she walks into grave danger knowingly every day. Her job is to screen people for possible symptoms. “There is no other option. It’s the fight of our lifetime, but one can’t ignore the risks,” she says. “But it poses great risk because we don’t know who among the ones, we are screening is actually positive,” she adds.

She says doctors like her don’t always get proper medical-grade personal protective equipment. “The fear of getting infected is always there and we have to live with it. It does play on our mind and we have to fight hard to keep such negative thoughts away.”

But her biggest fear, she says, is getting infected and not showing any symptoms. “Then the risk is that we may end up infecting others. That is why field doctors also need PPE,” she adds. And the stress, sometimes, also comes home.

“It’s so draining. My husband is also a doctor, most nights we don’t even have energy to cook and our dinner involves just bread.”

Aqueel Khan, a bureaucrat and a colleague of Dr Saxena, acknowledges that psychological stress is a reality for all frontline workers, including officers like him who are embedded with medical teams. The fear really comes home for these workers when somebody close to them dies.

“I lost my uncle and a friend recently. It shook me, I can’t stop thinking about them. You can’t stop thinking that it can easily happen to you,” he says.

Mr. Khan is also staying away from his family: this year is the first time he will miss his daughter’s birthday. “My heart says to go home and see her from far, but the mind tells me otherwise. This constant struggle is very stressful.

“But we can’t turn our backs on the job. We just have to just keep at it, hoping that we come out alive on the other side of this fight.” ‘The risk is always there’

There is no respite for doctors and nurses even when they are not directly involved in the fight against coronavirus. People with other ailments are continuing to come to hospitals. And there has also been a surge in the number of people who are turning up at hospitals with coronavirus-like symptoms.

Dr Mohsin Bin Mushtaq, who works at the GMC Hospital in Indian-administered Kashmir, says coronavirus has “fundamentally changed our lives”. “We are seeing patients every day for other ailments. But the risk is always there that some of them could be infected,” he said.

And it worries him even more when he reads about doctors getting infected despite wearing PPE and dying. A number of doctors have died in India and dozens have tested positive. There is nothing we can do about it, he says, adding that “we just have to be mentally strong and do our jobs”.

Dr Mehnaz Bhat and Dr Sartaz Bhat also work in the same hospital, and they say that the “fear among patients is too much”. Dr Sartaz says people with a slight cold end up thinking they have coronavirus, and rush to the hospital. “So apart from treating them, we also have to deal with their fear,” Dr Sartaz adds.

He recently diagnosed Covid-19 symptoms in a patient and advised him to go for testing. But his family refused and took him away. The patient was brought back to the hospital after Dr Sartaz called the police. He says he had never imagined doing something like this in his medical career. “This is the new normal.”

The way patients are examined has also changed for some doctors. “We really have to try and limit close interactions with patients,” Dr Mehnaz Bhat says. “But it’s not what we have been trained for. So much has changed so quickly, it’s stressful,” she says.

And several attacks on doctors and nurses across the country have made them even more worried. She says it’s difficult to understand why anybody would attack doctors. “We are saving lives, risking our lives every day. We need love, not fear.” she adds.

And even worse:

E.R. doc on COVID-19 ‘front lines’ died by suicide                             To show how serious the stress is seen in this report by Cory Siemaszko reported that a New York City emergency room doctor who was on the “front lines” of the fight against the coronavirus has died by suicide, police said Monday. Dr. Lorna Breen, 49, who worked at New York-Presbyterian Allen Hospital, was in Virginia when she died on Sunday, said Tyler Hawn, a spokesman for the Charlottesville Police Department.

“The victim was taken to U.V.A. Hospital for treatment, but later succumbed to self-inflicted injuries,” Hawn said.

It was her father, Dr. Phillip Breen, who revealed the first details about his daughter’s tragic death. “She tried to do her job, and it killed her,” he told The New York Times. “She was truly in the trenches of the front line.”

He said his daughter seemed very detached of late and that she had described some of the horrors she had witnessed at the hospital while battling the virus. “Make sure she’s praised as a hero, because she was,” Phillip Breen said. “She’s a casualty just as much as anybody else who has died.”

The hospital confirmed Lorna Breen’s death in a statement released by chief spokesperson Lucky Tran, but gave few other details. “Words cannot convey the sense of loss we feel today,” the statement said. “Dr. Breen is a hero who brought the highest ideals of medicine to the challenging front lines of the emergency department. Our focus today is to provide support to her family, friends, and colleagues as they cope with this news during what is already an extraordinarily difficult time.”

NewYork-Presbyterian Allen Hospital has 200 beds, is in northern Manhattan and is one of the seven hospitals that make up NewYork-Presbyterian Hospital.

Infectious Disease Expert Makes Chilling Prediction for States Reopening Amid Pandemic                                                                 Reporter Lee Moran noted that infectious disease expert Michael Osterholm warned that the states starting to reopen amid the coronavirus pandemic “will pay a big price later on.”

Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota, told CNN’s Jake Tapper on Thursday that states like Georgia, Colorado and others that are easing social distancing restrictions were “putting gasoline on fire.”

“I think right now, this is one of the things we’ve learned, if we’re going to learn to live with this, then you just don’t walk in the face of it and spit in its eye, because it will hit you,” said Osterholm. “And I think that that’s a really important issue right now,” he continued. “When we have transmission increasing, when our hospitals are not able to take care of it and we don’t have enough testing to even know what’s going on, then that’s not the time to loosen up.”

Osterholm suggested it was “the worst example of how to start this discussion” about the “loosening” of society. “I wouldn’t do it,” he added. “I fear that these states will have to pay a big price later on because of what they’re doing.”

COVID-19: National Psychiatrist-Run Hotline Offers Docs Emotional PPE                                                                                              Emily Sohn reported that Mona Masood, DO, a Philadelphia-area psychiatrist and moderator of a Facebook forum called the COVID-19 Physicians Group, reviewed post after post about her colleagues’ fears, anxieties, and the crushing pressure to act like a hero, inspiration struck. Would it be possible, she wondered, to create a resource through which psychiatrists would be available to provide frontline physicians with some emotional personal protective equipment (PPE)?

She floated the idea in the Facebook forum, which has more than 30,000 members. The response was immediate. “All these psychiatrists just started contacting me, saying, ‘Please let me be a part of this. I want to volunteer,’ ” she told Medscape Medical News.

On March 30, Masood launched the Physician Support Line, a free mental health hotline exclusively for doctors. Within the first 3 weeks, the hotline logged more than 3000 minutes of call time. Some physicians have called repeatedly, and early feedback suggests the resource is meeting a vast need.

“Most of the cases have a lot of emotion from both sides. There are a lot of tears, a lot of relief,” said Masood.

“If Not Me, Then Who?”

Physicians have been facing mental health challenges long before the pandemic, and doctors have long struggled with stigma in seeking psychological help, says Katherine Gold, MD, a family medicine physician at the University of Michigan, Ann Arbor, who studies physician well-being, suicide, and mental health.

As a whole, physicians tend to be perfectionists and have high expectations of themselves. That combination can set them up for mental distress, Gold notes. Studies that have focused mainly on medical students and residents show that nearly 30% have experienced depression. Physicians are also at significant risk of dying by suicide.

Compounding the issue is the fact that physicians are also often reluctant to seek help, and institutional stigma is one persistent reason, Gold says. Many states require annual license renewal applications in which physicians are asked questions about mental health. Doctors fear they’ll lose their licenses if they seek psychological help, so they don’t pursue it.

A study conducted by Gold and colleagues that analyzed data from 2003 to 2008 showed that compared to the general public, physicians who died by suicide were less likely to have consulted mental health experts, less likely to have been diagnosed with mental health problems, and less likely to have antidepressants in their system at the time of death.

The COVID-19 pandemic may exacerbate these trends, suggests a recent study from China in which investigators surveyed 1257 healthcare workers in January and February.

Results revealed that a significant proportion of respondents had symptoms of depression, anxiety, insomnia, and distress. This was especially true among women, nurses, those in Wuhan, and frontline healthcare workers who were directly engaged in diagnosing, treating, or caring for patients with suspected or confirmed cases of COVID-19.

As Masood watched similar concerns accumulate on the COVID-19 Physicians Group Facebook forum, she decided to take action. She says her mentality was, “If not me, then who?”

Assisted by a team of experts, she created the hotline without any funding but with pro bono contributions of legal and ethical work, and she received a heavy discount from a company called Telzio, which developed the hotline app.

The hotline is open daily from 8:00 AM to midnight Eastern Time, and calls are free. Services are available only to physicians, in part because as a group, doctors tend to harbor guilt about asking for help that someone else might need more, Masood says.

When other types of healthcare workers call in, volunteers redirect them to hotlines set up for first responders and other healthcare providers.

So far, more than 600 psychiatrists have volunteered. They sign up for hour-long shifts, which they fit in between their own patients. Two or three psychiatrists are available each hour. Calls come directly through the app to their phones. There is no time limit on calls. If calls run long, psychiatrists either stay on past their shifts or pass the call to another volunteer.

Since its launch, the number of calls has steadily increased, Masood says. Callers include ICU doctors, anesthesiologists, surgeons, emergency department doctors, and some physicians in private practice who, Masood says, often express guilt for not being on the front lines.

Some physicians call in every week at a certain time as part of their self-care routine. Others call late at night after their families are in bed. If indicated, psychiatrists refer callers for follow-up care to a website that has compiled a list of psychiatrists across the United States who offer telehealth services.

There are no rules about what physicians can discuss when they call the hotline, and popular topics have evolved over time, says Masood. In the first week after the hotline’s launch, many callers were anxious about what the future held, and they saw other hospitals becoming overwhelmed. They worried about how they could prepare themselves and protect their families.

By the second week, when more doctors were in the thick of the pandemic and were working long hours, sometimes alone or covering shifts for infected colleagues, there were concerns about coworkers. Some were grieving the loss of patients and family members. The lack of personal protective equipment (PPE), says Masood, has been a common topic of conversation from the beginning.

Given the many unknowns about the virus, physicians have also grappled with the uncertainty around safety protocols for patients and for themselves.

On a deeper level, physicians have expressed a desire to run away, to stop going to work, or to quit medicine altogether. These escape fantasies are a normal part of the fight-or-flight response to stress, Masood says.

Doctors often feel they can’t share their fears, even with family members, in part because of societal pressures to act like heroes on the front lines of what has been framed as a war, she adds.

Heroes aren’t supposed to complain or show vulnerability, Masood says, and this can make it hard for physicians to get the support they need. Through the hotline, psychiatrists give doctors permission to feel what they are feeling, and that can help motivate them to go back to work.

“They don’t want to look like cowards, because that’s the opposite of a hero,” she said. “Saying it to another doctor feels much better because we get it, and we normalize that for them. It’s normal to feel that way.”

Each week, Masood conducts debriefing sessions with volunteers, who talk about conversations filled with raw emotion. When conversations wind down, most physicians express gratitude.

They tell volunteers that just knowing the hotline is there provides them with an emotional safety net. Masood says many physicians tell volunteers, “I know that if anything’s going wrong, I can just call and somebody will be there.” Volunteers, too, say they are benefiting from being involved.

“We are all really having this desperate need to be there for one another right now. We truly feel like no one gets it as much as we get one another,” said Masood.

Long-term Fallout

The need for psychiatric care is unlikely to end after the pandemic retreats, and Masood’s plan is to keep the hotline running as long as it’s needed. Like the rest of the world, physicians are in survival mode, but she expects a wave of grief to hit when the immediate danger ends. Some might blame themselves for patient deaths or question what they could have done differently. The long-term impact of trauma is definitely a concern, Gold says. Physicians in the ER and ICU are seeing many patients who decline quickly and die alone, and they witness young, previously healthy people succumb to the virus.

They’re seeing these kinds of cases over and over, and they’re often doing it in an environment where they don’t feel safe or supported while people in many places stage protests against the measures they feel are helping protect them.

Like veterans returning from war, they will need to reflect on what they’ve experienced after the adrenaline is gone and there is time to think.

“Even when things calm down, it will be great to have resources like this still functioning that can help folks think back through what they’ve been through and how to process that,” Gold said. “Things are going to remind them of experiences they had during COVID, and they can’t predict that right now. There will be a need for the support to go on.”

Masood is optimistic that the pandemic will bring the issue of physicians’ mental health out of the shadows.

“We have a really deep feeling of hope that that there’s going to be a lot more empathy for one another after this,” she said. “There’s going to be a willingness to not take mental health for granted. Doctors are people, too.”

We understand about those on the frontline of this pandemic. But do you all realize that many physicians and nurses are being furloughed during this pandemic due to elimination of elective surgery, many of which are necessary such as transplants and cancer treatments and surgery as well as limitation of their practice during this pandemic.

How do physicians pay their malpractice insurance and pay their staff and overhead and their huge education loans?

I fear that we may see a mass quitting/retirement of many nurses and physicians in our country and maybe world wide or many suffering from PTSD (Post Traumatic Stress Syndrome).

What then happens to our healthcare system? Will this pandemic force Congress to finally get serious regarding improving our healthcare system for All?

American life has been transformed in a few short weeks and the Cost to Economies and the Ethics in Decision Making in a Pandemic

Italy a country at the heart of the Corona virus outbreak in Europe — watched its number of cases and deaths due to the novel Corona virus astronomically leap once again, up 793 deaths with 6,557 newly confirmed cases recorded in just 24 hours.

Saturday’s jump marks the worst day for fatalities since the crisis began just four months ago. The country now counts 53,578 diagnosed infections, up 13.9 percent, with 4,825 deaths — the highest in the world.

More than 60 percent of the most recent deaths occurred in the northern region of Lombardy. Hospitals in the area have been reeling under a staggering caseload that has left intensive care beds scarce and respirators in extremely limited supply.

According to the Financial Times, 2,857 people were in intensive care in Lombardy on Saturday, up from 2,655 on Friday. The new increases come almost two weeks into a nationwide lock down in an attempt to stop the COVID-19 virus in its tracks there.

There were also 943 full recoveries tallied yesterday — another record for the country.

On Thursday, Italy was witness to yet another grim milestone in its fight against the deadly disease by overtaking China to become the country with the highest number of deaths.

On Friday the government banned the last types of outdoor exercise Italians were able to participate in under the lock down measures by deciding that running and bicycle rides were no longer permitted. In addition, the Italian military has also been dispatched to Milan to ensure that citizens follow the new lock down measures.

The Italian interior ministry reported that more than 223,633 people were inspected by the Italian police nationwide on Friday, with 9,888 people reported for breaking the lock down measures and 260 for false declarations about why they were outside.

Across the Atlantic, the number of cases in the United States has now exceeded 22,000 with more than 270 deaths. New York tops the list with at least 10,000 confirmed cases; Washington state follows with just over 1,500 cases, and California is in tow with more than 1,200.

Thus far, the global pandemic has infected more than 287,000 people and killed over 11,900. More than 90,000 people have recovered so far, mostly in China.

The Associated Press and The Financial Times contributed to this report.

I found this article in the Economist discussing what the economic influence would be from the COVID-19 pandemic. The titular conceit of “28 Days Later”, as with many contagion-style horror films, is of a man waking up after a month-long coma only to find society upended by a rampaging virus. Many Americans are experiencing something similar. On March 3rd there were just 122 confirmed cases of COVID-19—the disease currently sweeping the world—and only seven deaths. By March 17th there were 7,786 confirmed cases (even these were a sure underestimate given the dearth of testing) and 118 deaths. Twenty-eight days later, on March 31st, what might America look like?

cap.gifp-a8GHW19EK4IzY.gif“We don’t know whether we’re going to look like Italy or the provinces outside Hubei” in China where the spread of COVID-19 was fairly effectively contained, says David Blumenthal, president of the Commonwealth Fund, a health-policy think-tank. “But the likelihood is—given the slowness with which we responded to the epidemic—that we look more like Italy,” he adds. Jerome Adams, the surgeon-general, has warned of the same.

Can America’s health system cope? The structural problems that make pandemic response more difficult—lack of paid sick pay, a large uninsured population and a significant number of insured people nonetheless worried about out-of-pocket medical bills—cannot be mended overnight. Instead, public-health experts and doctors are increasingly worried about sheer capacity constraints. In China, 5% of those diagnosed needed intensive care. There are roughly 97,000 beds in intensive care units (ICUs), of which one-third are empty. Though America has relatively few total hospital beds per person compared with other countries, it ranks among the highest for ICU beds per person, with nearly three times as many as Italy.

“The real limiting factors are likely to be the ventilators or the staff,” says Greg Martin, a professor of medicine at Emory University and president-elect of the Society of Critical Care Medicine. There are roughly 50,000 physicians trained in critical care and 34,000 similarly specialized nurses and assistants. This could be insufficient in the face of hundreds of thousands of cases at peak rates of infection.

Then there is the problem of kit. In China, half of those in critical care required the use of ventilators, machines that help people breathe. There are thought to be 62,000 full-featured mechanical ventilators in the country, many of which are already in use. Older stocks of perhaps 100,000 devices—including CPAP machines used for those with sleep apnea—could be called upon if needed, but would provide only basic functions. Ramp-ups in ventilator production are being pondered, including through emergency powers given to the president under the Defense Production Act of 1950, but there has been little actual action yet. On a phone call with state governors, President Donald Trump urged “respirators, ventilators, all of the equipment—try getting it yourselves”, which could spark an unhelpful competition between states for scarce resources.

“Under almost any basic scenario, things look tough. Hospital beds will be completely full many times over if we don’t substantially spread the load,” warns Ashish Jha, director of the Global Health Institute at Harvard. To head that off, Mr Jha has called for an Italy-style national quarantine, lasting for at least two weeks, in which all non-essential businesses are closed and gatherings of more than five people are barred to give time for testing to become widespread. After a dismally slow start to testing, the numbers are finally heading up—although the best estimates come not from public-health agencies, but volunteer trackers using a Google sheet—to an estimated 12,535 tests conducted on March 17th. Given the expected scope of the disease, and the reported obstacles to people with symptoms actually getting tested, much more will be needed.

Most hospitals are making contingency plans. There are plans to add physical beds by cancelling elective surgeries that can be postponed, converting recovery rooms into added beds and building tents to house some patients. The Cleveland Clinic, a prominent hospital, says it has plans in place to add 1,000 beds of capacity within 72 hours if needed. Teams of doctors and nurses with other specialties could be conscripted into critical-care work, supervised by critical-care doctors who handle the trickiest cases—like respiratory distress coupled with organ failure in the kidneys or heart. If this is insufficient, recently retired doctors could be drafted into service. Some teaching hospitals are using simulation centers to prepare medical staff for the inevitable surge in cases.

Testing? Testing?

Whether it will come to all this is still unclear. Testing capacity remains constrained, limiting the information epidemiologists have to feed both their models and their willingness to speculate. Their policy recommendations—social distancing, closure of schools and large gatherings—are nevertheless clear. One team of researchers has concluded that an epidemic resembling that of Wuhan, where the novel Corona virus first broke out, would overwhelm hospitals many times over, while one resembling Guangzhou, a city that locked down in the early days of the virus, could be dealt with.

On March 16th, however, a team of scientists based at Imperial College London, who have been advising the British government, also published forecasts of the epidemic’s trajectory in America. As with Britain, the figures look grim. Without any mitigation, America would experience 2.2m deaths, they predict. Even in the case of some mitigation—isolation of the sick, social distancing for the elderly, but an otherwise normal society—American hospital and ICU capacity would be exceeded eight times over, and the country would be on track for at least 1.1m deaths. Averting this through “suppression”—isolation of sick, closing of schools and universities, social distancing for everyone—would require months until therapeutics or vaccines can be developed.

America is therefore turning towards suppression of the virus. Millions of pupils and university students have been sent home and left to take classes online. Mr. Trump has advised that people not congregate in gatherings of more than ten people. San Francisco and surrounding counties have issued a “shelter-in-place” order that requires 7m to remain in their homes unless necessary. New York City is expected to do the same for its 8m residents. In 22 states, bars and restaurants have been ordered to close their seating and only serve takeaway. The state of New York is setting up drive-through testing centers, starting in New Rochelle, a commuter town in Westchester County that was one of the early sites of a COVID-19 cluster, and is urging federal troops to build emergency, temporary hospital facilities. New Rochelle’s mayor says he is surviving the lock down there on “adrenalin, coffee and M&Ms”.

The goal is to increase general hospital capacity by a factor of two and ICU capacity by a factor of ten within two months. Elections have been postponed in a few states for the Democratic primary, which now seems a dull, distant affair. America’s devolved system means that the shuttering will happen at different rates in different places, but the trajectory is clear. “You want a single national response. But when the federal government completely fails, as it has so far, then you can get states and cities to step up,” says Mr. Jha.

The question is how long this can go on for. Unmitigated, the epidemic would not peak for at least another three months. Suppression can reduce the spread of the disease, as China’s experiment with locking down most of its population showed, but relaxing these measures will inevitably bring another surge in cases. Mr. Trump, who a few weeks ago was suggesting the virus was the latest hoax invented to damage him, is now warning that this could be the start of a months-long reorientation in American life. And while these extraordinary actions should smother the disease, they will also smother the economy.

The dismal economic forecasts will require further action from Congress. It spent the last week haggling over a bill that would make testing for the disease free, increase the flow of safety-net benefits and grant paid sick leave to more workers (though this provision appears to be hollowing out with every iteration). Even before that bill was finalized, Washington’s attention had already turned to the even bigger economic stimulus package that must come next. Senators, both Democrats and Republicans, are tripping over themselves issuing plans to send cash directly to American families.          

The total package, which could be worth $1trn or more, dwarfs the $100bn-or-so bill recently signed into law and every other stimulus package in history. The Trump administration has proposed sending $500bn in direct cash to taxpayers, $300bn to keep firms afloat, and $200bn to bail out critical industries like airlines. The typical partisan bickering from Congress and even from Mr. Trump has been muted. Every politician seems to now realize that the country faces an unprecedented crisis, first of public health and then of the economy, that will last for months. Whether this action will look sufficient 28 days later is, as with seemingly every aspect of the Covid-19 pandemic, deeply uncertain. ■

Ethicists agree on who gets treated first when hospitals are overwhelmed by Corona virus 

As a member of our Ethics Committee I thought that the decisions that physicians and staff in other countries were facing regarding who gets the ventilators was an interesting conundrum. This article contributed by Oliva Goldhill in her article, The Aging Effect, is a great introduction into the decisions that we may have to make here in the US. Pandemics bring ethical dilemmas into sharp, terrible focus. Around the world, hospitals have been unable to cope with the millions who need treatment for Corona virus. China created makeshift hospitals and denied treatment to those who needed non-Corona virus care; Italians wait an hour on the phone to get through to emergency services. Few countries will fare better: The United States has fewer than 100,000 ICU beds, and is expected to need a minimum of 200,000 to cope with Corona virus; the UK has just 8,200 ventilators and is getting an extra 3,800.

As health care systems are overwhelmed with more patients than they can feasibly treat, medical personnel are forced to decide who should get the available ventilators and ICU beds. Quartz spoke with eight ethicists, all of whom agreed that in such dire situations, those who have the best chance of surviving get priority. Despite the unanimity, all agreed that this decision is far from easy and should not be taken lightly.

Different moral theories, same answer

The decision to prioritize those with good survival odds is reinforced by several moral theories. Utilitarianism, for example, argues that morality is determined by the consequences of actions, and so we should strive to create the maximum good for the maximum number of people. “If we give scarce treatments to those who don’t stand to benefit (and have a high chance of dying anyway), then not only will they die, but those with higher likelihood of survival (but require ventilator support) will also die,” says Lydia Dugdale, professor of medicine and director of the center for clinical medical ethics at Columbia University. “It’s not fair to distribute scarce resources in a way that minimizes lives saved.”

A contrarian theory, which bases ethics on the social contract we would agree to if we didn’t know our status in society, arrives at the same conclusion. Joshua Parker, a trainee general practitioner (primary care doctor) who co-wrote an article on the ethics of Corona virus care for the Journal of Medical Ethics, points to philosopher John Rawls’ concept of a “veil of ignorance” as a way to determine the just action: “Behind the veil of ignorance, I am stripped of any knowledge of my position. I don’t know if I’ll be old, young, rich, poor, well, unwell, male or female; and I don’t know if I will catch COVID-19 or if I do, what resources I will need,” he writes in an email to Quartz. This thought experiment makes it easier to judge what’s fair for society as a whole. Alex John London, director of the Center for Ethics and Policy at Carnegie Mellon University, agrees: “Such agents might agree that in a pandemic, when not everyone can be saved, health care systems should use their resources to save as many lives as possible—because that is the strategy that allows each person a fair chance of being able to pursue their life plan.”

Even typically diverging ethical theories are likely to point to this conclusion. Utilitarianism, which focuses on the consequences of an action, is typically opposed to deontology, which says morality is determined by the act itself. “The deontologist might well start with a justice argument: each person is individually valuable and should have an equal chance of health care,” says Anders Sandberg, a philosopher at the Future of Humanity Institute at the Oxford University. But if this is simply impossible, then the theory doesn’t hold. “As Kant said, “ought implies can,” and if one cannot do an action it cannot be obligatory.” A deontologist approach to treat everyone equally falls short when there simply isn’t enough medical equipment to treat everyone; if some will have access and some won’t, then we have to face the question of who gets preferential treatment. And so “even the most die-hard deontologist will usually agree” that it’s wrong to treat people who are unlikely to benefit while others are in need, agrees Brian D. Earp, associate director of the Yale-Hastings Program in Ethics and Health Policy at Yale University and The Hastings Center.

Doctors have reckoned with the need to allocate resources in the face of overwhelming demand long before Corona virus. Dugdale points out that the New York department of health’s ventilator allocation guidelines, published in November 2015 to address the issue amid a flu epidemic, states that first-come first-serve, lottery, physician clinical judgment, and prioritizing certain patients such as health care workers were explored but found to be either too subjective or failed to save the most lives. Age was rejected as a criterion as it discriminates against the elderly, and there are plenty of cases in which an older person has better odds of survival than someone younger.

So the decision was to “utilize clinical factors only to evaluate a patient’s likelihood of survival and to determine the patient’s access to ventilator therapy.” In tie-breaking circumstances, though, they did approve treating children 17 and younger over an adult where both have an equal odds of surviving. Dugdale adds that there’s talk of applying these guidelines to address Corona virus treatment in New York.

No good answer

The dire consequences of any decision made under such extreme circumstances means that, despite agreement, the best course of action is hardly favorable. “I would say that leaving some to die without treatment is NOT ethical, but it may be necessary as there are no good options,” David Chan, philosophy professor at the University of Alabama at Birmingham, writes. “Saying that it is ethical ignores the tragic element, and it is better that physicians feel bad about making the best of a bad situation rather than being convinced that they have done the right thing.”

Rather, it’s simply the least bad option. Alternatives, such as a lottery system or prioritizing the sickest, are likely to lead to more deaths. “There is a good chance that we invest resources into patients who don’t survive, and we have thus doomed not just the patient we tried to save, but also the patient who was passed over for care, because the resources have been used up,” says Vanessa Bentley, philosophy professor at the University of Alabama at Birmingham. “Lives that could have been saved were lost.”

Although there’s broad agreement on the best approach, the nuances of applying this decision will always be difficult. Not only must doctors accurately assess and prioritize those with the best chance of survival, but there could also be times when the hospital doesn’t have enough equipment to help even those with equal odds. Italy has prioritized treatment for those with “the best chance of success” but adds as a second criterion those “who have more potential years of life.” This secondary factor is not so easily agreed upon but, in the face of Corona virus, it’s an ethical question doctors will have to face.

Governments are spending big to keep the world economy from getting dangerously sick

The help is targeted at companies and individuals. More will be needed

In the recent edition of the Economist Today it was noted a character in a novel by Ernest Hemingway once described bankruptcy as an experience that occurs “two ways: gradually, then suddenly”. The economic response to the COVID-19 pandemic has followed this pattern. For weeks policymakers dithered, even as forecasts for the likely economic damage worsened. But in the space of just a few days the rich world has shifted decisively. Many governments are now on a war footing, promising massive state intervention and control over economic activity.

The new phrase on politicians’ lips is “whatever it takes”—a line borrowed from Mario Draghi, president of the European Central Bank (ECB) in 2011-19. He used it in 2012 to convince investors he was serious about solving the euro-zone crisis, and prompted an economic recovery. Mr Draghi’s promise was radical enough. Politicians are now proposing something of a different magnitude: sweeping, structural changes to how their economies work.

There are unprecedented promises. On March 16th President Emmanuel Macron of France declared that “no company, whatever its size, will face the risk of bankruptcy” because of the virus. Germany pledged unlimited cash to businesses hit by it. Japan passed a hastily compiled spending package in February, but on March 10th supplemented it with another one that included over ¥430bn ($4bn) in spending and almost four times as much in cheap lending. Britain has said it will lend over £300bn (15% of GDP) to firms. America may enact a fiscal package worth well over $1trn (5% of GDP). The most conservative estimates of the total extra fiscal stimulus announced thus far put it at 2% of global GDP, more than was shoveled out in response to the global financial crisis of 2007-09.

That sinking feeling

In part this radical action is motivated by the realization that the Corona virus, first and foremost a public-health emergency, is also an economic one. The jaw-dropping bad economic data coming out of China hint at what could be in store for the rest of the world. In the first two months of 2020 all major indicators were deeply negative: industrial production fell by 13.5% year-on-year, retail sales by 20.5% and fixed-asset investment by 24.5%. GDP may have declined by as much as 10% year-on-year in the first quarter of 2020. The last time China reported an economic contraction was more than four decades ago, at the end of the Cultural Revolution.

Grim numbers are starting to pile up elsewhere, not so much in the official statistics, which take time to be published, as in “real-time” economic data produced by the private sector. Across the world, attendance at restaurants has fallen by half, according to OpenTable, a booking platform. International-passenger arrivals at the five biggest American airports are down by at least 30%. Box-office receipts have crumpled (see chart 2).

The disruption to international travel will hurt trade, since over half of global air freight is carried in the bellies of passenger planes. The combination of disrupted supply chains and depressed demand from shoppers should hit trade far harder than overall GDP, if the experience of the last financial crisis is anything to go by. Already, the American Association of Port Authorities, an alliance of the ports of Canada, the Caribbean, Latin America and the United States, has warned that cargo volumes during the first quarter of 2020 could be down by 20% or more from a year earlier.

Official data are now starting to drip out. The Empire manufacturing index, a monthly survey covering New York state, in March saw its steepest drop on record, and the lowest level since 2009. In February Norway’s jobless rate was 2.3%; by March 17th it was 5.3%. State-level numbers from America suggest that unemployment there has been surging in recent days.

All this is fueling grim forecasts. In a report on March 17th Morgan Stanley, a bank, estimated that GDP in the euro area will fall by an astonishing 12% year-on-year in the second quarter of the year. The Japanese economy is forecast to contract by 2% this quarter and 2% next. Most analysts see global GDP shrinking in the first half of the year, with barely any growth over 2020 as a whole—the worst performance since the financial crisis of 2007-09.

Even that is likely to prove optimistic. On March 17th analysts at Goldman Sachs noted that they had “not yet built a full lock down scenario” into their forecasts for advanced economies outside Europe. Forecasts for America, which is at an earlier stage than Europe and Asia when it comes to the outbreak, remain Panglossian; very slow growth in China and a big recession in Europe could by itself be enough to send the world’s largest economy the same way. Steven Mnuchin, America’s treasury secretary, warned this week that the country’s unemployment rate could reach 20% unless Congress passes a stimulus package. A negotiating ploy? With shopping malls emptying, factories grinding to a halt and financial markets buckling, lawmakers may be loath to challenge the claim.

Despite stomach-churning declines in GDP in the first half of this year, and especially the second quarter, most forecasters assume that the situation will return to normal in the second half of the year, with growth accelerating in 2021 as people make up for lost time. That judgment is in part informed by China’s experience. More than 90% of its big industrial firms are officially back in business. Its stock market had been one of the world’s worst performers in early February but is now the best (or rather, least bad). There remains, however, a risk that global containment and suppression of the virus will need to continue for a year or longer. If so, global economic output could be dragged down for much longer than most people expect.

Perhaps the greatest lesson of the global financial crisis was that it paid to act decisively and to act big, convincing markets and households that policymakers were serious about countering the slump. If done right, central banks and governments can end up doing a lot less than they actually promised. A pledge to bail out banks makes it less likely savers will withdraw deposits and make a rescue necessary.

This time around, central banks sprang into action. Since February the Federal Reserve has cut interest rates by 1.5 percentage points. Other central banks have followed suit. Further deep rate cuts are not possible, though; interest rates were very low long before the virus began to spread.

Let’s get fiscal

Not all central banks are acting as boldly as they can. China has room to cut interest rates—its benchmark rate is 1.5%—but has held back in part because inflation is quite high (largely as a result of African swine fever, which hit pig stocks, raising prices). Central banks could try more creative policies. On March 19th the ECB’s governing council agreed to launch a €750bn bond-buying program, covering both sovereign and corporate debt. But the real action is now taking place on the fiscal front.

Governments are falling over each other to offer bigger and better stimulus packages. All countries are spending more on health care, both in an effort to find vaccines and cures and to increase hospital capacity. However, the bulk of the extra spending is on companies and people.

Take companies first. China, where the outbreak has slowed, is now trying to get people out and buying things. Foshan, a city in Guangdong province, has launched a subsidy program for people buying cars. Some cities have started giving out coupons that can be spent in local shops and restaurants. Nanjing this month gave out e-vouchers worth 318m yuan ($45m).

Most countries, however, are in or about to enter the worst part of the outbreak. As customers dry up, many firms will go bust without government help. Calculations by The Economist suggest that 40% of consumer spending in advanced economies is vulnerable to people shunning social situations. Firms in leisure and hospitality are especially rattled. The Moor of Rannoch hotel, in about as rural a part of Scotland as it is possible to find, says its insurer will not be paying out a penny for lost custom, since COVID-19 is a new disease and thus not covered under its policy.

One approach is to reduce firms’ fixed costs, largely rent and labor. China’s finance ministry will exempt companies from making social-security contributions for up to five months. The government has also temporarily cut the electricity price for most companies by 5% and enacted short-term value-added-tax cuts. The British government has extended a one-year business-rates holiday to all companies operating in the retail, hospitality and leisure sectors. Yet for many firms, no matter how much the government helps them reduce costs, revenues are likely to fall further.

So, measures may be needed to allow firms to maintain cash flow. Many banks are offering hefty overdrafts to tide corporate clients over. To encourage banks to keep lending, Britain has promised them cheap funding and state guarantees against losses. For very small firms, many of which do not borrow at all, it is offering non-repayable cash grants of up to £25,000.

Other countries are enacting similar plans. The Japanese government is helping small firms by mobilizing its state-owned lenders to provide up to ¥1.6trn of emergency loans, much of it free of interest and collateral requirements. Small firms qualify for help if their monthly sales fall at least 15% below a normal month’s takings. Bavaria, a rich state in Germany, announced on March 16th that small and medium-sized companies with up to 250 employees could receive an immediate cash injection of between €5,000 and €30,000. The European Commission has already relaxed state-aid rules so that governments can channel help to ailing companies.

The second part of the fiscal response is about helping people, and in particular protecting them from being made unemployed or suffering a drastic drop in income if that does happen. Ugo Gentilini of the World Bank counts more than 25 countries that are using cash transfers as part of their economic response to the virus. Brazil will give informal workers, who make up roughly 40% of the labor force, 200 Reais ($38) each. Small businesses will be allowed to delay tax payments and pensioners will get year-end benefits early. Australia is instituting a one-time cash payment of A$750 ($434) to pensioners, veterans and people on low incomes.

Northern Europe has led the way on implementing policies that make it less likely firms lay off workers. Germany has relaxed the criteria for Kurzarbeit (“short-time work”), under which the state pays 60-67% of the forgone wages of employees whose hours are reduced by struggling firms. Applications are going “through the roof”, according to the federal labor agency. The use of Kurzarbeit probably halved the rise in unemployment during the recession of 2008-09. More firms are now eligible to use it, temporary workers are covered, and the government will also reimburse the social-security contributions companies make on behalf of affected workers.

Bringing home, the Danish bacon

In Denmark firms that risk losing 30% or more of their workforce will see the government pay 75% of the wages of employees who would otherwise be laid off, until June. Norway’s government has beefed up unemployment benefits, guaranteeing laid-off workers the equivalent of their full salary for the first 20 days. Freelancers whose work vanishes for more than a fortnight will get payments equivalent to 80% of their previous average income. In Sweden the state will cover half of the income of workers who have been let go, with employers asked to cover most of the rest.

So far America has passed more modest legislation. Federal funding for Medicaid, which provides health care for the poor, is likely to boost spending by about $30bn, assuming it remains in place until the end of December, reckons Oxford Economics, a consultancy. America also has a new paid-sick-leave policy for some 30m workers, including 10m who are self-employed, worth just over $100bn. But in that regard America is merely catching up with other rich countries, which have far more generous sick-leave policies. America also has fewer automatic economic stabilizers, such as generous unemployment insurance, than most other rich countries. As a result, its discretionary fiscal boost needs to be especially large to make a difference.

It might be. The Trump administration’s plan to funnel money directly to households, if approved by Congress, is the most significant policy. It bears some resemblance to a scheme that was introduced in February in Hong Kong, in which the government offered HK$10,000 ($1,290) directly to every permanent resident. Mr. Mnuchin is thought to favor a check of $1,000 per American—roughly equal to one week’s average wages for a private-sector worker—with the possibility of a second check later. Some $500bn-worth of direct payments could soon be in the post.

Some economists are leery about such a policy. For one thing, it would do little to prevent employers from letting people go, unlike the plans in northern Europe. Another potential problem, judging by Hong Kong’s experience, is administration of the plan: the territory’s finance secretary hopes to make the first payments in “late summer”, far too far away for people who lost work last week. Mr. Mnuchin promises that payments will happen much sooner.

Checkered past

America has done something similar before, with results that were not entirely encouraging. The government sent out checks in both 2001 and 2008 to head off a slowdown. The evidence suggests that people saved a large chunk of it. The psychological reassurance of a bit of extra cash could be significant for many Americans, but the sums involved are not especially impressive. Bernie Sanders, a Democratic presidential contender, is not known for his smart economic policy making, but his suggestion of $2,000 per household per month until the crisis is over is probably closer to what is required.

Indeed, more fiscal stimulus will be needed across the world, especially if measures to contain the spread of the virus fall short. After the Japanese government passes the budget for next fiscal year at the end of this month, it can begin work on a supplementary budget that takes the virus into full account. Britain’s Parliament has given Rishi Sunak, the chancellor of the exchequer, carte blanche to offer whatever support he deems necessary, without limit.

How much further can fiscal policy realistically go? Last year the 35-odd rich countries tracked by the IMF ran combined fiscal deficits of $1.5trn (2.9% of GDP). On the not-unrealistic assumption that the average deficit rose by five percentage points of GDP, total rich-country borrowing would rise to over $4trn this year. Investors have to be willing to finance that splurge. The yield on ten-year Treasury bonds, which had fallen as low as 0.5% as fears of the virus took hold and traders sought havens, has recently risen above 1%. This is probably due to firms and investors selling even their safest assets to raise cash, but might reflect some anxiety over the scale of planned government borrowing.

Jesse Watters began “Waters’ World” on Saturday by delivering a message of positivity to his audience, saying he’s sure America can overcome the devastation from the coronovirus. “The United States of America is rolling into a recession or a depression. What we do now will determine which one it’ll be. First, we have to stop the spread. You know what to do. Wash your hands, stay clean and practice social distancing,” Watters said, reminding people of the guidelines given to keep people safe from exposure to the virus.

“If you can stay inside this week, work from home if you can. Don’t fly if you don’t have to. The virus is mostly in 10 large counties. A very high percentage in New York, California and Washington state,” he continued. “Some of these areas recognize the threat and are shutting down everything. All of them need to do that.”

Watters talked about where the country stands medically and scientifically, assuring people the “brightest” are on the case. “All the brightest scientists in America [are] working around the clock to find a vaccine. Our people are the most innovative in the world,” Watters said.

The host also addressed the president’s leadership, urging him and American industry leaders to do whatever they can. “The president should be invoking every possible law and power available to him. He should be mobilizing the military and declaring war on the coronavirus. Rally the country around the mantra ‘made in America,'” Watters said. “Every American industry should have all hands-on deck. This isn’t a time for weakness. This is a time for strength.”

“Our country’s fighting an invisible enemy within our borders,” Watters added. “We’ll dull the spike and kill it if we all work together.” Watters expressed his optimism toward an American rebound. “We’ve had to come together by staying apart. I know one thing for sure, we’ll stop it and we’ll kill it and we’ll be a better country for it. Tough times are ahead,” Watters said. “The American character shining bright, loving our families and our neighbors and working nonstop to save lives. It’s now in your hands. We have a great spirit and we shall overcome.”

Italy reported a second successive drop in daily deaths and infections from a coronavirus that has nevertheless claimed more than 6,000 lives in a month.The Mediterranean country has now seen its daily fatalities come down from a world record 793 on Saturday to 651 on Sunday and 601 on Monday.

The number of new declared infections fell from 6,557 on Saturday to 4,789 on Monday. The top medical officer for Milan’s devastated Lombardy region appeared on television smiling for the first time in many weeks. “We cannot declare victory just yet,” Giuglio Gallera said. “But there is light at the end of the tunnel.”

Surprise medical bills, coronavirus and bad insurance: 3 arguments for Medicare for All’ Really?

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!