Tagged COVID-19

California Hospitals Face Surge With Proven Fixes And Some Hail Marys

California’s hospitals thought they were ready for the next big disaster.

They’ve retrofitted their buildings to withstand a major earthquake and  whisked patients out of danger during deadly wildfires. They’ve kept patients alive with backup generators amid sweeping power shutoffs and trained their staff to thwart would-be shooters.

But nothing has prepared them for a crisis of the magnitude facing hospitals today.

“We’re in a battle with an unseen enemy, and we have to be fully mobilized in a way that’s never been seen in our careers,” said Dr. Stephen Parodi, an infectious disease expert for Kaiser Permanente in California. (Kaiser Health News, which produces California Healthline, is not affiliated with Kaiser Permanente.)

As California enters the most critical period in the state’s battle against COVID-19, the state’s 416 hospitals — big and small, public and private — are scrambling to build the capacity needed for an onslaught of critically ill patients.

Hospitals from Los Angeles to San Jose are already seeing a steady increase in patients infected by the virus, and so far, hospital officials say they have enough space to treat them. But they also issued a dire warning: What happens over the next four to six weeks will determine whether the experience of California overall looks more like that of New York, which has seen an explosion of hospitalizations and deaths, or like that of the San Francisco Bay Area, which has so far managed to prevent a major spike in new infections, hospitalizations and death.

Some of their preparations share common themes: Postpone elective surgeries. Make greater use of telemedicine to limit face-to-face contact. Erect tents outside to care for less critical patients. Add beds — hospital by hospital, a few dozen at a time — to spaces like cafeterias, operating rooms and decommissioned wings.

But by necessity — because of shortages of testing, ventilators, personal protective equipment and even doctors and nurses — they’re also trying creative and sometimes untried strategies to bolster their readiness and increase their capacity.

In San Diego, hospitals may use college dormitories as alternative care sites. A large public hospital in Los Angeles is turning to 3D printing to manufacture ventilator parts. And in hard-hit Santa Clara County, with a population of nearly 2 million, public and private hospitals have joined forces to alleviate pressure on local hospitals by caring for patients at the Santa Clara Convention Center.

Yet some hospitals acknowledge that, despite their efforts, they may end up having to park patients in hallways.

“The need in this pandemic is so different and so extraordinary and so big that a hospital’s typical surge plan will be insufficient for what we’re dealing with in this state and across the nation,” said Carmela Coyle, president and CEO of the California Hospital Association.

Across the U.S., more than 213,000 cases of COVID-19 have been confirmed, and at least 4,750 people have died. California accounts for more than 9,400 cases and at least 199 deaths.

Health officials and hospital administrators are singling out April as the most consequential month in California’s effort to combat a steep increase in new infections. State Health and Human Services Secretary Mark Ghaly said Wednesday that the number of hospitalizations is expected to peak in mid-May.

Gov. Gavin Newsom said there were 1,855 COVID-19 cases in hospitals Wednesday, a number that had tripled in six days, and 774 patients in critical care. By mid-May, the number of critical care patients is expected to climb to 27,000, he said.

Newsom said the state needs nearly 70,000 more hospital beds, bringing its overall capacity to more than 140,000 — both inside hospitals and also at alternative care sites like convention centers. The state also needs 10,000 more ventilators than it normally has to aid the crush of patients needing help to breathe, he said, and so far has acquired fewer than half.

Newsom and state health officials worked with the Trump administration to bring a naval hospital ship to the Port of Los Angeles, where it is already treating patients not infected with the novel coronavirus. The state is working with the Army Corps of Engineers to deploy eight mobile field hospitals, including one in Santa Clara County. And it is bringing hospitals back online that were shuttered or slated to close, including one each in Daly City, Los Angeles, Long Beach and Costa Mesa.

The governor is also drafting a plan to make greater use of hotels and motels and nursing homes to house patients, if needed.

But the size of the surge that hits hospitals depends on how well the public follows social distancing and stay-at-home orders, said Newsom and hospital administrators. “This is not just about health care providers caring for the sick,” said Dr. Steve Lockhart, the chief medical officer of Sutter Health, which has 22 hospitals across Northern California.

While hospitals welcomed the state assistance, they’re also undertaking dramatic measures to prepare on their own.

“I’m genuinely very worried, and it scares me that so many people are still out there doing business as usual,” said Chris Van Gorder, CEO of Scripps Health, a system with five major hospitals in San Diego County. “It wouldn’t take a lot to overwhelm us.”

Internal projections show the hospital system could need 8,000 beds by June, he said. It has 1,200.

In addition to taking precautions to protect its health care workers — such as using baby monitors to observe patients without risking infection — it is working with area colleges to use dorm rooms as hospital rooms for patients with mild cases of COVID-19, among other efforts, he said.

“Honestly, I think we should have been better prepared than we are,” Van Gorder said. “But hospitals cannot take on this burden themselves.”

Van Gorder and other hospital administrators say a continued shortage of COVID-19 tests has hampered their response — because they still don’t know exactly which patients have the virus — as has the chronic underfunding of public health infrastructure.

Kaiser Permanente wants to double the capacity of its 36 California hospitals, Parodi said. It is also working with the garment industry to manufacture face masks, and eyeing hotel rooms for less critical patients.

Harbor-UCLA Medical Center, a 425-bed safety-net hospital in Los Angeles, is working to increase its capacity by 200%, said Dr. Anish Mahajan, the hospital’s chief medical officer.

Harbor-UCLA is using 3D printers to produce ventilator piping equipped to serve two patients per machine. And in March it transformed a new emergency wing into an intensive care unit for COVID-19 patients.

“This was a shocking thing to do,” Mahajan said of the unprecedented move to create extra space.

He said some measures are untested, but hospitals across the state are facing extreme pressure to do whatever they can to meet their greatest needs.

In March, Stanford Hospital in the San Francisco Bay Area launched a massive telemedicine overhaul of its emergency department to reduce the number of employees who interact with patients in person. This is the first time the hospital has used telemedicine like this, said Dr. Ryan Ribeira, an emergency physician who spearheaded the project.

Stanford also did some soul-searching, thinking about which of its staff might be at highest risk if they catch COVID-19, and has assigned them to parts of the hospital with no coronavirus patients or areas dedicated to telemedicine. “These are people that we might have otherwise had to drop off the schedule,” Ribeira said.

Nearby, several San Francisco hospitals that were previously competitors have joined forces to create a dedicated COVID-19 floor at Saint Francis Memorial Hospital with four dozen critical care beds.

The city currently has 1,300 beds, including 200 ICU beds. If the number of patients surges as it has in New York, officials anticipate needing 5,000 additional beds.

But the San Francisco Bay Area hasn’t yet seen the expected surge. UCSF Health had 15 inpatients with COVID-19 Tuesday. Zuckerberg San Francisco General Hospital and Trauma Center had 18 inpatients with the disease Wednesday.

While hospital officials are cautiously optimistic that local and state stay-at-home orders have worked to slow the spread of the virus, they are still preparing for what could be a major increase in admissions.

“The next two weeks is when we’re really going to see the surge,” said San Francisco General CEO Susan Ehrlich. “We’re preparing for the worst but hoping for the best.”

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

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Listen: COVID-19 Stresses Rural Hospitals Even Before They Have A Single Case

KHN Midwest correspondent Lauren Weber appeared on WOSU’s “All Sides with Ann Fisher” out of Columbus, Ohio, to talk about the coronavirus pandemic’s impact on rural hospitals. Weber recently reported on the financial implications for such hospitals even before they handle any COVID-19 cases.

Almost half of the nation’s rural hospitals already operated in the red on a good day. Rural hospital CEOs now warn that some soon may be unable to pay their workers because they’ve had to cancel elective procedures, therapy, tests and other visits that bring in most of their revenue. Despite the recent federal bailout, their doors may close when the community most needs them.

Click here to listen on WOSU’s website.

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Under Pressure, Florida Governor Finally Orders Residents To Stay Home

With pressure mounting from public health officials and political leaders nationwide, Florida Gov. Ron DeSantis on Wednesday reversed course and ordered residents across the state to stay at home to help reduce the toll of the coronavirus pandemic.

The order takes effect at 12:01 a.m. Friday, April 3.

Florida joins more than 30 other states and the District of Columbia in moves that have similarly restricted residents and businesses. DeSantis’ decision came as Texas and Pennsylvania took similar action.

For more than a week, DeSantis said a statewide order was unnecessary because many parts of the state ― particularly large swaths of central and northern Florida — had few if any cases. When asked about the issue Tuesday, the governor said he wasn’t issuing an order because he had not been told by the White House coronavirus task force that an order was necessary.

DeSantis spoke to President Donald Trump about the outbreak before his announcement.

DeSantis said what changed his mind was Trump’s call on Sunday for the national social-distancing guidelines to be extended through April because of mathematical models showing how death tolls would soar if the population did not observe the recommended public health guidelines for staying at home. Trump has not issued a national stay-at-home order.

“That was a signal,” DeSantis said. “It’s a very serious situation.”

Scott Gottlieb, a former Food and Drug Administration commissioner under Trump who has been outspoken on the need for officials to act to quell the outbreak, said in a tweet:

“New actions just announced by Florida’s Governor to implement tougher mitigation will hopefully reduce spread of #COVID19 in state. Florida is also testing much less than other states and needs more screening capacity to keep up with its expanding epidemic.”

Before DeSantis reversed course, Gottlieb said in an interview with CNBC earlier Wednesday that Florida and Texas are “wild card” states that could leave the United States with more deaths from the coronavirus if they don’t take tougher actions.

Many public health experts had strongly criticized Florida officials for allowing large spring-break beach gatherings in mid-March, raising concerns that the parties could be spreading COVID-19, the disease caused by the coronavirus. Even more recently, large beach and sandbar parties in late March have brought condemnation.

DeSantis resisted closing all beaches via a state decree, but most counties in Florida have now done so on their own.

The Florida order is less restrictive than that of some other states. In addition to common exceptions for errands deemed essential, such as grocery shopping and picking up prescriptions, it allows people to still attend religious services at churches and synagogues and take care of relatives and their pets.

The Florida governor had already ordered nightclubs and restaurant dining rooms across the state to close and restricted gatherings of 10 or more people on beaches. The state had already closed all schools.

Several of Florida’s largest cities and counties — including all of South Florida, which on Wednesday afternoon had about 3,900 COVID-19 cases — had earlier ordered residents to stay at home.

Public health and political leaders praised DeSantis’ order Wednesday, although some said he should have acted earlier.

“Thank you, Governor, for making the right call,” said Florida Agriculture Commissioner Nikki Fried, a statewide elected member of the Florida Cabinet. She noted she asked DeSantis to issue the order on March 20 to save lives.

As of Tuesday morning, Florida had about 7,000 confirmed cases of COVID-19, nearly 900 hospitalizations and at least 87 deaths. More than 60% of the cases were in South Florida.

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Listen: Why It Takes So Long To Get COVID-19 Test Results

In this episode of “The Daily Dive,” a news podcast, KHN senior correspondent Julie Appleby and iHeart Radio’s Oscar Ramirez discuss the steps involved in processing coronavirus tests and how these circumstances can lead to lags and variations in the turnaround time the patients face as they wait for results.

For more on this topic, check out Julie’s story.

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Temperature Check: Tips For Tracking A Key Symptom Of Coronavirus Contagion

After I was told I’d been exposed to the novel coronavirus, I tried to follow the best medical advice. I started working from home. I socially isolated. And I “self-monitored” for signs I’d been infected.

Or, at least, I tried to.

COVID-19 symptoms seem pretty clear. The dry cough and difficulty breathing. Fatigue. And the fever.

To track all that, the federal Centers for Disease Control and Prevention recommends that people who may have been exposed take their temperature twice daily. As someone who covers the outbreak, I understand the soundness of this advice. There’s a nationwide shortage of coronavirus diagnostics, so health care providers are trying to reserve tests for people who have been exposed, are symptomatic or are at clear risk of dangerous complications.

What the CDC’s guidelines don’t note: Taking your temperature is surprisingly difficult.

Especially when, like most of my 20-something friends, you don’t own a thermometer. (I do have a candy thermometer, but those aren’t useful here. A meat thermometer wouldn’t be, either.) I called my local CVS. They were sold out. Another friend told me he had checked four stores in our neighborhood and come up empty-handed. My twin brother was able to find one — but he lives in Connecticut, almost 400 miles from me.

When I checked online, I discovered I’d have to wait weeks to months for a thermometer, unless I was willing to shell out at least $50. I was not.

Since I had no symptoms ― I still felt comfortable going out for a run or doing yoga in my kitchen — I decided to wait and watch. It’s been two weeks, officially, and my only symptoms are cabin fever and existential anxiety. The coronavirus seemed a no-show.

But was that the best course of action? And what should people in my situation do?

I did what any health journalist would do. I researched and called the experts.

Their advice was comforting. Splurging on a pricey thermometer isn’t the right move, especially if you aren’t showing symptoms. There are other ways to figure out if you have a fever, or are at risk of COVID-19 complications. And a few principles are worth considering.

The Number Varies

First of all, for people like my brother, who was able to find a thermometer in stock and buy it, or those who actually owned one long before this need arose, the number you’re looking for varies.

We’re taught the average human temperature is 98.6 degrees Fahrenheit. But that isn’t necessarily correct. Research published this year suggests the average human body temperature is a bit lower ― maybe 97.9. It differs from person to person, based on factors like body weight, height, the weather, age or gender.

“Some people are like, ‘Oh, I run a low temperature.’ ‘Oh, I run high.’ That’s right! There is variation,” said Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University.

Generally, keep an eye out for a temperature of 100.5 F or higher. But the timing matters, too. Some people running a fever might not register a high number in the morning but will by afternoon. That’s because people run cooler in the morning, and their temperature peaks in the evening, usually from 4 to 9 p.m., he told me.

If you are taking your temperature twice a day, at least one of those should be done during that evening window — and ideally around the same time every day, to account for daily fluctuation.

Another factor to consider when using oral thermometers, advised Dr. Leigh Vinocur, a Maryland-based physician and spokesperson for the American College of Emergency Physicians: If you’ve just had hot coffee, or water or ice cream, wait a little bit before checking for fever.

The Equipment?

That gets at another question. Are specific kinds of thermometers better than others?

If you can’t find a thermometer, everyone told me ― again, don’t worry. (There are lots of other things to worry about!) But if you have options, you don’t need anything fancy.

High-tech models, like the smart thermometer Kinsa, track and map where people register fevers. This has been touted as a way to help predict the spread of disease. But they’re expensive. When in stock, they retail for between $35 and $69, per the manufacturer’s website.

There are other digital scanning thermometers that use infrared technology to scan someone’s forehead — from a distance! ― and deliver an accurate temperature reading.

These are the kinds used in high-traffic settings like the airport, or before journalists can enter White House press briefings — scenarios in which you don’t want to stick the same thermometer in multiple people’s mouths, spreading germs. When in stock (and again, many are not), those can cost $60-$80. That doesn’t include shipping, if you’re ordering online.

But those high-end devices aren’t necessary, especially at home.

“You don’t have to have the most expensive one. You can get a cheap one,” urged Dr. Brad Uren, an assistant professor and emergency doctor at the University of Michigan. Simple, under-the-tongue thermometers that (normally) retail for less than $10 are more than sufficient.

Actually, scanning devices can be more vulnerable to user error, said Dr. Rob Davidson, an emergency physician in western Michigan. He has seen them misread temperatures as lower than what’s accurate.

In fact, when I was still trying to buy a thermometer, one friend warned me she has seen those lower readings occur at home — a reason she refuses to buy scanning devices now. (She also doesn’t currently have a thermometer.)

Products marketed for children are fine for adults. The only real precaution, doctors told me, is to make sure you properly clean it between uses and among people ― soapy water or sterilizing alcohol will usually do the trick.

Mom Had The Right Idea

But for people like my friends, these are moot points. If we don’t have thermometers and aren’t ready to drop $50 on one, what else can we do?

Don’t sweat the number. A specific temperature is only one of many indications of a fever. People will also have alternating chills and sweats, and body aches. And doctors don’t consider the precise number when deciding whether someone is ill.

“Fever is a yes-no thing, and chills are a big thing,” Davidson told me.

The childhood forehead test may be less precise than a digital reading, but it’s generally accurate in gauging sickness, he added. No wonder my mom relied on it to determine if her kids were well enough to go to school.

Since talking to Davidson, my social isolation partner and I have designated each other as sole “forehead testers” for the duration of this period: an effective way to self-monitor and mitigate germ-spreading from either of us to the rest of the world.

And if you are sick and seem to be registering a high body temperature? Call the doctor. If you’re really worried (or if, like me, you don’t have a primary care doctor), you may have to call the ER instead.

That said, the severe shortage of coronavirus tests and medical supplies — a shortage many worry will soon include hospital beds themselves ― means running a temperature or having a fever won’t get you into the hospital, even if you might have the coronavirus. It probably won’t even qualify you for diagnostic testing.

To register that level of concern, doctors said, you need to experience trouble breathing so bad that you feel winded walking to the mailbox or even to the refrigerator.

If that doesn’t happen, care for yourself at home. Self-isolate. Rest. Drink plenty of fluids, and take acetaminophen. (And my grain-of-salt advice: I swear by the healing powers — or at least comfort capacity ― of Cocoa Puffs and Ritz crackers.)

Otherwise, follow basic infection-control guidelines (which don’t necessarily involve rushing out to the drugstore as soon as a new stock of thermometers is delivered): Wash your hands frequently with soap. Avoid touching your face. Put on your favorite isolation playlist, or some early-season “Gilmore Girls,” and practice your social distancing.

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‘Essential’ Or Not, These Workers Report For Duty

Pauline Lawrence is a home health aide for a 97-year-old man who depends on her.(Heidi de Marco/KHN)

WEST HOLLYWOOD, Calif. — Pauline Lawrence is 63, an age that puts her at increased risk if she contracts COVID-19.

Yet, three days a week, she spends 16 hours with someone at even greater risk: a 97-year-old man who depends on her and two other home health aides to survive.

“Somebody has to take care of him,” said Lawrence, an immigrant from Jamaica who lives with her 30-year-old son in a South Los Angeles apartment. “I will stand up to do what I have to do to help.”

Under California’s statewide stay-at-home order that is intended to stem the spread of the novel coronavirus — as well as similar orders issued by cities and counties — many businesses must shut down completely. More than 30 governors have issued similar orders for their states.

But the orders allow “essential” businesses to remain open and “essential” workers to stay on the job.

Who’s considered “essential”? For starters, health care workers, law enforcement personnel, plumbers and grocery store clerks. But many workers dubbed essential are not as obvious, including cannabis dispensary and entertainment industry employees under California’s statewide order, and gardeners and landscapers under the Los Angeles County order.

Among the people who continue to work without the luxury of working from home are a high percentage of low-wage earners, those who earn median hourly wages of $10.22, according to a recent national analysis by the Brookings Institution. And among low-wage earners, black and Latino workers are overrepresented compared with their share of the total workforce.

Lawrence cares for Charles Smurr, 97, a retired office manager. Smurr lives alone and depends on three home health aides to help him with his needs, from 7:30 a.m. to 11:30 p.m. every day. “I’m not afraid to keep working,” Lawrence says. “I’m a woman of God.”(Heidi de Marco/KHN)

Lawrence, who wears protective gear during her entire shift, disinfects everything when she enters the two-bedroom apartment and as she works. After she leaves, she says, she does her best to prevent any germs from entering her home. “I take my clothes off and put them in a plastic bag before I enter my house.”(Heidi de Marco/KHN)

Jose Solorio, 56, Ismael Garcia, 33, and Oscar Bravo, 41, are landscapers in Pasadena, California. “We are worried like everyone else, but our risk is lower than if we worked in an office,” Garcia says.(Heidi de Marco/KHN)

 (Heidi de Marco/KHN)

Jose Solorio says he will continue to work as long as he can. Like his co-workers, he is the main provider for his family. “It’s in God’s hands,” he says about the threat of getting sick.(Heidi de Marco/KHN)

Tony Serrato, 34, is a cook at Pie ‘n Burger in Pasadena, where takeout orders keep him busy. His hours were cut when the stay-at-home order went into effect, and he now works 20 hours a week, down from 40. “It’s not enough, but it’s something,” he says.(Heidi de Marco/KHN)

Serrato prepares a burger Thursday. Pie ‘n Burger employs just two workers per shift under the new coronavirus rules: one cook and one person answering the phones. Owner Michael Osborn says the restaurant is doing only about one-third of its regular business and is producing about 120 burgers a day. Osborn had to cut 25 employees when restaurants were ordered closed except for takeout or pickup service. He describes it as the hardest thing he’s ever had to do.(Heidi de Marco/KHN)

Gustavo Rojas, 33, works as an auto mechanic at Homer’s Auto Services in Monrovia, California. Rojas says work is consistent but slower than before. “Everyone needs their car,” he says. Rojas is part of a three-man crew. The mechanics don’t wear masks and only sometimes wear gloves, but Rojas says they wipe down high-touch parts of each car when it arrives at the shop, with a focus on the steering wheel.(Heidi de Marco/KHN)

 (Heidi de Marco/KHN)

 (Heidi de Marco/KHN)

Victoria Garrido, 23, is a sales associate at Get Yok’d Sports Nutrition, a supplement and health food store in Pasadena. Sales have fallen 70% since the stay-at-home orders went into effect, says owner Sarb Derzakarian. With only about 25 customers a day, he says, he doesn’t know how long he can keep the store open.(Heidi de Marco/KHN)

Garrido and other employees disinfect after each customer leaves. Garrido cleans the door handles, credit card machines and anything else the customer has touched. “I want to wear a mask,” says Garrido, “but it’s hard to work like that.”(Heidi de Marco/KHN)

Tommie Ramirez, 29, is a “budtender” at The Pottery, a cannabis dispensary in the Mid-City neighborhood in central Los Angeles. Ramirez wears gloves at work and practices social distancing but worries about bringing the virus home to her elderly parents.(Heidi de Marco/KHN)

Ramirez grabs a cannabis tincture for a customer. The dispensary has taken precautions to keep employees and customers safe, including placing signs around the shop.(Heidi de Marco/KHN)

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

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With Coronavirus Rare In Rural Florida, Experts Dispute Way Forward

JUPITER, Fla. ― Florida Gov. Ron DeSantis has refused to issue a statewide “stay-at-home” order to stem the spread of the novel coronavirus because the disease has not hit many areas of the state, he said.

At least 30 states have issued statewide stay-at-home orders so far. Florida, among eight states with the most COVID-19 cases, is the only one without such an order.

DeSantis’ approach in trying to manage the disease without doing undue harm to the economy mirrors comments from President Donald Trump, who Monday reiterated his belief that a nationwide stay-at-home order is not needed. “There are some parts of the country that are in far deeper trouble than others,” he told reporters. “There are other parts that, frankly, are not in trouble at all.”

But as the outbreak marches across the country, public health officials stress that the lack of testing is masking the true picture of the epidemic, a situation that they argue is playing out in Florida.

As of Tuesday night, 29 of Florida’s 67 counties had 10 or fewer cases of COVID-19, the disease caused by the coronavirus. In 13 largely rural and poor counties — mostly in the northern part of the state between Gainesville and Tallahassee — no cases had been reported to the state health department.

Yet many rural counties have tested fewer than 75 patients in the past two weeks, according to health department data.

Public health experts and emergency management officials disagree on whether a statewide stay-at-home order would make a difference in these rural counties.

Several of Florida’s largest cities and counties — including all of South Florida, which has about 3,900 COVID-19 cases — have ordered people to stay at home. These orders generally make exceptions only for travel to grocery stores, pharmacies, gas stations or other essential errands. People are allowed outside their homes to walk or run but are not allowed to congregate in groups. They also exempt essential workers, including those in health care.

“I would be doing a stay-at-home order” across the state, said Dr. Leslie Beitsch, chairman of the behavioral sciences and social medicine department at Florida State University’s College of Medicine. “It tells people this is serious, and we are doing something unprecedented.”

But in Okeechobee County, an agricultural community with about 40,000 people in the south-central part of the state, Emergency Management Director Mitch Smeykal said, an order would have little benefit.

“The cows still have to be milked twice a day or they are not going to be able to produce any milk,” he said.

He said residents already understand the seriousness of the outbreak, having seen the run on food in area grocery stores and the early departure of thousands of part-time residents to return to their permanent homes.

As of Tuesday night, just 55 people have been tested in the county and no COVID-19 cases had been confirmed.

Smeykal said rural counties are likely not seeing anyone with the virus yet because people already live and work far from neighbors and crowds. But it’s only a matter of time until a positive test emerges, he said.

“We probably do have a case in the county, but it hasn’t presented itself yet,” he said. “We are not going to be spared from this.”

Florida has more than 6,700 cases of COVID-19 and has done about 65,000 tests — far fewer than the tallies in New York and other states. As of Tuesday night, more than 85 people had died and 850 had been hospitalized because of COVID-19 in Florida.

According to the Florida health department, only people who have had close contact with a laboratory-confirmed case of COVID-19 and have a fever, cough and/or shortness of breath can be tested.

On Monday, DeSantis issued a stay-at-home order for residents of South Florida until April 14, saying the action makes sense for the region because of the number of cases concentrated there.

DeSantis has ordered restaurant dining rooms and bars to close and restricted gatherings of more than 10 people across the state. The state has also closed all public schools. DeSantis directed travelers arriving in the state from the New York metro area or Louisiana to self-isolate for 14 days.

Dr. Marissa Levine, a professor of public health and family medicine at the University of South Florida in Tampa, said the paucity of positive test results in many Florida counties gives a false sense of security.

“Until we do more widespread community testing, we won’t really know who has been exposed,” Levine said. From her standpoint, she said, the governor should set restrictions across the state. “From a public health standpoint, there is no question that the earlier you do it the better.”

Florida’s large senior population, the age group hit hardest by COVID-19, is another reason to go to a statewide lockdown, Levine added. A stay-at-home order would signal to people, even in counties with few or no cases, that people need to change their normal behavior.

“When you don’t have such an order in place, I worry people may not be as cautious or [not] go about their hand-washing and social distancing,” Levine said.

In Hendry County, which has four positive COVID-19 cases after administering 63 tests, residents are practicing the same precautions as in urban areas on lockdown, said R.D. Williams, CEO of Hendry Regional Medical Center. The rural community halfway between West Palm Beach and Fort Myers reported its first positive test Sunday.

Williams said he favors DeSantis’ approach because projections on the spread of the outbreak in the region don’t support the need for a shelter-in-place approach statewide.

March and April mark the peak of the harvest season for sugar cane, so hundreds of migrant workers in Hendry County are still going to work.

“Those operations are going full speed,” Williams said. Because those workers are outside, he added, it’s easier for them to practice social distancing than in a production facility.

While rural Florida has not struggled with the coronavirus, if cases escalate, these areas could be hard-pressed to handle an outbreak because of a lack of doctors and hospitals, said Jerne Shapiro, a lecturer in the department of epidemiology at the University of Florida. Many rural residents also lack insurance and may not have a strong understanding of the health system or how to seek help, she said.

“This is going to exacerbate the problems we have in these rural counties where people now are struggling to get seen by a provider,” she noted. “The gap for this underserved population is only going to be magnified.”

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Blood Centers Will Collect Plasma From COVID-19 Survivors In Bid For Treatment

Blood donation centers across the U.S. are ramping up efforts to collect plasma from people who have recovered from COVID-19 in hopes it could be used to save the lives of others infected with the pandemic disease.

Under guidelines released Tuesday by the AABB, an international nonprofit agency focused on transfusion medicine and cellular therapies, dozens of community blood centers nationwide could become a key source for the century-old treatment known as convalescent plasma therapy.

The treatment uses blood products taken from people who have recovered from a viral infection and injects them into those still suffering. The experimental practice was used during the devastating 1918 flu, as well as to treat measles in the 1930s. In recent years, plasma therapy been used to treat victims of Ebola, SARS and H1N1 influenza.

The treatment is not a sure thing.

Studies suggest that using the plasma had some success in reducing symptoms and death in past outbreaks, but its true efficacy has not been proved in rigorous clinical trials. In the current outbreak, anecdotal evidence from China shows that passive antibody therapy appears to help sick patients fight off COVID-19 until they can develop antibodies on their own.

Given there’s no treatment or vaccine for COVID-19, experts say it’s a promising option to try.

“There isn’t anything else out there,” said Dr. Louis Katz, a blood industry expert who is leading the AABB’s working group on convalescent plasma. “There are historical precedents that it may be beneficial and enough early data that it’s safe.”

The new guidelines come a week after the federal Food and Drug Administration authorized the emergency use of convalescent plasma by doctors for individual patients who are critically ill with COVID-19. Houston Methodist Hospital was the first academic medical center to use the therapy. Since Saturday, the hospital has treated two COVID-19 patients with donor plasma, a spokesperson said. Results are pending.

A few sites in the U.S., including the New York Blood Center, started collecting plasma last week. And a few clinical trials have started testing the use of survivor plasma for COVID-19. The American Red Cross has set up a website to collect information about potential plasma donors.

As the AABB and another group, America’s Blood Centers, join the effort, the new rollout could expand the practice exponentially, Katz said.

“This is all medicine on the fly, right?” Katz said. “We don’t have the randomized controlled trials. We’re going to do the best we can.”

At community blood centers, plasma will be drawn from donors with lab-confirmed tests showing that they had COVID-19 — and that they’ve since tested negative for it, or that 28 days has passed since they’ve shown symptoms. Donors will be eligible to provide plasma every 28 days, the guidelines say.

Several academic laboratories and medical companies are racing to roll out tests that use a pinprick of blood to detect infection-fighting antibodies to the virus. At first, it may be difficult for some blood centers to access the tests, Katz said.

In the meantime, the centers will be allowed to harvest plasma from recovered COVID-19 donors, speed it to “very sick individuals as quickly as possible” and then test for antibody titers, or measurements, later, FDA spokesperson Michael Felberbaum said Tuesday.

That will make a huge difference in the potential volume of convalescent plasma collected, Katz said. “Now that we have such an accommodating stance from the agency, we can go whole hog,” he said.

An emergency investigational new drug, or e-IND, authorization is required to transfuse convalescent plasma into patients, but not to collect it from donors or distribute it. The FDA has granted “numerous” requests for emergency INDs and continues to grant them as they are received, Felberbaum noted.

A Seattle-area blood center, Bloodworks Northwest, is working with the National Institutes of Health and the University of Washington to begin collecting plasma from patients who have recovered from COVID-19. Those donations will become part of a research study co-led by Dr. Terry Gernsheimer, a professor of medicine at the UW School of Medicine. They’ll also be logged in a national registry being created to track the outcomes of the plasma therapy, said Dr. Rebecca Haley, medical director of Bloodworks Bio, which produces biological products.

Interest is expected to be high among those who have suffered through the pandemic infection.

Dr. Jon Peters, 66, a family practice physician in Portland, Oregon, tested positive for COVID-19 last week. He’s still at home with a fever and cough, but expects to get back to work when his symptoms subside. He plans to donate plasma as soon as he’s able.

“It’s such a low-risk issue for the person donating it, but it could save a life,” he said. “At this point, they need every option they can get.”

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Public Health

Sheltered At Home, Families Broach End-Of-Life Planning

Long before she contracted COVID-19 at a Kirkland, Washington, nursing home, Barbara Dreyfuss made sure to document the wishes that would govern how she died.

The medical directive she signed last year at the Life Care Center outside Seattle called for no resuscitation if her heart stopped, no machine to help her breathe. The 75-year-old, who suffered from lung disease and heart problems, had been on a ventilator for two weeks in 2016, a grueling experience she didn’t want to repeat.

“Mom’s form said, ‘Do not resuscitate, allow natural death,’” said son Doug Briggs, 54. “That was her choice.”

So after Dreyfuss fell ill in late February, becoming one of the first U.S. patients sickened by the new coronavirus sweeping the globe, her family reluctantly allowed doctors to halt lifesaving treatment in favor of comfort care.

Dreyfuss, a once-vivacious feminist and activist, died March 1, two days before tests formally confirmed she had COVID-19. But her decision to confirm her wishes in advance could serve as an example for growing numbers of individuals and families feeling new urgency to pin down end-of-life preferences and plans.

In the weeks since the coronavirus has surged, sickening nearly 165,000 people in the U.S. and killing more than 3,000 as of Tuesday morning, interest in advance care planning has surged, too. More than 4,000 requests poured in during the week of March 15 for copies of “Five Wishes,” an advance directive planning tool created by the Tallahassee, Florida, nonprofit agency Aging with Dignity. That’s about a tenfold increase in normal volume, said Paul Malley, the group’s president.

“We started hearing from families that they want to be prepared.” said Malley, noting that more than 35 million copies of the living will were already in circulation.

Stephanie Anderson, executive director of Respecting Choices, a Wisconsin-based group that provides evidence-based tools for advance care planning, said her organization put together a free COVID-19 toolkit after seeing a spike in demand.

“We had hundreds of calls and emails saying, ‘We need help having these conversations now,’” she said.

The tools and documents aim to help adults of all ages plan for their medical, personal, emotional and spiritual care at the end of life with a series of thoughtful questions and guides.

Malley said the COVID-19 crisis has spurred interest from two primary groups. The first: people immediately concerned that they or someone they love will contract COVID-19.

“They’re saying, ‘Will we know what Mom or Dad wants?’” Malley said. “They’re motivated by the urgency of a health crisis around the corner.”

New requests also are coming from families sidelined at home by shelter-in-place orders, he said, as they spend relaxed time with loved ones and have more breathing room for such discussions.

“Their family is playing more board games together and catching up on movies,” he said. “Advance care planning is falling into that bucket of that thing people wanted to do when they had time.”

These conversations can be difficult enough during ordinary times, but the crisis has provided an urgent new reason to start talking, said Anderson. “We’re hearing people are really worried,” she said. “I’ve heard the word ‘terrified’ about what’s happening in the country.

It’s more than just filling out a document, Anderson emphasized. The conversations about preferences and values can help provide real relief. “They want somebody to talk about these things,” she added.

Eliciting end-of-life preferences in advance also could help ease the strain on the health care system as doctors grapple with how best to divvy up care amid dwindling medical supplies and equipment.

Dr. Matthew Wynia, a University of Colorado bioethicist and infectious disease doctor, is planning how to triage seriously ill patients when the supply of mechanical ventilators runs short at his medical campus. Understanding — and soliciting — patients’ end-of-life preferences are key, he said.

“We’ve always had the requirement that people get asked about an advance care plan, but now we are taking that incredibly seriously,” he said. “Because we need to know if you get much worse, what would you want?”

One new and potentially controversial question his hospital is considering would ask patients whether they’d be willing to forgo a lifesaving ventilator for someone else in a crisis. “Would you want to get in line for those crucial care resources?” Wynia said. “Or are you the kind of person who would say, ‘I’ve had a good life and I’ll let other people get ahead of me in line’?”

The most “ethically defensible” way to make a triage decision is to ask patients in advance, Wynia said. “By the time you’re asking for volunteers, these people can’t talk to you anymore.”

But some experts worry that asking such a question crosses a line, even during an emergency. Malley balked at the thought of asking COVID-19 patients to weigh their lives against others, fearing it could pressure vulnerable people — the elderly, disabled and others — into decisions they don’t really want.

“I think we shouldn’t resort to coercive questions,” he said. “I don’t think anyone should be made to feel they have a duty to die.”

Even if you’ve made advance care plans in the past, Malley and Wynia emphasized the need to reevaluate them in light of the COVID-19 scare. If you’ve documented your wishes to decline CPR or intubation because of a primary disease, such as cancer, consider whether you still want to forgo such treatment for the novel virus. Similarly, if you’ve opted for full treatment — prolonging life by all measures — make sure you’ve considered the potentially devastating aftermath of mechanical ventilation for COVID-19.

“For this condition, people who need to be on a vent for COVID-19 are staying on it for two weeks or three, and they may have very severe lung disease afterward,” Wynia said.

Indeed, Barbara Dreyfuss’ two-week stint on a ventilator shaped her answer to questions on the medical directive that guided her care, her son said. “Because of what had happened to Mom four years ago, we had already sat around as a family and discussed this,” Briggs said.

That doesn’t mean it was easy, said Meri Dreyfuss, 62, Barbara’s sister, who called stopping active treatment “a hellish decision.” But as the infection in her lungs worsened, Barbara Dreyfuss was clearly in pain. “I was like, ‘Oh, my God, I can’t stand the thought of her suffering,’” Meri Dreyfuss recalled.

Late on the evening of March 1, Briggs was with his mother in her isolation room. Nurses asked him to step out because he had exceeded the allowed contact time. But when he looked back, monitors showed that his mother’s vital signs were dropping fast.

Nurses allowed him to rush back into the room. Dressed in a hospital gown, mask and gloves, his cellphone wrapped in a plastic bag, Briggs quickly turned on the ’60s music his mother loved. Nurses had increased doses of drugs to decrease her air hunger and anxiety.

“Somewhere between ‘Stand by Me’ and ‘Here, There and Everywhere,’ my mom passed away,” he said.

At the center of a global crisis, Dreyfuss’ earlier decision allowed her to have control over how she died.

“It felt like she was peacefully sleeping,” Briggs said. “She just stopped.”

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Aging Public Health

Online Coronavirus Tests Are Just The Latest Iffy Products Marketed To Anxious Consumers

Companies with experience in the “at-home” testing market began announcing in mid-March that they would be offering direct-to-consumer test kits for COVID-19.

With panic running high and tests at hospitals and doctors’ offices hard to come by, the appeal was obvious.

The kits were touted as a way for consumers to manage this difficult situation themselves. No struggle to see the doctor. No calls to the health department. No waiting in line at a drive-thru test site. Instead, consumers could collect their own samples, by either swabbing the throat or cheek or spitting into a cup. The samples would then be mailed back to the companies’ partner laboratories, which would test for the coronavirus. Prices ranged from $135 to $181.

But criticism was swift. At-home tests could be skimming the resources needed for lab-based tests. There is also the possibility of people collecting their samples incorrectly and questions about follow-up care.

Not to mention the risk of inaccurate results.

The Food and Drug Administration responded with a March 20 press release, which stated that the FDA had not authorized any test “that is available to purchase for testing yourself at home for COVID-19.”

At least four companies, Nurx, EverlyWell, Forward and Carbon Health, have since said they halted sales — though two of the companies still have information about the tests on their websites as of Monday afternoon.

While these companies are legitimate and have a track record for at-home testing and providing medical care, there may be others out there hawking products that do not.

“Some are coming from reputable places and some are not, and that’s hard for the average consumer to tell,” said Eric Topol, director and founder of the Scripps Research Translational Institute.

‘A Lot Of Bunk, Junk And Crank Stuff’

For example, a number of questionable internet reports related to coronavirus tests, vaccines and “miracle” cures already are circulating on social media.

And for scared consumers, it may be difficult to tell the difference. “There’s a lot of bunk, junk and crank stuff out there,” said Arthur Caplan, founding head of the Division of Medical Ethics at NYU School of Medicine in New York City.

The FDA said, for instance, in its March 20 release that it “is beginning to see unauthorized fraudulent test kits that are being marketed to test for COVID-19 in the home.”

One key sign that an at-home kit is a sham is that it will offer consumers an almost immediate test result. “That would not be possible,” said Topol.

Websites touting miracle cures and preventatives ― herbs, teas, essential oils, tinctures and colloidal silver — are prevalent.

QAnon conspiracy theorists on YouTube and Twitter have irresponsibly told viewers to buy and drink “Miracle Mineral Solution,” an industrial bleach product, to ward off the coronavirus. Facebook and Instagram posts claim that marijuana, cocaine or vitamin C can kill or prevent the coronavirus. Salespeople are offering fake N95 masks.

To be clear, the FDA said in 1999 that any products containing colloidal silver are not “safe or effective,” and the National Institutes of Health has said that there are no known benefits to ingesting silver supplements and that it can cause serious side effects. The FDA also warned consumers in 2019 not to buy or ingest “Miracle Mineral Solution” because it can cause severe health effects.

The FDA and the Federal Trade Commission jointly issued warning letters on March 9 to seven companies for selling “products that fraudulently claim to prevent, treat or cure COVID-19.”

One of the warning letters was issued to Jim Bakker, a prominent televangelist, who allowed a guest to promote colloidal silver as a cure for COVID-19, and then sold it during a Feb. 12 broadcast of “The Jim Bakker Show.” The state of Missouri has since filed a lawsuit against Bakker for “falsely promising to consumers that Silver Solution can cure, eliminate, kill or deactivate coronavirus.”

Conservative radio host Alex Jones received a cease-and-desist letter March 12 from the New York attorney general’s office for selling products on his website that contain colloidal silver and claim to treat or cure coronavirus infections.

“There is nothing homeopathic or nutritional that can help you with the virus,” said Caplan. “The idea that people are floating some kind of diagnostic solution or magic or therapy on the internet, it’s all total crap.”

There have also been reports of consumers buying up a fish tank cleaner on eBay that has the same active ingredient as the antimalarial drug chloroquine, which President Donald Trump touted as a possible treatment for COVID-19. An Arizona man recently died after ingesting the fish tank additive, thinking it would prevent the coronavirus.

In an update issued March 24, the FDA said it was aware of people buying the fish tank cleaning product and advised consumers: “Don’t take any form of chloroquine unless it has been prescribed for you by your health care provider and obtained from legitimate sources.”

On March 20, the Department of Justice announced that Attorney General William Barr had asked all U.S. attorneys “to prioritize the investigation and prosecution of Coronavirus-related fraud schemes.”

The DOJ detailed its first enforcement action on March 22 for a COVID-19 fraud against a website called “coronavirusmedicalkit.com,” which claimed to sell coronavirus vaccine kits from the World Health Organization.

Despite all the false promises from these products, it’s important for consumers to remember that there is no FDA-approved treatment or vaccine for the novel coronavirus.

And the best way to prevent the spread of the virus is to practice social distancing and wash your hands, public health experts say.

Regaining A Sense Of Control Is A Motivator

Consumers may be motivated to buy these types of items because they are trying to regain control in an uncertain situation, explained April Thames, an associate professor of psychology at the University of Southern California’s Dornsife College of Letters, Arts and Sciences.

“People have this heightened anxiety, and they are willing to try anything out there that’s a possible treatment or cure,” said Thames. It creates an opening for scam artists “to market products that sound like they are effective.”

Caplan’s ultimate advice to consumers who see coronavirus-related products on the internet?

“Anything online, ignore it.”

Related Topics

Global Health Watch Public Health

Should You Bring Mom Home From Assisted Living During The Pandemic?

Dr. Alison Webb took her 81-year-old father out of assisted living, to live.

Coleen Hubbard took her 85-year-old mother out of independent living, to die.

With the coronavirus moving through facilities that house older adults, families across the country are wondering “Should I bring Mom or Dad home?”

It’s a reasonable question. Most retirement complexes and long-term care facilities are excluding visitors. Older adults are asked to stay in their rooms and are alone for most of the day. Family members might call, but that doesn’t fill the time. Their friends in the facility are also sequestered.

In a matter of weeks, conditions have deteriorated in many of these centers.

At assisted living sites, staff shortages are developing as aides become sick or stay home with children whose schools have closed.

Nursing homes, where seniors go for rehabilitation after a hospital stay or live long term if they’re seriously ill and frail, are being hard hit by the coronavirus. They’re potential petri dishes for infection.

Still, older adults in these settings are being fed and offered other types of assistance. My neighbor’s 80-something parents are at a continuing care community outside Denver. It has started a concierge service for residents who need to order groceries and fill prescriptions. At rehab centers, physical, occupational and speech therapists offer valuable services.

But would be Mom or Dad fare better, even with all due social distancing, in the family home?

Of course, care there would fall squarely on the family’s shoulders, as would the responsibility for buying groceries, cooking, administering medication, doing the laundry and ensuring the environment is free from potential contamination.

Home health care services could lend a hand. But they may not be easy to get because of growing demand, shortages of personal protective equipment and staffing issues.

Another concern in bringing someone home: Some facilities are telling residents that if they leave, even temporarily, they can’t return. That happened to a family in western New York, according to Roxanne Sorensen, a geriatric care manager with Elder Care Solutions of WNY.

When this family took their elderly parents out of an assisted living facility for a brief “stay-with-us” respite, they were told the parents had been discharged and had to be placed on a waiting list before they could return.

Sorensen has a client in her early 70s who’s in rehabilitation at a nursing home after emergency surgery for a life-threatening infection. The facility is on lockdown and her client is feeling trapped and desperate. She wants to go home, but she’s still weak and needs a lot more therapy.

“I’ve told her, stay here, get stronger and when you go home you won’t end up in the hospital or with disabilities that could put you back in a nursing home for the rest of your life,” Sorensen said.

Those in nursing care who have cognitive impairments may become disoriented or agitated if a family moves them from an environment that feels familiar, said Dr. Thomas Cornwell, executive chairman of the Home Centered Care Institute. Some have behavioral issues that can’t be managed at home.

Families with children need to think carefully about bringing an older parent home, especially if he or she has underlying chronic illnesses such as heart, lung or kidney disease, Cornwell said. “Kids, generally, even in the past few weeks, have been exposed to hundreds of others [at school],” he said. “They tend to be vectors of infection.”

Ultimately, every family must weigh and balance the risks. Can they give an older parent enough attention? Do they have the emotional and physical stamina to take this on? What does the parent want? Will the pangs of displacement and disrupted routines be offset by the pleasures of being around adult children and grandchildren?

Dr. Alison Webb, a retired physician, is a single mom raising a 3-year-old and a 7-year-old. Her father, Bob Webb, 81, has mild dementia and had been hospitalized for depression before she asked him to leave assisted living and move into her Seattle home.

“Initially he resisted. He feared change, and he was concerned that his stuff was going to be left behind and he wouldn’t get it back, ever,” Webb said. Even today, Bob talks about going back home to his apartment.

Webb said a geriatrician on a Facebook group for female physicians convinced her it was safer for her father to leave his assisted living center. “’You’ll do a lot better here with the grandkids. You can play games. There’s a big yard. You can do some gardening,’” Webb said she told her dad.

There’s another benefit. Because she’s a physician, Webb said, she hopes “I’ll notice if he’s not doing well and take care of it right away.”

Coleen Hubbard’s mother, Delores, whom she described as “really resilient and really stubborn,” had loved living in a one-bedroom apartment in a Denver senior housing complex for the past decade. In October, Delores was diagnosed with endometrial cancer and decided not to have medical treatment.

“Mom had a lot of surgeries and hospitalizations in her life,” Hubbard said. “She was done dealing with the medical community.”

Every time Hubbard suggested her mother move in with her, Delores refused: She wanted to die in her own apartment. But then, a few weeks ago, serious pain set in and Delores asked the Denver Hospice to begin giving her morphine.

“That’s when I realized that we may be close to the end,” Hubbard said. “And I felt an incredible urgent panic that I had to get her out of there. Things were already starting to close [because of the coronavirus]. I could not fathom that she might be cut off from me.”

Hubbard prepared a room at home and found a small, tinny metal bell that Delores could ring if she needed help. “We made a lot of jokes about Peter Pan and Tinker Bell,” Hubbard remembered. “When she rang the bell, I’d come in and say, ‘Yes, m’lady, what’s happening?’”

Five days after arriving, Delores passed away. “Grieving right now happens in a space of solitude and silence,” Hubbard wrote in a Facebook post. “Sure, there are texts and phone calls, emails and snail mail, but no embraces, no questionable casseroles delivered by neighbors, no gathering of family and friends to share stories and memories.”

Amid the grief is relief that Delores had what she wanted: a death without medical interventions. “I’m pinching myself that we made that happen,” Hubbard said. “And I’m so glad we brought her home.”

Patricia Scott’s story is unfinished. The 101-year-old was living in a retirement community in Castro Valley, California, before her son, Bart Scott, brought her to his house in Santa Rosa, moving her into a spacious in-law apartment.

Asked how she felt about the change, Patricia Scott said, “I’ve never been particularly thrilled with the idea of homogenized residency with a bunch of old farts, of whom I am one.”

Yet, she longs for her two-bedroom apartment: “It’s just that everything is there. I know where crap is. I miss my regular life.”

Bart Scott has four siblings, and they agreed that it was untenable to leave his mother alone during the coronavirus scare. “She is the matriarch of this family,” he said. “There are a lot of people who put a lot of store in her well-being.”

As for potential health threats, Patricia Scott is characteristically sardonic. “I was born in 1918, in the middle of the influenza epidemic,” she said, “and I think there’s a delicious irony that I could very well exit in this one.”

Related Topics

Aging Navigating Aging

More Than 5,000 Surgery Centers Can Now Serve As Makeshift Hospitals During COVID-19 Crisis

The Trump administration cleared the way Monday to immediately use outpatient surgery centers, inpatient rehabilitation hospitals, hotels and even dormitories as makeshift hospitals, health care centers or quarantine sites during the coronavirus crisis.

The Centers for Medicare & Medicaid Services announced it is temporarily waiving a range of rules, thereby allowing doctors to care for more patients.

Hospitals and health systems overwhelmed with COVID-19 patients will be able to transfer people with other medical needs to the nation’s 5,000 outpatient surgery centers, about half of which are affiliated with hospitals. This will give the country thousands of additional hospital beds and operating rooms, some of which have ventilators or anesthesia gas machines that could be repurposed as ventilators.

Outpatient surgery centers will be allowed to treat patients with other critical needs — such as serious injuries, cancer or heart attacks — unrelated to COVID-19, allowing hospitals to conserve scarce resources and reduce the risk of infection to these patients.

Until now, federal regulations allowed outpatient surgery centers to care for patients for a maximum of 24 hours.

“Transferring uninfected patients will help hospital staffs to focus on the most critical COVID-19 patients, maintain infection control protocols, and conserve personal protective equipment,” the agency said in a statement.

Many outpatient surgery centers had closed after being told to halt elective procedures. A coalition of anesthesiologists in recent weeks called for them to stop performing nonessential surgery and assist hospitals.

The waivers “will allow hospitals to save more lives” by performing “surgeries and procedures that can’t wait until the pandemic is over,” said Bill Prentice, CEO the Ambulatory Surgery Center Association, an industry group.

Before the CMS announcement, the California Ambulatory Surgery Association had expressed its willingness to help.

The outpatient centers “want to be part of the solution as the entire healthcare industry must rise to meet this enormous challenge,” said Michelle George, president of the California Ambulatory Surgery Association, in a statement issued Monday morning. “We have valuable resources to lend to this crisis — whether it is staff, space, equipment, supplies or other capabilities. ASCs are coordinating with the public health teams on local and regional levels to identify how their facilities can be utilized most effectively on a case by case basis.”

Advocates who have pushed for surgery centers to assist hospitals praised the move.

“This is a great step in fighting this pandemic,” said Dr. Adam Schlifke, an anesthesiologist and clinical assistant professor at Stanford University in California.

“We recognize that it’s going to be hard,” Schlifke said. “It’s extremely complicated, but we are here to support all the surgery centers that will need to convert as a result of this order.”

The waivers will allow hospitals to hire local physicians and health care providers to address potential surges; transfer critical equipment, including telemedicine equipment, to doctors’ offices; and provide meals and child care for their health care workers.

Hospitals will be able to triage sick patients at community locations, then send them to the most appropriate facility, according to CMS.

“Front-line health care providers need to be able to focus on patient care in the most flexible and innovative ways possible,” said CMS Administrator Seema Verma. “This unprecedented temporary relaxation in regulation will help the health care system deal with patient surges by giving it tools and support to create nontraditional care sites and staff them quickly.”

Even with additional facilities, hospitals and health care systems could run out of staff, especially as health providers become sick with COVID-19. Although surgery centers typically employ their own nurses, they tend to share surgeons with local hospitals.

More than a dozen states and health care associations had requested waivers. The CMS move means that other states will no longer need to apply for waivers.

Texas had taken the lead in recent days, even before the new announcement, by permitting hospitals to use off-site facilities. Texas Gov. Greg Abbott last week signaled his interest in using outpatient surgery centers to expand care by ordering them to tell the state how many ventilators they possess.

Among other sweeping changes:

  • Ambulances will be allowed to transport patients to outpatient surgery centers, community mental health centers, federally qualified health centers, physician’s offices, urgent care facilities and any locations furnishing dialysis services when a dedicated kidney failure treatment center isn’t available. Hospitals will be able to charge for services provided outside their four walls and emergency departments can use telehealth services to evaluate sick people.
  • Physician-owned hospitals can temporarily increase their number of licensed beds, operating rooms and procedure rooms, according to CMS.
  • Instead of going to crowded emergency rooms, patients could go to off-site locations to be evaluated by emergency health care providers using telemedicine. That change will help preserve space in the emergency room for those who need it most. CMS will allow health providers to treat more patients via apps or telephone and bill at the same rate as in-person visits.
  • Physician assistants and nurse practitioners will be allowed to order tests and medications that may have previously required a physician’s order, as long as state law allows it. Also, certified registered nurse anesthetists will no longer have to work under the supervision of a doctor, freeing up physicians to focus more on patients and less on supervising.
  • To reduce the need for patients with health problems unrelated to COVID-19 to go to a doctor’s office or hospital, doctors will be allowed to monitor patients remotely with devices that can measure a patient’s oxygen saturation levels using pulse oximetry.

Health care experts have been suggesting the administration offer such waivers for weeks. The country has “got to muster all reasonable facilities and personnel,” said Arthur Caplan, a bioethics professor at NYU Langone Medical Center. “The best way to ration is to avoid it by stretching resources and sharing.”

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Health Industry Public Health States

COVID-19 Bonanza: Stimulus Hands Health Industry Billions Not Directly Related To Pandemic

The coronavirus stimulus package Congress rushed out last week to help the nation’s hospitals and health care networks hands the industry billions of dollars in windfall subsidies and other spending that has little to do with defeating the COVID-19 pandemic.

The $2 trillion legislation, which President Donald Trump signed Friday, includes more than $100 billion in emergency funds to compensate hospitals and other health care providers for lost revenue and other costs associated with COVID-19. The measure also calls for spending up to $16 billion to replenish the nation’s depleted stockpile of medical gear, such as ventilators, medicines and personal protective equipment, or PPE.

But health care businesses will get billions of dollars in additional funding not directly related to the pandemic, in some cases because Congress agreed to reverse scheduled cuts in the rates paid by Medicaid and Medicare, which the federal government had tried for years to impose.

“Anything that could tangentially be related to the crisis lobbyists tried to get stuffed in this bill ― particularly health-care-related items,” said Steve Ellis, vice president of Taxpayers for Common Sense, a nonpartisan watchdog group. While the stimulus package is “not as big” a “Christmas tree” as some other bills, Ellis said, “I’m sure we’ll find a few baubles and gifts along the way.”

Hospitals have won widespread praise as their doctors and other medical staffs labor under perilous conditions, including shortages of protective gear. And, perhaps not surprisingly, the industry emerged as a big winner in the stimulus negotiations. Not only can hospitals draw on the $100 billion fund to stem their losses and cover other costs, but they will also see a boost in one stream of revenue as Congress overturned some planned rate cuts.

More than 3,000 hospitals that treat outsize numbers of Medicaid or uninsured patients, for instance, will share in an $8 billion windfall through the stimulus provision that reverses cuts in their Medicaid payments for 2020 and 2021.

Separately, hospitals will rake in at least $3 billion more because of a temporary suspension of a 2% cut in Medicare fees, according to the Federation of American Hospitals, which represents more than 1,000 for-profit hospitals and health systems. The infusion of cash also benefits doctors, nursing homes, home health companies and others.

“That’s welcome news during this time of crisis,” said Joanne Cunningham, executive director of the Partnership for Quality Home Healthcare.

Also tucked into the stimulus: a rollback of planned rate cuts to clinical laboratories and some medical equipment suppliers.

At this stage, it is unclear how much these measures will add to the COVID-19 tab ― or if far more stimulus would be required for the health care industry to rebound.

Take the 2% rate cut known as “the sequester.” The Office of Management and Budget expected it would save Medicare $16.2 billion in fiscal 2021. But the stimulus bill rescinds that rate cut from May 1 through the end of this year. As part of the legislation, Congress said it would, in effect, recoup the payments later by adding another year to the sequester. Whether lawmakers will follow through on that is anyone’s guess.

Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association (MGMA), expects the sequester relief to translate to a “huge” financial boost for more than 15,000 medical practices his group represents.

“This would never have been done under any other circumstances,” Gilberg said. “The situation was recognized as dire.”

Dr. Patrice Harris, president of the American Medical Association, said the stimulus offers “needed financial relief to hard-hit workers, health systems and physician practices. At this critical moment, physician practices need significant financial support to sustain themselves and continue to meet the health care needs of all Americans during this time.”

Similarly, American Hospital Association CEO Rick Pollack called the legislation “an important first step forward. But, he added, “more will need to be done to deal with the unprecedented challenge of this virus.”

In a nod to clinical laboratories, which have helped bail out the federal government’s early failure to supply enough COVID-19 tests, the stimulus delayed planned rate cuts in 2021 likely to amount to tens of millions of dollars in revenue. Medicare officials have been at odds with the lab industry for years over rates for lab tests.

While other health care interests praised the bill, the laboratory trade association said it comes up short.

Just before the Senate passed the stimulus bill Wednesday, American Clinical Laboratory Association President Julie Khani slammed Congress for not designating funding to support labs. She said labs were in “an untenable situation, absorbing growing, uncompensated costs for testing specimens with no assurance that they will be appropriately or fairly reimbursed for all the tests they are performing.”

She added a not-so-veiled threat, saying: “If Congress fails to designate essential emergency funding for clinical laboratories to support our efforts, labs will be soon be forced to make difficult decisions about whether they can keep building the [testing] capacity our nation needs.”

The lab association, in a statement to Kaiser Health News, said labs have absorbed “stunning” Medicare reimbursement cuts of as much as 30% for many common tests in recent years.

In public securities filings this year, lab giants Quest Diagnostics Inc. and Laboratory Corp of America Holdings, known as LabCorp, reported they expected rate cuts in 2020 totaling more than $150 million. LabCorp said it supported the views of the lab association. Quest did not respond to a request for comment.

While labs processing COVID-19 tests missed out on direct funding, they could be eligible for some of the $100 billion allocated for hospitals and other providers to cover their losses, congressional aides said.

And the stimulus measure states that even in the event a lab is out-of-network, health plans are expected to pay the price it sets — as long as the lab publishes that price online — or negotiate with the lab.

Given that laws in some states ban surprise billing in particular, this provision seems to favor the labs, said Katie Keith, a Georgetown University law professor and health policy expert. “No one just lets the provider set the price,” she said.

The lab association disputes that, saying that many health plans are expected to pay them less than the $51.50 government recommended for a COVID-19 test.

Just how the $100 billion in health care funding will be distributed and how much oversight will occur is another unknown.

Health and Human Services Secretary Alex Azar has the authority to decide how long the emergency provisions remain in effect. Tracking all that money will be a challenge as well.

Ellis, the taxpayer advocate, noted that no government agency “is ready to handle the rush of extra funding.” He said that the stimulus grants extra resources to inspector general offices to monitor spending.

“There will be waste, there will be abuse,” he said. “It’s about exposing and rooting it out.”

The HHS Office of Inspector General expects to receive $4 million to support this oversight, according to spokesman Donald White.

Some groups aren’t waiting to compete over the $100 billion. The MGMA sent a letter March 27 to Azar and the Centers for Medicare & Medicaid Services chief Seema Verma asking for more direct help. Gilberg noted that some medical practices, such as doctors who perform colonoscopies, have not been able to continue their work.

“Doctors and physician practices are having a lot of trouble right now,” Gilberg said. “They are literally shut down, and they are having financial troubles. Their operations have come to a full halt.”

KHN correspondents Rachana Pradhan and Emmarie Huetteman contributed to this report.

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Already Taxed Health Care Workers Not ‘Immune’ From Layoffs And Less Pay

Just three weeks ago, Dr. Kathryn Davis worried about the coronavirus, but not about how it might affect her group of five OB-GYNs who practice at a suburban hospital outside Boston.

“In medicine we think we’re relatively immune from the economy,” Davis said. “People are always going to get sick; people are always going to need doctors.”

Then, two weeks ago, she watched her practice revenue drop 50% almost overnight after Massachusetts officials told doctors and hospitals to stop performing elective tests and procedures. For Davis, that meant no more non-urgent gynecological visits and screenings.

Late last week, as Davis and her partners absorbed the stunning turn of events, they devised a stopgap plan. The 35 nurses, medical assistants and secretaries they employ would have two options: move from full-time to part-time status or start collecting unemployment. Doctors in the practice would take a substantial pay cut. Davis said she’s hearing from colleagues who may have to permanently close their offices if the focus on crisis-level care continues for months.

“It’s shocking,” she said. “Everyone has been blindsided.”

Atrius Health, the largest independent physician group in Massachusetts, said patient volume is down 75% since mid-March. It is temporarily closing offices, placing many nonclinical employees on furlough and withholding pay for those who remain. The average withholding is 20%, and the company pledges that pay withheld will be returned. The lowest-paid workers, those earning up to $55,000, are exempt.

“What we’re trying to do is piece together a solution to get through the crisis and keep employed as many people as we can,” said Dr. Steven Strongwater, Atrius Health’s CEO.

Atrius cares for 745,000 patients in clinics that often include primary care, specialists, radiology and a pharmacy under one roof.

Strongwater said physician groups must be included when the federal government distributes $100 billion to hospitals from the $2 trillion stimulus package.

It’s not clear if that money will stop the tide of layoffs and lost pay at hospitals as well as in doctor’s offices. A Harvard Medical School physician group will suspend retirement contributions starting April 1.

Beth Israel Lahey Health, the second-largest hospital network in Massachusetts, announced executive pay cuts Monday.

“The suspension of elective procedures and decline in visits to our primary care practices and urgent care centers have resulted in financial challenges,” wrote CEO Dr. Kevin Tabb in an email to employees. Tabb said he would take a 50% salary cut. Other executives and hospital presidents in the system will forgo 20% of their salaries for the next three months.

“Although executive leadership compensation is being reduced, we will never compromise on doing the things that are essential to protect your safety and the safety of our patients,” Tabb told staff.

Dallas-based Steward Health Care has told hospital employees in Massachusetts and eight other states where it operates to expect furloughs focused on nonclinical staff. In a statement, Steward Health Care said it prepared for the pandemic but is experiencing a “seismic financial shock.”

“Elective surgeries are the cornerstone of our hospital system’s operating model — and the negative impact due to the cancellations of these procedures cannot be overstated. In addition, patients are understandably cautious and choosing to defer any nonemergency treatments or routine visits until this crisis has passed.”

Dr. Kaarkuzhali Babu Krishnamurthy, an assistant professor of neurology at Harvard Medical School who studies medical ethics, said employers need to think more carefully about the ethics of asking doctors and nurses to live on less when many are working longer hours and putting the health of their families at risk.

“At a time when health care systems are calling on doctors and nurses to do more, this is not the time to be making it more difficult to do that,” said Krishnamurthy.

There’s talk of redeploying laid-off health care workers to new COVID-19 units opening in shuttered hospitals or to patient overflow sites. Tim Foley, executive vice president for the largest health care union in Massachusetts, 1199SEIU, is promoting the development of a staff registry.

“It is more important, now more than ever, to explore all options to maintain the level of urgent care needed across the state and we look forward to working with all stakeholders to do just that,” Foley said in an email.

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

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Coronavirus Patients Caught In Conflict Between Hospital And Nursing Homes

A wrenching conflict is emerging as the COVID-19 virus storms through U.S. communities: Some patients are falling into a no man’s land between hospitals and nursing homes.

Hospitals need to clear out patients who no longer need acute care. But nursing homes don’t want to take patients discharged from hospitals for fear they’ll bring the coronavirus with them.

“It’s a huge and very difficult issue,” said Cassie Sauer, president of the Washington State Hospital Association, whose members were hit early by the coronavirus.

Each side has legitimate concerns. Hospitals in coronavirus hot spots need to free up beds for the next wave of critically ill patients. They are canceling elective and nonessential procedures. They are also trying to move coronavirus patients out of the hospital as quickly as possible.

The goal is to “allow hospitals to reserve beds for the most severely ill patients by discharging those who are less severely ill to skilled nursing facilities,” Seema Verma, administrator of the Centers for Medicare & Medicaid Services, said a few weeks ago as the federal agency relaxed rules restricting which Medicare patients can receive nursing home care.

Nursing homes are alarmed at the prospect of taking patients who may have coronavirus infections. The consequences could be dire. The first nursing home known to have COVID-19, the Life Care Center in Kirkland, Washington, saw the virus spread like wildfire. It killed 37 people.

“We’re looking at case fatality rates of 30, 40, 50% in nursing homes when coronavirus gets introduced,” said Christopher Laxton, executive director of AMDA — the Society for Post-Acute and Long-Term Care Medicine, which represents nursing home medical directors.

Fears extend to patients with other conditions, such as strokes or heart attacks, who’ve been in the hospital and do not have COVID-19 symptoms but could harbor the virus.

In its most recent guidance, the American Health Care Association, an industry trade group, said nursing homes can accept patients “who are COVID negative or do not have symptoms.” If someone has symptoms such as a dry cough or fever, they “should be tested for COVID-19 before being admitted to the facility.” If someone is COVID positive, they should be kept only “with other COVID positive residents.”

But nursing home doctors worry this doesn’t go far enough. According to a resolution by the California Association of Long Term Care Medicine, nursing homes should not have to take patients known to have the coronavirus unless “they have two negative tests that are 24 hours apart, OR 10 days after admission AND no fever for 72 hours.” A new AMDA resolution echoes this caution.

“We have an obligation to our patients to draw the line,” said Dr. Michael Wasserman, president of the California association. “Increasing the number of COVID-19 positive residents in facilities — whether these facilities have patients with the virus or not — raises the risk of infecting the uninfected and dramatically increasing the number of deaths.”

For their part, hospital leaders say an emphasis on testing before discharging patients is impractical, given the shortage of tests and delays in receiving results.

“Many nursing homes are requiring a negative COVID-19 test even for patients who were in the hospital for nothing to do with COVID,” said Sauer in Washington state. “We don’t agree with this. It’s using up very limited testing resources.”

Nowhere are tensions higher than in New York, where Gov. Andrew Cuomo has said 73,000 extra hospital beds will be needed within weeks to treat a surge of COVID-19 patients. Hospitals in the state have 53,000 beds.

On Wednesday, the New York State Department of Health issued an advisory noting: “No resident shall be denied re-admission or admission to the NH [nursing home] solely based on a confirmed or suspected diagnosis of COVID-19.”

Speaking on behalf of nursing home physicians, AMDA voiced strong opposition, calling the policy “over-reaching, not consistent with science, unenforceable, and beyond all, not in the least consistent with patient safety principles” in a statement.

Some nursing homes are sending residents with suspected coronavirus to hospitals for evaluation and then refusing to take them back until tests confirm their negative status.

“Essentially, they’re dumping patients on hospitals and saying, ‘Too bad — you’re stuck with them now,’” said a consultant who works closely with hospitals and spoke on the condition of anonymity.

Others want to do their part to serve COVID-19 patients. “It is our obligation to keep the health care system flowing,” said Scott LaRue, president of ArchCare, the health care system of the Archdiocese of New York.

LaRue has no illusions about keeping the coronavirus out of ArchCare’s five nursing homes, which, combined, have 1,700 beds.

“In New York City the virus is everywhere,” he said. That means it has to be managed, not avoided. “Our intention is to take COVID-19 stable patients” and move them to a single floor at each nursing home, he said.

That will happen under two conditions, LaRue said. First, ArchCare will need sufficient personal protective equipment — gowns, masks and face shields — for its staff. Currently, the system can’t get face shields. It was due to run out of gowns by Wednesday.

Second, ArchCare will need to test whether its protocols for managing COVID-positive patients are working. Those include putting patients in isolation, monitoring them more closely, limiting the number of people who can go in, and ensuring that staff use personal protective equipment and are trained properly.

So far, only one of its nursing home patients is known to have COVID-19.

“We won’t know for 14 days if the steps we’re taking are working,” LaRue said.

But it’s unrealistic to expect other nursing homes to follow suit.

“I would be surprised if 10% to 15% of skilled nursing facilities in the U.S. could take a COVID-positive patient and treat that patient safely while ensuring that other residents in the home are safe,” said David Grabowski, a professor of Health Care Policy at Harvard Medical School.

In a new commentary in the Journal of the American Medical Association, Grabowski calls for establishing “centers of excellence” to care for patients recovering from COVID-19 and building “temporary capacity” in hot spots where the need for post-hospital services is likely to surge.

That’s beginning to happen. On Tuesday, Cuomo announced that a field hospital being built by the U.S. Army Corps of Engineers to house overflow coronavirus patients at the Jacob K. Javits Convention Center in New York City would include 1,000 beds for patients who don’t need acute care services.

On Wednesday, a unit of Partners HealthCare, a large Massachusetts health care system, announced a new center for patients recovering from COVID-19 on the fourth floor of Spaulding Hospital for Continuing Care, a long-term care hospital in Cambridge. The center, set to open soon, will have 60 beds and accept patients from Massachusetts General Hospital and Brigham and Women’s Hospital.

In the Twin Cities area of Minnesota, Allina Health, which operates 11 hospitals, is partnering with Presbyterian Homes & Services to convert a 50-bed skilled nursing home to a “step-down site,” said Dr. Emily Downing, a vice president of Allina Health. The goal is to help COVID-19 patients recover so they can return to nursing homes or senior living communities.

Katie Smith Sloan, president of LeadingAge, which represents not-for-profit nursing homes, home care agencies and assisted living centers, said she was hearing about nascent plans to reopen closed nursing homes for COVID-19 patients. Government agencies need to make financing available to build extra capacity to care for these patients, she said.

As for patients who need less intensive care or who need to be quarantined after the hospital to ensure they aren’t infectious, other options exist.

“King County has bought a hotel and is leasing another and is looking at what are now empty ambulatory surgery centers or a Christian summer camp in the area,” said Sauer of the Washington State Hospital Association.

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What Takes So Long? A Behind-The-Scenes Look At The Steps Involved In COVID-19 Testing

After a slow start, testing for COVID-19 has ramped up in recent weeks, with giant commercial labs jumping into the effort, drive-up testing sites established in some places and new types of tests approved under emergency rules set by the Food and Drug Administration.

But even for people who are able to get tested (and there’s still a big lag in testing ability in hot spots across the U.S.), there can be a frustratingly long wait for results — not just hours, but often days. Sen. Rand Paul (R-Ky.) didn’t get his positive test results for six days and is now being criticized for not self-quarantining during that time.

We asked experts to help explain why the turn-around time for results can vary widely — from hours to days or even a week — and how that might be changing.

It’s A Multistep Process

First, a sample is taken from a patient’s nose or throat, using a special swab. That swab goes into a tube and is sent to a lab. Some large hospitals have on-site molecular test labs, but most samples are sent to outside labs for processing. More on that later.

That transit time usually runs about 24 hours, but it could be longer, depending on how far the hospital is from the processing lab.

Once at the lab, the specimen is processed, which means lab workers extract the virus’s RNA, the molecule that helps regulate genes.

“That step of cleaning, the RNA extraction step, is one limiting factor,” said Cathie Klapperich, vice chair of the department of biomedical engineering at Boston University. “Only the very biggest labs have automated ways of extracting RNA from a sample and doing it quickly.”

After the RNA is extracted, technicians also must carefully mix special chemicals with each sample and run those combinations in a machine for analysis, a process called polymerase chain reaction (PCR), which can detect whether the sample is positive or negative for COVID.

“Typically, a PCR test takes six hours from start to finish to complete,” said Kelly Wroblewski, director of infectious disease programs at the Association of Public Health Laboratories.

Some labs have larger staffs and more machines, so they can process more tests at a time than others. But even for those labs, as demand grows, so does the backlog.

Capacity Is Expanding, But Not Enough

Initially, only a few public health labs and the federal Centers for Disease Control and Prevention processed COVID-19 tests. Problems with the first CDC test kits also led to delays.

Now the CDC has a better kit, and 94 public health labs across the country do COVID-19 testing, said Wroblewski.

But those labs can’t possibly do all that’s needed. In normal times, their main function is regular public health surveillance — detecting more common threats such as outbreaks of measles or monitoring seasonal influenza — “but not to do diagnostic testing of the magnitude that is required in this response,” she said.

Large commercial labs like those run by companies such as Quest Diagnostics and LabCorp were given the go-ahead late last month by the FDA to start testing, too.

The FDA has said it won’t stop certain private labs — those that are already certified to perform complex testing — and diagnostic companies from developing their own test kits. Labs at some big-name hospital systems, such as Advent Health, the Cleveland Clinic and the University of Washington, are among those doing this.

In addition, the FDA has approved more than a dozen testing kits by various manufacturers or labs under special emergency rules designed to speed the process. Those include tests by Quest Diagnostics, LabCorp, Roche, Quidel Corp. and others. The kits are used in PCR machines, either in hospital labs or large commercial labs.

“A chief medical officer on the East Coast said that, up until two days ago, on average it was taking 72 hours to get results,” said Susan Van Meter, executive director of AdvaMedDx, a division of the Advanced Medical Technology Association, a device and diagnostics industry trade group. “That will get better as our member companies come on the market.”

Even so, supply is not keeping up with demand, Roche CEO Severin Schwan told CNBC on March 23. Roche won the first approval from the FDA for a test kit under emergency rules, and it has delivered more than 400,000 kits so far.

“Demand continues to be much higher than supply,” Schwan told CNBC. “So we are glad that overall capacity is increasing, but the reality is that broad-based testing is not yet possible.”

How Many Tests Can Be Done At A Time?

That varies. Large commercial labs can do a lot. LabCorp, for example, said it is processing 20,000 tests a day — and hopes to do more soon. Other test kit makers and labs are also ramping up capacity.

Smaller labs — such as molecular labs at some hospitals — can do far fewer per day but get results to patients faster because they save on transit time.

Still, it’s usually only large academic medical centers and some health systems that have their own molecular testing labs, which require complex equipment.

One of those is Medstar Georgetown University Hospital in Washington, D.C.

“From beginning to results can take five to six hours,” said Joeffrey Chahine, technical director for the molecular pathology division there.

Even at such hospitals, the tests are often prioritized for patients who have been admitted and staff who might have been exposed to COVID-19, said Chahine. His lab can process 93 samples at a time and run a few cycles a day, up to about 280, he said. Last week, it did 186 a day, three days in a row.

But hospitals with this ability are generally “not testing from their outpatient centers or the ER,” he said. In other words, the in-house labs aren’t running tests from walk-in patients.

Those tests are sent to large outside labs “so as not to overwhelm the hospital lab.” While those outside labs have large staffs, “the demand is so high that these outpatient clinics and ERs say the turnaround time can be four to seven business days,” he said.

Supply Shortages Are Slowing Test Production

As the worldwide demand for testing has grown, so, too, have shortages of the chemical agents used in the test kits, the swabs used to get the samples, and the protective masks and gear used by health workers taking the samples.

“There is an inadequate supply of so many things associated with testing,” said Wroblewski, which is why her group, along with officials in states including New York and cities including Los Angeles, recommend prioritizing who should be tested for COVID-19.

At the front of the line, she said, should be health care workers and first responders; older adults who have symptoms, especially those living in nursing homes or assisted living residences; and people who may have other illnesses that would be treated differently if they were infected. Bottom line: prioritizing who is tested will help speed the turnaround time for getting results to people in these circumstances and reduce their risk of spreading the illness.

Still, urgent shortages of some of the chemicals needed to process the tests are hampering efforts to test health care workers, including at hospitals such as SUNY Downstate medical center in hard-hit New York.

Looking forward, companies are working on quicker tests. Indeed, the FDA in recent days has approved tests from two companies that promise results in 45 minutes or less. Those will be available only in hospitals that have special equipment to run them. One of those companies, Cepheid of Sunnyvale, California, says about 5,000 U.S. hospitals already have the equipment needed to process these tests. Both firms say they will ship to the hospitals soon but have given few specifics on quantity or timing.

But many public health officials say doctors and clinics need a truly rapid test they can use in their offices, one like the tests already in use for influenza or strep throat.

A number of companies are moving in that direction. Late Friday, for instance, Abbott Laboratories announced that the FDA has given emergency-use authorization for the company’s rapid, point-of-care test, which can deliver positive results in as little as five minutes and negative results in 13.

The tests are processed on a small device already installed in thousands of medical offices, ERs, urgent care clinics and other settings. Abbott said it will begin this week to make 50,000 tests available per day.

“That’s going to make a meaningful difference,” said Van Meter at AdvaMedDx, who believes the rapid tests are a critical piece in the continuum of available testing.

Even though lab-based PCR tests, which are done at large labs and academic medical centers, can take several hours to produce a result, the machines used can test high numbers of cases all at once. The rapid test by Abbott — and other, similar tests now under development — do far fewer at a time but deliver results much faster.

“This can be provided in a doctor’s office or an ER, helping to triage patients who are waiting to get in,” said Van Meter. “It’s a very fine complement to the testing that exists.”

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Addiction Is ‘A Disease Of Isolation’ — So Pandemic Puts Recovery At Risk

Before the coronavirus became a pandemic, Emma went to an Alcoholics Anonymous meeting every week in the Boston area and to another support group at her methadone clinic. She said she felt safe, secure and never judged.

“No one is thinking, ‘Oh, my God. She did that?’” said Emma, “’cause they’ve been there.”

Now, with AA and other 12-step groups moving online, and the methadone clinic shifting to phone meetings and appointments, Emma said she is feeling more isolated. (KHN is not using her last name because she still uses illegal drugs sometimes.) Emma said the coronavirus may make it harder to stay in recovery.

“Maybe I’m old fashioned,” said Emma, “but the whole point of going to a meeting is to be around people and be social and feel connected, and I’d be totally missing that if I did it online.”

While it’s safer to stay home to avoid getting and spreading COVID-19, addiction specialists acknowledge Emma’s concern: Doing so may increase feelings of depression and anxiety among people in recovery — and those are underlying causes of drug and alcohol use and addiction.

“We consider addiction a disease of isolation,” said Dr. Marvin Seppala, chief medical officer at the Hazelden Betty Ford Foundation. “Now we’re isolating all these people and expecting them to pick up the phone, get online, that sort of thing — and it may not work out as well.”

Emma has another frustration: If the methadone clinic isn’t allowing gatherings, why is she still required to show up daily and wait in line for her dose of the pink liquid medication?

The answer is in tangled rules for methadone dispensing. The federal government has loosened them during the pandemic — so that patients don’t all have to make a daily trip to the methadone clinic, even if they are sick. But patients say clinics have been slow to adopt the new rules.

Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, said he issued guidelines to members late last week about how to operate during pandemics. He recommended that clinics stop collecting urine samples to test for drug use. Many patients can now get a 14- to 28-day supply of their addiction treatment medication so they can make fewer trips to methadone or buprenorphine clinics.

“But there has to be caution about giving significant take-home medication to patients who are clinically unstable or actively still using other drugs,” Parrino said, “because that could lead to more problems.”

The new rules have a downside for clinics: Programs will lose money during the pandemic as fewer patients make daily visits, although Medicare and some other providers are adjusting reimbursements based on the new stay-at-home guidelines.

And for active drug users, being alone when taking high levels of opioids increases the risk of a fatal overdose.

These are just some of the challenges that emerge as the public health crisis of addiction collides with the global pandemic of COVID-19. Doctors worry deaths will escalate unless people struggling with excessive drug and alcohol use and those in recovery — as well as addiction treatment programs — quickly change the way they do business.

But treatment options are becoming even scarcer during the pandemic.

“It’s shutting down everything,” said John, a homeless man who’s wandering the streets of Boston while he waits for a detox bed. (KHN is not including his last name because he still buys illegal drugs.) “Detoxes are closing their doors and halfway houses,” he said. “It’s really affecting people getting help.”

Adding to the scarcity of treatment options: Some inpatient and outpatient programs are not accepting new patients because they aren’t yet prepared to operate under the physical distancing rules. In many residential treatment facilities, bedrooms and bathrooms for patients are shared, and most daily activities happen in groups — those are all settings that would increase the risk of transmitting the novel coronavirus.

“If somebody were to become symptomatic or were to spread within a unit, it would have a significant impact,” said Lisa Blanchard, vice president of clinical services at Spectrum Health Systems. Spectrum runs two detox and residential treatment programs in Massachusetts. Its facilities and programs are all still accepting patients.

Seppala said inpatient programs at Hazelden Betty Ford are open, but with new precautions. All patients, staff and visitors have their temperature checked daily and are monitored for other COVID-19 symptoms. Intensive outpatient programs will run on virtual platforms online for the immediate future. Some insurers cover online and telehealth addiction treatment, but not all do.

Seppala worried that all the disruptions — canceled meetings, the search for new support networks and fear of the coronavirus — will be dangerous for people in recovery.

“That can really drive people to an elevated level of anxiety,” he said, “and anxiety certainly can result in relapse.”

Doctors say some people with a history of drug and alcohol use may be more susceptible to COVID-19 because they are more likely to have weak immune systems and have existing infections such as hepatitis C or HIV.

“They also have very high rates of nicotine addiction and smoking, and high rates of chronic lung disease,” said Dr. Peter Friedmann, president of the Massachusetts Society of Addiction Medicine. “Those [are] things we’ve seen in the outbreak in China [that] put folks at higher risk for more severe respiratory complications of this virus.”

Counselors and street outreach workers are redoubling their efforts to explain the pandemic and all the related dangers to people living on the streets. Kristin Doneski, who runs One Stop, a needle exchange and outreach program in Gloucester, Massachusetts, worried it won’t be clear when some drug users have COVID-19.

“When folks are in withdrawal, a lot of those symptoms can kind of mask some of the COVID-19 stuff,” said Doneski. “So people might not be taking some of their [symptoms seriously], because they think it’s just withdrawal and they’ve experienced it before.”

Doneski is concerned that doctors and nurses evaluating drug users will also mistake a case of COVID-19 for withdrawal.

During the coronavirus pandemic, needle exchange programs are changing their procedures; some have stopped allowing people to gather inside for services, safety supplies, food and support.

There’s also a lot of fear about how quickly the coronavirus could spread through communities of drug users who’ve lost their homes.

“It’s scary to see how this will pan out,” said Meredith Cunniff, a nurse from Quincy, Massachusetts, who is in recovery for an opioid use disorder. “How do you wash your hands and practice social distancing if you’re living in a tent?”

This story is part of a partnership that includes WBUR, NPR and Kaiser Health News.

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‘Red Dawn Breaking Bad’: Officials Warned About Safety Gear Shortfall Early On, Emails Show

A high-ranking federal official in late February warned that the United States needed to plan for not having enough personal protective equipment for medical workers as they began to battle the novel coronavirus, according to internal emails obtained by Kaiser Health News.

The messages provide a sharp contrast to President Donald Trump’s statements at the time that the threat the coronavirus posed to the American public remained “very low.” In fact, concerns were already mounting, the emails show, that medical workers and first responders would not have enough masks, gloves, face shields and other supplies, known as PPE, to protect themselves against infection when treating COVID-19 patients.

The emails, part of a lengthy chain titled “Red Dawn Breaking Bad,” includes senior officials across the Department of Veterans Affairs, the State Department, the Department of Homeland Security and the Department of Health and Human Services, as well as outside academics and some state health officials. KHN obtained the correspondence through a public records request in King County, Washington, where officials struggled as the virus set upon a nursing home in the Seattle area, eventually killing 37 people. It was the scene of the first major outbreak in the nation.

“We should plan assuming we won’t have enough PPE — so need to change the battlefield and how we envision or even define the front lines,” Dr. Carter Mecher, a physician and senior medical adviser at the Department of Veterans Affairs, wrote on Feb. 25. It would be weeks before front-line health workers would take to social media with the hashtag #GetMePPE and before health systems would appeal to the public to donate protective gear.

In the email, Mecher said confirmed-positive patients should be categorized under two groups with different care models for each: those with mild symptoms should be encouraged to stay home under self-isolation, while more serious patients should go to hospital emergency rooms.

“The demand is rising and there is no guarantee that we can continue with the supply since the supply-chain has been disrupted,” Eva Lee, director of the Center for Operations Research in Medicine and HealthCare at Georgia Tech and a former health scientist at the Atlanta VA Medical Center, wrote that same day citing shortages of personal protective equipment and medical supplies. “I do not know if we have enough resources to protect all frontline providers.”

Reached on Saturday, Lee said she isn’t sure who saw the message trail but “what I want is that we take action because at the end of the day we need to save patients and health care workers.”

Mecher, also reached Saturday, said the emails were an “an informal group of us who have known each other for years exchanging information.” He said concerns aired at the time on medical protective gear were top of mind for most people in health care. More than 35 people were on the email chain, many of them high-ranking government officials.

The same day Mecher and others raised the concern in the messages, Trump made remarks to a business roundtable group in New Delhi, India.

“We think we’re in very good shape in the United States,” he said, noting that the U.S. closed the borders to some areas. “Let’s just say we’re fortunate so far.  And we think it’s going to remain that way.”

The White House declined to comment. In a statement, VA press secretary Christina Mandreucci said, “All VA facilities are equipped with essential items and supplies to handle additional coronavirus cases, and the department is continually monitoring the status of those items to ensure a robust supply chain.”

Doctors and other front-line medical workers in the weeks since have escalated concerns about shortages of medical gear, voicing alarm about the need to protect themselves, their families and patients against COVID-19, which as of Saturday evening had sickened more than 121,000 in the United States and killed at least 2,000.

As Mecher and others sent emails about growing PPE concerns, HHS Secretary Alex Azar testified to lawmakers that the U.S. had 30 million N95 respirator masks stockpiled but needed 300 million to combat the outbreak. Some senior U.S. government officials were also warning the public to not buy masks for themselves to conserve the supply for health care providers.

U.S. Surgeon General Jerome Adams tweeted on Feb. 29: “Seriously people – STOP BUYING MASKS!  They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!”

Still, on Feb. 27, the FDA in a statement said that officials were not aware of widespread shortages of equipment.

“We are aware of reports from CDC and other U.S. partners of increased ordering of a range of human medical products through distributors as some healthcare facilities in the U.S. are preparing for potential needs if the outbreak becomes severe,” the agency said.

Simultaneously, Trump downplayed the risk of the novel coronavirus to the American public even though the Centers for Disease Control and Prevention was warning it was only a matter of time before it would spread across the country. On Feb. 29, the CDC also updated its strategies for health workers to optimize supplies of N95 masks.

An HHS spokesperson said Saturday the department has been in “an all-out effort to mobilize America’s capacity” for personal protective equipment and other supplies, including allowing the use of industrial N95 respirators in health care settings and awarding contracts to several private manufacturers to buy roughly 600 million masks over the next 18 months.

“Health care supply chains are private-sector-driven,” the spokesperson said. “The federal role is to support that work, coordinate information across the industry and with state or local agencies if needed during emergencies, and drive manufacturing demand as best we can.”

The emails from King County officials and others in Washington state also show growing concern about the exposure of health care workers to the virus, as well as a view into local officials’ attempts to get help from the CDC.

In one instance, local medical leaders were alarmed that paramedics and other emergency personnel were possibly exposed after encountering confirmed-positive patients at the Life Care Center of Kirkland, the Seattle-area nursing home where roughly three dozen people have died because of the virus.

“We are having a very serious challenge related to hospital exposures and impact on the health care system,” Dr. Jeff Duchin, the public health officer for Seattle and King County, wrote in a different email to CDC officials March 1. Duchin pleaded for a field team to test exposed health care workers and additional support.

Duchin’s email came hours after a physician at UW Medicine wrote about being “very concerned” about exposed workers at multiple hospitals and their attempts to isolate infected workers.

“I suspect that we will not be able to follow current CDC [recommendations] for exposed HCWs [health care workers] either,” wrote Dr. John Lynch, medical director of employee health for Harborview Medical Center and associate professor of Medicine and Allergy and Infectious Diseases at the University of Washington. “As you migh [sic] imagine, I am very concerned about the hospitals at this point.”

Those concerns have been underscored with an unusual weekend statement from Dr. Patrice Harris, president of the American Medical Association, which represents doctors, calling on Saturday for more coordination of needed medical supplies.

“At this critical moment, a unified effort is urgently needed to identify gaps in the supply of and lack of access to PPE necessary to fight COVID-19,” the statement says. “Physicians stand ready to provide urgent medical care on the front lines in a pandemic crisis. But their need for protective gear is equally urgent and necessary.”

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The Nation’s 5,000 Outpatient Surgery Centers Could Help With The COVID-19 Overflow

As the number of COVID-19 cases continues to rise, a group of anesthesiologists wants to convert America’s surgery centers into critical care units for infected patients.

Many of the country’s more than 5,000 outpatient surgery centers have closed or sharply cut back on the number of elective procedures they perform, to comply with requests from government agencies and professional societies. But those surgery centers have space and staff, as well as anesthesia machines that could be repurposed into ventilators — all of which could be especially crucial in hard-hit areas like New York.

“Half of the surgery centers in New York are not doing anything,” said Adam Schlifke, an anesthesiologist and clinical assistant professor at Stanford University in California, who is leading the push for the centers to help. “All these anesthesiologists and nurses who are sitting on the sidelines, they want to help. They don’t know how to help. There’s nowhere for them to help. What if they could work in the surgery centers?”

Opening such outpatient centers nationwide to coronavirus patients would nearly double the number of facilities nationwide, up from the country’s fewer than 6,200 hospitals. But turning day facilities into places for 24/7 care worries some anesthesiologists. There are questions about staffing, regulations and payment. They also fear that using surgery centers as critical care units would do more harm than good if the centers aren’t properly equipped to handle severe cases of COVID-19.

“Even if we lifted the regulatory restrictions, surgery centers are licensed to do a certain thing,” said Dr. Steven Dalbec, a private practice anesthesiologist in Columbia, Missouri, who once ran a surgery center in Arizona. “If we could say, ‘OK, we’re going to lift all those restrictions and let you take care of critically ill patients,’ it’s not something that could happen overnight.”

Still, that’s exactly why Schlifke argues that it’s important to start now, especially in parts of the country with fewer cases. His group has created a blueprint that outlines the steps needed for surgery centers to convert.

In the coming days, Schlifke said, he and the approximately 75 members of the CovidVent coalition of anesthesiologists he’s helping organize will call for a federal executive order to enable the conversion of surgery centers and hospital operating rooms into COVID-19 care sites to help save lives.

The order is needed, he said, because he recognizes that providers want to get paid. The idea is so new, he said, there’s no reimbursement plan in place for surgery centers that agree to treat COVID-19 patients.

What’s most troubling, Schlifke said, is the number of anesthesiologists who cannot help with the pandemic because their center is either closed or they are busy with elective surgeries that aren’t necessary. It’s a frustrating dilemma.

“They want to work,” Schlifke said.

The CovidVent group also wants to make sure surgery centers follow Centers for Medicare & Medicaid Services recommendations that call for them to end nonessential elective surgeries to keep front-line medical providers safe amid shortages of protective supplies such as masks. Many of those surgery centers are in states like New York, California and Washington where hospitals can’t keep up with the demand.

“An important question for hospitals and health systems that continue to perform elective and nonessential surgeries is, ‘Why?’” said Dr. Greg Martin, president-elect of the Society of Critical Care Medicine, which represents intensive care doctors. “How do they justify the risk to the otherwise healthy individuals, justify the risk to the health care provider workforce who may be imminently needed elsewhere, and justify the unnecessary consumption of health care resources such as masks, gloves and gowns?”

But William Prentice, CEO of the Ambulatory Surgery Center Association, an industry group, argued that some surgeries remain necessary. “We’re pushing things off that can be pushed off,” he said.

Meanwhile, in Washington, D.C., Vice President Mike Pence has already come out in support of the use of anesthesiology equipment as ventilators.

Anesthesia machines used in the operating room can be repurposed as mechanical ventilators, Martin said. “But they function differently and do not have all the same settings as ICU ventilators, so employing them in COVID-19 care requires education or oversight from those who are expert in using them.”

Dalbec also supports converting anesthesia machines into ventilators. He now works at Boone Hospital Center in Columbia, Missouri, which he said is prepared to do that if needed. As of Friday, he said, the 230-bed hospital hasn’t treated a confirmed COVID-19 patient.

But creating new intensive care units is challenging, according to both Dalbec and Martin.

Dalbec, who ran a surgery center in Tucson, Arizona, for 10 years, worries a lot of surgery centers don’t have the training, skills or supplies to care for critically ill patients.

“Time is of the essence,” Dalbec said. “And so that would make the care for these patients considerably challenging.”

An ICU has sophisticated equipment, such as bedside machines to monitor a patient’s heart rate and mechanical ventilators to help them breathe, Martin said. Ventilators need to be hooked up to oxygen and gas lines, which supply patients with the appropriate mix of air.

Only a few areas of the hospital have the equipment and gas hookups to provide ventilator care to critically ill patients, Martin said. These include the operating room, emergency department and units used for post-anesthesia care. To convert an ordinary hospital unit to an ICU, Martin said, “You would literally need to tear down the wall and run the piping in.”

Hospitals are already looking to use operating rooms for intensive care, Martin said.

“Using OR space, equipment and staff to care for sick COVID-19 patients is the right thing to do,” Martin said. “This is one approach that most health systems are already considering and using.”

Many outpatient operating rooms at surgery centers already have the required gas and oxygen hookups, Martin said. “Some will have fully configured operating rooms with ventilators,” he said. “It would be one way to expand ICU-level patient care space.”

But they are unlikely to stock all the medications used in an ICU.

Another challenge, he said, would be that staff from most surgery centers may be pulled into hospitals — anesthesiologists, nurses and nurse anesthetists — and surgery centers would not have all the pharmacists, respiratory therapists and other staff.

Intensive care units are staffed by specially trained doctors, nurses and respiratory therapists, who set up ventilators and closely monitor patients’ breathing, Martin said. “The hardest thing to change is the staffing,” he said. “We only have a certain number of doctors, nurses and respiratory therapists.”

CovidVent is working with several telemedicine groups that could help treat patients in areas where the staff lacks the expertise, Schlifke said.

Outpatient surgery centers would need to receive a waiver from federal regulators to keep patients overnight or perform medical care they don’t currently perform, Prentice said.

Prentice said he’s optimistic that the Centers for Medicare & Medicaid Services will make an announcement about such waivers in coming days.

“Once we get that flexibility, we can find the best way to help,” Prentice said. “Decisions about how to best to use ambulatory surgery centers need to be made in conjunction with hospitals at the local level.”

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Listen: How Hospitals Are Preparing For Surge In COVID-19 Patients

California Healthline senior correspondent Anna Maria Barry-Jester appeared on KALW’s “Your Call” on Friday to discuss how hospitals are preparing for a surge in COVID-19 patients.

Dr. Mark Ghaly, the state’s secretary of Health and Human Services, said on Wednesday that COVID-19 cases in California continued to double every three to four days ― a pace on par with New York, where some hospitals are already overwhelmed by coronavirus patients.

As of Friday afternoon, the number of coronavirus cases in California topped 4,000 and at least 85 people had died.

Hospitals have been shifting patients with less urgent medical needs to other facilities to free up beds and working to boost supplies of personal protective equipment for medical staff, but still face shortages of both.

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Centros de salud comunitarios enfrentan al coronavirus, bajo presión financiera

La administración Trump acaba de anunciar $100 millones en fondos suplementarios para centros de salud comunitarios, para apoyar la respuesta a la pandemia de coronavirus.

“Los centros de salud están desempeñando un papel fundamental”, dijo James Macrae, administrador asociado de la Oficina de Atención Primaria de Salud del gobierno federal.

Alrededor de 29 millones de personas en el país dependen de estos centros, que ofrecen atención médica a pacientes de bajos ingresos y sin seguro. Millones de latinos reciben atención en estas clínicas.

A medida que los hospitales reciben más pacientes con COVID-19, los centros están revisando la forma en que atienden a los pacientes y han puesto en marcha nuevos protocolos para el manejo de enfermedades infecciosas.

Los fondos extra del gobierno se repartirán entre 1,381 centros de salud comunitarios (muchos de los cuales operan múltiples clínicas), principalmente para respaldar más pruebas para COVID-19, telemedicina y adquisición de equipos de protección personal.

“No está cerca de lo que se necesita, pero estamos agradecidos”, dijo Bob Marsalli, CEO de la Washington Association for Community Health, un grupo que representa a los centros de salud comunitarios en el estado de Washington.

Marsalli dijo que los centros en el estado están bajo una creciente presión financiera a medida que recrudece la batalla contra el coronavirus, al tiempo que pierden algunas fuentes clave de financiación.

“[Nuestras clínicas] están reasignando su fuerza laboral de manera inteligente, pero frenética, para mantenerse al día con la demanda”, dijo Marsalli.

Nuevas reglas de juego

En circunstancias normales, HealthPoint, un centro de salud comunitario en Auburn, Washington, alentaría a los pacientes a ir a la clínica para todas sus necesidades médicas, tanto para surtir una receta como para aprender sobre nutrición.

“Por lo general, nuestro lobby está colmado”, dijo la doctora Esther Johnston. “Es un espacio abierto y todos están juntos”.

Pero en estos días solo hay unos pocos pacientes con máscaras quirúrgicas esperando que los atiendan. Y Johnston les dice a los pacientes que no vayan a menos que realmente necesiten atención médica.

“Es un poco frustrante y desmoralizante, pero es la realidad de la situación”, dijo.

HealthPoint dirige más de una docena de clínicas en todo el oeste de Washington. Ahora, en la entrada de sus centros, el personal hace preguntas a los pacientes para identificar los síntomas de COVID-19 y controlar los mantiene a distancia uno del otro una vez dentro.

Johnston dijo que la clínica no se abrió para albergar una afluencia de pacientes con enfermedades infecciosas. Tienen un limitado número de cuartos, y cada uno debe cerrarse y limpiarse después que entra un paciente sospechoso de tener COVID-19.

“Simplemente no tenemos suficiente espacio para poder hacer eso de forma rutinaria”, dijo.

Al igual que muchos centros de salud comunitarios, el modelo de HealthPoint es atender a más personas para que no vayan a las salas de emergencia. Pero ahora la organización está tomando nuevas precauciones para prevenir la propagación del coronavirus y mantener al personal seguro. (Will Stone for KHN)

Johnston se preocupa por lo que vendrá a medida que aumenten los casos de COVID-19 en su área.

“Nos enorgullecemos de ser un espacio de atención primaria”, dijo Johnston. “No tenemos suficientes máscaras N95, ni, para ser sinceros, estábamos preparados para una situación en la que todos debían estar bien equipados”.

La doctora Judy Featherstone, directora médica de HealthPoint, dijo que ahora la mayoría de las citas se hacen por teléfono. Su personal está atendiendo llamadas de personas preocupadas por los síntomas, así como de nuevos pacientes que quieren tener un médico en caso que contraigan el coronavirus.

“Es un poco como tomar 20 años de trabajo y rediseñarlo en una semana”, dijo Featherstone. “Creo que estamos anticipando posibles problemas de la fuerza laboral”.

Al igual que muchas clínicas en Washington, HealthPoint ha establecido sitios de pruebas al aire libre, pero el suministro de kits y equipos de protección personal, limita el número de pacientes que pueden hacérselas.

Crece la tensión financiera

A medida que van menos pacientes para recibir atención, autoridades se preocupan por el futuro financiero de los centros. Las clínicas han cambiado a citas telefónicas, pero el programa de Medicaid de Washington tardó varias semanas en ajustar la forma en que paga esas visitas. Mientras tanto, los centros de salud comunitarios están eliminando las visitas dentales de rutina, un flujo de financiación clave.

“Toma esos tres factores… y ya has comenzado a perder ingresos antes de prepararte para nuevas formas de brindar atención”, dijo Michael Erikson, CEO de Neighborcare Health, que atiende a más de 70,000 residentes de Washington, más de la mitad de ellos bajo Medicaid. “Estamos en camino de perder $3 millones al mes”.

La Washington Association for Community Health proyecta que el recorte en la atención dental podría llevar a un déficit de $250 millones para el sistema de centros de salud comunitarios del estado durante los próximos nueve meses.

Rol vital en el sistema de salud

Las clínicas comunitarias juegan un papel importante en el servicio a pacientes que de otro modo terminarían en una sala de emergencias. Erikson dijo que su organización está tratando de aliviar la presión sobre el sistema hospitalario al ver pacientes con problemas de atención médica urgentes no relacionados con COVID-19.

“Por ejemplo, a un paciente para el cuidado de heridas que tiene diabetes subyacente no quieres exponerlo a un posible entorno con COVID-19”, dijo Erikson.

Algunos líderes de clínicas comunitarias también se preocupan por perder personal debido a una infección real o sospechada por coronavirus.

“Es muy crítico que las clínicas permanezcan con todo el personal, de modo que solo aquellos que están gravemente enfermos vayan al hospital”, dijo Sheila Berschauer, directora ejecutiva de Moses Lake Community Health Center, un proveedor de atención médica rural en Washington que atiende a un tercio de la población de su condado, de aproximadamente 100,000 residentes.

Si incluso cinco a 10 trabajadores de salud se enferman, dijo Berschauer, eso podría afectar su organización y, como resultado, posiblemente abrumar al hospital local.

Berschauer agregó que algunos pacientes aún no se dan cuenta de la gravedad de la pandemia y se enojan cuando se los deriva al sitio de prueba al aire libre en lugar de a la clínica.

Un trabajador de alud en un centro en las afueras de Seattle dijo que varios pacientes han tergiversado sus riesgos de COVID-19 para pasar el examen.

“Recibimos una paciente que logró pasar todos los controles y llegó ante un médico para recién entonces revelarnos que su pareja está expuesta a COVID y que se siente enferma”, dijo un empleado (le preocupa perder su trabajo por hablar, por lo que NPR y KHN no están usando su nombre).

Los trabajadores de salud que vieron al paciente no usaron equipo protector porque esos suministros limitados están reservados para pacientes con riesgo conocido de COVID-19.

“Ahora todos los proveedores y el personal de esa instalación deben comenzar a autocontrolarse para detectar signos de infección”, dijo el empleado. “Si se infectan, entonces toda la clínica cierra. Es un problema muy grande”.

Esta historia es parte de una asociación entre NPR y Kaiser Health News

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Para luchar contra el coronavirus, médicos y enfermeras retirados vuelven a trabajar

Laura Benson se retiró de la enfermería en 2018, pero hace pocos días volvió a presentarse a trabajar en New Rochelle, Nueva York, donde se registró uno de los primeros grupos de casos de COVID-19.

“Las enfermeras somos entregadas”, dijo. “Si no hay suficiente gente, simplemente te presentas”.

Con más de 40,000 casos confirmados, Nueva York es ahora el epicentro del brote de coronavirus en el país: casi la mitad de los más de 92,900 casos en todo el país hasta el viernes 27 de marzo al mediodía.

Anticipándose a una grave escasez de personal médico para tratar el flujo de pacientes enfermos, el gobernador Andrew Cuomo y otros funcionarios hicieron un llamado para que médicos, enfermeras y otros profesionales de salud retirados desempolvaran sus guardapolvos y regresaran al trabajo.

Para el jueves 26, habían respondido 52,000 personas.

Funcionarios de otros estados, incluidos California, Colorado e Illinois, han hecho pedidos similares para que los profesionales de salud retirados den un paso adelante.

En el condado de Westchester, en Nueva York -que incluye New Rochelle y otras ciudades al norte de la ciudad de Nueva York- su ejecutivo, George Latimer, dijo que cerca de 90 enfermeras retiradas y un puñado de médicos respondieron después que publicara un mensaje en la página de Facebook del condado en busca de ayuda.

No hay un plan definitivo para desplegar con los voluntarios médicos, explicó Latimer. Pueden ser necesarios para atender a pacientes por fuera del coronavirus, o para ayudar al personal del Westchester County Center, que ahora funciona como un hospital temporal.

Laura Benson(Courtesy of Laura Benson)

Benson, de 60 años, trabaja para el Departamento de Salud del condado. Enfermera practicante con especialidad en oncología, pasó 20 años en el Albert Einstein Cancer Center en el Bronx. Se retiró de un trabajo en una compañía de dispositivos médicos, donde trabajó con pacientes con tumores cerebrales. También enseña a estudiantes de enfermería en un colegio comunitario.

En su primer día como voluntaria jubilada, Benson llamó por teléfono a pacientes que habían sido examinados recientemente para detectar el nuevo coronavirus para explicarles las pautas que deberían seguir para protegerse a sí mismos y a los demás.

Si hay una necesidad, dijo, está “absolutamente” dispuesta a trabajar directamente con pacientes que tengan COVID-19.

“Pienso en la persona en esa cama de hospital”, dijo. “Me gustaría que alguien la cuide”.

Benson no está particularmente preocupada por el virus, ya que trabajó durante la crisis del sida y trató a los pacientes incluso antes que la gente entendiera qué era esa enfermedad. “Sigues las pautas y te proteges”, explicó.

El mejor papel para muchos profesionales médicos retirados puede ser ayudar detrás de escena, dijeron expertos, liberando a colegas más jóvenes para que puedan centrarse en la atención directa del paciente.

Una razón para esto: la edad.

“Mi única preocupación es que muchas de estas personas retiradas estén en grupos de alto riesgo” con mayor probabilidad de verse gravemente afectados por COVID-19, dijo el doctor Arthur Fougner, presidente de la Sociedad Médica del Estado de Nueva York.

Otra preocupación es si los jubilados están actualizados con sus conocimientos médicos.

“Si han estado sin trabajar por más de dos o tres años, debes preocuparte que estén al día”, dijo el doctor Janis Orlowski, director de atención médica de la Asociación de Colegios Médicos Americanos.

Además, las licencias estatales de los proveedores de atención médica pueden haber caducado si han estado retirados por unos años. Renovarlas puede llevar mucho tiempo.

Aun así, “si alguien todavía tiene su licencia y está dispuesto a regresar, deberíamos recibirlo”, dijo Orlowski.

Michele Pedicone es una de esas profesionales. La terapeuta de atención respiratoria dejó su trabajo en Seattle el año pasado para dirigir el área de educación clínica en el departamento de educación de terapia respiratoria de la Universidad Médica SUNY Upstate en Syracuse, Nueva York.

Con sus clases ahora en su mayoría en línea y las prácticas de los estudiantes, suspendidas, tiene tiempo para volver a la atención clínica. Pedicone contactó a dos hospitales cercanos para ver si podían usar sus servicios y espera trabajar tres o cuatro días a la semana.

“Sinceramente, no sé lo que me están pagando; el dinero no es un problema “, dijo Pedicone, de 54 años.” Es lo correcto”.

Los terapeutas respiratorios, los médicos de cuidados críticos y las enfermeras capacitadas en la operación de ventiladores que ayudan a los pacientes hospitalizados a respirar se encuentran entre los especialistas que se espera que comiencen a escasear a medida que la pandemia de coronavirus empeora en Nueva York y en otros lugares, según un análisis de la Sociedad de Medicina de Cuidados Críticos.

La expansión de la oferta de trabajadores de cuidados intensivos será clave para manejar la pandemia de coronavirus, dijo Ashish Jha, director del Instituto de Salud Global de Harvard, en una sesión informativa la semana del 23 sobre asuntos de la fuerza laboral de atención médica patrocinados por el Commonwealth Fund.

Una opción que los encargados de formular políticas han discutido es que los estados podrían permitir, por ejemplo, que los profesionales médicos que se retiraron en los últimos cinco años con licencias vigentes obtengan una licencia automática de tres o seis meses sin tener que hacer muchos trámites, dijo Jha.

Mientras tanto, los sistemas de atención médica están desarrollando sus propias estrategias.

Northwell Health posee y opera 19 hospitales en la ciudad de Nueva York, el condado de Westchester y Long Island. La semana del 23, el sistema de salud ha tenido más de 700 pacientes con COVID-19, en comparación con solo 40 pacientes la semana anterior, según Terry Lynam, vicepresidente senior del sistema de salud.

Northwell ha estado planeando cómo fortalecer al personal desde enero, contó Judy Howard, vicepresidenta de adquisición que supervisa la contratación de personal. Desarrollaron una lista de 200 enfermeras jubiladas a las que se ha contactado para evaluar su interés en regresar al trabajo remunerado de alguna manera. Hasta ahora, 28 han firmado, dijo Howard.

En este momento, están pidiendo a las enfermeras jubiladas que trabajen en el centro de llamadas del sistema de salud y compartan las responsabilidades para capacitar a las nuevas enfermeras. Algunas trabajan en atención directa al paciente. Otra posibilidad es que colaboren en las instalaciones que Northwell ha establecido para cuidar a los hijos de los miembros del personal durante la pandemia de coronavirus.

“Si alguien realmente quiere trabajar cuatro horas a la semana o le gustaría trabajar 10 horas a la semana, trabajaremos con ellos para satisfacer sus necesidades”, dijo Howard.

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Resurge la telemedicina, por miedo al coronavirus y cambios en los pagos

Lukas Kopacki, quien regresó a casa después que el campus de su universidad cerrara por la pandemia de coronavirus, se había estado sintiendo mal durante días, con dolores de cabeza y garganta, y dificultad para respirar. Pero le preocupaba que ir al consultorio médico pudiera enfermarlo más.

“No tenía ganas de entrar en ese agujero negro de bacterias y virus”, dijo Kopacki, de 19 años, de Ringwood, Nueva Jersey.

Entonces, la semana del 16 de marzo, el estudiante de la Universidad de Vermont decidió llamar a Teladoc, una compañía que conecta a pacientes con médicos por teléfono en todo el país. El médico le diagnosticó una infección sinusal y le envió una receta para un antibiótico a su farmacia local.

Con su cobertura de salud de Aetna, que a principios de marzo renunció temporalmente a su copago de $45 por atención virtual, Kopacki pagó de su bolsillo $1.44, que cubrió los costos del medicamento.

“Fue fácil y rápido”, dijo.

Recibir atención médica por teléfono o videoconferencia ha existido durante varias décadas, pero el brote de coronavirus ha llevado a un aumento en el uso de la telemedicina como nunca antes se había visto, según los sistemas de salud y los grupos de proveedores en todo el país.

Millones de estadounidenses buscan atención conectándose electrónicamente con un médico, muchos por primera vez. Los sistemas de salud, las aseguradoras y los grupos de médicos dijeron que esta práctica permite a las personas practicar el distanciamiento social a la vez que reduce la propagación de la enfermedad, y protege a los trabajadores de salud.

Las empresas privadas de tecnología como Teladoc, Doctor On Demand y Amwell, y los grandes sistemas de atención médica, pueden proporcionar un médico directamente a alguien que se contacte con ellos.

Otros pacientes pueden pedir una cita de telemedicina con su médico habitual, que puede utilizar aplicaciones informáticas a través de celulares y computadoras. Todos los tipos de atención primaria y especializada, y los servicios de salud mental se pueden proporcionar a través de la telemedicina.

Muchos hospitales han agregado recientemente servicios de telemedicina para evitar que los pacientes preocupados por el coronavirus colmen sus salas de emergencia.

También estimulados por el objetivo de mantener a los pacientes alejados de las instalaciones médicas abarrotadas, las aseguradoras, del gobierno y privadas han aumentado el pago de las visitas de telemedicina para que estén a la par de las citas en persona.

Antes del brote, las aseguradoras pagaban menos de la mitad de esa cantidad, lo que disuadía a muchos médicos de ofrecer este servicio.

La semana del 16, Medicare habilitó a todos los afiliados usar la telemedicina, una opción que anteriormente solo estaba disponible para personas que viven en áreas remotas, y para chequeos específicos y breves. El gobierno federal también dijo que los médicos podrían ofrecer servicio fuera de sus estados durante la pandemia para tratar a los pacientes de Medicare virtualmente, incluso si no tienen licencia en el estado del paciente.

California, Florida y otros estados también han renunciado a sus requisitos de que un médico tenga licencia en el estado para brindar atención.

La Clínica Cleveland está en camino de registrar más de 60,000 visitas de telemedicina en marzo, según sus autoridades. Antes de marzo, ese sistema de salud, que tiene hospitales en Ohio y Florida, promediaba unas 3,400 visitas virtuales al mes.

Su sistema Express Care Online atiende a pacientes de todo el país las 24 horas del día. Alrededor del 75% de las llamadas ahora provienen de personas preocupadas de haber contraído COVID-19, dijo el doctor Matthew Faiman, director médico del servicio. Al igual que muchos otros sistemas de salud, la atención de urgencia virtual de Cleveland Clinic está renunciando a los copagos de los pacientes durante la pandemia.

“Estamos viendo un aumento significativo en la demanda de pacientes que buscan atención, tanto las personas preocupadas por el virus como los pacientes que están enfermos y que necesitan saber cómo manejar sus síntomas”, explicó Faiman.

La clínica ha contratado más médicos para telesalud desde que se cancelaron las cirugías electivas y menos pacientes van al consultorio.

“La telemedicina ha estado en los bordes del sistema por un tiempo”, dijo el doctor Manish Naik, director de tecnología de información médica de la Clínica Regional de Austin, en Texas. “Y, cuando todo esto termine, muchos médicos y pacientes querrán que la opción de telemedicina permanezca”.

Por supuesto, tales visitas tienen limitaciones, como cuando los médicos necesitan auscultar los pulmones o el corazón de un paciente u ordenar una radiografía para verificar si hay neumonía. Pero Naik dijo que la telemedicina también brinda a los médicos una visión más completa de los pacientes a través de “observación en el hogar” e interacciones que muestran “cosas que nunca antes pudimos ver”.

Antes de marzo, NYU Langone Health en Nueva York tenía alrededor de 50 visitas virtuales por día a través de su plataforma de telemedicina de atención de urgencia. Durante la semana del 23 de marzo, el sistema hospitalario ha promediado alrededor de 900 por día.

Para el 80% de las visitas de telemedicina, la tos es la principal preocupación, seguida por la fiebre, dijo el doctor Paul Testa, jefe de información médica. NYU Langone tiene 170 médicos que atienden a pacientes a través de la telemedicina, en comparación con 35 antes, dijo.

“No estamos recomendando pruebas para todos, pero estamos aconsejando el cuidado personal, la hidratación y el autoaislamiento”, agregó Testa. “El objetivo es crear una opción para estos pacientes en lugar que se apresuren a una urgencia o a una sala de emergencias”.

Si un paciente tiene problemas para respirar, un proveedor de telemedicina de la NYU le indicará que llame a una ambulancia si es necesario o que vaya a la sala de emergencias.

Teladoc tiene un promedio de 15,000 visitas de pacientes por día en los Estados Unidos, 50% más que en febrero. Los tiempos de espera han aumentado de minutos a horas en algunos casos, dijo un vocero.

En la Clínica Regional de Austin, que cuenta con 340 médicos en 28 consultorios, casi la mitad de las visitas de pacientes ahora son virtuales en comparación con una fracción antes del brote.

“Con la situación de COVID-19, tenemos pacientes que están nerviosos por venir, y no queremos pacientes con síntomas que expongan a otros”, dijo Naik.

La administración Trump estuvo actuando para ampliar las opciones de telemedicina incluso antes de la pandemia. En 2019, le permitió a Medicare pagar por primera vez a los médicos un promedio de $14 por una llamada telefónica de cinco minutos para comunicarse con sus pacientes.

Ken Prussner, de 74 años, de Herndon, Virginia, usó la computadora de su casa el lunes 23 para conectarse con su médico de toda la vida.

Prussner tenía una enfermedad gastrointestinal y un poco de fiebre, y su familia quería asegurarse que no tuviera COVID-19. Habló con su médico como si estuviera en el consultorio. Prussner tenía una infección típica del intestino delgado que desaparecería por sí sola en tres o cinco días.

“Fue bastante sencillo”, dijo Prussner, oficial retirado del Servicio Exterior de los Estados Unidos.

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Must-Reads Of The Week From Brianna Labuskes

Hello! We have once again reached Friday, and I’ll do my best to give you a snapshot of the biggest health news from the week. But, first, I must dispel some bad advice that I’ve seen: Everyone wants to see your pet on those video conferences! Don’t hide them away in this time of need! Show us the doggos, the cats, and the … whatever this is. (A porcupine, I think?) Also make sure you’re following DogsOfKFF on Twitter for some of the best content on that social media platform.

All right, onto the news.

As predicted, the United States has surpassed China in the number of confirmed coronavirus cases, with nearly 93,000 to China’s nearly 82,000, as of 1 p.m. ET Friday. According to Johns Hopkins’ tracker, we also have surpassed 1,300 recorded deaths. (Worldwide, we’re at more than 566,000 and over 25,000 deaths.) Meanwhile, all that data comes with an asterisk in that most experts believe there are far more cases going unrecorded either because of testing flaws or overwhelmed state health departments that can’t keep up. Either way, not exactly something we want to be first in.

Meanwhile, the House came back to Washington to approve the $2.2 trillion stimulus package the Senate managed to send through this week (more on that in a second), despite concerns over lawmakers’ safety. There had been (dim but existent) hope earlier in the week that the House might be able to pass the legislation by unanimous consent. But that seemed too easy to be true, and it was. Concerns that a voice vote would be derailed by objections from a libertarian Kentucky lawmaker went unrealized, and the House passed the legislation Friday afternoon. The bill now goes to President Donald Trump, who is expected to sign it.

So what exactly is in that legislation?

— Direct payments of $1,200 to millions of Americans, including those earning up to $75,000, and an additional $500 per child

— $100 billion for grants to hospitals, public and nonprofit health organizations and Medicare and Medicaid suppliers, including a 20% bump in Medicare payments for treating patients with the virus

— $221 billion in a variety of tax benefits for businesses, including allowing businesses to defer payroll taxes, which finance Medicare and Social Security, for the rest of the year

— More than $25 billion in new money for food assistance programs, like SNAP

— Expanded jobless aid, providing an additional 13 weeks and a four-month enhancement of benefits, and extending the payments for the first time to freelancers and gig workers

— $377 billion in federally guaranteed loans to small businesses and the establishment of a $500 billion government lending program for distressed companies

— Millions in aid for states to begin offering early voting or voting by mail

— A rule that blocks foreclosures and evictions during the crisis on properties where the federal government backs the mortgage

— The suspension of federal student loan payments for six months and waives the interest

Predictably, some sectors (like cruise ships) were unhappy with being left out, but for once some people were pleased — for example, the hospital industry, which got the $100 billion it asked for.

For those of you, like me, who love a good tick-tock, here are a few inside looks at how Senate leaders and White House advisers struck a quick, expansive deal in a Washington that typically seems incapable of compromise.

The New York Times: As Coronavirus Spread, Largest Stimulus in History United a Polarized Senate

Politico: Inside the 10 Days to Rescue the Economy

The Washington Post: The Dealmaker’s Dealmaker: Mnuchin Steps In as Trump’s Negotiator, but President’s Doubts Linger With Economy in Crisis

The urgency of the legislation was underscored by an astronomical jump in jobless claims this week. Nearly 3.3. million Americans applied for benefits, up from 200,000 during pre-outbreak days. The “widespread carnage,” as one economist put it, is expected to get worse. While the stimulus package is expected to help mitigate some of the devastation, many have said it should be looked at as just the beginning.

It seemed strangely appropriate this week that the health law turned 10 amid a pandemic — the legislation’s journey to here has been anything but smooth, why should this anniversary be? But one ripple effect of the pandemic and economic fallout might actually be a boost to the health law, which is likely to serve as a crucial safety net for many Americans who possibly lost their employer-sponsored coverage in the past few weeks. States have already started reopening their marketplaces, and the federal government is being urged to follow suit.

Trump chafed this week at the drastic measures states are putting in place to try to curb the outbreak, raising eyebrows when he said he’d like to see church pews full by Easter. Public health experts have warned that lifting the social-distancing measures would result in a surge of cases that slam an already stretched-thin hospital system. But for Trump, who has tied his reputation to the well-being of the stock market, the economic toll seems too much. (The rhetoric also started a truly bizarre push from conservatives for older Americans to sacrifice themselves for the good of the country.)

The president’s most recent proposal to kick-start parts of the country is identifying places by risk level and applying strategies to match. But experts, like Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, warn that even “cool spots” that aren’t seeing many cases might be in for a surge coming down the pike.

Meanwhile, Gov. Andrew Cuomo has said that New York’s experience presages America’s future. But some say that’s not necessarily accurate. Leading specialists say that while it is likely that devastation similar to New York’s will emerge in other places, there’s hope that in lower-density areas, where there are fewer factors like mass transit to exacerbate the spread, the outcome might be different.

Realistically, though, Americans will need to eventually think about returning to normalcy. Are there exit strategies from this complete lockdown that would work effectively? Here’s the problem: All the experts say success relies on extreme, aggressive and widespread testing to isolate the sick before they can give it to anyone. This has not exactly been America’s strong suit in recent weeks.

There are two storylines that have taken hold to demonstrate how much this pandemic will strain the hospital system, the first being the lack of ventilators available. States and hospitals have been pleading with the federal government to invoke war powers to jump-start the manufacturing process on the equipment. This comes as doctors are being forced to split ventilators between patients (a risky practice), planning to make the tough ethical decisions to ration care, creating policies to not resuscitate, searching for alternative treatments despite the dangers they might pose, and being warned that morgues are reaching capacity.

But Trump, who had been set to announce a partnership with GM to produce up to 80,000 ventilators, balked this week at the $1 billion price tag that came with it. “I don’t believe you need 40,000 or 30,000 ventilators,” he said, in a reference to New York, where Gov. Andrew Cuomo has appealed for federal help in obtaining them. “You go into major hospitals sometimes, and they’ll have two ventilators. And now all of a sudden they’re saying, ‘Can we order 30,000 ventilators?’”

The second notable thread throughout the country is a lack of personal protective equipment for health care workers on the front lines of the epidemic. There might be a long medical tradition of accepting elevated risk in the middle of a crisis, but many health care workers are frustrated that they’re being put in that position. Some are resorting to using hand-sewn masks, which do little to protect them and trash bags for surgical gowns. But others are drawing a line in the sand.

Meanwhile, something that might get missed with everyone’s attention directed at the coasts: Atlanta’s mayor is warning that its hospitals are at capacity.

Gilead, whose antiviral drug is getting a lot of buzz, was granted orphan drug status for the treatment because there are fewer than 200,000 cases of COVID-19 in the States right now. The designation would have granted Gilead lucrative perks, like the ability to keep generic competitors from the marketplace. But the news was meant with rage-filled incredulity from, uh, pretty much everyone, and so the company rescinded the request. As one expert said: “I think it’s embarrassing to take something that’s potentially the most widespread disease in the history of the pharmaceutical industry and claim it’s a rare disease.”

Meanwhile, an antimalarial drug is getting tons of attention after Trump touted it as a possible game changer. But a new, more carefully constructed study that finds it did little to help patients in China shows why people shouldn’t be looking for a quick, miracle cure. Researchers say this doesn’t disprove that the drug works but is a good check on expectations, especially when people are trying to self-medicate with the drug — resulting in shortages for those who need it for other illnesses and fatal consequences for others.

On the good-news front (there is some!), Moderna said there could be a vaccine ready for the fall for health care workers under emergency use authorization, ahead of the wider release that’s not expected to come for about a year.

And another treatment that some scientists are hopeful about is the practice of injecting recovered patients’ blood into new patients. The strategy is at least a century old but has scattershot results. “It’s not exactly a shot in the dark, but it’s not tried and true,” says one scientist. Still, in this era, people are willing to try what they can.

And here are some other interesting stories to get you through the weekend.

Federal Response:

Politico: Trump Team Failed to Follow NSC’s Pandemic Playbook

Politico: Those Who Intentionally Spread Coronavirus Could Be Charged As Terrorists

The New York Times: As Coronavirus Surveillance Escalates, Personal Privacy Plummets

2020 Elections:

The New York Times: Joe Biden, Struggling for Visibility, Faults Trump’s Response to Coronavirus

The New York Times: Is All of 2020 Postponed?

From The States:

Stateline: One Governor’s Actions Highlight the Strengths — and Shortcomings — of State-Led Interventions

The New York Times: Governors Tell Outsiders From ‘Hot Zone’ to Stay Away as Virus Divides States

NBC News: Entire Senior Home in New Jersey, 94 People, Presumed to Have Coronavirus

Science And Innovation:

The New York Times: The Virus Can Be Stopped, But Only With Harsh Steps, Experts Say

The New York Times: Warmer Weather May Slow, But Not Halt Coronavirus

The Washington Post: What Research on Coronavirus Structure Can Tell Us About How to Kill It

The Washington Post: The Science of Why Coronavirus Is So Hard to Stop

Reuters: Smokers Likely to Be More at Risk From Coronavirus: EU Agency

Public Health:

ProPublica: Domestic Violence and Child Abuse Will Rise During Quarantines. So Will Neglect of At-Risk People, Social Workers Say.

NBC News: Anti-Abortion Groups Seek Halt to Abortions During Coronavirus Pandemic

Politico: New York’s Health Care Workforce Braces for Influx of Retirees, Inexperienced Staffers

That’s it from me! Have a safe and healthy weekend!

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Coronavirus Has Upended Our World. It’s OK To Grieve.

On weekday evenings, sisters Lesley Laine and Lisa Ingle stage online happy hours from the Southern California home they share. It’s something they’ve been enjoying with local and faraway friends during this period of social distancing and self-isolation. And on a recent evening, I shared a toast with them.

We laughed and had fun during our half-hour FaceTime meetup. But unlike our pre-pandemic visits, we now worried out loud about a lot of things — like our millennial-aged kids: their health and jobs. And what about the fragile elders, the economy? Will life ever return to ‘normal’?

“It feels like a free fall,” said Francis Weller, a Santa Rosa, California, psychotherapist. “What we once held as solid is no longer something we can rely upon.”

The coronavirus pandemic sweeping the globe has not only left many anxious about life-and-death issues, but it also has left people struggling with a host of less obvious, existential losses as they heed stay-home warnings and wonder how bad all this will get.

To weather these uncertain times, it’s important to acknowledge and grieve lost routines, social connections, family structures and our sense of security — and then create new ways to move forward — said interfaith chaplain and trauma counselor Terri Daniel.

“We need to recognize that mixed in with all the feelings we’re having of anger, disappointment, perhaps rage, blame and powerlessness is grief,” said Daniel, who works with the dying and bereaved.

Left unrecognized and unattended, grief can negatively affect “every aspect of our being — physically, cognitively, emotionally, spiritually,” said Sonya Lott, a Philadelphia psychologist specializing in grief counseling.

Yet with our national focus on the daily turn of events as the new coronavirus spreads and with the chaos it has brought, these underlying or secondary losses may escape us. People who are physically well may not feel entitled to their emotional upset over the disruption of normal life. Yet, Lott argued, it’s important to honor our own losses even if those losses seem small compared with others.

“We can’t heal what we don’t have an awareness of,” said Lott.

Recognize Our Losses

Whether we’ve named them or not, these are some of the communitywide losses many of us are grieving. Consider how you feel when you think of these.

Social connections. Perhaps the most impactful of the immediate losses as we hunker down at home is the separation from close friends and family. “Children aren’t able to play together. There’s no in-person social engagement, no hugging, no touching — which is disruptive to our emotional well-being,” said Daniel.

Separation from our colleagues and office mates also creates a significant loss. Said Lott: “Our work environment is like a second family. Even if we don’t love all the people we work with, we still depend on each other.”

Habits and habitat. With the world outside our homes no longer safe to inhabit the way we once did, Daniel said, we’ve lost our “habits and habitats.” We can no longer engage in our usual routines and rituals. And no matter how mundane they may have seemed — whether grabbing a morning coffee at the local cafe, driving to work or picking up the kids from school — routines help define your sense of self in the world. Losing them, Daniel said, “shocks your system.”

Assumptions and security. We go to sleep assuming that we’ll wake up the next morning, “that the sun will be there and your friends will all be alive and you’ll be healthy,” Weller said. But the spread of the coronavirus has shaken nearly every assumption we once counted on. “And so we’re losing our sense of safety in the world and our assumptions about ourselves,” he said.

Trust in our systems. When government leaders, government agencies, medical systems, religious bodies, the stock market and corporations fail to meet public expectations, citizens can feel betrayed and emotionally unmoored. “We are all grieving this loss,” Daniel said.

Sympathy for others’ losses. Even if you’re not directly affected by a particular loss, you may feel the grief of others, including that of displaced workers, of health care workers on the front lines, of people barred from visiting older relatives in nursing homes, of those who have already lost friends and family to the virus, and of those who will.

4 Ways To Honor Your Grief

Once you identify the losses you’re feeling, look for ways to honor the grief surrounding you, grief experts urge.

Bear witness and communicate. Sharing our stories is an essential step, Daniel said. “If you can’t talk about what’s happened to you and you can’t share it, you can’t really start working on it,” Daniel said. “So communicate with your friends and family about your experience.”

It can be as simple as picking up the phone and calling a friend or family member, said Weller. He suggests simply asking for and offering a space in which to share your feelings without either of you offering advice or trying to fix anything for the other.

“Grief is not a problem to be solved,” he said. “It’s a presence in the psyche awaiting, witnessing.”

For those with robust social networks, Daniel suggests gathering a group of friends virtually to share these losses together. Using apps like Zoom, Skype, FaceTime or Facebook Live, virtual meetups are easy to set up daily or weekly.

Write, create, express. Whether you’re an extrovert or introvert, keeping a written or recorded journal of these days offers another way to express, to identify and to acknowledge loss and grief.

And then there’s art therapy, which can be especially helpful for children unable to express themselves well with words, and also for teens and even many adults. “Make a sculpture, draw a picture or create a ceremonial object,” said Daniel, who often incorporates shamanic ceremonies into grief workshops she conducts.

Another exercise she often uses in grief workshops is a simple one in which participants use their breath to blow their sadness, fear and anger into a rock they then throw away.

“What this does is takes all that intense, painful energy out of your body and into an inanimate object that they symbolically throw far away from themselves,” Daniel said.

Meditate. Regular meditation or just taking time to slow down and take several deep, calming breaths throughout the day also works to lower stress — and is available to everyone, Lott said. For beginners who want guidance, she suggests downloading a meditation app onto your smartphone or computer.

Be open to joy. And finally, Lott urges, make sure to let joy and gratitude into your life during these challenging times. Whether it’s a virtual happy hour, teatime or dance party, reach out to others, she said.

“If we can find gratitude in the creative ways that we connect with each other and help somebody,” she said, “then we can hold our grief better and move through it with less difficulty and more grace.”

This story was produced in partnership with NPR and Kaiser Health News.

Stephanie O’Neill is the recipient of a journalism fellowship at the Natural Hazards Center at the University of Colorado-Boulder, supported by Direct Relief.

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