From Health and Fitness

Grow a Hydroponic Garden

Emily Marsh, who lives in Sonoma County, Calif., always thought the best thing about gardening was the feel of soil on her fingertips. But last year she and her fiancé moved to a townhouse with an 8-by-12-foot concrete slab for a backyard. As lockdowns in California stretched into the month of May, and Ms. Marsh, 30 and a co-owner of a janitorial company, read about the surge in gardens, she felt the urge to plant her own. But her only real option was a hydroponic setup.

“I was completely against it at first,” she said, adding that it just didn’t seem like real gardening. Reluctantly, Ms. Marsh purchased a unit from Lettuce Grow, a company that sells ready-to-grow hydroponic kits. “Now it’s just my favorite thing,” she said.

As fall’s first frost strikes plants across the country, you can practically hear the collective moan of America’s gardeners: No more fresh herbs, zucchini or heirloom tomatoes until next summer.

Unless you bring your pandemic garden indoors.

Like urban chicken coops and backyard beekeeping, interest in hydroponics has surged during the pandemic. For Aerogarden, another company selling hydroponic gardens, sales jumped 384 percent in the two weeks of March, a time period that followed most state lockdowns. From April through June, sales were up 267 percent year over year.

“It has been a really amazing year for us,” said Paul Rabaut, the company’s director of marketing. A representative for Lettuce Grow said it was on track to do 10 times the sales compared with last year.

Meanwhile, D.I.Y.-ers are building hydroponic gardens out of PVC pipes and five-gallon buckets. When lockdowns began, Vicki Liston, 45, a professional voice-over actor in New Mexico, wanted to limit her trips to the grocery store and started construction on a pipe-based system. She worried about keeping a pandemic garden alive in her very arid backyard, but so far the project has been a surprising success, she said.

Compared with traditional in-ground gardening, “hydroponics grows more food in less space with less water and less time,” said Dan Lubkeman, president of the Hydroponic Society of America.

That is, if you get everything right. Hydroponics is about optimizing growing conditions: You must have the perfect amount of light and nutrition available at all times. Nail it, and plants can grow up to five times as fast as they would in soil outside, Mr. Rabaut said.

Ms. Marsh, who now has gardens indoors and out, can vouch for Mr. Rabaut’s assertion. She is constantly amazed at the vigor of her plants. “We planted three tomato seedlings, and so far we have gotten 350 tomatoes,” she said. “It’s insane,” she said.

There’s a downside, though. Soil is pretty forgiving — get overzealous with your fertilizer, and your cucumbers may suffer but the soil can buffer a fair amount of the damage. Water is much less forgiving, and the Internet doesn’t always have great advice, Mr. Lubkeman said. He recommends connecting with your nearest hydroponics specialty shop where employees are likely to be experienced growers, or buying a book on the subject.

That’s one reason many new-to-hydroponic gardeners opt to buy a plug-and-play kit: These kits tell you exactly what to add and when. If you’re feeling crafty and a little adventurous, though, you can easily build one yourself.

Here’s how to reap a lot of produce without so much as getting your hands dirty.

A hydroponic garden kit, complete with tomatoes, from AeroGarden.
A hydroponic garden kit, complete with tomatoes, from AeroGarden.Credit…AeroGarden

A hydroponic setup requires a few basic elements.

Whether you construct it yourself or buy a kit, a hydroponic garden needs the following:

  • Seeds or seedlings. If you’re doing this inside, look for varieties that thrive in containers. This will ensure none of your plants get so big they take over your whole hydroponic setup.

  • A reservoir for the nutrient solution, which is made up of all the macronutrients (think nitrogen and phosphorus) and micronutrients (like iron and calcium) plants need.

  • An aerating pump for oxygenating your nutrient solution, since plant roots need oxygen, too.

  • A water pump to move water out of the reservoir and onto your plants throughout the day.

  • Light! More on this below.

  • A “medium.” Since you’re not using soil, you’ll need something to hold the plant’s roots in place. Many mediums also help keep roots moist between waterings. Mr. Lubkeman recommends a material called rockwool for beginners.

Decide whether to build yourself or build out of a box.

As with most hobbies, you can spend a little or a lot. Originally, Ms. Marsh wanted to go the cheap route. Setting up a medium-size D.I.Y. system with a few buckets and an aquarium pump can set you back less than $150. But Ms. Marsh worried about getting everything working correctly. Lettuce Grow’s container is made from recycled plastic, and for Ms. Marsh, that tipped the scales toward buying a premade kit, even if units start at $348 — no lights included.

Aerogarden’s smallest units, which do include grow lights, start at $99, with larger models going up to $600. Ultimately, the decision about whether to buy a kit or build your own comes down to whether you enjoy tinkering or would rather not spend a Saturday gluing PVC pipes and plastic tubing together.

It’s all about balance.

Once your set up is set up, you may see seeds sprouting within three days, though some plants take longer. By two weeks, your seedlings should start to look like real plants. Which is when Ms. Liston realized that her hydroponic experiment was not going quite right. Just a few weeks in, her plants were dying.

It turned out her tap water was too alkaline. A pH buffering solution fixed the problem. (Water testing between 6.5 and 7.0 on the pH scale is considered ideal.) A setup like AeroGarden will tell you when you need to add fertilizer or adjust the pH of your water. If you built your own operation, you’ll need to remember to add nutrients and check the pH of your water (using testing strips) weekly.

“It’s been fantastic,” Ms. Liston said, adding that once she got her light, pH and nutrient levels dialed in, “it just exploded.”

There is too much of a good thing.

If some plant nutrients are good, more seems as if it would be better, right? That’s not at all the case, Ms. Liston said. So far, she’s managed not to overfeed her plants, but too much plant food can result in dead or severely damaged plants. How often and how much you’ll need to feed depends on the type of nutrient solution you’re using. Read the directions on the bottle.

Lettuce Grow’s Farmstand can grow up to 36 plants.Credit…ONA Creative

Let those lights shine.

You may be able to grow lettuce, kale or herbs in a sunny window, but as days get shorter, investing in a full-spectrum, grow light is worth the expense. These lights provide the same range of light as the sun and you’ll see much faster growth, Mr. Lubkeman said. In Ms. Liston’s case, adding a light and moving her plants next to her sunniest window resulted in a noticeable change in their productivity.

Goodbye bugs (for better or worse).

Ms. Liston’s favorite thing about growing indoors is that it’s bug free. While that means you won’t need to pluck slugs from your lettuce, you will need to take over for bees and do your own pollinating. For plants like peppers, tomatoes and cucumbers, Mr. Rabaut said some customers report getting decent pollination rates just by shaking plants gently every day or two. However, you’ll get even better results if you’re willing to play the part of the bee — using a Q-tip or small brush to sweep pollen from one blossom to another.

Keep things clean.

This is in your house, after all. While there’s no dirt involved, these setups can get a little funky. Ms. Liston does a thorough wipe down of the PVC plant holders every two weeks. If you buy a premade kit, follow the manufacturer’s instructions on cleaning.

Maintenance is key.

Ms. Marsh tries to clip back greens and herbs at least two times a week. Many items — like basil — do need to be kept trimmed back or else they’ll go to seed and stop producing. While hydroponic gardens are significantly less work than their outdoor counterparts (no weeding!) you can’t neglect your plants completely and still expect them to thrive, Mr. Lubkeman said.

Footprints Mark a Toddler’s Perilous Prehistoric Journey

Several thousand years ago, a young adult moved barefoot across a muddy landscape. A toddler was balanced on the adult’s hip. There were large animals — mammoths and ground sloths — just over the horizon. It was a perilous journey, and scientists reconstructed it by closely studying an exceptional set of human and animal footprints found recently in the southwestern United States.

“This is an amazing trackway,” said Neil Thomas Roach, an anthropologist at Harvard University, who was not involved in the research, which was published online this month in Quaternary Science Reviews. “We rarely get tracks as well preserved as these are.”

It is one of the most extensive Pleistocene-age trackways found to date, and studying it highlights how ancient sets of fossilized footprints can reveal more than even fossilized bones. It’s rare for bones to reveal behaviors, but tracks can shed a lot of light on animal interactions, said Sally C. Reynolds, a paleoecologist at Bournemouth University in England and an author of the study.

The round-trip journey of the prehistoric young adult and the toddler was spotted in 2017 in White Sands National Park in southern New Mexico. The sequence extends over more than a mile and includes at least 427 human prints. The out-and-back journey was probably completed in no more than a few hours, the researchers suggest. (The gypsum sand that records the prints doesn’t hold water well, so the muddy conditions that captured the prints would have been short-lived.)

Hikers traversed a dune in the White Sands National Park in New Mexico this year.
Hikers traversed a dune in the White Sands National Park in New Mexico this year.Credit…David Zalubowski/Associated Press

Most of the human footprints were made by a barefoot adolescent of either sex, or a young adult female with roughly size 6 feet, the team determined. But about every 100 yards or so, a few much smaller human prints suddenly appear within the northbound set of tracks.

“We have many adult tracks, and then every now and again we have these tiny baby tracks,” Dr. Reynolds said.

A toddler-aged child was being carried and periodically placed on the muddy ground as the caregiver readjusted his or her human load, the researchers surmised, based on the three-dimensional digital models they had assembled. There are no toddler footprints within the southbound set of tracks, so the child probably wasn’t carried on that journey.

It’s likely that the child rode on the young person’s left hip. There’s a slight asymmetry between the left and right tracks on the northbound set of tracks. That’s consistent with someone carrying extra weight on that side, Dr. Reynolds said.

She and her collaborators estimated that the young person was moving at just shy of four miles per hour. That’s a good clip: “Imagine running for a bus,” Dr. Reynolds said. “It’s not a stroll.”

The urgency of the journey might have had something to do with the toddler, Dr. Reynolds suggests. “Why else would you travel so fast but encumber yourself with a child?”

A human footprint found inside that of a giant sloth track at White Sands. Credit…National Park Service, via Associated Press

There was another reason, however, for making haste over the landscape — the presence of large and potentially dangerous animals. Both a giant sloth and a mammoth ambled across the humans’ path, the trackway reveals. Their prints appear on top of the northbound footsteps but below the southbound ones, meaning that the animals walked by sometime in between the humans’ passage.

The mammoth — most likely a bull, based on the size of its tracks — was apparently uninterested in the humans who had walked by just hours before; its tracks do not indicate any reaction. The giant sloth, on the other hand, stopped and shuffled in a circle when it encountered the human trackway, its prints indicate. The sloth’s response suggests that humans had positioned themselves at the top of the food chain, Dr. Reynolds said.

In the future, Dr. Reynolds and her colleagues hope to better understand the people that inhabited this region. For instance, it’s an open question whether they had migrated seasonally or stayed put in one area throughout the year, Dr. Reynolds said. “We’re trying to assemble these little snapshots of what life was like in the past.”

Ideas for Lifting Your Mood This Weekend

Welcome. Friday again, the perfect time to consult our archives of those diversions that lighten the mood, that help us feel a little more hopeful, more balanced or excited or just OK. A couple days ago, I asked about those things that are making your days a little better. If you’ve been feeling short on delight lately, here’s hoping the responses we received from other At Home readers might help a bit.

Joan Shangold of Manhattan is looking for mushrooms. She wrote: “While I have seen edible hen of the woods in Central Park and large reishis on Ninth Avenue, I get just as much pleasure from spotting the smaller mushrooms that I cannot identify.”

“I’ve found people-watching out my window while working from home to be surprisingly uplifting,” wrote Brandelyn Hodgdon, 26, of Brunswick, Me., adding, “It’s the small reminders of human life outside our little cocoon that keep my spirits high.”

Greg Sadoian, 65, of Santa Monica, wrote: “The Kangaroo Sanctuary on Instagram melts my bitter heart every day. An amazing couple who rescue and raise orphan kangaroos in Australia’s Outback.”

The things that are lifting our spirits are those that take us outside of ourselves — music, nature, family, simple pleasures:

  • “The whole of the pandemic, I’ve been walking in my neighborhood, and discovering delightful things: a front container garden made entirely out of drums (yes, an actual drum kit); a small front yard with a field of multicolored zinnias and only zinnias; the house around the corner that has been fashioning hearts out of whatever outdoor materials they find — pine cones, grape leaf, stones — and leaving them out front for everyone to enjoy.” —Tracy MacMaster, 51, Toronto

  • “My mood lifter is the Harry Truman biography by David McCullough. Truman was a wonderful man, always looking for the good in people and usually honest in stating his opinions. It is very uplifting when I feel down.” —Cyrus V. Godfrey, Beverly Hills, Calif.

  • “I checked Lee J. Ames’ “Draw 50 Famous Cartoons” out from the library. Trying to draw a Jughead here and a Felix the Cat there has provided a relaxing mental escape. The results have been pretty hilarious (I’m no artist), and it’s fun to look back at my progress.” —Staci Sturrock, 53, West Palm Beach, Fla.

  • “The thing bringing me the most joy lately is The Drew Barrymore Show. She has been my favorite since the tender young age of 12 and I love her more than ever now. She is doing a fantastic job as host because she is as real as it gets; there are no false pretenses with her. She revels in the sometimes-awkwardness of her new gig as much as her enthusiasm for matters she is so passionate about.” —Keri Gibbs, 37, Massapequa, N.Y.

  • “I find the biggest help has been sea swimming. Getting out under a big, open sky in the cold water shocks my mind out of the situation we are in. I am reminded that there are still so many moments to enjoy and that life is here to be lived.”—Abigail Smith, 43, Dublin

Many of us are missing community these days, whether that’s our parents or children we haven’t seen in months, our colleagues whose faces we encounter only on screens, friends, classmates, neighbors or strangers with enthusiastic dogs we might once have stopped to pet, lingering for a chat.

In the meantime, I’m grateful for you, the community of At Home, who offer so many ideas for staying busy, staying the course. Keep writing: athome@nytimes.com. Include your full name, age and location. Keep telling us what’s inspiring you, what brings you joy, and we’ll keep sharing your contributions. We’re all of us up and down, day to day, and hearing from others who are figuring things out too can provide immense comfort. We’re At Home. We’ll read every letter sent.

More ideas for leading a full life at home this weekend appear below. See you next week.


How to deal

Credit…DC

What to watch

Heidi Schreck in “What the Constitution Means to Me.”Credit…Joan Marcus/Amazon

How to deal

Credit…Fatinha Ramos

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Arguing to Undo the ACA. Harming Medicare. Do They Go Hand in Hand?

It’s a tried-and-true campaign strategy.

Candidates go on the attack, claiming their opponent will do harm to Medicare. After all, people 65 and older are good about making it to the polls on Election Day. These voters are also generally motivated to protect the federal health insurance program for seniors.

It’s no surprise, then, that in an ad released this month, former Vice President Joe Biden’s campaign played the Medicare card.

“Donald Trump is lying about Medicare and Social Security,” an ominous, mature, male voice warns viewers in the ad. He goes on to say that “Trump’s pushing to slash Medicare benefits.”

Clearly, we’ve heard this dire message before — from candidates of both parties through the years.

We issued a skeptical rating of a claim that Trump promised to gut Social Security and Medicare if re-elected, noting that his deferral of payroll taxes did not mention Medicare at all. But Trump has not mentioned cuts to Medicare benefits on the trail, and he’s promised to make cuts to the program in the future. So what is Biden’s claim talking about?

As a rationale for the statement, a Biden campaign spokesperson pointed us to the Trump administration’s support of Republicans’ efforts in a court case, California v. Texas, which seeks to overturn the Affordable Care Act. But the ad does not include any reference or explanation of how the case would affect Medicare benefits.

The legal challenge, brought by a group of Republican attorneys general, is pegged to the 2017 tax bill, which zeroed out the tax that functioned as a penalty for not having health coverage — known as the individual mandate. Without this linchpin tax, the Republicans argue, the entire law should be struck down. They based that on the Supreme Court decision in 2012 that the law was constitutional because the penalty was a valid use of Congress’ ability to levy taxes.

In the current case, lower courts have found the law unconstitutional, and a group of Democratic attorneys general appealed to the Supreme Court.

Oral arguments are scheduled for Nov. 10. The Trump administration filed a brief in support of invalidating the entire law unconstitutional.

Though best known for its vast expansion of health coverage through marketplace plans and Medicaid, the ACA also included a range of consumer protections — such as the ban on discrimination against people with preexisting conditions — and an estimated 165 Medicare-related provisions.

The Biden spokesperson pointed to one, which ended Medicare’s so-called doughnut hole.

We asked experts for their take. Immediately, we found differences in opinion.

That’s a “perfectly fair claim,” said Nicholas Bagley, a professor at the University of Michigan Law School. Closing the doughnut hole matters to many people, he said.

Case Western Reserve University law professor Jonathan Adler took a different view. The argument that Medicare would be affected “is a very aggressive reading of the filing in this case,” he said, referring to the Trump administration’s brief in support of nullifying the ACA.

The next step seemed to be getting a better grasp of what’s at stake.

A Quick Review of the Doughnut Hole, Other Medicare Provisions

The Medicare doughnut hole refers to the gap in Part D prescription drug coverage that begins after a beneficiary spends a set amount — usually a few thousand dollars. Before the ACA, beneficiaries who reached that threshold were responsible for 100% of their medication costs until they spent enough for catastrophic coverage to kick in, which could be more than $1,000 in additional spending. Even with this coverage, beneficiaries were responsible for 5% of their drug expenditures. (If beneficiaries were responsible for 100% of costs today, people with high drug costs would obviously pay a lot more without the ACA provision.)

The ACA would have gradually ended that coverage gap. But, in 2018, Congress adopted changes to expedite the process. As of 2019, the doughnut hole was closed. Adler pointed to that congressional intervention as a step that could keep the doughnut hole closed if the ACA were overturned. Based on this legislative history, the argument could be made that closing the coverage gap was something Congress had an interest in apart from the ACA. Since the doughnut hole is officially closed, some analysts said this provision may not be vulnerable to the upcoming Supreme Court decision on the ACA.

“You can make a lot of claims,” said Gail Wilensky, a former head of the Centers for Medicare & Medicaid Services. “That one is really a stretch.”

Other ACA provisions tied to Medicare benefits seem more at risk, such as the one that mandated annual wellness visits and certain preventive services, such as mammograms, bone mass measurement for those with osteoporosis, and depression and diabetes screening, with no patient cost sharing.

“It’s not clear that the administration actively supports any change to the Medicare benefits with the case before SCOTUS,” said Tricia Neuman, KFF senior vice president and executive director of the KFF’s program on Medicare policy. “But if they didn’t explicitly seek to wall off certain provisions, it is at least conceivable — though maybe not likely — that Medicare benefits in the ACA could be collateral damage.” (KHN is an editorially independent program of KFF.)

According to an amicus brief filed by the AARP, the Center for Medicare Advocacy and Justice in Aging in 2016, an estimated 40.1 million Medicare beneficiaries received at least one preventive service and 10.3 million had an annual wellness visit with no copay or deductible.

Other experts pointed to a troubling implication for Medicare: the nullification of the ACA provisions related to costs and slowing the growth of the program’s spending. Those efforts had been credited with extending the solvency of the Health Insurance Trust Fund and slowing the growth in Medicare premiums.

It “would impair the financial fitness” of the trust fund, said Paul Van de Water, a senior fellow at the Center on Budget and Policy Priorities.

Trump “may not say it is his intent to slash Medicare benefits,” agreed David Lipschutz, associate director of the Center for Medicare Advocacy, but overturning the ACA entirely would “cause chaos writ large.” And, because of the program’s size, that chaos “would upend the financial markets and the entire health care system,” according to the brief filed by Medicare advocates.

What Comes Next Is Complicated

Enter the concept of severability. Many court watchers are quick to say the high court’s decision could go beyond upholding the entire law or declaring it unconstitutional. Instead, the justices could separate or sever parts of it not directly related to the zeroed-out tax penalty, the so-called individual mandate.

Of course, the Trump administration argued in its brief that the interwoven nature of the ACA’s provisions demanded that the entire law be invalidated.

“If you just go on that basis, they are not arguing for severability,” said Van de Water.

But others point out another layer that warrants consideration.

“Everyone who comments on this focuses on the administration’s argument for inseverability,” Adler said. But he said it was more complicated than that.

The Trump administration’s position is “simultaneously that the entire ACA should be invalidated” and also that relief should be provided only where injury to the plaintiffs is shown. (The administration defines the plaintiffs as the two individuals who signed on to the original challenge.)

Another view is that this point in the administration’s argument is not clear-cut, mostly because it gives no hint as to which programs or provisions would fit into the category of harming the plaintiffs.

Ultimately, the fate of the sweeping health law is in the hands of the Supreme Court.

“Legal analysts didn’t anticipate the case getting as far as it has,” said Lipschutz.

But “the White House threw its weight behind the lawsuit,” said Bagley, at the University of Michigan. “So, they own the consequences. Especially in the context of this presidential campaign.”

Our Ruling

An attack ad by the Biden campaign states that Trump is “pushing to slash Medicare benefits” and ties this charge to the administration’s position on the pending legal challenge to the ACA.

The Biden campaign pointed to an ACA provision that sought to close the Medicare doughnut hole to support this claim. It may not be the best example, though, because some experts suggest it may not be as vulnerable as other parts of the law.

Experts outlined a range of other Medicare provisions that either provided new benefits or shored up the program’s financial fitness. If the whole law were to be nullified, as the administration has advocated, these changes could also be erased — a step that would affect benefits and potentially cause premiums to rise.

Overall, the Biden ad seems plausible, even though the link between Trump’s position on the legal challenge and its impact on Medicare benefits is less straightforward than in similar claims we have checked regarding preexisting conditions.

We rate the claim Half True.

Related Topics

Elections Medicare The Health Law

5 Tips for Reducing Screen Time

A scene from “The Social Dilemma.”
A scene from “The Social Dilemma.”Netflix

1. Start the conversation.

As a family, watch a documentary like “Social Dilemma,” “Screenagers” or “LIKE.” Use it to discuss the benefits and pitfalls of screen time and social media. Or bring up relevant news items, such as the proposed TikTok ban, over dinner.

¿Viajas para el Día de Acción de Gracias? Deberás atravesar la barrera de COVID

Molly Wiese estaba perpleja. Sus padres y hermanos viven en el sur de California, y Wiese, abogada de 35 años, ha viajado cada Navidad desde que se mudó a Minnesota en 2007.

Por la pandemia, Wiese pensó que esta vez sería más prudente quedarse. Pero en junio, el padre de Wiese fue diagnosticado con cáncer en estadio 4 y la familia teme que éstas sean sus últimas fiestas.

¿Debería volar con su esposo y sus dos hijos pequeños a California, poniendo a su padre inmunodeprimido en riesgo de COVID-19? ¿O quedarse en casa y perderse la oportunidad de crear recuerdos de estas fiestas?

Sus hijos están en la guardería y el marido de Wiese trabaja en una escuela. No tienen suficiente tiempo de vacaciones para ponerse en cuarentena antes o después de un vuelo, y conducir ocho días de ida y vuelta está fuera de discusión.

Teme transmitirle el coronavirus a su padre. Pero sus padres, que viven en la ciudad de Yucaipa de Inland Empire, creen que vale la pena correr el riesgo de ver a sus nietos y tener “nuestra Navidad normal”, contó Wiese.

“Idealmente, tendríamos una vacuna”, dijo. “Pero no creo que sea una expectativa realista”. Pfizer, el aparente líder en la carrera para una vacuna contra COVID, dice que ni siquiera estará listo para solicitar la aprobación hasta fines de noviembre, como muy pronto.

El padre de Molly Wiese tiene cáncer avanzado y Wiese teme que ésta sea su última temporada de fiestas. Pero duda en viajar al sur de California para visitar a su familia, por temor de ponerlo en riesgo de contraer COVID. De izquierda a derecha: Molly Wiese, su hijo Calvin, su esposo Phil Wiese, su hijo Bennett, y sus padres, Becky y Bill Miller.

Si bien el enigma de Wiese es especialmente importante, su historia ilustra la difícil decisión a la que se enfrentan millones de estadounidenses sobre si viajar o no durante las vacaciones de invierno, y cómo hacerlo.

La mejor forma de evitar la propagación de enfermedades sería evitar los viajes o ampliar los círculos sociales. Para las celebraciones locales, la cuarentena durante dos semanas antes de un evento festivo minimizaría el riesgo, pero solo si todos los comensales se comprometieran a seguirla. Pero algunas personas tienen que trabajar fuera de casa.

Después de al menos siete meses de estar prácticamente encerrados, las vacaciones de invierno representan una tentación casi insuperable. Incluso expertos en salud pública y enfermedades infecciosas reconocen el dilema.

“Hay mucho que ganar con el contacto físico, en la misma sala y no en una pantalla de Zoom o FaceTime”, dijo el doctor Peter Chin-Hong, especialista en enfermedades infecciosas y profesor de medicina en la Universidad de California-San Francisco.

El doctor Anthony Fauci, la autoridad nacional en enfermedades infecciosas en los Institutos Nacionales de Salud, no es inmune al problema. El 13 de octubre, le dijo a “The World” que él y sus tres hijas adultas, que viven en distintos estados, todavía estaban decidiendo si estar juntos “valdría la pena”.

Al día siguiente, Fauci le dijo a “CBS Evening News” que la reunión de Acción de Gracias de su familia estaba cancelada, dados los riesgos que plantean los vuelos. “Puede que tenga que sacrificar esa reunión social, a menos que esté bastante seguro de que las personas con las que está tratando no están infectadas”, dijo.

El doctor Robert Redfield, director de los Centros para el Control y Prevención de Enfermedades (CDC), y la doctora Deborah Birx, coordinadora del equipo de respuesta a COVID de la administración Trump, advirtieron que las reuniones de Thanksgiving podrían propagar el virus.

En California, funcionarios de salud pública están adoptando un enfoque de “reducción de daño”: no están fomentando las reuniones de varias familias, pero han emitido pautas para hacer que las reuniones sean más seguras si se realizan al aire libre y duran menos de dos horas.

Funcionarios del condado de Los Ángeles, que ha visto un aumento en las tasas de transmisión en las últimas semanas, publicaron una guía similar, reconociendo que las personas separadas de sus seres queridos durante meses anhelan cada vez más ese contacto.

“Estamos tratando de encontrar un balance, pero creo que es apropiado que intentemos llevar a cabo algunas de las actividades que la gente está desesperada por poder hacer, con total apego a la guía”, dijo Barbara Ferrer, directora de del departamento de salud pública del condado, en una conferencia de prensa el 14 de octubre.

En todo el mundo, los feriados nacionales han impulsado la propagación de COVID-19 de manera explosiva. En China, donde comenzó la pandemia, se estima que 5 millones de personas que viajaban por el Año Nuevo chino abandonaron Wuhan, el epicentro del brote, antes de que se promulgara una prohibición de viajar.

En Irán, la pandemia se impulsó por Nowruz, una celebración de primavera de dos semanas durante la que viajan millones. En Israel, las fiestas y reuniones religiosas de Purim provocaron una transmisión generalizada a fines de marzo.

Las celebraciones de Memorial Day, el 4 de julio y el Día del Trabajo impulsaron aumentos repentinos de casos en los Estados Unidos, por eso el Día de Acción de Gracias asusta a los funcionarios de salud pública.

El año pasado, viajaron más de 55 millones de personas durante los días que rodearon ese cuarto jueves de noviembre.

Sin embargo, funcionarios de todo el país están siendo suaves cuando se trata de advertencias.

En Minnesota, donde vive Wiese y los casos están alcanzando niveles récord, funcionarios instan al público a evitar las tiendas abarrotadas y las grandes reuniones en interiores con varias familias.

Pero dicen que las cenas de Acción de Gracias al aire libre con amigos y familiares locales son menos riesgosas. Su guía no explica cómo tolerar un Día de Acción de Gracias al aire libre en Minnesota. La temperatura máxima promedio en Minneapolis el 26 de noviembre es de 33 grados.

Michael Osterholm, director del Centro de Investigación y Política de Enfermedades Infecciosas de la Universidad de Minnesota, dice “paremos un poco”.

Osterholm explicó que si no puedes ponerte en cuarentena durante 10 a 14 días antes del evento, es decir, sin contacto con personas además de los miembros de tu hogar que también están en cuarentena, no vayas a la cena de Acción de Gracias en otra casa: el estado ya ha visto demasiados ejemplos de personas vulnerables que se enferman y mueren después de asistir a bodas, funerales y cumpleaños.

“Que este sea tu año COVID”, dijo Osterholm. “Es un año muy desafiante, pero no quieres introducir este virus en entornos familiares y experimentar las consecuencias”.

Osterholm y su pareja pasarán el Día de Acción de Gracias y la Navidad sin familiares, a pesar de que sus hijos y nietos son todos locales. Debido a que todos sus nietos están en la guardería o en la escuela, no hay suficiente tiempo para que sus familias se pongan en cuarentena antes de disfrutar juntos de una comida navideña.

Sintió empatía con la difícil situación de Wiese. Si decide volar a California, dijo, debería acuartelar a su familia lo más posible durante 10 días antes, y luego no pasar más de dos días con su padre.

“Incluso si se infectara, no sería más contagiosa hasta probablemente el tercer día”, dijo. “Entonces, si ella pasa esos dos días con él, puede sentirse relativamente bien por el hecho de que no los puso en riesgo”.

Para aquellos que viajan, conducir es mucho más seguro que volar porque los conductores pueden estar aislados en un compartimento doméstico y evitar la exposición al coronavirus renunciando a los restaurantes y desinfectando las manijas del baño y la bomba de gasolina antes de tocarlos.

El doctor Iahn Gonsenhauser, director de calidad y seguridad del paciente del Centro Médico Wexner de la Universidad Estatal de Ohio, dijo que planea conducir con su familia, pasando la noche en un hotel en el camino, para pasar el Día de Acción de Gracias con la familia de su hermana en Colorado.

Él y su familia se mantienen aislados y trabajan desde casa tanto como sea posible, dejando la casa solo para compras y mandados básicos mientras evitan restaurantes y centros comerciales, dijo. Si alguien en cualquiera de las familias comenzara a mostrar síntomas de COVID, o confirmara la exposición a una persona con COVID positivo, todo el viaje se cancelaría instantáneamente.

“Es por eso que hacemos todos los planes con una reserva reembolsable”, dijo. “Si las personas no tienen forma de salirse de sus reservas, están más inclinadas a tomar un riesgo aparente”.

Chin-Hong ofreció este consejo para los viajeros de vacaciones: házte la prueba antes del vuelo para tu tranquilidad, compra boletos en un avión que deje los asientos del medio vacíos, usa máscaras N95 altamente protectoras y escudos faciales, y coloca las rejillas de ventilación individuales del avión directamente sobre cada miembro de la familia para romper las posibles partículas de virus. Y, por supuesto, lávate las manos con frecuencia.

Chin-Hong está adoptando ese enfoque en un viaje familiar planificado a la ciudad de Nueva York para visitar a su madre, que tiene más de 80 años y quiere ver a su hijo, nuera y nietos. Cada visita podría ser la última, dijo Chin-Hong.

“Para mí, la relación riesgo-beneficio apoya la idea ir a verla”.

Después de escuchar los consejos de Chin-Hong y otros expertos en enfermedades infecciosas, Wiese decidió el fin de semana pasado comprar boletos de avión para visitar a sus padres.

“Realmente nos ayudó a tomar una decisión que me estaba dando mucha ansiedad”, expresó.

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Noticias En Español Public Health States

Did Trump Confuse the Public Option With ‘Medicare for All’?

During the final presidential debate, President Donald Trump claimed that 180 million people would lose their private health insurance to socialized medicine if the Democratic presidential nominee, former Vice President Joe Biden, is elected president.

“They have 180 million people, families under what he wants to do, which will basically be socialized medicine — you won’t even have a choice — they want to terminate 180 million plans,” said Trump.

Trump has repeated this claim throughout the week, and we thought the linkage of Biden’s proposed health care plan with socialism was something we needed to check out. Especially since Biden opposed “Medicare for All,” the proposal by Sen. Bernie Sanders (I-Vt.) that would have created a single-payer health system run completely by the federal government, and has long been attacked by Republicans as “socialist.”

The Trump campaign did not respond to our request asking where the evidence for this claim came from. Experts called it a distortion of Biden’s plan.

Where the Number Comes From

Experts agreed the number of people who have private health insurance either through an employer-sponsored plan or purchased on the Affordable Care Act’s health insurance marketplace is around 180 million people.

KFF, a nonpartisan health policy organization, estimated in 2018 that about 157 million Americans had health insurance through their employer, while almost 20 million had insurance they purchased for themselves. Together, that adds up to about 177 million with private health insurance. (KHN is an editorially independent program of KFF.)

What Does Biden Support?

Biden supports expanding the ACA through several measures, including a public option. Under his plan, this public option would be a health insurance plan run by the federal government that would be offered alongside other private health insurance plans on the insurance marketplace.

“The marketplace is made up of multiple insurers in areas,” said Linda Blumberg, a health policy fellow at the Urban Institute. “Sometimes there are five or more [plans]; sometimes there is only one. Biden is talking about adding a public option in the marketplace. You could pick between these private insurers or you could pick the public option.”

Getting rid of the so-called employer firewall is also part of Biden’s proposal.

This firewall was implemented during the rollout of the ACA. It was designed to maintain balance in the insurance risk pools by preventing too many healthy people who have work-based coverage from opting instead to move to a marketplace plan. And it all came down to who qualified for the subsidies that made these plans more affordable.

Currently, those who are offered a health insurance plan through their employer that meets certain minimum federal standards aren’t eligible to receive these subsidies, which come in the form of tax credits. But that leaves many low-income workers with health care plans that aren’t as affordable or comprehensive as marketplace plans.

Biden’s plan would eliminate that firewall, meaning anyone could choose to get health insurance either through their employer or through the marketplace. That’s where many Republicans argue that we could start to see leakage from private health insurance plans to the public option.

“The problem is healthy people leaving employer plans,” said Joseph Antos, a scholar in health care at the conservative-leaning American Enterprise Institute. That could mean the entire workplace plan’s premiums would go up. “You could easily imagine a plan where it spirals, the premiums go up, and then even more people start leaving the plans to go to the public option.”

Blumberg, though, said that because the marketplace would still include private health insurance plans alongside the public option, it doesn’t mean everyone who chooses to leave their employer plan would go straight to the public option.

She has done estimates based on a plan similar to the one Biden is proposing. She estimates that only about 10% to 12% of Americans would choose to leave their employer-sponsored plans, which translates to about 15 million to 18 million Americans.

KFF also did an estimate and found that 12.3 million people with employer coverage could save money by buying on the exchange under the Biden plan.

But “it’s not clear all of those people would choose to leave their employer coverage, though, as there are other reasons besides costs that people might want to have job-based insurance,” Cynthia Cox, vice president and director of the program on the ACA at KFF, wrote in an email.

Either way, none of the estimates are anywhere close to the 180 million that Trump claimed.

Is This Type of Public Option Socialism?

Overall, experts said no, what Biden supports isn’t socialized medicine.

“Socialized medicine means that the government runs hospitals and employs doctors, and that is not part of Biden’s plan,” Larry Levitt, executive vice president for health policy at KFF, wrote in an email. “Under Biden’s plans, doctors and hospitals would remain in the private sector just like they are today.”

However, Antos said that, in his view, the definition of socialism can really vary when it comes to health care.

“I would argue in one sense, we would already have socialized medicine. We have massive federal subsidies for everybody, so in that sense, we’re already there,” said Antos. “But, if socialized medicine means the government is going to dictate how doctors practice or how health care is delivered, we are obviously not in that situation. I don’t think the Biden plan would lead you that way.”

And in the end, Antos said, invoking socialism is a scare tactic that politicians have been using for years.

“It’s just a political slur,” said Antos. “It’s meant to inflame the emotions of those who will vote for Trump and meant to annoy the people who will vote for Biden.”

Our Ruling

Trump said 180 million people would lose their private health insurance plans to socialized medicine under Biden.

While about 180 million people do have private health insurance, there is no evidence that all of them would lose their private plans if Biden were elected president.

Biden supports implementing a public option on the health insurance marketplace. It would exist alongside private health insurance plans, and Americans would have the option to buy either the private plan or the public plan. While estimates show that a number of Americans would likely leave their employer-sponsored coverage for the public plan, they would be doing that by choice and the estimates are nowhere near Trump’s 180 million figure.

Experts also agree that the public option is not socialized medicine, and it’s ridiculous to conflate Biden’s plan with Medicare for All.

We rate this claim Pants on Fire.

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Elections Insurance The Health Law

In Tamer Debate, Trump and Biden Clash (Again) on President’s Pandemic Response

In the second and final debate of the 2020 presidential race, President Donald Trump and former Vice President Joe Biden sparred over Trump’s handling of the pandemic and Biden’s plan to reform health care. In stark contrast to the first debate, there was more policy talk. There was also less interrupting.

Trump said a COVID-19 vaccine is “ready” and will be announced “within weeks,” shortly before conceding that it is “not a guarantee.”

Biden said Trump still has no comprehensive plan to deal with the pandemic, even as case counts continue to climb. “We’re about to go into a dark winter, and he has no clear plan,” Biden said.

Trump claimed Biden’s health care plan would lead to “socialized medicine,” conflating Biden’s proposal to introduce a government insurance option with more progressive proposals that would eliminate private insurance. “I support private insurance,” Biden said, promising, “Not a single person with private insurance would lose their insurance under my plan.”

You can read a full fact check for the evening, done in partnership with PolitiFact, here.

Meanwhile, we broke down the candidates’ closing coronavirus and other health-related claims so you can do your part: vote.

Here are the highlights:

Trump: “We are rounding the turn [on the pandemic]. We are rounding the corner.”
False.“Rounding the corner” suggests that significant and sustained progress is being made in the fight against the coronavirus, and that’s not the case, according to the data.

The number of COVID cases is climbing once again, after falling consistently between late July and mid-September. Cases are now at their highest point since early August, with almost 60,000 new confirmed infections a day. That’s only about 10% lower than the peak in late July.

New daily hospitalizations today are lower than in previous spikes, but in the past few weeks there has been a modest increase. The positivity rate, which measures the percentage of tests that come up positive for the virus, has also been going up again in the past few weeks. Higher positivity rates are an indicator of community spread.

The one encouraging change is that, since a peak in August, deaths have fallen fairly consistently. That’s due to a combination of factors, including improved understanding of how to treat the disease. Yet COVID deaths have settled in at about 800 a day, keeping total deaths per week in the U.S. above normal levels.

Trump: His administration has done “everything” Biden suggested to address COVID-19. “He was way behind us.”
We rated a similar claim Pants on Fire. While there are some similarities between Biden’s and Trump’s plans to combat COVID-19, experts told us any pandemic response plan should have certain core strategies. The Trump administration has released no comprehensive plan to battle the disease, except with regard to the development and distribution of vaccines. Trump’s main intervention was implementing travel restrictions, while efforts to roll out a widespread testing plan faced difficulties.

Biden released a public COVID plan; the first draft was published March 12. It included public health measures such as deploying free testing and personal protective equipment, as well as implementing economic measures such as emergency paid leave and a state and local emergency fund.

Trump: “As you know, 2.2 million people were expected to die. We closed the greatest economy in the world to fight this horrible disease that came from China.”
His claim about the estimated deaths rates Mostly False. Trump frequently refers to this number to claim that his administration’s moves saved 2 million lives. However, the number is from a mathematical model that hypothesized what would happen if, during the pandemic in the U.S., neither people nor governments changed their behaviors, a scenario that experts considered unrealistic. The U.S. has the highest death toll from COVID-19 of any country, and one of the highest death rates. Also, credit for shutting down the economy doesn’t go primarily to Trump, but rather to states and local jurisdictions. In fact, Trump encouraged states to open back up beginning in May, even when there were high rates of COVID transmission in those areas.

Trump: “We cannot lock ourselves in a basement like Joe does.”
We rated a similar claim False. It is one of Trump’s favored shots to say Biden isolated himself in his basement. In the first few months of the pandemic, Biden did run much of his campaign from his Delaware home. He built a TV studio in his basement to interact with voters virtually. But that changed.

In September alone, Biden gave remarks and held events in, among other places, Kenosha, Wisconsin; Lancaster, Pennsylvania; Warren, Michigan; Tampa, Florida; and Charlotte, North Carolina. We counted 14 locations.

Trump: Said of Dr. Anthony Fauci, “I think he’s a Democrat, but that’s OK.”
This is wrong. Fauci, director of the National Institute of Allergy and Infectious Diseases, is not affiliated with a political party. He hasn’t endorsed any parties or candidates.

Biden: “We are in a circumstance where the president still has no plan, no comprehensive plan.”
This is largely accurate. When Biden claimed during the first debate that Trump “still won’t offer a plan,” we noted the Trump administration’s “Operation Warp Speed” for vaccine development as well as its more detailed plan for vaccine distribution. But the administration has not released a comprehensive plan to address COVID-19.

Trump: “There was a spike in Florida. That is gone. There was a spike in Texas. That is gone. There was a spike in Arizona. It is gone.” 

This is inaccurate. Over the summer, Florida, Texas and Arizona experienced record surges in cases that later eased — but now they are all seeing new surges. Over the past week, The New York Times’ tracker notes, as of Friday, new infections are up 37% in Florida, 13% in Texas and 47% in Arizona, from the average two weeks earlier.

Trump: “When I closed [travel from China], he said I should not have closed. … He said this is a terrible thing, you are a xenophobe; I think he called me racist. Now he says I should have closed it earlier.”

Mostly False. Joe Biden did not directly say he thought Trump shouldn’t have restricted travel from China to stem the spread of the coronavirus.

Biden did accuse Trump of “xenophobia” in an Iowa campaign speech the same day the administration announced the travel restrictions — Jan. 31 — but his campaign said that his remarks were not related and that he made similar comments before the restrictions were imposed. Biden didn’t take a definitive stance on the subject until April 3, when his campaign said he supported Trump’s decision to impose travel restrictions on China.

Trump: “They have 180 million people, families under what he wants to do, which will basically be socialized medicine — you won’t even have a choice — they want to terminate 180 million plans.” 

Pants on Fire. About 180 million people have private health insurance. But there is absolutely no evidence that under Biden’s health care proposal all 180 million would be removed from their insurance plans. Biden supports creating a public option, which would be a government-run insurance program that would exist alongside and compete with other private plans on the health insurance marketplace.

Under Biden’s plan, even people with employer-sponsored coverage could choose a public plan if they wanted to. And estimates show that only a small percentage of Americans would likely leave their employer-sponsored coverage if a public option were available, and certainly not all 180 million. Experts said it is not socialized medicine.

Biden: “Not one single person with private insurance” lost their insurance “under Obamacare … unless they chose they wanted to go to something else.”

This is inaccurate. This is a variation of a claim that earned President Barack Obama our Lie of the Year in 2013. The Affordable Care Act tried to allow existing health plans to continue under a complicated process called “grandfathering,” but if the plans deviated even a little, they would lose their grandfathered status. And if that happened, insurers canceled plans that didn’t meet the new standards.

No one determined with any certainty how many people got cancellation notices, but analysts estimated that about 4 million or more had their plans canceled. Many found insurance elsewhere, and the percentage was small — out of a total insured population of about 262 million, fewer than 2% lost their plans. However, that still amounted to 4 million people who faced the difficulty of finding a new plan and the hassle of switching their coverage.

This story includes reporting by KHN reporters Victoria Knight and Emmarie Huetteman, and Jon Greenberg, Louis Jacobson, Amy Sherman, Miriam Valverde, Bill McCarthy, Samantha Putterman, Daniel Funke and Noah Y. Kim of PolitiFact.

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Elections Insurance Public Health The Health Law

COVID Spikes Exacerbate Health Worker Shortages in Rocky Mountains, Great Plains

COVID-19 cases are surging in rural places across the Mountain States and Midwest, and when it hits health care workers, ready reinforcements aren’t easy to find.

In Montana, pandemic-induced staffing shortages have shuttered a clinic in the state’s capital, led a northwestern regional hospital to ask employees exposed to COVID-19 to continue to work and emptied a health department 400 miles to the east.

“Just one more person out and we wouldn’t be able to keep the surgeries going,” said Dr. Shelly Harkins, chief medical officer of St. Peter’s Health in Helena, a city of roughly 32,000 where cases continue to spread. “When the virus is just all around you, it’s almost impossible to not be deemed a contact at some point. One case can take out a whole team of people in a blink of an eye.”

In North Dakota, where cases per resident are growing faster than any other state, hospitals may once again curtail elective surgeries and possibly seek government aid to hire more nurses if the situation gets worse, North Dakota Hospital Association President Tim Blasl said.

“How long can we run at this rate with the workforce that we have?” Blasl said. “You can have all the licensed beds you want, but if you don’t have anybody to staff those beds, it doesn’t do you any good.”

The northern Rocky Mountains, Great Plains and Upper Midwest are seeing the highest surge of COVID-19 cases in the nation, as some residents have ignored recommendations for curtailing the virus, such as wearing masks and avoiding large gatherings. Montana, Idaho, Utah, Wyoming, North Dakota, South Dakota, Nebraska, Iowa and Wisconsin have recently ranked among the top 10 U.S. states in confirmed cases per 100,000 residents over a seven-day period, according to an analysis by The New York Times.

Such coronavirus infections — and the quarantines that occur because of them — are exacerbating the health care worker shortage that existed in these states well before the pandemic. Unlike in the nation’s metropolitan hubs, these outbreaks are scattered across hundreds of miles. And even in these states’ biggest cities, the ranks of medical professionals are in short supply. Specialists and registered nurses are sometimes harder to track down than ventilators, N95 masks or hospital beds. Without enough care providers, patients may not be able to get the medical attention they need.

Hospitals have asked staffers to cover extra shifts and learn new skills. They have brought in temporary workers from other parts of the country and transferred some patients to less-crowded hospitals. But, at St. Peter’s Health, if the hospital’s one kidney doctor gets sick or is told to quarantine, Harkins doesn’t expect to find a backup.

“We make a point to not have excessive staff because we have an obligation to keep the cost of health care down for a community — we just don’t have a lot of slack in our rope,” Harkins said. “What we don’t account for is a mass exodus of staff for 14 days.”

Some hospitals are already at patient capacity or are nearly there. That’s not just because of the growing number of COVID-19 patients. Elective surgeries have resumed, and medical emergencies don’t pause for a pandemic.

Some Montana hospitals formed agreements with local affiliates early in the pandemic to share staff if one came up short. But now that the disease is spreading fast — and widely — the hope is that their needs don’t peak all at once.

Montana state officials keep a list of primarily in-state volunteer workers ready to travel to towns with shortages of contact tracers, nurses and more. But during a press conference on Oct. 15, Democratic Gov. Steve Bullock said the state had exhausted that database, and its nationwide request for National Guard medical staffing hadn’t brought in new workers.

“If you are a registered nurse, licensed practical nurse, paramedic, EMT, CNA or contact tracer, and are able to join our workforce, please do consider joining our team,” Bullock said.

This month, Kalispell Regional Medical Center in northwestern Montana even stopped quarantining COVID-exposed staff who remain asymptomatic, a change allowed by Centers for Disease Control and Prevention guidelines for health facilities facing staffing shortages.

“That’s very telling for what staffing is going through right now,” said Andrea Lueck, a registered nurse at the center. “We’re so tight that employees are called off of quarantine.”

Financial pressure early in the pandemic led the hospital to furlough staff, but it had to bring most of them back to work because it needs those bodies more than ever. The regional hub is based in Flathead County, which has recorded the state’s second-highest number of active COVID-19 cases.

Mellody Sharpton, a hospital spokesperson, said hospital workers who are exposed to someone infected with the virus are tested within three to five days and monitored for symptoms. The hospital is also pulling in new workers, with 25 traveling health professionals on hand and another 25 temporary ones on the way.

But Sharpton said the best way to conserve the hospital’s workforce is to stop the disease surge in the community.

Earlier in the pandemic, Central Montana Medical Center in Lewistown, a town of fewer than 6,000, experienced an exodus of part-time workers or those close to retirement who decided their jobs weren’t worth the risk. The facility recently secured two traveling workers, but both backed out because they couldn’t find housing. And, so far, roughly 40 of the hospital’s 322 employees have missed work for reasons connected to COVID-19.

“We’re at a critical staffing shortage and have been since the beginning of COVID,” said Joanie Slaybaugh, Central Montana Medical Center’s director of human resources. “We’re small enough, everybody feels an obligation to protect themselves and to protect each other. But it doesn’t take much to take out our staff.”

Roosevelt County, where roughly 11,000 live on the northeastern edge of Montana, had one of the nation’s highest rates of new cases as of Oct. 15. But by the end of the month, the county health department will lose half of its registered nurses as one person is about to retire and another was hired through a grant that’s ending. That leaves only one registered nurse aside from its director, Patty Presser. The health department already had to close earlier during the pandemic because of COVID exposure and not enough staffers to cover the gap. Now, if Presser can’t find nurse replacements in time, she hopes volunteers will step in, though she added they typically stay for only a few weeks.

“I need someone to do immunizations for my community, and you don’t become an immunization nurse in 14 days,” Presser said. “We don’t have the workforce here to deal with this virus, not even right now, and then I’m going to have my best two people go.”

Back in Helena, Harkins said St. Peter’s Health had to close a specialty outpatient clinic that treats chronic diseases for two weeks at the end of September because the entire staff had to quarantine.

Now the hospital is considering having doctors take turns spending a week working from home, so that if another wave of quarantines hits in the hospital, at least one untainted person can be brought back to work. But that won’t help for some specialties, like the hospital’s sole kidney doctor.

Every time Harkins’ phone rings, she said, she takes a breath and hopes it’s not another case that will force a whole division to close.

“Because I think immediately of the hundreds of people that need that service and won’t have it for 14 days,” she said.

Mountain States editor Matt Volz contributed to this story.

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States

Travel on Thanksgiving? Pass the COVID

Molly Wiese was truly stumped. Her parents and siblings live in Southern California, and Wiese, a 35-year-old lawyer, has returned home every Christmas since she moved to Minnesota in 2007.

Because of the pandemic, Wiese thought it would be wiser to stay put for once. But in June, Wiese’s father was diagnosed with stage 4 cancer, and they feared this could be his final holiday season.

Should she fly with her husband and two young sons to California, putting her immunocompromised father at risk of COVID-19? Or stay home and miss out on making treasured holiday memories with her parents and children?

Her children are in day care, and Wiese’s husband works at a school. They don’t have enough vacation time to self-quarantine before or after a flight, and driving eight days round trip isn’t practical.

She fears giving her father coronavirus. But her parents, who live in the Inland Empire city of Yucaipa, believe it’s worth the risk to see Wiese’s children and have “our normal Christmas,” she said.

“Ideally, we’d have a vaccine,” she said. “But I don’t think that’s a realistic expectation.” Pfizer, the apparent leader in the COVID vaccine race, says it won’t even be ready to apply for vaccine approval until late November at the earliest.

Molly Wiese’s father has late-stage cancer and she fears this could be his last holiday season. She struggled with whether she and her family should fly to Southern California to visit him for Christmas because she doesn’t want to put him at risk of contracting COVID-19. From left: Molly Wiese, son Calvin, husband Phil Wiese, son Bennett, and Wiese’s parents, Becky and Bill Miller. (Molly Wiese)

While Wiese’s conundrum is especially high-stakes, her story illustrates the tough decision millions of Americans are facing about whether and how to travel for the winter holidays.

The best way to avoid spreading disease would be to avoid traveling or widening one’s social circles. For local celebrations, self-quarantining for two weeks before a holiday event would minimize risk if all those invited committed to doing the same. But some people have to work outside the home.

For everyone, after at least seven months of being mostly sequestered, the winter holidays pose an almost insurmountable temptation. Even public health and infectious disease experts recognize the dilemma.

“There’s so much to be gained by physical touch, by being in that room and not in a two-dimensional Zoom or FaceTime screen,” said Dr. Peter Chin-Hong, an infectious disease specialist and professor of medicine at the University of California-San Francisco. “And even to embrace, with the right preparation.”

Dr. Anthony Fauci, the nation’s authority on infectious diseases at the National Institutes of Health, isn’t immune to the problem. He told PRI’s “The World” on Oct. 13 that he and his three adult daughters, each living in a different state, were still deciding whether being together would be “worth it.”

The next day, Fauci told “CBS Evening News” that his family’s Thanksgiving reunion was off, given the risks posed by air travel. “You may have to bite the bullet and sacrifice that social gathering, unless you’re pretty certain that the people that you’re dealing with are not infected,” he said.

Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, and Dr. Deborah Birx, the Trump administration’s senior coordinator in the COVID fight, have both warned that Thanksgiving gatherings could spread the virus.

In California, public health officials are taking a “harm reduction” approach: They aren’t encouraging multi-household gatherings, but they’ve issued guidelines to make get-togethers safer if they happen outdoors and last less than two hours.

Officials in Los Angeles County, which has seen transmission rates increase in recent weeks, released similar guidance, acknowledging that people separated from their loved ones for months increasingly yearn for that contact.

“We are threading the needle here, but I think it is appropriate for us to try to do some of the activities that people are desperate to be able to do, with absolute adherence to the guidance,” Barbara Ferrer, director of the county’s public health department, said at an Oct. 14 news conference.

Around the world, national holidays have fueled the spread of COVID-19 in explosive ways. In China, where the pandemic started, an estimated 5 million people traveling for Chinese New Year left Wuhan, the epicenter of the outbreak, before a travel ban was enacted. In Iran, the pandemic was aided by Nowruz, a two-week spring celebration that prompted millions to travel. In Israel, parties and religious gatherings for Purim caused widespread transmission in late March.

Memorial Day, Fourth of July and Labor Day celebrations fueled surges in the United States, which is why Thanksgiving frightens public health officials. Last year, more than 55 million people were expected to travel during the days surrounding that fourth Thursday in November.

Nevertheless, officials across the nation are using a light touch when it comes to warnings.

In Minnesota, where Wiese lives and cases are hitting record highs, officials urge the public to avoid crowded stores and large indoor gatherings with other households, but say outdoor Thanksgiving dinners with local friends and family are less risky. Their guidance doesn’t explain how to endure an outdoor Thanksgiving in Minnesota. The average high in Minneapolis on Nov. 26 is 33 degrees.

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, is waving his hands to stop the game.

If you can’t self-quarantine for 10 to 14 days before the event — that is, no contact with people besides members of your household who are also quarantining — don’t go to another household’s Thanksgiving dinner, he said: The state has already seen too many examples of vulnerable people becoming sick and dying after attending weddings, funerals and birthday parties.

“Let this be your COVID year,” Osterholm said. “It’s a very challenging year, but you don’t want to introduce this virus into family settings and experience the consequences.”

Osterholm and his partner will spend Thanksgiving and Christmas without extended family, even though their children and grandchildren are all local. Because all his grandchildren are in day care or school, there isn’t enough time for their families to self-quarantine before enjoying a holiday meal together.

He was sympathetic to Wiese’s “compelling” plight. If she decides to fly to California, he said, she should sequester her family as much as possible for 10 days beforehand, then spend no more than two days with her father.

“Even if she got infected, she wouldn’t be most infectious until probably day three,” he said. “So if she spends those two days with him, she can feel relatively good about the fact that she didn’t put them at risk.”

For those who do travel, driving is much safer than flying because drivers can be isolated in a household pod and avoid exposure to the coronavirus by forgoing restaurants and by disinfecting bathroom and gas pump handles before touching them.

Dr. Iahn Gonsenhauser, chief quality and patient safety officer for the Ohio State University’s Wexner Medical Center, said he plans to drive with his family — overnighting at a hotel on the way — to spend Thanksgiving with his sister’s family in Colorado.

He and his family keep to themselves and work from home as much as possible, leaving the house only for groceries and basic errands while eschewing restaurants and malls, he said. If anyone in either family began showing COVID symptoms, or had confirmed exposure to a COVID-positive person, the whole trip would be called off instantly.

“This is why we make all plans with a refundable reservation,” he said. “If people have no way of backing out of their reservations, they’re more inclined to push through an apparent risk.”

Chin-Hong offered this advice for holiday flyers: Get tested before the flight for peace of mind, buy tickets on a plane that is leaving middle seats empty, use highly protective N95 masks and possibly face shields, and blast the individual airplane vents directly onto each family member to disrupt potential virus particles. And, of course, wash your hands frequently.

Chin-Hong is taking that approach on a planned family trip to New York City to visit his mother, who is in her 80s and wants to see her son, daughter-in-law and grandchildren. Every visit they have could be their last, Chin-Hong said.

“To me, the risk-benefit ratio really supports me going to see her.”

After hearing the advice from Chin-Hong and other infectious disease experts, Wiese decided last weekend to buy plane tickets to visit her parents.

“It really did help us make a decision that was giving me a lot of anxiety,” she said.

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Public Health States

KHN on the Air This Week

KHN chief Washington correspondent Julie Rovner discussed the impact of the election and the upcoming Supreme Court challenge on the Affordable Care Act with New Hampshire Public Radio’s “The Exchange” and WNYC’s “The Brian Lehrer Show” on Wednesday. Rovner also spoke with Newsy’s “Morning Rush” on Thursday about the roles of health care and COVID-19 in the presidential campaign.


KHN Midwest correspondent Lauren Weber discussed COVID vaccine distribution with “Newsy Reports” on Oct. 16.


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Courts Elections The Health Law

Workers Fired, Penalized for Reporting COVID Safety Violations

When COVID-19 began making headlines in March, Charles Collins pulled out a protective face mask from the supply at the manufacturing company in Rockaway, New Jersey, where he was the shop foreman and put it on. The dozen or so other workers at the facility followed suit. There was no way to maintain a safe distance from one another on the shop floor, where they made safety mats for machines, and a few of the men had been out sick with flu-like symptoms. Better safe than sorry.

Management was not pleased. Collins got a text message from one of his supervisors saying masks were to be used to protect workers from wood chips, metal particles and other occupational safety hazards. “We don’t provide or for that matter have enough masks to protect anybody from CORVID-19 [sic]!” If workers didn’t stop using the masks for that purpose, the supervisor texted, “we’ll have to store them away just like the candy!”

“I was shocked,” said Collins, 38. “They weren’t taking it seriously.”

Shortly after that, Collins left for a planned vacation. When he returned a week later, the company told him to quarantine at home for two weeks because he’d been traveling.

But when the quarantine ended, Collins didn’t want to go back to work. Co-workers, he said, told him that recommended safety measures such as wearing masks and maintaining social distancing hadn’t been implemented. When he told human resources that he feared becoming infected and endangering his mother and his 8-year-old nephew who live with him, he said, he got an ultimatum: Return to work or resign.

Collins stayed home and says he was fired. He hired a lawyer and filed a complaint in the Superior Court of New Jersey under the state’s whistleblower law, the Conscientious Employee Protection Act. The law prohibits employers from firing, demoting or otherwise retaliating against workers who refuse to take part in activities they believe are incompatible with public health and safety mandates.

As many employers, with the strong encouragement of the Trump administration, move to bring employees back, a growing number of workers are resisting what they feel are unsafe, unhealthy conditions. In recent months, a few states have passed laws specifically aimed at protecting workers who face COVID-related safety risks and retaliation for speaking up about them. Some states, like New Jersey, have whistleblower protection laws already. But advocates say stronger federal protections are needed.

The Occupational Safety and Health Administration, part of the U.S. Department of Labor, is responsible for enforcing 23 federal whistleblower statutes that protect workers from retaliation if they report workplace safety violations, among other problems.

But according to a new analysis, the agency isn’t up to the task. The National Employment Law Project, a workers’ advocacy and research group, found that of 1,744 COVID-related retaliation complaints filed with OSHA between April and mid-August, 20% were docketed for investigation and 2% were resolved. More than half were dismissed or closed without investigation.

“Even before COVID, workers had a really bad track record of getting any justice for their concerns if they were retaliated against,” said Debbie Berkowitz, director of the worker health and safety program at the National Employment Law Project and a former senior OSHA official.

The numbers are growing. Whistleblower complaints filed with OSHA increased by 30% between February and May, to 4,101, according to an August report by the Department of Labor’s Office of the Inspector General that criticized the agency’s handling of the complaints.

Nearly 40% of the complaints — 1,618 — were related to COVID-19, the report found, filed primarily by workers who claimed they were punished for reporting workplace safety violations. Those could include, for example, not having appropriate personal protective equipment or sanitation materials, or a lack of social distancing on the job.

While complaints rose, the number of whistleblower investigators decreased from the previous year, according to the report. The average time it took to close an investigation at the end of March was roughly nine months.

Worker whistleblower protections under the Occupational Safety and Health law are “incredibly weak” compared with whistleblower statutes that protect employees who report other types of wrongdoing, Berkowitz said. If OSHA dismisses a complaint, workers have no right to appeal the decision, and once they file a complaint with OSHA they aren’t permitted to take their case to court on their own, she said.

Consumer advocates would like to see those provisions changed.

Advocates have urged OSHA to adopt mandatory COVID safety standards for workplaces, but the agency has declined to do so, maintaining that its “general duty clause,” which requires employers to maintain a workplace free from hazards likely to cause death or physical harm, is sufficient.

“The Administration has remained committed to providing the Whistleblower Protection program with the resources it needs to fulfill its mission,” a spokesperson for the Department of Labor wrote in an email to KHN. “In fiscal year 2020, OSHA asked for and received five new full-time employees and requested an additional ten in the President’s budget for fiscal year 2021.”

If workers don’t pursue a whistleblower complaint through OSHA, they can file a state lawsuit claiming “wrongful discharge” or use a state’s whistleblower law, as Collins did.

According to a COVID employment litigation tracker by Fisher Phillips, an employment law firm, since the beginning of the year 169 retaliation/whistleblower lawsuits have been filed across the country — the second-biggest category, behind suits related to remote work/leave, with 206 cases. An additional 27 lawsuits have been filed for wrongful discharge.

Juan Carlos Fernandez, the Morristown, New Jersey, attorney representing Charles Collins, said he’s seen a significant uptick in inquiries from workers about safety concerns in recent months. Before the pandemic began, he typically received one or two such calls per month. Now, he gets three or four a day.

Many callers say they were terminated after they asked for protective equipment on the job, Fernandez said. Others had asked for time off to care for a family member or a child whose school had closed because of COVID-19 and then were told not to come back to work.

In addition to reporting safety violations, Collins’ lawsuit claims, he was fired for asking to take time off. Under the federal Families First Coronavirus Response Act, employees are generally entitled to two weeks’ paid leave if they’re quarantined, and another two weeks’ paid sick leave at two-thirds pay to care for a child whose school has closed, as well as expanded family and medical leave. Collins has cared for his nephew since his sister died two years ago in a car accident. His nephew’s school closed in March because of COVID-19.

Collins said his employer, ASO Safety Solutions, paid him for only the first week of his company-ordered quarantine. Any additional time off would come out of his accrued sick and vacation time, he was told.

ASO Safety Solutions didn’t respond to requests for comment, nor did the law firm representing the company.

In his response to the complaint submitted to the court, the lawyer representing the company denied that ASO had retaliated against Collins for whistleblowing, asserting he had resigned. The response, by John Olsen, with Ferdinand IP Law Group, also said that the provisions of the Families First Coronavirus Response Act do not apply to the company. The lawyers have exchanged requests for discovery, Fernandez said, which should be answered in the next several weeks.

A few states and cities have stepped in to help whistleblowers. Virginia was the first to put in place statewide workplace safety standards related to COVID-19, spurred by concerns from workers in poultry plants, said Rachel McFarland, a staff attorney at the Legal Aid Justice Center in Charlottesville. The standards include specific provisions protecting workers from retaliation for raising safety concerns or refusing to work in a location they believe is unsafe.

Colorado and the cities of Philadelphia and Chicago likewise passed laws prohibiting employers from retaliating against workers who raise COVID-related safety concerns, refuse to work in unsafe conditions or take time off to minimize the transmission of the virus.

But these laws are the exceptions, said Brent Newell, a senior attorney at Public Justice in Oakland, California, who has represented the interests of workers in meatpacking plants. “Many states haven’t done that and won’t do that,” he said. “For the federal government to put it on the states to protect workers is wholly and fundamentally inadequate.”

The Complexity in ‘Where Are You From?’

When I asked my father where he was born, I never got a straight answer. Wuhan, he’d say. In other moments, he’d claim Wuchang.

I didn’t understand why he couldn’t state a simple fact. My assumption reflected my privilege, that of a girl who’d known only the peace and stability of the suburbs east of San Francisco. Much later, I would realize that his birthplace had been absorbed into Wuhan, a provincial capital formed from the sprawl of Wuchang, Hankou and Hanyang.

My father is gone now, but I’ve wondered what he would make of the coronavirus. He surely would have worried about his family more than himself.

It would have pained him that relations have cratered between his ancestral and adopted homelands, causing a backlash against Asian-Americans. “Go back to where you came from!” we’re told.

But where did we come from, and why does it matter? Among other Chinese, the question is a conversation starter in which we can situate ourselves and our people, in every far-flung corner of the diaspora. Your ancestral province might stamp itself upon your character, in your traits — determining your height, your ambitions and your looks.

Born in China, my parents fled to the island of Taiwan at the close of World War II. Later on, they came to the United States for graduate school in science and engineering.

I used to think my parents were cagey about their past because they wanted to focus on the future. Perhaps, growing up in the shadow of Communism, or in making a life for themselves in this country, they’d also learned not to disclose too much, for who knew how it might get turned against them?

All that might have been true, though now I understand I may have missed another reason. Just as my father couldn’t readily tell me where he was born, neither of my parents could say exactly where they were from because they’d moved around so much during their childhood, amid conflicts with Japanese forces in the years before and during World War II.

At the bustling dim sum parlors in San Francisco’s Chinatown, I noticed my father chatting with the cart ladies to order the plumpest har gow and juiciest siu mai. Our family spoke Mandarin, and I asked why he could converse with the workers in Cantonese, spoken in Hong Kong, parts of southeast China and in certain diasporic enclaves.

“At school,” my father replied. In every new place, he had new classmates, he explained. Those families could have been seeking refuge from the war, too, I now understand, and the students could have picked up on each other’s native tongues.

No matter how much he told me, I couldn’t fully comprehend what it had been like for his military family to move every few months, sometimes every few weeks, crammed into inns or shacked up with relatives. They must have been fearful of the whine of approaching warplanes, forcing them to hide in caves or bomb shelters.

The rare details I gleaned seemed in the realm of the fantastic: his family once had fled in a wood-burning truck, in use because of gas shortages. It sounded like something from a fairy tale, when a small child gets lost in the forest, in the cold, in the dark.

I never faced such perils. Before leaving for college, I lived at the same address all my life, in the airy, light-filled house designed by my father, a structural engineer. It’s the same house where I now live with my twin sons, my husband and my mother.

And yet the question “where are you from?” is just as complicated for me to answer. Or rather, my initial reply — “I’m from California”— never seems to satisfy the strangers asking. Their mouths twitch and silence lengthens between us.

“I’m from the Bay Area,” I’ll clarify, even though I know I’m delaying the inevitable. It’s clear what they want to know, which perversely makes me want to hold out on them.

“But …” they trail off.

I can tell they think I’m misleading them. Some can’t hide their irritation that I’m not revealing information they feel entitled to having.

At last I’ll say, “I was born in the United States, but my parents are from China.”

They nod, pleased to confirm their suspicion that my family isn’t from here, that Asian-Americans are perpetual foreigners. They don’t realize they’re asking a question even my father couldn’t have answered.

When I asked about his childhood, doing research for a novel, he sent me an email entitled, “WWII Moving Dates and Places.” His terse entries list Wuhan, Nanjing, Huizhou, Jiujang, Wuhu, Liuzhou, Guilin, Guiyang, Chongqing and elsewhere. A typical entry: “1938 — spent time in Hunan province in counties named Yochow, Yuanling, Chenlingi, and Senchi, etc.”

He transliterated some names in an older style of Romanization developed by British diplomats and Sinologists in the 19th century, and others in Pinyin, a system that China adopted in the late 1950s.

It’s why “Peking” is now Beijing, “Szechuan” is Sichuan, why “Mao Tse-Tung” is “Mao Zedong.” The same places, the same people, but different spellings.

The entry ends with an “etc.,” an abbreviation from Latin for “and the rest.” What comes next, it’s implied, is similar to what has come before it, so similar it isn’t worth noting. Or maybe my father felt the information was too granular for his American-born daughter, who’d never heard of these places and hadn’t the faintest understanding of them.

Or it could have been he didn’t remember. In 1938, my father was only a toddler. Then, as now, families must have struggled to maintain a home for their children, a semblance of normality despite daily upheaval.

In my father’s birthplace, and across China, the spread of the coronavirus has largely been halted and routines have resumed. In the Bay Area, much remains uncertain. On top of our pandemic precautions and distance learning this fall, we’ve been preparing a go-bag. In this fire season, we’ve been shellshocked by the apocalyptic skies, by the falling ash and choking smoke blotting out the sun.

I wasn’t sure how much to gather, if I should stuff a backpack with passports, important papers, wallets and laptop or also fill a rollerbag with spare clothes, a first-aid kit, flashlights, portable chargers and energy bars? Could we make a getaway in our car with our camping gear, or would we have to run for our lives in our pajamas?

How much could my father carry, when he and his family traveled across China? The clothes on their backs, I suspect, and not much more. They had precious little materially to remind them of who they were and where they were from.

From 1929 to 1932, my grandfather trained at the Royal Naval College in Greenwich, England. On his return voyage, he stopped in Sri Lanka, which was then called Ceylon, where he purchased a moonstone and sapphire necklace.

My grandparents exhausted their savings to survive the war. My grandmother sold off her jewelry to help pay for our family’s passage — every piece but for the necklace, which she would give my mother as an engagement present. My parents passed it down to me. When I wear it, I feel transformed into an Erté ingénue, all gleaming bare shoulders and butterfly swoops of a collar bone.

The luminous gems hang from a delicate gold chain, so thin it could snap if caught on a button or a lock of hair. Yet the necklace has survived for nearly a century, carried to all the places my family has learned to call home. Where I’m from is everywhere it’s been.

I tucked the necklace into a black leather case and zipped it tight into our go-bag — proof, a prayer that not everything is lost in the end.


Vanessa Hua is the author, most recently, of the novel “A River of Stars.”

Weekly Health Quiz: Elections, Knees and a New Organ?

1 of 7

In the days following the 2016 presidential election, hospitalization rates for this disorder spiked:

Migraine headaches

Heart attacks and strokes

Asthma attacks

Appendicitis

2 of 7

Researchers in the Netherlands recently reported this possible new anatomic discovery:

A “glymphatic system” in the brain

A fourth set of salivary glands at the back of the throat

The fabella, a tiny bone located in a tendon behind the knee

A collagen-fluid network in the space between cells

3 of 7

A study found that as systolic blood pressure, the top number, rose above this level, the risk of cardiovascular disease increased:

90

100

110

120

4 of 7

Which statement about running and knees is not true?

Running exerts greater forces on the knees than walking does

Running can fray the cushioning cartilage inside the knee

Over time, runners are much more likely to develop knee arthritis than those who don’t run

Running may, over time, actually help to build up cartilage inside the knee joint

5 of 7

This country became the fifth to reach a million reported coronavirus cases, after the U.S., India, Brazil and Russia:

Argentina

Spain

France

Sweden

6 of 7

Per capita, this state now has the highest number of new coronavirus cases:

New Jersey

Texas

Colorado

North Dakota

7 of 7

What percentage of confirmed coronavirus cases in the United States have been in children?

2.1 percent

5.2 percent

10.9 percent

22.4 percent

I Was Done Dating. Then I Joined a Hookup App.

Last summer, as I neared 25 years in Vancouver, I concluded that I had exhausted the local dating pool. I had overfished Plenty of Fish and used up all my arrows at OkCupid. A silly hand injury forced me to retire from the gay volleyball league, and I found myself trekking alone whenever I showed up for a gay hiking outing I’d found on Meetup.com.

While I finally felt bold enough to make eye contact with men on the sea wall and in cafes, it was only because they had long stopped looking my way. I could look — or leer, if I wanted to — and no one would notice. I needed to break up with my city.

More than two decades earlier, I had decided to move to Vancouver 20 minutes into a weekend trip from Los Angeles. This time, in deciding to leave, I wouldn’t rely on whims and dreams. My gut had repeatedly proved itself to be an unreliable barometer. I needed to base decisions on logic and planning.

I began by nixing Victoria and Ottawa for being smaller than where I already was, and I eliminated Montreal because my French was too weak. Which left Toronto.

I flew there in early August for three days, walked Queen Street and marveled at the city’s diversity. The shoreline of Lake Ontario didn’t quite match Vancouver’s ocean and mountains but, yes, Toronto would do. I would make it work.

For financial reasons, I set April 1, 2020, as my target moving date, but my plans were grander. Movers would store my belongings for three months and, while I was temporarily free from paying mortgage or rent, I would use the extra cash to flit about Europe. Only there would I let my whims rumble, acting on recommendations mentioned in passing at the foreign cafe du jour.

“Have you been to the Algarve?” “You should go to Bucharest.”

I haven’t and would, finally a free spirit at 55.

As 2020 arrived, I decided my last three months in Vancouver would be freer as well. I suspended my accounts on traditional online dating sites and created a profile on a hookup app. Coming out in 1989, at the peak of the AIDS crisis, I had never shaken my sexual fears and hangups. This would be a time to work through them, before I set foot in my new city.

But it wasn’t easy being “easy.” While I prepared myself for the possibility that names might never be exchanged, I still wanted some significance of interplay. I blocked the guy who kept sending me lewd messages about spit and ignored the guys who didn’t use complete sentences. But maintaining standards meant staying home.

[Sign up for Love Letter, our weekly email about Modern Love, weddings and relationships.]

And so finally, on the first day of February, I caved. A guy my age with a single, respectable head shot messaged “Good morning” — no verb, no punctuation, but hey, it was saliva-free.

By noon, we had agreed to meet at a coffee spot that was roughly a midway point between our neighborhoods. Meeting in public felt safe. We each had an out.

I was thrown when David — was it even his real name? — suggested we sit and have our coffee. If this was only about hooking up, wouldn’t we just grab cups to go and head back to his place? Maybe he wanted a moment to talk about preferences and confirm the absence of sexually transmitted diseases. Very responsible.

But, no. We talked about our days, segued into conversation about travel, and I batted away a dismissive remark I’d made about an ex.

“That’s for another time,” I said. As if.

We chatted for a full hour until the cafe closed.

“Would you like my number?” he said.

We exchanged phones to enter the data. On the sidewalk, there was a cordial goodbye, a forced hug initiated by me. Then he went back to his place and I went back to mine. Somehow, I had mishandled the hookup.

Sporadic texting followed and, a week later, we met again. It would be a hookup do-over. But this time he made reservations at a trendy Thai restaurant. From what I understood, fancy dinners weren’t part of hooking up.

As I drove there, I reviewed the game plan. Not a date. Not dating. We would have a bite and have sex, that’s all. We hadn’t even gotten through the green papaya salad when I blurted that I was leaving in less than two months. Still, we ate.

The whole meal had been ordered. Despite my intention to keep things light, we drifted from commenting on the spices in the pad thai to talking about past relationships, about what made him passionate about his work and, ever tentatively, about my aspirations on my new path as a writer. Foreplay fodder never entered the mix.

Two days later, my condo sold with the possession date slated for the beginning of April, just as I had planned. David was the first person I texted. I didn’t mean it as a blunt reminder that I was leaving; I simply wanted to share my good news. That same night, I went online and booked a one-way ticket for Stockholm.

And yet our text exchanges escalated, and we continued the weekly get-togethers. A summer fling, I told myself, on the tail end of a Vancouver winter. I had been open. We would both get something out of this. I’d leave Vancouver, shedding some of my bitterness and he’d hopefully have found a glimmer of hope, stepping back into the dating world after a 25-year relationship. We could both enjoy the moment.

On Feb. 14, he texted an image of a heart superimposed over a rainbow background with the message “Happy Valentine’s Day.”

“Happy Friday,” I replied.

Saturday nights became Friday and Saturday nights which became weekends.

In the second week of March, we discovered compatibility on the tennis courts, and I began to share my stress about how the world was getting increasingly edgy about the coronavirus. What if I couldn’t fly to Stockholm? Would it be foolish to move to Toronto and risk falling through a gap in provincial health care coverage?

“You can always stay in my second bedroom,” David said.

The offer felt at once too much and too little. Being roommates wasn’t how I saw a relationship evolving, but what was I doing even thinking about such a thing? I had my plan. I was traveling and then moving. They would have to shut down the borders to stop me. And so they did.

Still, I bargained. This was a radical, two-week measure. They would get control of the virus. And, even if that didn’t happen, I would say my goodbyes on schedule and find an Airbnb a thousand miles north in the Yukon.

I continued to engage my planning brain while feeling all the more foolish. My preparations had been laser focused on paring down rather than hoarding. I had spent months whittling supplies down to the final shakes of a cinnamon tin and a last roll of toilet paper. I could still have my three months of travel, gas station Doritos and the remoteness of the tundra filling in for Swedish cardamom buns and the medieval charm of Old Town in Estonia’s capital.

Seven weeks in, David and I took our first selfie, my hair still relatively tame and a full two weeks before he shaved his head. We walked many miles that day, appreciating the sunshine, the beaches and each other. The time outdoors felt like a special privilege. Would the country soon go into full lockdown, like France and Italy?

With changes in his work schedule, including a big savings without a commute, we began seeing each other daily, taking to walking along the most scenic parts of the city, offering each other an ear and a distraction as David tracked the daily coronavirus numbers in British Columbia and I fretted over packing and where I would wind up in a week after getting booted from my home.

The pressures for staying in Vancouver increased as nether regions shunned potentially contaminated outsiders and the relentless social distancing messages reduced my personal network to David. In a hasty 24-hour period, I signed a six-month lease for a condo in Vancouver’s notoriously tight rental market and reduced my move from more than two thousand miles to less than two.

While the coronavirus mucked up eight months of planning for a major life change, it left something decidedly unplanned in its wake. David and I went on, our fling flung. Through our daily coffees and strolls in favorite parts of the city, we walked a little closer, united in our efforts to keep the rest of the world six feet at bay.

Gregory Walters is a writer living in Vancouver, British Columbia.

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KHN’s ‘What the Health?’: A Little Good News and Some Bad on COVID-19


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For the first time in a long time, there is some good news about the coronavirus pandemic: Although cases continue to climb, fewer people seem to be dying. And there are fewer cases than expected among younger pupils in schools with in-person learning. But the bad news continues as well — including a push for “herd immunity” that could result in the deaths of millions of Americans.

Meanwhile, the Trump administration is doubling down on efforts to allow states to require certain people with low incomes to prove they work, go to school or perform community service in order to keep their Medicaid health benefits. The administration is appealing a federal appeals court ruling to the Supreme Court and just granted Georgia the right to impose a work requirement.

This week’s panelists are Julie Rovner of Kaiser Health News, Margot Sanger-Katz of The New York Times, Paige Winfield Cunningham of The Washington Post and Alice Miranda Ollstein of Politico.

Among the takeaways from this week’s podcast:

  • Opinions seem to be slowly shifting on opening schools around the country. As fall approached, many people were hesitant to send their children back to school because they feared a resurgence of coronavirus infections, but early experiences seem to show that there has been little transmission among young kids in classrooms.
  • Even with good results in those school districts that have reopened, however, the debate about whether schools should be conducting in-person learning is quite polarized. President Donald Trump repeatedly calls for all schools to resume, while groups, such as unions representing teachers and other employees, are more likely to be calling for continued online learning.
  • California, which had a strong resurgence of the virus during the summer, is seeing signs of success in fighting back. The state has been among the most aggressive in shutting down normal activities to reduce case levels. It devised a county-specific method to determine closures, restrictions and reopenings — and it appears to be working.
  • A proposal by some researchers to move the country toward a “herd immunity” plan, in which officials would expect the virus to spread among the general population while also trying to protect the most vulnerable — such as people living in nursing homes — is gaining support among some of Trump’s advisers. Public health advocates are raising alarms because it would likely lead to hundreds of thousands more deaths. They also fear the administration’s focus on restoring normalcy would by default move in this direction.
  • Federal researchers this week announced that nearly 300,000 excess deaths have been recorded this year and much of it is attributed to COVID-19 or the lack of other health care by people who could not or did not seek treatments because they were frightened by the pandemic.
  • With the Senate poised to confirm Amy Coney Barrett, who opposes abortion, to the Supreme Court within days, the fate of the landmark Roe v. Wade decision is in question. If the court overruled that decision, abortion policies would likely fall back to individual states. A recent report on the effects of such a scenario finds that a huge swath of the South and the Midwest would be left without a local facility offering abortion services.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: Cook’s Illustrated’s “The Best Reusable Face Masks,” by Riddley Gemperlein-Schirm, and The Washington Post’s “Consumer Masks Could Soon Come With Labels Saying How Well They Work,” by Yeganeh Torbati and Jessica Contrera

Margot Sanger-Katz: The Hill’s “Republicans: Supreme Court Won’t Toss ObamaCare,” by Peter Sullivan

Paige Winfield Cunningham: The Wall Street Journal’s “Some California Hospitals Refused Covid-19 Transfers for Financial Reasons, State Emails Show,” by Melanie Evans, Alexandra Berzon and Daniela Hernandez

Alice Miranda Ollstein: ProPublica’s “Inside the Fall of the CDC,” by James Bandler, Patricia Callahan, Sebastian Rotella and Kirsten Berg


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Digital Hygiene in the Zoom Era

“If someone asked you before, ‘Do you want to sign up for a world in which your co-workers see inside of your house all the time?’, the answer would probably be ‘no,’” said Kelly Williams Brown, an etiquette expert.

Whelp, here we are. In a recent poll, one in four American workers said they’d been working from home entirely.

The line between our personal and professional spaces may be blurred, but in many ways, the rules of conduct are the same. For starters, it is still not OK to expose your genitalia to your co-workers, like Jeffrey Toobin, a writer for The New Yorker, did in a recent Zoom call. Nor should you look at pornography on your work computer — unless that is literally your job.

With our offices situated steps away from our living rooms and kitchens, it is easy to forget that our work computer is still for work, and that our colleagues are not our roommates.

“When people are sitting in their homes, it’s easy to multitask, to go between work and home,” said Samantha Ettari, the privacy counsel at Kramer Levin Naftalis & Frankel. “It’s tempting to do everything on your work laptop.” But, she said, it’s important to “protect your private space.”

How can I make sure private things don’t become public?

Many of us are now living with grown-up versions of the “I came to school naked” nightmare: Texts to your girlfriend showing in your work chats. The nude self-portrait you painted popping up in a video chat on the wall behind you. Your collection of cannabis cookbooks appearing in the background of a video call with your boss.

“When you do these work video Zooms, you’re letting people into your home, but you’re still in a work environment,” Ms. Ettari said. From a legal perspective, that means you are still protected from discriminatory actions. For example, if you have a disability that your employer did not know about, they cannot retaliate against you based on that information.

Of course, much of what we do not want people to see has nothing to do with legality. Our concerns are more about the impressions we make.

“First of all, turn off your camera when you don’t need it,” said Lorrie Cranor, the director of the CyLab Security and Privacy Institute at Carnegie Mellon University. Or, “get a tiny webcam cover,” said Ms. Brown, the author of “Gracious: A Practical Primer on Charm, Tact and Unsinkable Strength.” “You don’t have to worry about turning your video off. You will truly know that nobody can see you. That’s a lot of security for $8.” Dr. Cranor said a Post-it or a piece of opaque tape works, too.

When your camera is on, Dr. Cranor said, “make sure your computer is facing the wall.” She added: “Other than your cat dropping in, it should be hard for anyone to get into the frame.” Both Dr. Cranor and Ms. Brown suggested making use of virtual backgrounds. (Here is a guide to the dos and don’ts of video meetings.)

Finally, Dr. Cranor said, “never share your whole screen, just share the particular application,” such as Microsoft PowerPoint or Word. If you’re hosting the meeting, you can disable other people’s ability to share their screens.

I had a minor disaster. How do I handle the situation gracefully?

“Make a very quick joke and move right on,” Ms. Brown said. “Say, ‘That was a lot more than I intended to share with you today. I’m sorry about that.’ The less you react to it the less others will react to it.” She noted that, in most cases, people are sympathetic.

“If you have a bra in the background, presumably your co-workers know you wear bras or they could assume you do,” she said. The news will not be a revelation.

Lizzie Post, the great-great-granddaughter of Emily Post and host of the podcast “Awesome Etiquette,” recommended being sincere when apologizing, and letting people know it will not happen again.

How to judge if something you did or experienced is a serious offense? Think of it this way: If it is something that would not fly in your office, it is a no-go in a professional video meeting, conference call, or on your company-issued laptop or phone.

Remember, sexual harassment in the workplace does not need to occur inside of the office. If you experience sexual harassment, including in the digital space, you have options, such as making a criminal complaint, alerting your employer or going to a government agency.

What if it is not you who is being embarrassing, but your colleague?

“It depends on the offense,” Ms. Post said. “If background noise is getting in the way, like the dog is barking, the kids are screeching, the construction is loud, those are things you can say, ‘Jim, do you mind muting for the background noise right now?’ You can be direct and upfront. If Jim doesn’t realize in any capacity that he’s doing embarrassing things, I would try to call or text Jim.”

Ms. Post pointed out that in some cases, your colleague’s actions might be beyond a faux pas. “Like the Jeffrey Toobin incident,” she said. “It’s so egregious, it has to be dealt with then and there. Say, ‘Your camera is on and it shouldn’t be right now, shut it off and we will discuss it later.’ Or ‘we will end the call and discuss it now.’”

When should I mute myself?

“With any group larger than three you should be muted if you’re not talking,” Ms. Brown said. “The less people that are muted, the more that video call makes all of us subtly crazy because we were not designed to hear 10 environments at once.”

Ms. Post said the host of the conversation should take on the responsibility of muting and un-muting people, if they have that capability.

There are accessories that can make the mute-unmute transition simpler. “I got these gamer headphones with a microphone,” Ms. Brown said. “The sound quality is much better for hosting panels. Mine have a little button that can mute and un-mute.” (Here are some recommended from Wirecutter.)

Can I just skip being on camera?

“I think it’s a good idea to at least be present at the beginning of the call,” Ms. Brown said. “If it’s a meeting where you’re not presenting, it’s nice to show up, smile, greet people and once people start talking, turn your camera off.”

After all, once upon a time, many of us used to put on professional costumes and commute to our offices. If you were able to put in that amount of effort, you should probably still be willing to show your face on a screen.

Appearing on video might also be a nice way to support your co-workers. When people have their cameras off and are muted and only one person is visible and speaking, Ms. Brown said, “there’s something eerie about it.” She added: “If it’s a shy co-worker or you want to be able to give body language feedback in real time, that’s a good reason to keep your camera on.”

How do employers monitor what we do on our computers and how much do they know?

Not all employers monitor what you do on the devices they issue. Some will block entire websites, or regulate how, where and when you can use the company-issued device.

Or, “they could be monitoring you by having software on your computer that’s logging your keystrokes or taking a screenshot of what you’re doing,” Dr. Cranor said.

In some cases, all of your work computer’s web requests go through the employer’s proxy system, so whoever is tracking you can see what websites you visited.

Some companies do not just want to know what you are doing during work hours; they want to know where you are doing it, too, and will track where your devices are.

When it comes to newer technologies, like Slack or WhatsApp, Ms. Ettari said that your company might not be able to monitor you in real time, depending on privacy settings or if the applications are loaded onto personal devices.

But that does not guarantee that your communications will remain private, even if they took place on your personal phone. For example, if you send work-related texts on your own phone and are later pulled into a lawsuit related to that work, your records could be required as evidence in court.

On a nonwork-related note, if you are wondering how to keep your personal exchanges safe, consider using messaging apps with end-to-end encryption options, like Signal. For more on that, read the guide to “Communicating With Others” from the Electronic Frontier Foundation, a digital rights organization.

How do I know if I’m being monitored?

“If your employer is monitoring which websites you’re going to, every now and then, when you go to a website, there’s a notice that says you’re not allowed to go there,” Dr. Cranor said. Some employers have an alert set up for each time you log in that will tell you that you’re being watched.

To find out whether your company keeps track of your digital activities, ask the I.T. department or human resources, or check your employee handbook.

But does your employer have to tell you that they’re monitoring you? Not always.

Unions sometimes negotiate contracts that require employers to notify workers that they’re being watched. Some government employees fall under the scope of federal protections that require the same.

But when it comes to most private enterprises, the requirements depend on the state. Search for “electronic monitoring notice law” and your state’s name to see where your state stands.

“Some states have laws requiring employers to provide notice if they’re monitoring your email,” Ms. Ettari said. “A very small handful of states make them provide a daily notice.” Others have no laws around the issue.

What if I’m on my lunch break?

All the experts agreed: When you’re working, treat your at-home office the way you would your regular office. Based on what employer allows, it may be perfectly acceptable to spend a work break reading consumer reviews of hiking boots or texting your friends to plan trivia night.

“Employers and colleagues should adjust expectations and allow a certain amount of grace when it comes to workers’ personal lives bleeding into the workday — whether it’s taking time for child care, virtual schooling, looking after pets or managing our own well-being,” Dena Haritos Tsamitis, the director of the Information Networking Institute at Carnegie Mellon University, wrote in an email.

Ideally you could switch over to a personal computer, phone or tablet during your break, if possible.

After hours, the same theory applies. Take care when using your employer’s devices and inquire what expectations and rules surround your usage of them.

I opened an inappropriate website on my work computer. What do I do?

Close it!

“If you were there for five seconds and closed it and they are not monitoring closely, it won’t trigger any issues probably,” Dr. Cranor said. Consider telling someone what happened. “If you click a link that’s legitimate and it takes you somewhere that’s not legitimate, you should think about reporting it to your tech people,” Ms. Ettari said. “You could have been the victim of a phishing scam that introduced malware into your company system.”

If you’re concerned about how private your browser is, review its security settings, and check out these protective add-ons from the Electronic Frontier Foundation.

While we’re here, someone please explain “incognito mode.”

Dr. Cranor said there is a lot of confusion around “incognito mode.”

“The main thing it gets you is that it doesn’t store the list of websites you’ve visited on your computer,” she said. Incognito mode does not provide a shield of anonymity. “If your employer is tracking you, they’ll still be able to track you if you’re using incognito mode.”

What should I definitely not do on my work devices?

“We are all responsible for setting boundaries between our personal and professional lives,” Dr. Haritos Tsamitis said. She suggested taking broad steps to separate different parts of your life. “This means sticking to scheduled work hours, creating a designated work space, restricting your work email to work-related communication and using your personal email for everything else,” she said.

But generally, you can be sure that some things are no-nos, such as anything that is illegal.

Do not spam people, do not harass anyone, do not download movies and shows illegally, and definitely, “don’t look at pornography,” Dr. Cranor said.

As a general rule of thumb, Dr. Haritos Tsamitis wrote, “behave as though you are physically in the office even when working from home.”

Aunque el destino de ACA es incierto, la inscripción ya comienza. Y hay cosas nuevas

Frente a una pandemia, un desempleo sin precedentes y unos costos inciertos para los tratamientos de COVID-19, las aseguradoras que venden planes médicos en los mercados establecidos por la Ley de Cuidado de Salud a Bajo Precio (ACA) reaccionaron, en general, con sólo aumentos modestos de las primas para 2021.

“Lo que resulta fascinante es que las aseguradoras, en general, no proyectan el impacto de la pandemia en sus primas para 2021”, dijo Sabrina Corlette, profesora del Centro de Reformas de Seguros de Salud de la Universidad de Georgetown, en Washington, D.C

Aunque las tasas finales todavía deben analizarse en todos los estados, quienes estudian el mercado dicen que los aumentos de las primas que han visto, hasta la fecha, serán de un solo dígito, y las reducciones abundan.

Esa es una buena noticia para los más de 10 millones de estadounidenses que compran su propio seguro médico a través de los mercados estatales y el federal.

El mercado federal, que sirve a 36 estados, abre del 1 de noviembre al 15 de diciembre, para la inscripción de 2021. Algunos de los 14 estados y el Distrito de Columbia que operan sus propios mercados tienen períodos de inscripción más largos.

La otra cara de las primas más bajas, es que también puede haber menos subsidios para aquéllos que reciben ayuda para pagarlas.

Estas son algunas cosas que hay que saber sobre la cobertura de 2021:

Podría costar lo mismo que este año, o incluso menos.

A pesar del debate en curso sobre ACA, agravado por una impugnación en la Corte Suprema presentada por 20 estados republicanos y apoyada por la administración Trump, no se prevé que los precios cambien mucho.

“Es el tercer año consecutivo con primas que se mantienen bastante estables”, aseguró Louise Norris, una corredora de seguros en Colorado que escribe sobre las tendencias en el mundo de los seguros. “Hemos visto modestos cambios en las tarifas y la llegada de nuevas aseguradoras”.

A esa relativa estabilidad siguieron altibajos, y los últimos aumentos significativos se produjeron en 2018, como respuesta, en parte, a los recortes en los pagos a las aseguradoras de la administración Trump.

Esos incrementos afectaron a algunos inscritos, particularmente a los que no califican para  subsidios, que están ligados tanto a los ingresos como al costo de las primas. La inscripción en ACA ha disminuido desde su pico en 2016.

Charles Gaba, un desarrollador web que desde finales de 2013 ha rastreado los datos de inscripción en ACA en su sitio web ACASignups.net, sigue los cambios en las primas en base a las solicitudes ante los reguladores estatales. Cada verano, las aseguradoras deben presentar las tarifas para el año siguiente ante los estados, que tienen diferentes poderes de supervisión.

Gaba dijo que aumento promedio solicitado para el próximo año a nivel nacional es del 2,1%. Cuando se fijó en 18 estados para los cuales los reguladores han aprobado las tarifas solicitadas por las aseguradoras, el porcentaje resultó ser menor, un 0,4%.

Un estudio de KFF sobre primas preliminares presentadas este verano tuvo resultados similares: Los cambios en las primas en 2021 serían modestos, sólo unos pocos puntos porcentuales al alza o a la baja. (KHN es un programa editorialmente independiente de KFF.)

Aún así vale la pena comparar precios.

Los actuarios y otros expertos dicen que las primas varían según el estado o la región —incluso según el asegurador— por varias razones, entre ellas el número y el poder relativo de mercado de los aseguradores u hospitales en una zona, lo que afecta a la capacidad de los aseguradores para negociar las tarifas con los proveedores.

Dado que los subsidios están vinculados al plan de referencia de cada región, y que esos costos de las primas pueden haber disminuido, los subsidios también podrían disminuir. (Los planes de referencia son el segundo plan de plata de menor precio en una región).

El cambio al plan de referencia puede ayudar a los consumidores a mantener lo que gastan en primas.

Los inscritos deben actualizar su información financiera, particularmente este año cuando muchos se ven afectados por la reducción de trabajo o la pérdida de empleos. “Podrían ser elegibles para un subsidio mayor”, señaló Myra Simon, directora ejecutiva de políticas comerciales de America’s Health Insurance Plans, el grupo de presión de la industria.

Los inscritos pueden actualizar su información en línea, o llamar a su mercado federal o estatal para solicitar asistencia. Los corredores de seguros también pueden ayudar a las personas a inscribirse en los planes de ACA. Al comprar, los consumidores deben verificar si los médicos y hospitales que desean utilizar están incluidos en la red del plan.

Las primas son sólo una parte de la ecuación. Los consumidores también deben examinar detenidamente los deducibles anuales, porque la contrapartida de optar por una prima de menor costo puede ser que los deducibles anuales sean más altos y deban cumplirse antes de que se active gran parte de la cobertura.

“Animamos a la gente a considerar todas sus opciones”, dijo Simon.

Lo que hay detrás de la variación. 

Los inscritos en algunos estados el próximo año verán disminuidas las primas, según el sitio web de Gaba: Maine, por ejemplo, muestra una caída del 13% en el promedio ponderado de los precios de las primas, mientras que Maryland ha bajado casi un 12%. Al mismo tiempo, el promedio de Indiana ha subido un 10%. Y Kentucky sube un 5%.

Tanto Maine como Maryland atribuyen la disminución a los programas estatales que proporcionan pagos de reaseguro a las aseguradoras de salud para ayudar a compensar las reclamaciones médicas de alto costo.

En Florida, los reguladores dicen que las primas de los seguros aumentarán alrededor de un 3%, mientras que el intercambio estatal en California reporta un aumento de poco más de medio punto porcentual, su menor aumento promedio desde la apertura en 2014. Los funcionarios en California citan factores que incluyen un flujo de inscritos más saludables y una reducción de las tarifas que pagan las aseguradoras.

Otros factores que afectan a las tasas incluyen la intervención de los reguladores estatales para alterar las solicitudes iniciales, junto con una disposición de ACA que exige a las aseguradoras gastar al menos el 80% de los ingresos en atención médica directa. Si las aseguradoras no cumplen con esa norma, deben emitir reembolsos a los asegurados. Muchas aseguradoras ya estaban obligadas a devolver el dinero en 2020 por años anteriores.

La mayoría de las aseguradoras no citaron costos adicionales de tratamiento o pruebas de COVID como factores en el aumento de la tarifa solicitada, explicó Gaba. Sin embargo, incluso aquellas que lo hicieron, las consideraron innecesarias debido a la reducción de gastos al retrasar los pacientes el cuidado electivo durante la primavera y el verano.

De hecho, muchas aseguradoras en el segundo trimestre registraron beneficios récord.

“Algunos pensaron: ‘Vamos a ganar más de lo que pensábamos este año, así que no seamos agresivos con los precios el año que viene’”, explicó Donna Novak, miembro del Comité de Mercados Individuales y de Grupos Pequeños de la Academia Americana de Actuarios.

Un factor menor puede ser la derogación de una tasa pagada por las aseguradoras en las primas. La tasa, que era parte de ACA, fue eliminada permanentemente por la administración de Trump a partir de 2021.

Su elección de aseguradores puede haberse ampliado.

Más aseguradoras, incluyendo UnitedHealth Group, o bien volvieron a ese mercado individual o se expandieron a nuevos condados.

“Las aseguradoras están viendo un beneficio o un potencial en esto”, comentó John Dodd, un corredor de seguros de Columbus y ex presidente de la Asociación de Aseguradores de Salud de Ohio.

Las tarifas de los planes de ACA han bajado en general en todo su estado, dijo, y espera que los agentes estén más ocupados que nunca, simplemente porque hay más ofertas de planes, más dónde elegir, y la gente quiere ayuda.

A las aseguradoras les gusta la forma en que funciona ACA, añadió.

“La gente que sale en televisión diciendo que no funciona, no saben de qué están hablando”, expresó Dodd. “Funciona bien [para las aseguradoras] y cada año mejora”.

Cosas nuevas en algunos estados, incluyendo una opción pública.

Los residentes de Nueva Jersey y Pennsylvania comprarán cobertura en nuevos mercados estatales para el 2021, después de que esos estados se retiraran del healthcare.gov federal, que ahora cubre 36 estados.

Los legisladores de esos estados dijeron que dirigir sus propios mercados les da más control y puede ahorrarles dinero con el tiempo.

En 19 condados del estado de Washington, las aseguradoras ofrecen “planes de opción pública”, que cuentan con todos los beneficios, incluyendo deducibles más bajos, y deben cumplir con estándares de calidad adicionales.

Tal como se había previsto, los planes de opción pública pretendían ser menos costosos, y la legislación vinculaba las tasas de pago a Medicare. Los aseguradores que ofrezcan una opción pública deben atenerse a un tope agregado de pago a médicos, hospitales y otros proveedores de salud en un promedio del 160% de lo que Medicare pagaría por los mismos servicios.

Sin embargo, cuando las tarifas de las primas entraron en vigor, las cinco aseguradoras que ofrecían los planes tenían precios variables. No todas las partes del estado tienen la opción, pero donde la tienen, dos de las aseguradoras de opción pública tienen primas que o bien son más bajas que otros planes en el área o son el plan de más bajo costo que la aseguradora ofrece.

Pero tres son más caros.

El personal del mercado estatal explicó que los precios más altos pueden reflejar varias cosas, desde la dificultad para iniciar el programa durante COVID-19 hasta la falta de incentivos para que los proveedores participen.

También podría ser, simplemente, el nerviosismo normal del primer año.

“Es el primer año. Como con cualquier estrategia de entrada al mercado, la gente es bastante conservadora”, apuntó Michael Marchand, director de marketing del Washington Health Benefit Exchange.

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Why Doesn’t My Mom Realize What Her Vote Means for Me?

I am a recent college graduate. I came out to my mom as transgender once I got a job, moved in with great roommates and felt safer in the world. She was shocked and not nice about it when I first told her. But to her credit, she did her research and came around pretty quickly. She’s even been supportive of me recently. The problem: She intends to vote for political candidates who want to deny me and other trans people basic rights and take back the few legal protections we do have. I’ve tried to explain to her that her votes will harm me, but she doesn’t care. And that hurts. Any advice?

J.L.

I get that your mother’s politics feel like a personal rejection, but try to be patient with her. She sounds like a quick study: fast to recognize that her love for you is greater than her abstract discomfort at having a transgender child. It may take an election cycle (or two) for her to connect that love with political support for other trans people.

That’s how it was with my parents when I came out. And in time, they were great allies. Many parents need a minute to process our identities, just like we do. No promises, though. Because I also have friends whose (inevitably estranged) parents have never been able to connect the dots between the children they love and the rights they deserve.

Remember too: Your mother is not only a mother. She is entitled to her own vote. But for the sake of your relationship, I hope she soon comes to value the equal protection of all people. If there’s a support group nearby, like PFLAG, for parents and friends of L.G.B.T.Q. people, steer her there. She may find comfort and wisdom in that community. (And for the record, I think you’re doing a great job!)

Credit…Christoph Niemann

Divvying Up the Inheritance

In the ’70s, I bought a beautiful photograph by William Eggleston for not much money. My parents admired it, so I gave it to them. Now that my father has died, 10 years after my mother, I assumed the photo would come back to me. It’s appreciated tremendously in value. After their house, it’s probably the most valuable asset in my parents’ estate. But my siblings feel differently. They think they have a right to share in the value of the Eggleston I bought. This strikes me as selfish. You?

H.

The good news? You have exquisite taste in art. And you were generous to your parents. But if you really gave the picture to them, 40-plus years ago, it’s now part of their estate. Unless they bequeathed it to you in their wills, its value will be divided among their beneficiaries like the rest of their personal property.

When we give something away, it’s not ours anymore. If you can afford it, your siblings probably won’t object to your taking the photograph and a smaller portion of your parents’ other assets. An estate lawyer can help you divide things fairly, crediting the value of the photograph against your share of the estate.

To Gather, or Not to Gather?

My grandparents, who are in their 80s, are coming up on a big wedding anniversary. They invited me (four days out) to a celebratory brunch at an indoor restaurant, noting the tables will be “appropriately spaced.” My grandparents have been careful during the pandemic, but they think this is a risk worth taking for the occasion. Other relatives who have not been so vigilant about precautions are also going. I’ve been careful, but I haven’t isolated for two weeks. If I’d known about the party, I would like to have done that to protect my grandparents. What do I do?

ANONYMOUS

There used to be little downside in going to badly conceived parties. Not anymore! Tell your grandparents, in a loving way, that their risk assessment is seriously flawed. Neither you, nor your less careful relatives, should gather with octogenarians for indoor dining while coronavirus cases surge in most states. It’s too dangerous!

Now, this decision may not sit well with your family members. (Physical separation has been one of the true heartaches of this pandemic.) But I’d rather be unpopular and have everyone survive until Christmas. Still, you can’t control anyone’s behavior but yours. Skip the party, with sincere apologies, and offer to celebrate with your grandparents privately, at home, 14 days after all of you have resumed strict safety protocols.

How Sweet …

Since March, my family has been patronizing several local restaurants with weekly takeout orders to help them survive the pandemic. One of them regularly includes free desserts that we didn’t order and don’t want. How do we decline these generous gifts without hurting anyone’s feelings?

POPPY

Use your words, Poppy! Why would a restaurateur resent a regular patron for declining free food? Say, “We really appreciate the free desserts you’ve been sending, but can you leave them out from now on?” You may need to repeat this request when you order. The free desserts may be a general marketing strategy of the grateful restaurant, and not aimed at you specifically.


For help with your awkward situation, send a question to SocialQ@nytimes.com, to Philip Galanes on Facebook or @SocialQPhilip on Twitter.

Análisis: el invierno llega para los bares. Cómo salvarlos. Y salvarnos.

Si realmente queremos detener la propagación del coronavirus a medida que se acerca el invierno y esperamos una vacuna, aquí una idea: el gobierno debería pagar a los bares, y a muchos restaurantes y lugares de eventos, para que cierren durante algunos meses.

Puede sonar radical, pero tiene sentido científico e incluso tiene un precedente político. Pagamos a los agricultores para que no cultiven algunos campos (en teoría, para proteger el medio ambiente), así que ¿por qué no compensar a los propietarios para que cierren sus negocios para proteger la salud pública?

En los últimos nueve meses, hemos aprendido mucho sobre este coronavirus en particular y cómo es más probable que se propague. Los establecimientos que venden alcohol y los lugares de eventos en interiores se han convertido en entornos ideales para la transmisión. Y hay una buena lógica científica para explicar eso.

Los virus no son villanos que persiguen a sus presas; son oportunistas pasivos. Algunos se propagan a través de los alimentos o cuando se dejan en superficies. Otros, como este coronavirus, pueden transmitirse a través de pequeñas gotas que pueden permanecer en el aire después que una persona infectada tose, habla o respira. El virus se disemina con mayor facilidad en interiores y, en particular, en lugares concurridos y mal ventilados.

Más importante aún, las personas pueden infectar mientras sus cuerpos están incubando este virus durante un par de días antes de que desarrollen síntomas, o incluso si nunca los desarrollan. Así que podrías ir a un bar o una boda y beber, besar y bailar hasta desmayarte. Luego te despiertas a la mañana siguiente sintiéndote fatal. Pero no es solo una resaca. Es COVID-19.

Eso explica por qué este virus se contrae en los eventos de “superpropagación”. (Más que la gripe, según los Centros para el Control y Prevención de Enfermedades). Una persona que está eliminando una gran cantidad de virus todavía se siente lo suficientemente bien como para pasar el rato en un espacio estrecho (probablemente interior) donde las personas comparten ruidosamente con otras. Y no pueden usar máscaras porque están bebiendo.

No es de extrañar que las barras de los bares sean un problema.

En el lenguaje científico, el coronavirus es más un esparcidor “heterogéneo” que homogéneo, según Bjarke Frost Nielsen, investigador del Instituto Niels Bohr de la Universidad de Copenhague. Junto con su colega Kim Sneppen, Nielsen utiliza modelos matemáticos para estudiar el patrón de propagación del virus.

Es una propagación heterogénea, lo que significa que tiende a expandirse en brotes similares a explosiones, a menudo centrados en un lugar de reunión o un punto caliente, en vez de “avanzar” por todo el país.

Nielsen me dijo que hay buenas noticias en este hallazgo: “Puedes evitar ciertas reuniones y cerrar algunos lugares, y reducir la mayor parte de la propagación de la enfermedad. Y puedes seguir con el resto de manera bastante normal “.

Cuando sabíamos poco sobre el nuevo coronavirus, el gobierno respondió con un martillo. El Paycheck Protection Program trató a todas las pequeñas empresas por igual, brindándoles préstamos para cerrar siempre que pagaran a sus empleados. Ahora podemos utilizar herramientas más delicadas.

De hecho, los supermercados y las tiendas de ropa, u otras, pueden funcionar de manera segura con máscaras mandatorias, distanciamiento y desinfección. No vamos a estos lugares para charlar y todos podemos usar máscaras en su interior.

Las fábricas y las líneas de montaje pueden proteger a los trabajadores con las mismas normas. Las escuelas pueden hacer lo mismo por los estudiantes.

Incluso las salas de cine pueden funcionar de forma segura con clientes con cubrebocas, sistemas de ventilación de calidad y espacio entre espectadores o grupos de espectadores. Simplemente no podrán vender tantos asientos.

¿Pero los bares y restaurantes que dependen de comedores interiores abarrotados y salas de conciertos con pistas de baile? La mayoría son atractivos exactamente por las razones que los convierten en focos infecciosos para el coronavirus: el hacinamiento, la bebida, la fiesta con personas desconocidas.

Es por eso que algunos dueños de bares y restaurantes dicen que agradecerían un programa que los compensara por cerrar sus puertas este invierno. Peter Kurzweg, que es copropietario de tres de lo que él llama establecimientos de “bebida avanzada” en Pittsburgh que solían tener happy hours animados, dice que “los bares y restaurantes son únicos en el sentido de que, para ser realmente seguros, deben mitigar hasta el punto que ya no es una experiencia de bar o restaurante”.

Hasta ahora, él y sus socios han resistido la pandemia con asientos al aire libre en la acera y en un callejón. Han sacado provecho de los programas de préstamos del gobierno. Han invertido en carpas y calentadores y han animado a los clientes a divertirse al aire libre.

Pero a medida que el otoño se convierte en invierno en Pittsburgh, sabe que esta opción no durará. “Camino diciendo: ‘Se acerca el invierno. Se acerca el invierno “. Tenemos que hacer todo lo posible para sobrevivir”.

Algunos estados han permitido que los restaurantes abran en interiores al 25% o 50% de su capacidad; de hecho, eso está permitido ahora en Pittsburgh. Pero Kurzweg no lo ha hecho porque no cree que sea seguro.

Algunos restaurantes muy espaciosos, y aquellos en climas templados, podrían hacer que funcione. La mayoría no puede.

Los bares y otros locales que dependen de las bebidas no son servicios esenciales. Queremos que sobrevivan para que en el futuro podamos disfrutarlos. Entonces, ¿por qué no pagar a los propietarios que no pueden mantener sus negocios a flote de manera segura este año contaminado con COVID un promedio de sus ingresos mensuales normales para que cierren durante algunos meses?

De esta forma podrían seguir pagándoles a sus empleados y ayudarían a romper la cadena de transmisión del coronavirus. Tal vez podríamos ser creativos y pedirles que usen sus cocinas para ayudar a alimentar a los estadounidenses que pasan hambre.

Con los bares cerrados, aún se puede beber y socializar con grupos más pequeños de personas en casa o al aire libre, cuando el clima lo permita. Puede que no sea tan divertido, pero nada será muy divertido mientras el coronavirus esté presente.

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Californians Asked to Pony Up for Stem Cell Research — Again

SACRAMENTO, Calif. — In an election year dominated by a chaotic presidential race and splashy statewide ballot initiative campaigns, Californians are being asked to weigh in on the value of stem cell research — again.

Proposition 14 would authorize the state to borrow $5.5 billion to keep financing the California Institute for Regenerative Medicine (CIRM), currently the second-largest funder of stem cell research in the world. Factoring in interest payments, the measure could cost the state roughly $7.8 billion over about 30 years, according to an estimate from the nonpartisan state Legislative Analyst’s Office.

In 2004, voters approved Proposition 71, a $3 billion bond, to be repaid with interest over 30 years. The measure got the state agency up and running and was designed to seed research.

During that first campaign, voters were told research funded by the measure could lead to cures for cancer, Alzheimer’s and other devastating diseases, and that the state could reap millions in royalties from new treatments.

Yet most of those ambitions remain unfulfilled.

“I think the initial promises were a little optimistic,” said Kevin McCormack, CIRM’s senior director of public communications, about how quickly research would yield cures. “You can’t rush this kind of work.”

So advocates are back after 16 years for more research money, and to increase the size of the state agency.

Stem cells hold great potential for medicine because of their ability to develop into different types of cells in the body, and to repair and renew tissue.

When the first bond measure was adopted in 2004, the George W. Bush administration refused to fund stem cell research at the national level because of opposition to the use of one kind of stem cell: human embryonic stem cells. They derive from fertilized eggs, which has made them controversial among politicians who oppose abortion.

Federal funding resumed in 2009, and thus far this year the National Institutes of Health has spent about $321 million on human embryonic stem cell research.

But advocates for Proposition 14 say the ability to do that research is still tenuous. In September, Republican lawmakers sent a letter to President Donald Trump urging him to cut off those funds once again.

The funding from California’s original bond measure was used to create the new state institute and fund grants to conduct research at California hospitals and universities for diseases such as blood cancer and kidney failure. The money has paid for 90 clinical trials.

A 2019 report from the University of Southern California concluded the center has contributed about $10.7 billion to the California economy, which includes hiring, construction and attracting more research dollars to the state. CIRM funds more than 56,500 jobs, more than half of which are considered high-paying.

Despite the campaign promises, just two treatments developed with some help from CIRM have been approved by the Food and Drug Administration in the past 13 years, one for leukemia and one for scarring of the bone marrow.

But it’s a bit of a stretch for the institute to take credit for these drugs, said Jeff Sheehy, a CIRM board member who does not support the new bond measure. He said the agency funded the researcher whose lab discovered and developed the drugs, but CIRM holds no rights to those drugs and doesn’t receive royalties from them.

The state has received about $518,000 in revenue from licensing other institute-funded discoveries, such as devices, McCormack said.

McCormack also pointed to some promising stem cell therapies still in clinical trials, such as a treatment that has cured 50 children of severe combined immunodeficiency, a genetic disorder often called “bubble baby” disease, and others that have led to “dramatic” improvements in paralysis and blindness, he said.

The campaigns for both bond measures may be giving people unrealistic expectations and false hope, said Marcy Darnovsky, executive director of the Center for Genetics and Society. “It undermines people’s trust in science,” Darnovsky said. “No one can promise cures, and nobody should.”

Robert Klein, a real estate developer who wrote both ballot measures, disagrees. He was inspired to invest in stem cell research after he lost his youngest son to Type 1 diabetes. He said some of CIRM’s breakthroughs are helping patients right now.

“What are you going to do if this doesn’t pass? Tell those people we’re sorry, but we’re not going to do this?” Klein said. “The thought of other children needlessly dying is unbearable.”

Sheehy, who has served on the agency’s board for 16 years, said he’s proud of the work the institute has done but believes it should be funded through the legislature, not by borrowing more money.

“The promise was that it would pay for itself and it hasn’t,” Sheehy said. “We can’t really afford it, and this is the worst way to pay for it.”

Even if CIRM isn’t turning a profit, some researchers and private companies are benefiting from the public money. Take the company Forty Seven Inc., named after a human protein and co-founded by Irving Weissman, director of Stanford University’s stem cell research program. The state stem cell agency awarded more than $15 million to Forty Seven, and $30 million to Weissman at Stanford for research.

That money fueled research that uncovered a promising treatment for several different cancers. Gilead Sciences, the pharmaceutical giant, bought Forty Seven in 2018 for $4.9 billion. Of that, $21.2 million went back to CIRM to pay back Forty Seven’s research grants, with interest.

“Gilead will make far more than that if it turns out to be lucrative,” said Ameet Sarpatwari, a professor of medicine at Harvard Medical School who studies drug development.

Because this kind of work is both expensive and risky, private companies are reluctant to pay for early research, when scientists have no idea if their work will yield results, let alone profits, Sarpatwari said. So the state pays for this work, and drug companies come in to finance later-stage research once a molecule looks promising — and ultimately reap the profits.

Case in point: Fedratinib, one of the two FDA-approved drugs funded partly by CIRM, can cost about $20,000 for 120 capsules, according to GoodRx.

“We’re socializing the risk of drug development and privatizing the gains,” Sarpatwari said.

On paper, the institute has stricter pricing regulations than the NIH, which does not require that drugs developed with public money are accessible to the public. In California, companies have to submit plans for how uninsured patients will get medicine and are required to sell those medications to the state’s public health programs at a specified rate.

But in practice, the regulations have never really been tested.

Proposition 14 would add a new rule. It would take the money California makes from royalties and use it to help patients afford those treatments. It also benefits drug companies: Whatever revenue the state makes from these drugs will go back to the companies in the form of state-financed patient subsidies.

The measure also would establish a new working group (complete with 15 new, full-time staffers) that would help make clinical trials more affordable for patients by paying for lodging and transportation to the trials.

And it would increase the size of CIRM’s governing board from 29 to 35. This contradicts recommendations from the Institute of Medicine, which suggested shrinking the board to avoid conflicts of interest. Klein argues the extra board positions are necessary to represent different regions and areas of expertise.

Ultimately, California voters must weigh the possibility of new treatments against the cost of financing them with debt.

“We want to develop new therapies, and initiatives like what California is doing are well positioned to do that,” Sarpatwari said. “But at the end of the day, they’re only as good as people being able to access them affordably.”

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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Analysis: Winter Is Coming for Bars. Here’s How to Save Them. And Us.

If we really want to stem the spread of the coronavirus as winter looms and we wait for a vaccine, here’s an idea: The government should pay bars, many restaurants and event venues to close for some months.

That may sound radical, but it makes scientific sense and even has a political precedent. We pay farmers not to cultivate some fields (in theory, at least, to protect the environment), so why not compensate owners to shut their indoor venues (to protect public health)?

In the past nine months, we’ve learned a lot about this particular coronavirus and how it’s most likely to spread. Drinking establishments and indoor event venues have emerged as ideal environments for transmission. And there’s good scientific logic to explain that.

Viruses are not villains who go after their prey; they’re passive opportunists. Some spread through food or when left on surfaces. Others, like this coronavirus, can be transmitted through tiny droplets that can linger in the air after an infected person coughs, talks or breathes. The virus spreads most easily indoors and particularly in crowded, poorly ventilated places.

More important, people can be infectious while their bodies are incubating this virus for a couple of days before they develop symptoms, or even if they never develop symptoms at all. So you might go to a bar or a wedding feeling top-notch, or just maybe a little off. Drink, kiss and dance till you drop. Then you wake up the next morning feeling awful. It’s not just a hangover. It’s COVID-19.

That explains why this virus is exceedingly contracted at “superspreader” events. (More so than the flu, according to the Centers for Disease Control and Prevention.) A person who is shedding a good deal of the virus still feels well enough to hang out in a tight (likely indoor) space where people mingle boisterously with others they don’t know or don’t see often. And they can’t wear masks, because they’re drinking.

No wonder bars are a problem.

In scientific parlance, the coronavirus is more of a “heterogeneous” than a homogeneous spreader, according to Bjarke Frost Nielsen, a researcher at the Niels Bohr Institute at the University of Copenhagen. Along with his colleague Kim Sneppen, he uses mathematical modeling to study the pattern of the spread of the virus. That heterogeneous spread means that it tends to expand in burst-like outbreaks, often centered on a meeting place — a hot spot — rather than oozing slowly across a country.

There is some good news in this finding, Nielsen told me: “You can close down certain types of gatherings and a few types of places and tamp down the majority of the spread of the disease. And you can carry on with the rest as pretty normal.”

Back when we knew little about the novel coronavirus, the government responded with a hammer. The Paycheck Protection Program treated all small businesses equally, providing them with loans to shut down so long as they paid their employees. Now we can use more delicate instruments.

Food and clothing stores — indeed, most any kind of shop — can function safely with masking and attention to distancing and sanitizing. We don’t go to these places to chat, and we can all wear masks inside them. Factories and assembly lines can protect workers with masking and spacing. Schools can do the same for students.

Even movie theaters can arguably safely operate with masked patrons, quality ventilation systems and spacing between viewers or viewing groups. They just won’t be able to sell as many seats.

But bars and restaurants that depend on packed indoor dining and concert halls with dance floors? Most are attractive for exactly the reasons that make them such petri dishes for the coronavirus — the crowding, the drinking, the carousing with new, different people.

That’s why some bar and restaurant owners say they would welcome a program that compensated them to shut their doors this winter. Peter Kurzweg, who co-owns three of what he calls “drink forward” establishments in Pittsburgh that used to have bustling happy hours, says that “bars and restaurants are unique in that to be really safe, they have to mitigate to a point that it’s not a bar or restaurant experience anymore.”

He and his partners have so far weathered the pandemic with outdoor seating on the sidewalk and in an alley. They have taken advantage of government loan programs. They have invested in tents and heaters and encouraged patrons to “lean in” to having fun outside. But as fall turns to winter in Pittsburgh, he knows it won’t last. “I walk around saying, ‘Winter is coming. Winter is coming.’ We need to do everything we can to survive.”

Some states have allowed restaurants to open indoors at 25% or 50% capacity — indeed, that is permitted now in Pittsburgh. But Kurzweg has not done so, because he doesn’t feel it’s safe. Anyway, he added, “No bar or restaurant can make it at that capacity — on the best days in normal years, our profit margin is 10%.”

Some very spacious high-end restaurants, and those in temperate climates, might be able to make it work. Most can’t.

Bars and other venues that depend on drinks are not essential services. We want them to survive so that in the future we can enjoy them. So why not pay owners who cannot keep their businesses afloat safely this COVID-tainted year an average of their normal monthly income to shut down for some months? They would keep paying their employees and help break the chain of coronavirus transmission. Maybe we could get creative and ask them to use their kitchens to help feed Americans who are going hungry.

With bars closed, you could still drink and socialize with smaller groups of people at home or outdoors, when the weather allows it. That may not be quite as much fun, but nothing is much fun while the coronavirus is around.

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Even With ACA’s Fate in Flux, Open Enrollment Starts Soon. Here’s What’s New.

Facing a pandemic, record unemployment and unknown future costs for COVID-19 treatments, health insurers selling Affordable Care Act plans to individuals reacted by lowering rates in some areas and, overall, issuing only modest premium increases for 2021.

“What’s been fascinating is that carriers in general are not projecting much impact from the pandemic for their 2021 premium rates,” said Sabrina Corlette, a research professor at the Center on Health Insurance Reforms at Georgetown University in Washington, D.C.

Although final rates have yet to be analyzed in all states, those who study the market say the premium increases they have seen to date will be in the low single digits — and decreases are not uncommon.

That’s good news for the more than 10 million Americans who purchase their own ACA health insurance through federal and state marketplaces. The federal market, which serves 36 states, opens for 2021 enrollment Nov. 1, with sign-up season ending Dec. 15. Some of the 14 states and the District of Columbia that operate their own markets have longer enrollment periods.

The flip side of flat or declining premiums is that some consumers who qualify for subsidies to help them purchase coverage may also see a reduction in that aid.

Here are a few things to know about 2021 coverage:

It might cost about the same this year — or even less.

Despite the ongoing debate about the ACA — compounded by a Supreme Court challenge brought by 20 Republican states and supported by the Trump administration — enrollment and premium prices are not forecast to shift much.

“It’s the third year in a row with premiums staying pretty stable,” said Louise Norris, an insurance broker in Colorado who follows rates nationwide and writes about insurance trends. “We’ve seen modest rate changes and influx of new insurers.”

That relative stability followed ups and downs, with the last big increases coming in 2018, partly in response to the Trump administration cutting some payments to insurers.

Those increases priced out some enrollees, particularly people who don’t qualify for subsidies, which are tied both to income and the cost of premiums. ACA enrollment has fallen since its peak in 2016.

Charles Gaba, a web developer who has since late 2013 tracked enrollment data in the ACA on his ACASignups.net website, follows premium changes based on filings with state regulators. Each summer, insurers must file their proposed rates for the following year with states, which have varying oversight powers.

Gaba said the average requested increase next year nationwide is 2.1%. When he looked at 18 states for which regulators have approved insurers’ requested rates, the percentage is lower, at 0.4%.

Another study, by KFF, of preliminary premiums filed this summer had similar findings: Premium changes in 2021 would be modest, only a few percentage points up or down. (KHN is an editorially independent program of KFF.)

It’s still worth it to shop around.

Actuaries and other experts say premiums vary by state or region — even by insurer — for a number of reasons, including the number and relative market power of insurers or hospitals in an area, which affects the ability of insurers to negotiate rates with providers.

Because subsidies are tied to each region’s benchmark plan, and those premium costs may have gone down, subsidies also could decrease. (Benchmark plans are the second-lowest-priced silver plan in a region.)

Switching to the benchmark plan can help consumers maintain how much they spend in premiums.

Enrollees should update their financial information, particularly this year when many are affected by work reduction or job losses. “They might be eligible for a bigger” subsidy, said Myra Simon, executive director of commercial policies for America’s Health Insurance Plans, the industry lobbying group.

Enrollees can update their information online, or call their federal or state marketplace for assistance. Insurance brokers, too, can aid people in signing up for ACA plans. When shopping, consumers should check whether the doctors and hospitals they want to use are included in the plan’s network.

Premiums are just one part of the equation. Consumers should also look closely at annual deductibles, because the trade-off of going with a lower-cost premium may well be higher annual deductibles that must be met before much of the coverage kicks in.

“We encourage people to consider all their options,” said Simon.

What’s behind the variation.

Enrollees in some states next year will see premium decreases, according to Gaba’s website: Maine, for example, shows a 13% drop in weighted average premium prices, while Maryland’s is down almost 12%. At the same time, Indiana’s average is up 10%. And Kentucky is up 5%.

Both Maine and Maryland attribute the decrease to state programs that provide reinsurance payments to health insurers to help offset high-cost medical claims.

In Florida, regulators say insurance premiums will rise about 3%, while the state exchange in California is reporting just over a half-percent increase, its lowest average increase since opening in 2014. Officials in California cite factors that include an influx of healthier enrollees and a reduction in fees that insurers pay.

Other factors affecting rates include how much state regulators step in to alter initial rate filings, along with a provision of the ACA that requires insurers to spend at least 80% of revenue on direct medical care. If insurers don’t meet that standard, they must issue rebates to policyholders. Many insurers were already on the hook to return money in 2020 for previous years.

Most insurers did not cite additional COVID treatment or testing costs as factors in their requested rate increase, Gaba said. Even those that did, however, mainly found them unnecessary because of reduced expenditures resulting from patients delaying elective care during the spring and summer.

Indeed, many insurers in the second quarter posted record profits.

“Some of them thought, ‘We’re going to make more than we thought this year in profits, so let’s not be aggressive with pricing next year,’” said Donna Novak, a member of the American Academy of Actuaries’ Individual and Small Group Markets Committee.

A smaller factor may be the repeal of a fee paid by insurers on premiums. Part of the ACA, the fee was permanently eliminated by the Trump administration effective for 2021.

Your choice of insurers may have widened.

More insurers, including UnitedHealth Group, either stepped back into that individual market or expanded into new counties.

“Insurers are seeing a profit or potential for it,” said John Dodd, an insurance broker in Columbus and past president of the Ohio Association of Health Underwriters.

Rates are down in general across his state for ACA plans, he said, and he expects agents to be busier than ever, simply because there are more plan offerings and choices to make and people want help.

Insurers, he said, like the way the ACA is working.

“People on TV who say it’s not working, they don’t know what they’re talking about,” said Dodd. “It’s working well [for insurers] and every year it gets better.”

New stuff in some states, including a public option.

Residents of New Jersey and Pennsylvania will buy coverage from new state-based marketplaces for 2021, after those states pulled out of the federal healthcare.gov, which now covers 36 states.

Lawmakers in those states said running their own marketplaces gives them more control and may save them money over time.

In 19 Washington state counties, insurers are offering “public option plans,” which have all the standard benefits, including lower deductibles, and must meet additional quality standards.

As envisioned, the public option plans aimed to be less expensive, with the legislation tying payment rates to Medicare. Insurers offering a public option must stick to an aggregate cap of paying doctors, hospitals and other medical providers an average of 160% of what Medicare would pay for the same services.

When the premium rates came in, however, the five insurers offering the plans had varying prices. Not all parts of the state have the option, but where they do, two of the public option insurers have premiums that are either lower than other plans in the area or are the lowest-cost plan the insurer offers.

But three are more expensive.

The state’s marketplace staff said the higher prices may reflect a number of things, from difficulty getting the program started during COVID-19 to a lack of incentives to get providers to participate.

It could also just be normal first-year jitters.

“It’s Year One. As with any market entry strategy, people are pretty conservative,” said Michael Marchand, chief marketing officer of the Washington Health Benefit Exchange.

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Biden’s Big Health Agenda Won’t Be Easy to Achieve

If Joe Biden wins the presidency in November, health is likely to play a high-profile role in his agenda. Just probably not in the way he or anyone else might have predicted.

Barring something truly unforeseen, it’s fairly certain that on Jan. 20 the U.S. will still be in the grip of the coronavirus pandemic — and the economic dislocation it has caused. Coincidentally, that would put a new President Biden in much the same place as President Barack Obama at his inauguration in 2009: a Democratic administration replacing a Republican one in the midst of a national crisis.

Obama had only a financial crisis to deal with. Still, Biden would have a couple of advantages his Democratic predecessor lacked, including the fact that, as vice president, he helped guide the country through that financial meltdown. He’s also had time to plan how to address the crisis, which was not the case in 2009, when the economy was in freefall just as the new administration was taking office.

But like Obama before him, Biden will face a long must-do list on taking office. He will have to tackle the pandemic and economic crisis before he can turn to some of the big health changes he’s promised, such as expanding the reach of the Affordable Care Act, creating a “public option” that would allow every American to enroll in a government-sponsored plan and lowering the eligibility age for Medicare from 65 to 60.

And even if Democrats do retake the Senate majority and keep control of the House, it is unlikely the majority in either chamber will be as large as in 2009, when Obama had 60 Senate votes.

Still, no matter what the partisan makeup of Congress, “priority one is to get the COVID response going,” said Len Nichols, a professor of health policy at George Mason University.

Biden’s COVID plan includes taking major responsibility for the pandemic back from the states. His federal response would include more money for, and coordination of, testing and contact tracing; ensuring adequate protective equipment for health professionals; and assuring the public that new treatments and vaccines will be based on science, not politics.

In an updated version of his plan, Biden has also promised that one of his first calls if he is elected will be to Dr. Anthony Fauci, the government’s top infectious disease expert, who has been derided by President Donald Trump. “Dr. Fauci will have full access to the Oval Office and an uncensored platform to speak directly to the American people — whether delivering good news or bad,” says Biden’s website.

Biden’s COVID plan also addresses the economy — including calls for emergency paid leave for workers dislocated by the pandemic and more financial aid for workers, families and small businesses.

“If we’ve learned anything, it is that the health sector and the economy are not two separate spheres. They are connected,” said Nichols. “I think health care and the economy are complementary and will be for the foreseeable future.”

Assuming Biden gets beyond the pandemic and recession, he could move onto some of his bigger health promises, including expanding eligibility for Medicare, creating a “public option” health plan and boosting premium subsidies for the ACA.

Biden took heat throughout the primaries for his “moderate” approach to improving health insurance access and costs, compared with the “Medicare for All” plans for a government-run system supported by his top rivals, Sens. Bernie Sanders (I-Vt.) and Elizabeth Warren (D-Mass.). But that doesn’t mean his far less sweeping approach would be easy to get through Congress.

“There’s a really big difference when you’re running the government than when you’re running for office,” said Dan Mendelson, a former Clinton administration health official and founder of the health consulting firm Avalere Health.

Many of Biden’s proposals, including a public option and larger subsidies to help low- and middle-income people pay for insurance, are the very things that an overwhelmingly Democratic Congress could not pass as part of the original Affordable Care Act in 2010. Conservative Democratic senators objected to the plan.

“We pushed,” Obama said in a recent interview on the podcast “Pod Save America,” talking about the public option. “I needed 60 votes to get it through the Senate. Joe Lieberman, Ben Nelson and a couple others said, ‘I’m not voting for a public option.’”

Mendelson said another big obstacle is that for all the detail Biden has in his health plan, concepts like the public option “are not well-defined, and there are many different theories of what it should be and where it should be fielded. There’s no common vision about what it really means.”

The same thing is true, he added, for something that seems as simple as reducing the Medicare eligibility age. “More than half these people have commercial insurance,” he said. “What will happen to them?”

Grace-Marie Turner, of the conservative Galen Institute, suggested Biden — or Trump, if he’s reelected — might be better served by pursuing one of the more bipartisan health issues that already have broad support from the public, like prescription drug prices or “surprise” medical bills patients receive after getting care from a doctor outside their insurance network while being treated at an in-network facility. “It would be a big statement,” she said. “Whoever wins would then have the wind at their back.”

But even those issues have a way of getting complicated. Both Democrats and Republicans say they want to bring down drug prices, but Republicans are vehemently against one of the Democrats’ preferred ways of doing that: by allowing Medicare to negotiate with drugmakers. And surprise medical billing has so far defied efforts to fix it, as Congress seems unable to choose between health insurers and health providers, who each want the other to bear the additional costs.

As always, even when health is at the top of the agenda, it proves difficult to address.

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At 12, She’s a Covid ‘Long Hauler’

In early March, when coronavirus testing was still scarce, Maggie Flannery, a Manhattan sixth-grader, and both her parents fell ill with the symptoms of Covid-19. After three weeks, her parents recovered. Maggie also seemed to get better, but only briefly before suffering a relapse that left her debilitated.

“It felt like an elephant sitting on my chest,” Maggie said. “It was hard to take a deep breath, I was nauseous all the time, I didn’t want to eat, I was very light-headed when I stood up or even just lying down.” She also experienced joint pain and severe fatigue.

At first, specialists suggested Maggie’s symptoms might be psychological, in part because she showed no sign of heart or lung damage. She also tested negative for both the coronavirus itself and for antibodies to it. But viral tests taken long after the initial infection are generally negative, and antibody tests are frequently inaccurate.

“They didn’t know anything about ‘long-Covid’ at that point,” said Amy Wilson, Maggie’s mother. “They said it was anxiety. I was pretty sure that wasn’t true”

Maggie’s pediatrician, Dr. Amy DeMattia, has since confirmed the Covid-19 diagnosis, based on the child’s clinical history and the fact that both her parents tested positive for coronavirus antibodies.

More than seven months into the coronavirus pandemic, it has become increasingly apparent that many patients with both severe and mild illness do not fully recover. Weeks and months after exposure, these Covid “long-haulers,” as they have been called, continue experiencing a range of symptoms, including exhaustion, dizziness, shortness of breath and cognitive impairments. Children are generally at significantly less risk than older people for serious complications and death from Covid-19, but the long-term impacts of infection on them, if any, have been especially unclear.

Although doctors recognize that a small number of children have suffered a rare inflammatory syndrome shortly after infection, there is little reliable information about how many who get Covid-19 have prolonged complaints like Maggie Flannery. That could change as the proportion of children who are infected rises.

According to the American Academy of Pediatrics, children represented 10.9 percent of reported cases nationwide as of mid-October, up from just 2.2 percent in April.

Dr. Richard Besser, a pediatrician and chief executive of the Robert Wood Johnson Foundation, which focuses on health policy, said parents can be reassured by the data on children’s reduced overall risk. But he noted that much remains unknown about coronavirus infection and its medical consequences, including among children, and that continued vigilance is warranted.

“With schools reopening, we’re likely to see more infections in children,” he said. “We need to make sure we’re doing the studies to understand the short, medium and long-term effects.”

To manage her condition, Maggie, who is 12, must limit her activities. Although she has been able to attend socially distanced in-person classes at her small private school on the Upper West Side, she no longer walks the 15 blocks there and back. She has trouble concentrating, so homework takes a lot longer. She has stopped attending online ballet classes. Before the pandemic, she went to four ballet classes a week.

“Some days are a lot better than others,” said Maggie. “If I do too much on the good days, I feel a lot worse on the next day or next couple of days, and some days I can’t do anything if it’s a bad day.” She has felt a slight improvement over time, she said.

Maggie with her mother, Amy Wilson. “They didn’t know anything about ‘long-Covid’ at that point,” said Ms. Wilson. “They said it was anxiety. I was pretty sure that wasn’t true.”
Maggie with her mother, Amy Wilson. “They didn’t know anything about ‘long-Covid’ at that point,” said Ms. Wilson. “They said it was anxiety. I was pretty sure that wasn’t true.”Credit…Brittainy Newman for The New York Times

As with Maggie, 19-year-old Chris Wilhelm and his parents got sick around the same time. In their case, it was in June, when viral tests were more available. All three of them tested positive. Only Chris, a rising sophomore at Johns Hopkins and a member of the cross-country and track and field teams, did not get better.

Since he did not initially know about the possibility of chronic symptoms, Chris said, he was “confused” and “shocked” about his condition. The first doctors he consulted told him the symptoms would fade, he said.

“For a while it was just, ‘We need to wait a bit longer, it will just get better with time,’” he said. “Everyone was giving me this magic number, like the 12-week mark is when all your respiratory issues are supposed to go away. We hit that weeks ago, and there’s really not any improvement.”

Chris recently consulted with Dr. Peter Rowe, a professor of pediatrics at Johns Hopkins who specializes in chronic and debilitating conditions like myalgic encephalomyelitis/chronic fatigue syndrome, which is often triggered by a viral illness and has no approved drug treatments. Dr. Rowe determined that Chris has the heart-racing condition known as postural orthostatic tachycardia syndrome, or POTS, which can occur after viral infections and limits the ability to carry out day-to-day activities.

“He had been capable of training 60 and 70 miles a week as a runner,” said Dr. Rowe, adding that some of the symptoms and the “really severe impairment” that Chris and many other long-haulers suffer from are characteristic of ME/CFS.

Under Dr. Rowe’s direction, Chris has been trying different medications in an effort to alleviate the symptoms.

In Baltimore, the Kennedy Krieger Institute, a treatment facility for children with neurological and other chronic disabilities, is offering multidisciplinary services for those under 21 who continue to experience challenges after Covid-19. So far the institute has seen only one patient, said Dr. Melissa Trovato, the institute’s interim medical director of rehabilitation.

With infections on the rise, Dr. Trovato said she thought it was “quite possible” the clinic will see more patients with persistent symptoms in the coming months. Because of the perception that Covid-19 is rare in kids, she said, parents might not associate a mild illness and subsequent effects, like a loss of energy, with the coronavirus.

“It might take more time for family to pick up on it,” she said. “From a pediatric perspective there probably is more that we’re going to find out, as more children” with “prolonged symptoms come forward and get seen.”

Ziah McKinney-Taylor, a dancer and birth doula in Atlanta, never doubted that her 14-year-old daughter, Ava, was suffering from the lingering effects of Covid-19, even though she tested negative for both the virus and antibodies. Before Ava got sick in March, said Ms. McKinney-Taylor, she was a “super-energetic kid” who took dancing and aikido lessons five days a week. That has changed. “She has never really gotten her energy back, she is always sleeping and napping,” she said.

Ava herself rejected as “ridiculous” the suggestion from some doctors that her exhaustion might be related to the stresses of life under quarantine. “Like, ‘You’re just not getting to do your normal activities,’” she said. “I’m a very active person, this couldn’t just be, ‘Oh, I’m sad that my friends are gone.’”

Like other families confronting similar uncertainties, Ms. McKinney-Taylor and her daughter are feeling their way forward amid the unknowns of the disease. “It is very scary as a parent to not know how to prepare yourself and protect your child, other than read lots of articles and be on a Slack group,” she said, referring to the Body Politic Covid-19 online support community.

Under the circumstances, Ava said it can be tough to maintain her spirits. “It’s a little hard to have hope right now,” she said. “We don’t know if this will be a lifelong thing, if this will last a year, or two years or five years. So the future is not looking too bright for me personally.”