Tagged Public Health

Millennial Zeitgeist: Attitudes About COVID-19 Shift As Cases Among Young Adults Rise

When Laura Mae, 27, first heard about the coronavirus, it didn’t seem like a big deal.

“I’m in college, and school was still going on. It didn’t really sink in,” she said. “And once it did start spreading, I thought, if I did get it, I’m young and healthy, I’ll be fine. I don’t need to worry.”

It was Saturday, March 14, and concerns about the coronavirus were amping up around the nation, said Laura Mae, who lives in Milwaukee. (Kaiser Health News is using Laura Mae’s first and middle names to grant her request for partial anonymity due to concern about online harassment.)

She realized it might be the last weekend to go out before everything shut down. Plus, her spring break had just started. So she and a friend decided to party that night.

And she wasn’t the only one.

As college and university spring breaks across the country converged that weekend, news coverage showed young people frolicking on Miami beaches, walking down Bourbon Street in New Orleans and crowding music clubs in Nashville, Tennessee. And to celebrate St. Patrick’s Day, many cities, such as New York, Washington, Chicago and Austin, Texas, saw throngs of people dressed in green and lining up for beer. There wasn’t a lot of social distance to be seen.

Part of the reason these young adults might have felt comfortable going to spots with large crowds was that media reports, buttressed by data from China’s outbreak, indicated younger people were not as susceptible to the coronavirus as older age groups or people with underlying conditions. But, that hasn’t held true. Now, in several major American cities, young adults between 18 and 40 account for some of the largest shares among groups testing positive.

As of Thursday, in New York City, 39% of cases were among those ages 18 to 44. Out of Los Angeles County’s 7,194 confirmed cases, 2,409, or 33%, were in the 18-40 age range. Nearly half of those testing positive in Travis County, Texas, which encompasses much of the Austin metro area, were between 20 and 39. Washington, D.C., the nation’s capital, released numbers Wednesday showing that 40% of the district’s cases were ages 19-40.

Dissecting The Numbers

Epidemiologists say that these high percentages of young adults testing positive for the coronavirus don’t necessarily mean that a disproportionate number of young people are becoming infected. What the numbers show is that people in this demographic are just as susceptible to COVID-19 as other age groups.

“Young people are equally at risk of becoming infected and spreading [the coronavirus] to others who then become infected,” said Denis Nash, a professor of epidemiology at The City University of New York School of Public Health.

The percentages of coronavirus cases appear high partly because health departments are reporting based on age groups that cover wide spans of years, he added.

New York City, for example, has 3.5 million people in the 18-44 age range, Nash said, and 700,000 people in the 65-74 age range. Since the “young” age group constitutes a large segment of the city’s population, it is logical that the numbers of those testing positive for COVID-19 are high. In other words, the numbers make sense once a calibration for population size is done.

“This just means everybody in every age group has the same rate of infection,” said Adolfo García-Sastre, director of Mount Sinai’s Global Health and Emerging Pathogens Institute in New York.

But fewer 20- and 30-somethings are likely being diagnosed, García-Sastre said, since most of them have milder symptoms compared with older patients and can often recover at home. New York health care providers have been limiting coronavirus testing to individuals who are experiencing the most severe symptoms and need hospitalization.

The more important statistics to consider, Nash said, are whether young people are being hospitalized or dying from COVID-19. And those numbers are much less stark.

He calculated the case fatality rate (with data up to March 23) in New York City by dividing the number of COVID-19 deaths by the hospital admission numbers. He found that 1.8% of deaths were among people 18-44. By comparison, 3.9% of deaths were among people 45-64, 9.5% were 65-74, and 16.3% were 75 and older.

A March 18 CDC report showed a similar trend. While 29% of coronavirus cases were among those ages 20-44, the percentages of ICU admissions were lowest in this age category. In addition, the percentages of people who died from COVID-19 increased with age.

‘It Was A Complete Shock’

Young adults are now coming to terms with that new reality — driven in part by statistics that show they are not safe from the coronavirus. News reports, such as that of a 25-year-old dying from COVID-19 or the announcement by Texas public health officials that 44 college students tested positive for the illness after returning from a group spring break trip to Mexico, drove home the point that they, too, were at risk.

A couple of days after her Saturday night out, Laura Mae started to feel sick. First, she had a sore throat. Then she developed a fever and chills and was short of breath and constantly tired ― all reported symptoms of COVID-19. She called a local coronavirus hotline and a nurse told her she was presumptive positive, which meant it would be assumed she had the coronavirus but wouldn’t be tested for it.

“It was a complete shock,” said Laura Mae. “I didn’t realize that someone like me, a healthy 27-year-old who has no immune issues, could get so sick.”

While she’s now mostly back to normal, she said her experience changed her perspective — especially when she thinks about the people she might have unknowingly exposed in the days before her symptoms appeared.

“You might be young and healthy and be able to fight this off on your own, but there are people who could end up hospitalized, and it’s not a joke,” she said. “I was laughing at all the memes and the jokes [about the coronavirus], and now I’m not. It’s real.”

Ishaan Shah, a political science major and 22-year-old senior at Washington University in St. Louis, said some of his classmates had similar reactions, staying relatively carefree despite the public health warnings. Then, the university shut down in the middle of its spring break ― giving students only a few days to gather their belongings from the dorms before the campus was shuttered.

Once that happened, Shah said, “we knew what was up. That made it immediately serious.”

And as he hears more about the coronavirus, his concerns amplify. “Every day that goes by, I personally have become more scared of this virus,” he said.

This change in perspective seemed to happen fast in hot spots like New York City, where the virus exploded with a shockingly high daily death rate and case counts. People there now say that almost everyone — whether crossing paths on the street or in line at the grocery ― is presumed positive.

Indeed, a tracking poll released last week found that most of the nation has adjusted its behavior to slow the spread of the coronavirus. Eighty-two percent of respondents reported they are sheltering in place and nearly everyone (92%) now reports some kind of social distancing — up from 59% two weeks ago, according to the poll from the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

But there are those who had factored this new reality into their daily habits almost from the beginning.

Take Megan Bohley, a 30-year-old behavioral health nurse who works in an outpatient facility in Flint, Michigan, interacting with patients all day.

When she gets home from work, she drops everything by the door, washes her hands, changes out of her work clothes and then dons a pair of rubber gloves and Clorox wipes to clean off her belongings. She also has talked to her husband about offering to help at a nearby hospital if Flint’s circumstances worsen.

But she’s scared, knowing that nurses and doctors are getting exposed and falling ill. “Some are dying,” Bohley said. “It does make me more nervous about what I do.”

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‘It’s Like Walking Into Chernobyl,’ One Doctor Says Of Her Emergency Room

At one New York City hospital, a doctor’s used mask tore as she performed CPR on her infected patient.

In Seattle, a nurse compares walking into her intensive care unit to bathing in COVID-19.

And in St. Louis, a nurse slips her used N95 mask into a paper bag at the end of her shift and prays it’s disinfected properly.

These are scenes playing out in hospitals across the country, based on interviews with over a dozen residents, doctors and nurses who go into work every day feeling unprotected from the disease they’re supposed to treat.

Nearly a month into the declared pandemic, some health care workers say they’re exhausted and burning out from the stress of treating a stream of critically ill patients in an increasingly overstretched health care system. Many are questioning how long they can risk their own health. Some are falling sick themselves, and even dying. In many hospitals, the pandemic has transformed emergency rooms and upended protocols and precautions that workers previously took for granted.

“It’s like walking into Chernobyl without any gear,” said Jacklyn, an ER doctor at a New York City hospital who asked to go by her middle name for fear of being fired over speaking out.

At her hospital, 90% of patients have COVID-19, but health care workers get only one N95 mask every five days.

“We’re constantly breathing in everything that’s aerosolized because of all of the procedures that we’re doing,” the New York City doctor said.

Coronavirus can spread easily through droplets during close interactions such as coughing and talking. It can also stay on some surfaces for days. During certain procedures, the virus becomes aerosolized and can linger in a room for longer periods. In such cases, health care workers are directed to take “airborne precautions” and wear N95 masks or another kind of respirator.

She said she’s baffled by how unprepared the government and hospitals are for this moment.

The day Jacklyn shows up to the hospital and there are no N95 masks, she said, she’ll refuse to work.

“I’m not on a suicide mission here. I’m not going to do anything that puts my life at risk. What is my daughter going to do without me? What would my husband do without me?” she said.

With a nationwide shortage of protective equipment, many hospitals are limiting how often nurses and doctors can get new masks and devising ways to stretch supplies.

“Whoever is disinfecting these masks, are they trained to do this? Is someone supervising? Where are they doing it and how?” wondered Sophia Rago, an ER nurse based in St. Louis, about her hospital’s policy.

Rago said she gets only one surgical mask and one N95 mask for three shifts in a row. Afterward, she places her gear in a brown paper bag and writes her name on it.

“You give it to somebody and they are supposed to be disinfecting it between your shifts,” she said. “Do I trust that? No! It can be disheartening to have that feeling of uncertainty that you are not going to be protected.”

Much of the anxiety felt by front-line health care workers stems from the ever-shifting federal guidance that in some cases later turned out to be wrong.

For example, in the early days of the pandemic, the Centers for Disease Control and Prevention had narrow criteria for screening suspected coronavirus cases, which was later broadened as the virus spread in the U.S.

The CDC still recommends, in cases where N95s aren’t readily available, that a simple surgical mask will suffice for health care workers unless they’re doing procedures that cause aerosol spray from the patients, such as intubating someone. It was only last week that the agency changed its guidelines and told all Americans to cover their faces with masks or cloth when in public.

Health care workers are distrustful of recommendations that, many said, appear to err on the side of less than what they require for protection. They point to the CDC’s recommendation to use a bandana or scarf as a last resort if masks run out.

“I don’t care what the CDC guidelines say. If your nurses feel uncomfortable in a certain area, you should give them what they need,” said Ramona Moll, a nurse who works at UC Davis Medical Center in Sacramento, California.

Moll said she contracted COVID-19 in mid-March after treating a patient suspected of having contracted the coronavirus. She believes the exposure happened when the older patient with dementia became combative and tried to bite her. At the time, Moll was wearing a surgical mask, goggles, gloves and a gown, but no N95 mask. Her gear was in line with CDC guidelines.

“The hospitals need to take responsibility for the fact that they did not take care of their nurses. They did not have N95s available,” she said.

Her hospital disputes her account. Spokesperson Edwin Garcia said there were no COVID-19 patients at the hospital at the time and that it has “dedicated, full-time teams that are committed to infection prevention and keeping our employees safe.”

Grueling Shifts, Stress And Bruised Faces

The lack of protective gear is one piece of a mosaic of stress that comes with caring for COVID-19 patients.

There are the 12- and 13-hour shifts in uncomfortable masks, the many unknowns of the disease and difficulties screening for it, the fear of getting infected or accidentally infecting another patient and the sadness of watching people die alone.

At an underresourced community hospital in Los Angeles, a nurse practitioner, Marie, has a plastic bag in her car in which she stashes her used N95s for the day her hospital may run out.

“I’ll spend the majority of my shift trying not to have a panic attack and then come home and fear going back to work,” she said. “If this goes on for weeks and weeks and things only get worse, I just don’t know how I’m going to be able to handle it.”

She asked to use her middle name because her hospital has warned employees not to speak publicly; some workers have been reprimanded for critical social media posts.

Marie has lost 3 pounds in a week. Once she puts her mask on during a shift, she won’t take it off and, thus, avoids eating. The bridge of her nose is cut open from wearing it on her face for hours at a time. The lack of preparation has her considering leaving nursing after the pandemic passes.

“I have dedicated my life to treating other people,” she said. “And yet when I’m in need, I’m not provided with what I need. It’s like an abusive relationship.”

Health care workers across the country and the globe are sharing selfies of their bruised faces from wearing N95 masks.

“It is a long six hours to be in all that gear,” said Amanda Adams, a travel nurse who works at an ER in the New York City suburbs. “I try to put aside my emotions and cheer up the patients. Meanwhile, I am thinking, which one is going to give it to me and am I going to get sick?”

Once Infected, Who Takes Care Of The Health Care Worker?

Already, front-line workers are falling ill and feeling they have to choose whether to risk their lives to save others.

At least 40 U.S. health care workers in the U.S. have died of COVID-19, according to Medscape. Some of them were young and early in their careers.

“That also increases the fear. That it’s hitting young people,” said Dr. Roy Akarakian, an ER resident at Henry Ford Hospital in Detroit. “I’m worried and afraid about the overall situation. This is something we’ve never seen before.”

Akarakian has already survived the virus — one of more than 730 employees of the Henry Ford Health System who have tested postive since tracking began on March 12.

In Seattle, Edward, an ICU nurse, said he developed flu-like symptoms and shortness of breath last month, after treating COVID-19 patients. He decided to stay at home out of caution, while he waited for his test results. Seven days passed before he learned he was positive.

“It was just really hard and nerve-wracking,” said Edward who works at Swedish Medical Center, and is using only his first name because he’s afraid of losing his job for speaking publicly.

While in isolation and recovering, he was required to use his own vacation and sick time. After learning he had COVID-19, he said, his employer “tried to pin those results on something outside the hospital” — probably, Edward said, because the hospital provides fully paid emergency administrative leave only if you can prove you caught it on the job.

“I did not feel supported at all,” he said. “Their main concern was trying to explain away my positive results as community-acquired.”

In a statement, Swedish said “it’s grateful for our caregivers’ unwavering commitment to our patients and the selflessness they bring to work every day to ensure our patients and community are safe.”

Tiffany Moss, a hospital spokesperson, also noted Swedish provides 80 hours of full-paid emergency time off for workers affected by COVID-19 — no matter where they were exposed to the virus — but only after infected employees exhaust vacation and sick time.

When Edward got the green light to go back to work, his co-workers seemed afraid to be near him.

“When I would tell people, they would physically back away from me, they would question whether I should be at work,” he said. “It was hard to go home at night and deal with those emotions.”

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

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A Colorado Ski Community Planned To Test Everyone For COVID-19. Here’s What Happened.

In late March, residents of the Colorado town of Telluride and surrounding San Miguel County stood in line, along marked spots spaced 6 feet apart, to have their blood drawn by medical technicians wearing Tyvek suits, face shields and gloves for a new COVID-19 test.

While the Centers for Disease Control and Prevention’s tests for the virus that causes the respiratory illness have been in short supply since the outbreak began, this was a new type of test. It wasn’t to see who was sick right now. It was an antibody test that would assess who had been exposed and how widespread the virus was in the community to inform decisions about managing the outbreak.

When part-time Telluride residents and United Biomedical Inc. co-CEOs Mei Mei Hu and Lou Reese had offered to provide their company’s newly developed COVID-19 antibody tests for free to not just Telluride, but all of San Miguel County too, more than 6,000 of the county’s estimated 8,000 residents jumped at the chance.

“People really want to be part of it,” said Donna Fernald, a home health nurse who was tested the first day.

The widespread testing was an experiment in this community best known for its tony ski resort and summer music festivals. But it also served as a model for what, perhaps, could be possible everywhere to guard against the spread of the disease.

“This was a gift and an opportunity,” said San Miguel County spokesperson Susan Lilly.

That was the original plan, anyway. But on Tuesday, the grand experiment with bold aspirations appeared to fall apart. Lilly put out a statement announcing that testing was being “delayed indefinitely due to United Biomedical Inc.’s reduced ability to process the tests due to the COVID-19 pandemic.” Lilly declined to comment on the decision.

The test that Hu and Reese’s company had promoted as “fast — results in two hours” had slowed to a virtual halt. The company had initially told the county to expect results within 48 to 72 hours after the samples arrived at the company’s New York lab. Results from tests conducted March 26 and 27 were announced April 1, but results from subsequent tests have still not come in.

A San Miguel County Department of Public Health and Environment press release quoted a company statement that blamed the delay on operations and the majority of staff being located in New York, where the pandemic has hit especially hard. The press release issued Tuesday said the company is aiming to resume processing the estimated 4,000 outstanding tests from the first round of testing.

But with only a fraction of the results in so far, and additional testing in question, the COVAXX testing appears to be yet another example of the chaotic response to the coronavirus crisis gone wrong.

A Different Kind Of Test

The test that Hu and Reese donated to the Telluride community is an antibody test developed by COVAXX, a newly formed subsidiary of their New York-based United Biomedical. It’s one of more than 30 commercially available tests without Food and Drug Administration approval under flexible rules adopted to address the COVID-19 pandemic. So far only one antibody test has received official FDA approval — a test made by Cellex, which uses just a pinprick of blood and produces results in about 15 minutes.

Antibody tests are fundamentally different than the CDC swab tests currently used to make official diagnoses. Where the swab test looks for the virus’s genetic material to determine active infections, an antibody test looks for antibodies in a person’s blood that show an immune response to the virus that causes COVID-19. Robert Garry, a virologist at Tulane University School of Medicine, said the test can’t tell whether the person is currently sick or infectious.

The plan in Telluride was for participants to be tested twice, two weeks apart, with the COVAXX test because it can take a while for someone infected to show up as positive when measuring antibodies.

The COVAXX website claims its test has 100% sensitivity (that’s the test’s ability to find antibodies to the virus) and 100% specificity (a measure of how good the test is at differentiating this novel coronavirus’ antibodies from other antibodies).

But, Garry said, no test is perfect. And creating an antibody test for the virus being called SARS-CoV-2 is “tricky,” he said, because it needs to distinguish among several seasonal coronaviruses. Furthermore, he added, the COVAXX test is a peptide assay, which he said typically is not very sensitive.

“We know 100% is an almost impossible bar to reach,” Garry said. “It kind of raises some red flags.”

In an interview with KHN before the Telluride program stopped, Hu said that “I always hesitate when I say 100%,” but she said that the company validated the test against 900 samples collected before the COVID-19 outbreak, with no false positives. She added the test also correctly produced positive results from blood samples that have been verified as positive through other tests.

Theoretically, having antibodies to SARS-CoV-2 could make a person immune to the virus, but how robust this immunity is and how long it might last remain open questions. The big promise behind testing a whole community is that if one can identify people who have been infected and recovered (or never gotten sick in the first place), one can safely send them back to work or out in the community, Reese said.

“It’s absolutely my goal to make this standard for how we get the country back to a new normal,” Reese had said before the test was suspended. “If we tested everyone in the whole country and were prepared to do it twice, you would know exactly when you would be back at functioning — everybody back at work.”

Reese isn’t alone in his excitement. Hedge fund billionaire Bill Ackman invested an undisclosed amount of capital into COVAXX through his Pershing Square Foundation, and bestselling author and XPrize founder Dr. Peter Diamandis is listed as part of the COVAXX leadership team on the company’s website. Diamandis presents a fawning interview with Hu and Reese in a widely shared YouTube video, which does not disclose his relationship with the company. Neither responded to requests for comment.

Testing Results

In all, about 6,000 of San Miguel residents were tested at three locations across the county, which covers about 1,300 square miles. As of Monday, only 1,631 of the tests had been processed, with eight (0.5%) of them deemed positive, 25 (1.5%) “borderline” and 1,598 (98%) negative. Borderline results indicate the person may be in the early stages of producing antibodies, Lilly said.

Yet the single tests alone can’t provide a clear picture of how many people have been exposed.

As of Thursday, a total of 11 cases in San Miguel County had been identified with standard swab tests. Officials continue to recommend that all residents practice social distancing and that those experiencing symptoms practice further isolation to prevent the potential spread of COVID-19.

One way to look at this attempt at large-scale testing is that “everybody’s getting together and trying to do something cooperative and innovative,” said George Annas, director of the center for health law, ethics and human rights at Boston University School of Public Health.

“If you wanted to be cruel, you could say this is a publicity stunt,” Annas said.

The program certainly won COVAXX a lot of good publicity, along with gratitude from local residents — at least initially.

And a resort town in Wyoming is following suit. John Goettler, president of St. John’s Health Foundation in Jackson, said his organization is spending “less than $20,000” on COVAXX tests for about 500 health professionals and first responders. Goettler said Jackson resident Dakin Sloss, a hedge fund owner listed as another member of COVAXX’s leadership team, helped secure the tests. Testing is set to begin next week, and the test will be processed at a local lab, rather than in New York.

But in Ouray County, adjacent to San Miguel County, officials decided against such testing even before the Telluride suspension.

The cost “would shoot a hole in my budget for at least the next two years,” said Ouray County public health director Tanner Kingery.

But that wasn’t the only concern, Kingery said. It would have required a large supply of precious masks and other personal protective equipment, he said, while potentially exposing health care workers and community members to the virus.

Dr. Andrew Yeowell, an emergency room physician and Ouray County EMS medical director, also was concerned that negative tests might give people a false sense of security. If people with negative tests felt emboldened to go out in the community and interact with others, he said, it could undermine the county’s advisory to stay home.

“If you’re having symptoms or feel sick, stay home,” Kingery added. “That guidance doesn’t really change if you have a positive test.”

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‘Baby, I Can’t Breathe’: America’s First ER Doctor To Die In Heat Of COVID-19 Battle

At about 5 a.m. on March 19, a New York City ER physician named Frank Gabrin texted a friend about his concerns over the lack of medical supplies at hospitals.

“It’s busy ― everyone wants a COVID test that I do not have to give them,” he wrote in the message to Eddy Soffer. “So they are angry and disappointed.”

Worse, though, was the limited availability of personal protective equipment (PPE) — the masks and gloves that help keep health care workers from getting sick and spreading the virus to others. Gabrin said he had no choice but to don the same mask for several shifts, against Food and Drug Administration guidelines.

“Don’t have any PPE that has not been used,” he wrote. “No N95 masks ― my own goggles — my own face shield,” he added, referring to the N95 respirators considered among the best lines of defense.

Frank Gabrin’s messages to Eddy Soffer.(Courtesy of Eddy Soffer)

Less than two weeks later, Gabrin became the first ER doctor in the U.S. known to have died as a result of the COVID-19 pandemic, according to the American College of Emergency Physicians.

He is one of numerous medical workers across the U.S. who have succumbed to the virus, from doctors and nurses to paramedics and hospital food service employees. The Guardian and Kaiser Health News are launching a new project, “Lost on the Frontline,” to track them and tell their stories.

New York City-area hospitals have been particularly hard-hit. of all U.S. cases have occurred in New York state. At a hospital in the borough of Queens, patients have reportedly died while waiting for a bed, and a temporary trailer morgue was set up outside. Physicians at another hospital system created a GoFundMe drive because they had insufficient masks and gowns.

Gabrin knew the stakes of his job. “Inside the emergency, the angel of death is in the room,” he wrote in his 2013 book, “Back From Burnout.” “The pressure is intense, yet there is a calm, a peace, like being in the eye of the storm.”

His own resilience was hard-won after several close brushes with mortality, and his marriage to a special man only seven months prior to the COVID-19 spike in New York. But circumstances around the coronavirus unsettled him. “I have to admit,” he posted on Facebook, “I am having some anxiety.”

‘He Showed Me The Light’

Toothy and energetic, Gabrin, 60, was adored by colleagues at hospitals in Ohio, New York and elsewhere. He was loud. He always arrived at work bearing food to share. He was “a ray of sunshine,” said physician assistant Lois-Ann Welsh, and possessed the “emotional intelligence” that differentiated a great doctor from merely a good one.

“I don’t hold any fancy titles and I am not the director of anything,” Gabrin explained in his book. “But I can say that I have spent the last quarter of a century at the bedside of America’s sick, injured, intoxicated, impaired and disenfranchised.”

Born in Pennsylvania, Gabrin was a physician by calling, and his mother had photographs of him as a child tending to neighborhood dogs. His commitment to his profession was strengthened by his own illness. During his first year as an attending physician, he was diagnosed with testicular cancer. He survived, but it returned when he was 38. Both testicles were eventually removed ― he called it “the mutilating surgery.” Even so, he resolved to offer others the second chance that he himself received twice.

This, and an incident when a man tried to kill Gabrin at his ER, choking him so that he “started turning purple in the face,” helped lead to Gabrin’s unique professional philosophy. He described it in his book, explaining how medics can overcome burnout and feel greater compassion for their patients.

A huge shift in his life came a few years ago, when at a nightclub he met Arnold Vargas, a Peruvian who had lived in the U.S. for a decade.

Arnold Vargas and Frank Gabrin. ‘I saw [Gabrin] the happiest with Angel,’ says Eddy Soffer.(Courtesy of Arnold Vargas)

“I saw [Gabrin] the happiest with Angel,” said Eddy Soffer, using Vargas’ middle name, as Gabrin did. “All his fear dissipated and he became his true self.”

“I think it gave me a second chance,” said Vargas, now 28. “He showed me the light — how beautiful my life can be.” He had been miserable, in a rut, yet Gabrin pushed him to train in massage therapy and to apply for U.S. citizenship. There was an age difference, but to Vargas, who felt enriched by Gabrin and his experiences, it was irrelevant. “I was always thinking, ‘I just want to make you happy,’ and he did the same for me.”

They married in August 2019 at City Hall in New York.

‘It’s Not Going To Be This Way Forever’

When infections in New York surged in March, Gabrin posted a picture of ambulances crowding a hospital bay on Facebook. “I was thinking, ‘Oh my God, this is the moment Armageddon happens,’” said Debra Vasalech Lyons, another old friend. “He said, ‘No, it’s still manageable, but it’s not going to be this way forever.’”

In fact, St. John’s Episcopal in Queens, one of two hospitals where Gabrin worked at the time, was among local facilities “dealing with challenges around PPE,” said New York City Council member Donovan Richards. The hospital says it has always had enough equipment for staff.

Richards linked difficult conditions there to historical discrimination and underresourcing in the largely African American and Hispanic district. “When America gets a cold, black and brown communities get pneumonia,” Richards said. “But in this instance, we are getting death sentences.”

The other hospital at which Gabrin was employed, East Orange General in New Jersey, served a majority African American community, and also had a devoted staff that before the virus had struggled to maintain care standards.

In conversations with his husband and friends in mid- and late March, including in text messages shared with The Guardian, Gabrin said he had to reuse his PPE because he did not receive replacements. He told Lyons that he was attempting to wash an N95 mask to make it last several shifts, and that the only gloves available were too small for his hands and ripped.

When America gets a cold, black and brown communities get pneumonia. But in this instance, we are getting death sentences.

Donovan Richards, New York City Council member

Lyons mailed him gloves in the correct size from Florida, where she lives, and ordered 4 gallons of hand sanitizer for him. On Facebook, Gabrin wrote about concocting his own sanitizer from vodka and aloe vera plants.

The heads of the two emergency rooms where Gabrin worked both said they had sufficient supplies of protective equipment.

“I know for one thing he wasn’t speaking about a lack of PPE at St. John’s,” said Dr. Teddy Lee, the ER chairman there.

“If for a second I thought that was our problem at East Orange, I would tell you otherwise,” said ER chairman Dr. Alvaro Alban.

On March 25, when Gabrin arrived home, “he said, ‘Baby, something bad happened tonight,’” Vargas recalled. A coronavirus patient with whom Gabrin formed a deep connection had passed away. Gabrin took a shower and cried, then he and Vargas offered a prayer for the person’s soul.

Frank Gabrin’s messages to Debra Vasalech Lyons.(Courtesy of Debra Vasalech Lyons)

The next morning, a Thursday, they both had symptoms and self-quarantined. “It was me using the same mask for four days in a row that infected me,” he texted Lyons. Through the weekend, their cases seemed mild. Gabrin coughed and had joint aches but didn’t have significant respiratory issues. On Monday, though, Gabrin was in greater pain and spent the day in bed.

At around 10 a.m. on Tuesday, he woke Vargas and said, “Baby, I can’t breathe, help me.”

He was gasping for air in great, hoarse breaths, but could not get enough oxygen. Vargas called Lyons and 911. But by the time paramedics arrived, Gabrin was on the edge of death, or had already gone. His face had turned purple.

Frank “passed away in my arms,” Vargas said. “He was looking into my eyes.”

Vargas himself eventually recovered. On Tuesday, two weeks after his death, Gabrin will be buried at Maple Grove Cemetery in Queens.

Owing to the need for physical distancing, Vargas was told, only 10 mourners will be allowed.

The headstone, Vargas expects, will bear a middle name that Gabrin adopted through his decades-old interest in Kabbalah, the Jewish mystical tradition. That name, Pinchas, now seems poignant.

It comes from a biblical figure who halted a plague.

This story is part of Lost On The Frontline, a project from The Guardian and Kaiser Health News that aims to document the life of every healthcare worker in America who dies from COVID-19 during the pandemic. We’ll be sharing more about the project soon, but if you have a colleague or loved one we should include, please email covidtips@kff.org.

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KHN’s ‘What The Health?’: Who Will Pay For COVID-19 Care?

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In the absence of clear leadership from the federal government, states and private companies are pursuing their own plans to help Americans cope with the coronavirus pandemic. But while there are many examples of public and private officials working cooperatively, underlying political battles are also taking place, particularly when it comes to how to distribute funding already provided by Congress and funding that may be provided in the coming weeks and months.

This week’s panelists are Julie Rovner of Kaiser Health News, Paige Winfield Cunningham of The Washington Post and Alice Miranda Ollstein of Politico.

Among the takeaways from this week’s podcast:

  • The HHS inspector general’s hospital survey released this week showing that equipment shortages have not been resolved hit a sore spot for the Trump administration. The president criticized the inspector general and suggested that the results were politically motivated, but the hospital officials’ comments to HHS indicate that the federal response is a step behind as hospitals battle thousands of cases of COVID-19, the disease caused by the coronavirus.
  • Federal and state officials are not yet able to give Americans good guidance on what the future looks like. There are too many unanswered questions about the virus, its transmission and testing options.
  • Some of the programs implemented to help consumers during the crisis — things like reduced prices for insulin and insurers’ guarantees of coverage for testing and treatment — may be too popular to ditch after the epidemic ends. That will leave health care providers, drugmakers, insurers and others looking for new profit options.
  • Although Sen. Bernie Sanders of Vermont has pulled out of the race to be the Democratic presidential nominee, his platform still highlights many of the problems in the health care system, such as affordability and access to care, that have gained greater attention with the coronavirus pandemic.
  • Federal officials are looking for an equitable way to divvy up the $100 billion earmarked for hospitals in the relief bill signed by President Donald Trump last month. Hospitals in the pandemic’s hot spots think they should be rewarded first, but others, which may not have been hit as hard, note that they have also given up moneymaking elective procedures to prepare for the crisis and are in need of aid.
  • A federal court in Texas on Monday will consider new arguments on the state’s decision to declare abortion an elective procedure that must be prohibited during the coronavirus crisis. Reproductive rights advocates hope to get an exemption for nonsurgical abortions and for women who are close to the state’s time limit on abortions.

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

Julie Rovner: The Washington Post’s “Flushing Out the True Cause of the Global Toilet Paper Shortage Amid Coronavirus Pandemic,” by Marc Fisher

Alice Miranda Ollstein: Politico’s “How Public Health Failed Nursing Homes,” by Joanne Kenen, Rachel Roubein and Susannah Luthi

Paige Winfield-Cunningham: The Washington Post’s “The Dark Side of Ventilators: Those Hooked Up for Long Periods Face Difficult Recoveries,” by Carolyn Y. Johnson and Ariana Eunjung Cha

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Newsom’s Ambitious Health Care Agenda Crumbles In A ‘Radically Changed’ World

This was supposed to be a big health care year for California.

Democratic Gov. Gavin Newsom in January unveiled ambitious proposals to help him achieve his goal of getting every Californian health care coverage. Though it was far less than the single-payer promise Newsom had made on the gubernatorial campaign trail, his plans, if adopted, would have expanded the health care system as no other state has.

His $47 billion health care agenda, fueled by a once-booming economy and pressure from legislative Democrats, sought to expand the pool of undocumented immigrants covered by Medicaid, enable California to manufacture its own generic drugs, pour billions into the Medicaid program to address chronic homelessness and dramatically increase mental health and addiction treatment statewide.

Then, the novel coronavirus swept in, decimating those ambitions.

“The world has radically changed,” Newsom said this month, as he prepared California for a mid-May surge in COVID-19 hospitalizations.

Once buoyed by record economic growth and a $21 billion rainy-day fund to protect California from a major downturn, Newsom warned of a “budgetary crisis that is starting to manifest,” suggesting he can no longer follow through on his health care promises.

“All of that is being recalibrated,” he said.

But Democratic lawmakers who control both houses of the state legislature — and will negotiate with Newsom over the scope of the 2020-21 state budget — aren’t necessarily convinced they have to abandon their plans.

“If those workers providing the products, the services, the food that we eat don’t have health care, we’re all in danger,” said state Sen. Maria Elena Durazo (D-Los Angeles), who has pressed Newsom to expand Medicaid coverage to unauthorized immigrants ages 65 and up. “Our reasoning is a lot stronger now because if they don’t have health care, it weakens our ability to stop the spread of COVID-19.”

Newsom says he has no choice but to scale back his initial $222 billion state budget proposal.

The state may be able to fund only existing programs and coronavirus response and recovery, said state Finance Director Keely Bosler. There could even be cuts, she warned.

Exactly how much money will be available to keep the state running will not be known until mid-May. The legislature, which recessed in mid-March in the midst of the pandemic, isn’t scheduled to reconvene until May 4 and may conduct business remotely for the remainder of the session.

Staggering stock market and job losses have thrown the state’s fiscal outlook into turmoil, with California receiving more than 2 million unemployment claims since mid-March. Medi-Cal, California’s Medicaid program for the poor, already covers about 13 million Californians, and state budget analysts expect caseloads to explode.

“It is going to be bad, but we have not yet been able to determine how bad because of the fluid and dynamic nature of this pandemic,” said H.D. Palmer, spokesperson for the state Department of Finance. “Clearly what we are in the midst of is much more severe than a midpoint recession.”

Meanwhile, the state has already begun draining its rainy-day reserves and spending from its general fund to respond to the crisis.

Newsom has spent more than $850 million in response to the pandemic, such as boosting California’s supply of ventilators and other protective gear needed for a projected surge in COVID-19 cases. On Tuesday night, he announced the state had inked a $1 billion deal to get 200 million masks per month — enough for California and possibly to share with other states.

Newsom is also funding food and senior assistance programs, sending money to counties to house more jail inmates while state prisons temporarily pause intake, and paying for hotel and motel rooms for homeless people. And the state will help pay nearly 40,000 health care workers it is recruiting for the surge.

Some of the costs will be reimbursed by the federal government, Newsom said, but it’s not clear how much.

Not long ago, Newsom and the legislature were in a very different place, enacting policies that made California a national testing ground for expanding health coverage.

Last year, they approved a $100 million-per-year expansion of Medi-Cal to low-income undocumented immigrants ages 19 to 25, earning praise from national party leaders and ire from President Donald Trump. And they approved $1.5 billion over the next three years to fund new subsidies for some low- and middle-income Californians purchasing health coverage on the state health insurance exchange, Covered California.

This year would have been even bigger.

“We have a unique responsibility to show the way,” Newsom said in January.

Newsom sought to funnel state and federal Medicaid dollars into emergency rental programs to help homeless people get housing, and to bolster treatment for substance use disorders and mental health for homeless people, at-risk youth and incarcerated people.

He threatened steeper fines against health insurers that didn’t provide adequate access to behavioral health treatment, vowed to stop surprise medical billing, promised to lower prescription drug costs and hatched a sweeping plan to cut overall health care spending by going after the health care industry for jacking up prices.

Democratic leaders and even Republicans embraced his focus.

“California is certainly the most aggressive at trying to push towards universal coverage,” said Larry Levitt, executive vice president for health policy at the Kaiser Family Foundation. (Kaiser Health News, which produces California Healthline, is an editorially independent program of the foundation.)

“Typically, you find states focusing on either cost or universal coverage, but what sets California apart is a drive to deal with both.”

Some Democratic lawmakers acknowledge they must reimagine their health care agenda, including state Assembly member Phil Ting (D-San Francisco), chair of the Assembly Budget Committee.

“We’re going to have to be very disciplined,” Ting said. “I don’t think we’re going to spend money on much else other than coronavirus and economic recovery.”

But others argue that proposals to expand coverage and access are even more pressing because of COVID-19.

“Every person who can’t get health care and gets sick could potentially spread the disease to more people. We need to take care of that,” said state Sen. Richard Pan (D-Sacramento), who chairs the Senate Health Committee and leads the state Senate budget process for health-related expenditures.

Advocates and lobbyists also are flooding Newsom with budget request letters asking him not only to stick with existing proposals, such as protecting people from getting hit with surprise medical bills, but also to expand coverage even more and increase state subsidies for insurance. Doctor groups are asking the governor to provide relief for health care providers who have lost income due to declines in patient revenue, while organized labor is asking him to assist businesses so they don’t cut health employee health benefits.

County behavioral health directors argue the state must fund more mental health and substance use disorder treatment because the need is greater today, especially for students who can’t attend school and for those who have lost homes and work.

“We need to marshal additional attention and resources for lifesaving behavioral health treatment and services, unless we intend to deepen inequality,” said Michelle Doty Cabrera, executive director of the County Behavioral Health Directors Association. “This year, right now.”

Although Newsom has sought to quell the spending push by health advocates, he said Saturday that health care remains a top priority and he’s “committed” to adopting reforms within California’s budgetary constraints — even if it might not happen this year.

“We will do everything in our power to lean into the future despite these circumstances,” he said. “Reforms can happen on a good day or a bad day.”

California Healthline correspondent Rachel Bluth contributed to this report.

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

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What’s Missing In The Coronavirus Response

In the age of coronavirus, Americans are being told to stay home and wear masks outside. The federal government has made way for hospitals to treat patients in repurposed hotels and dormitories. Private companies are working to push out new diagnostic tests.

But the national effort has been disorganized, relying heavily on state action, said health systems experts and public health researchers. That approach has fallen short, they assert.

“We’re in a lot more trouble than we need to be,” said Dr. Donald Berwick, who ran the federal Centers for Medicare & Medicaid Services during the Obama administration.

So what else should the United States be doing?

Public health specialists said a range of tools, high-tech strategies and old-school public health interventions could help tamp down the spread of COVID-19, the illness caused by the coronavirus.

Though an ambitious playbook, “it’s all conceivable,” said Dr. Kedar Mate, chief innovation and education officer at the Institute for Healthcare Improvement, a Boston-based nonprofit organization.

Collecting Data

There’s plenty of room for improvement in using and collecting data that might inform a coordinated national response. So far, states are picking their own models to predict when cases might peak — with different localities using different formulas ― and private groups coming up with their own projections.

A bigger-picture look, experts said, would allow the federal government to connect the dots and deliver a proactive response — not waiting to see where the virus emerges next.

The CDC tracker and guidance are positive steps, but they fall short of what’s needed ― largely, experts said, because the virus is moving so fast, and best practices aren’t yet clear.

To be sure, some changes would be harder to implement than others.

Take predictive data. In California, Dr. Eric Topol, a cardiologist and director of the Scripps Research Translational Institute, is running a study in which people with smartwatches can have an app track their resting heart rate and collect the data in an anonymized format, to protect patient privacy.

Geographic clusters of spiking heart rates could suggest a wave of impending fevers. Though smartwatch users are typically wealthier, there are enough of them — potentially more than 100 million Americans with devices like Fitbits or Apple Watches — who could download the app. That data could help the government decide when and where to concentrate resources, Topol said.

Reporting from Politico suggests the White House is thinking about ways to collect real-time data, but those efforts haven’t gained traction.

Even simpler: a standardized hospital intake form — in which health professionals ask a set of questions and the answers are relayed to the Centers for Disease Control and Prevention. That could help federal officials get a better sense of which symptoms are most common and how people who get sick are typically exposed. Such data could inform nationwide efforts, researchers said. And multiple federal agencies have the authority to do this.

“The system, it has to come together,” said Eric Perakslis, a Rubinstein fellow at Duke University who previously managed technology for multiple responses to Ebola. It can’t be “‘Do you hear UCSF did this thing?’ And you have to go through the internet to dig for what they did.”

Strategic Testing, To Understand The Virus

Part of gathering data and information has to do with widespread testing for COVID-19. And, though rates have shot up, the United States still lags in per capita testing.

“We are flying blind unless we can find a way to find the people who are infected,” Berwick said.

Put simply, Washington needs to prioritize “contact tracing,” Perakslis said. That means testing people with strong symptoms, and their first-order contacts. The results give epidemiologists an idea of viral transmission and help them stop it.

Here’s the rub: Effective contact tracing requires coordinated dispersal of test kits from the federal government. So far, the administration has promised to provide more test kits, but that hasn’t materialized at the level experts say is needed.

It goes beyond coordinating diagnostics tests. There are also new and emerging “serology tests” that measure antibodies and can determine whether someone has been exposed to the virus and since acquired some kind of immunity, Topol said.

It’s still early, and the available tests aren’t perfect. But testing people for those antibodies could help pinpoint when people who have been infected are non-contagious and illuminate how long immunity lasts. People with that immunity could go back into the workforce. This knowledge could also help inform public health authorities about which parts of the country are on the mend, and which need more attention.

The Workforce

Here’s where the U.S. could take lessons from old-school public health interventions. One such strategy was used in the Ebola response in West Africa, and is again bearing fruit abroad. It involves enlisting community health workers ― trained professionals or skilled volunteers — who visit people at home, helping them stay healthy and triaging patients to help them stay at home rather than landing in the hospital.

The idea is that care at home would keep people away from emergency rooms and ICUs, minimizing the stress on the health system.

“That is how we turned the tide on Ebola,” Perakslis said.

Ideally, he said, federal and local authorities would work in partnership to mobilize workers and provide them the equipment to protect themselves from the virus. Workers could be trained to administer at-home testing, help people monitor for symptoms and care for themselves and, in less-hard-hit areas, encourage behaviors that prevent the spread of disease.

In Germany, where the coronavirus rate is an astonishingly low 1.6%, this approach has accompanied widespread diagnostic testing and effective social distancing. Heidelberg’s “corona taxis” deploy medics, suited up in hazmat suits, to visit people at home.

“We need that kind of large-scale mobilization of the public ― of an army of private citizens,” Mate argued.

‘A Clearly Stated National Plan’

President Donald Trump empowered the Federal Emergency Management Agency on March 18 to coordinate the distribution of important medical supplies, like ventilators and protective personal equipment (PPE) for health care workers. But, simultaneously, the administration has undercut FEMA’s management power.

“This is what FEMA was created to do. This is what FEMA is trained and prepared to do,” said John Cohen, a former acting undersecretary at the Department of Homeland Security and current adjunct professor at Georgetown University. “If FEMA was left to work on this on its own, even though it’s late, you would see better organization.”

Right now, FEMA is collecting input from around the country to determine which regions are at greatest risk, and who needs immediate aid with medical supplies. But news reports and presidential tweets show that states and hospitals are leveraging White House contacts to bypass FEMA’s approval process — diluting the effectiveness of national efforts to coordinate and distribute supplies where they’re needed.

Then there’s the issue of purchasing. So far, the president has not directed FEMA ― or any other federal authority — to be the sole agency purchasing equipment. That means many states and localities are bidding on the same supplies. These smaller buyers have less leverage and may end up paying more than they otherwise would have.

It’s a matter of the White House outlining a clear, organized system ― declaring FEMA the single entity in charge of buying ventilators and PPE — and then sticking to it, Cohen said.

“That’s what’s lacking,” he continued. “If they laid out a clear, comprehensive national strategy, and included that FEMA would be the sole purchaser, then that would probably be accepted by a majority of state and local governments ― as long as they had trust in federal authorities.”

The president could also direct FEMA to coordinate with another agency that has more experience with bulk purchasing to take on this task, said Tim Manning, a former deputy administrator for FEMA.

“There’s no reason to believe the existing frameworks we have are not a match for the current problem,” Manning said. “They’re just not being used.”

Instead, hospitals and states are independently trying to procure gear, with the help of individual donations and new groups like #GetUsPPE and Project N95, which coordinate between suppliers and hospitals. Right now, the high demand means masks that typically go for $1 are retailing for between $3 and $7 apiece, said Andrew Stroup, who co-founded Project N95. That difference adds up when hospitals are buying 100,000 masks at a time.

“We have a federal government for exactly this,” Manning said.

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What Does Recovery From COVID-19 Look Like? It Depends. A Pulmonologist Explains.

Reports of recovery from serious illness caused by the coronavirus have been trickling in from around the world.

Physicians are swapping anecdotes on social media: a 38-year-old man who went home after three weeks at the Cleveland Clinic, including 10 days in intensive care. A 93-year-old woman in New Orleans whose breathing tube was removed, successfully, after three days. A patient at Massachusetts General Hospital who was taken off a ventilator after five days and was doing well.

“Patients are definitely recovering from Covid-19 ARDS [acute respiratory distress syndrome] and coming off vents,” Dr. Theodore “Jack” Iwashyna, a professor of pulmonary and critical care medicine at the University of Michigan, wrote on Twitter recently.

But the outlook for older adults, who account for a disproportionate share of critically ill COVID-19 patients, is not encouraging. Advanced age is associated with significantly worse outcomes for older patients, and even those who survive are unlikely to return to their previous level of functioning.

According to a new study in The Lancet based on data from China, the overall death rate for people diagnosed with coronavirus is 1.4%. But that rises to 4% for those in their 60s, 8.6% for people in their 70s and 13.4% for those age 80 and older.

How often do people who are critically ill recover? According to a report from Britain out last week, of 775 patients with COVID-19 admitted to critical care, 79 died, 86 survived and were discharged to another location, and 609 were still being treated in critical care, with uncertain futures. Experts note this is preliminary data, before a surge of patients expected over the next several weeks.

According to a just-published small study of 24 critically ill COVID-19 patients treated in Seattle hospitals, 50% died within 18 days. (Four of the 12 who died had a do-not-resuscitate order in place.) Of those who survived, three remained on ventilators in intensive care units, four left the ICU but stayed in the hospital, and five were discharged home. The study appeared in the New England Journal of Medicine.

What does recovery from COVID-19 look like? I asked Dr. Kenneth Lyn-Kew, an associate professor of pulmonology and critical care medicine at National Jewish Health in Denver, named the No.1 respiratory hospital in the nation last year by U.S. News & World Report. Our conversation has been edited for length and clarity.

Q: What’s known about recovery?

It’s helpful to think about mild, moderate and severe disease. Most people, upwards of 80%, will have mild symptoms. Their recovery typically takes a couple of weeks. They might feel horrible, profoundly fatigued, with muscle aches, a bad cough, a fever and chest discomfort. Then, that goes away. Also, there are some people who never have symptoms, who never even know they had it.

Q: What about people with moderate illness?

Because we’re so early into this, we have less information about these patients. Often, they spend a few days in the hospital. People feel more short of breath: Sometimes, an underlying condition like asthma is exacerbated. Typically, they need a bit of oxygen for a few days.

Also, there are patients who have high fevers or severe diarrheal illness with COVID-19. Those patients can get dehydrated and need IV fluids.

There also appears to be a small population of people who can develop myocarditis ― inflammation of the heart. They come in with symptoms that mimic heart attacks.

Q: How long do these patients stay hospitalized?

It can vary. Some people get a little oxygen and IV fluid and leave the hospital after two to three days. Some of these moderate patients start to look a little better, then all of a sudden get a lot worse and decompensate.

Q: What about patients with serious illness?

Many of the sickest patients have acute respiratory distress syndrome [ARDS, a disease that floods the lungs with fluid and deprives people of oxygen]. These are the patients who end up on mechanical ventilators.

Those least likely to recover seem to be frail older patients with other preexisting illnesses such as COPD [chronic obstructive pulmonary disease] or heart disease. But there’s no guarantee that a young person who gets ARDS will recover.

ARDS mortality is usually between 30% and 40%. But if you break that down, people who have ARDS due to trauma — for instance, car accidents ― tend to have lower death rates than people who have ARDS due to infection. For older people, who tend to have more infections, mortality rates are much higher — up to 60%. But this isn’t COVID-specific data. We still have a lot to learn about that.

Q: If someone is sick enough to need ventilation, what’s involved?

People usually need a couple of weeks of mechanical ventilation.

Ventilation is very uncomfortable for many people and they end up on medication to make them more comfortable. For some people, just a bit of medication is enough.

Other people require heavier doses of medications such as narcotics, propofol, benzodiazepines or Precedex [a sedative]. Because they act on your brain, these medications can induce delirium [a sudden, serious alteration in thinking and awareness]. We really try to minimize that because delirium has a significant impact on a person’s recovery.

Being on more medication affects other things also: a patient’s sleep-wake cycle. Their mobility, which can make them weaker. It can slow down their gastrointestinal tract so they don’t tolerate nutrition as well and get suboptimal nutrition. Many of these patients end up having PTSD [post-traumatic stress disorder] and impaired concentration afterwards.

Q: When can someone go off a respirator?

There are three criteria. They have to be awake enough to protect their swallowing mechanism and their airway. They have to have a low enough need for oxygen that I can support that with something else, such as nasal prongs. And they have to be able to clear enough carbon dioxide.

Q: What will a patient look like at the end of those two weeks?

That depends. If we’re able to do everything right, these people are up and walking around with the ventilator. Those patients come out on the other end looking pretty good. Maybe they’ll have some weakness, some weight loss, a little PTSD.

The patients who are sicker and more intolerant of the technology, they tend to come out weak, forgetful, confused, deconditioned, maybe not even able to get out of bed. Sometimes, in spite of our best efforts, they’ll have skin wounds.

Some of these patients have significant lung fibrosis ― scarring of the lungs and reduced lung function. This might be a short-term part of their recovery or it could be long-term.

Q: Are there special considerations for older adults?

Older adults tend to have more preexisting illnesses that put them at more risk for complications. Their immune system is less robust. They’re more prone to secondary infections such as pneumonia in spite of everything we do to prevent that.

Frailty is an important factor as well. If you come in frail and weak, you have less reserve to fight this through.

Q: When are people ready to be discharged?

You can go home on supplemental oxygen if you still need that kind of assistance. But you need to be able to feed yourself and move around or, if you have more disability, have someone to provide that for you.

Some people spend a couple of weeks in the ICU, then two to three days on a medical/surgical ward. Other people take another week or two to regain some strength. Some will go to an acute rehabilitation facility to get rehab three times a day. Others can go to a skilled nursing facility, where they’ll get rehab over a couple of months and then go home.

Q: Who’s unlikely to recover?

That we just don’t know yet. When we sit down after all this and look at everything afterwards, we can pull up those patterns.

In the ideal world, I wish I could predict who would do well and who wouldn’t, so I could talk to them and their family and have an honest conversation.

Q: Are other factors complicating recovery?

With such a high number of sick people, it’s harder to do things to maximize recovery, such as bringing in physical therapy and occupational therapy. People aren’t able to get as much therapy because there are only so many therapists and some hospitals are limiting who can come in.

COVID-19 is really a nasty disease because of its infectiousness. It isolates people from a lot of things they need to get better — perhaps, most importantly, their family, whose support is really critical along with all the other things I’ve talked about here.

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Retiree-Rich Palm Beach County Leads Florida In COVID-19 Deaths

JUPITER, Fla. — No place in Florida has recorded more deaths from COVID-19 than Palm Beach County, the tropical vacation and retirement destination that bills itself — chutzpah notwithstanding — as “The Best of Everything.”

As of Wednesday afternoon, 69 people in the South Florida county of 1.5 million had died after being infected with the novel coronavirus. The death toll outpaces the state’s two more populated counties, including Miami-Dade, which has nearly twice the population and 49 deaths.

Health experts attribute the county’s high mortality rate to three factors: a large elder population, with 1 in 4 residents 65 or over; its lack of available testing, particularly compared with its southern neighbors, Broward and Miami-Dade counties; and frequent travel among residents and visitors to and from the New York metro area, the national epicenter of the outbreak.

Dr. Larry Bush, an infectious disease specialist in the county, said that, despite the risks to older residents and the paucity of testing, seniors can protect themselves.

“There is a lot of anxiety out there,” Bush said. His advice: “Stay away from everybody, and if you don’t have to be out, go home.”

About 6,700 people have been tested in Palm Beach County, fewer than one-fourth of Miami-Dade’s tally and one-third that of in Broward. Of the 69 deaths, 64 were people over 65, including 49 over 80.

The average age of residents with confirmed cases in Palm Beach County is 57, compared with 49 in both Miami-Dade and Broward.

Drive-thru testing sites in Palm Beach County have had overwhelming demand and turned away thousands of residents seeking appointments because health officials did not have enough tests.

Fear of the virus is sending a shudder through this affluent county about an hour’s drive from Miami that has attracted Northerners since the railroad arrived in the 1890s.

Although Palm Beach is Florida’s top agricultural county — leading the nation in sugar and sweet corn — it is better known for its gated retirement communities, golf courses and many oceanfront resort hotels catering to millions of annual visitors. It’s also home to President Donald Trump’s palatial home and club, Mar-a-Lago. Tourists seeking sun on the beaches or a glimpse of the old-money mansions that line a part of the coastline are nearly extinct now (though some seasonal residents haven’t headed home yet).

For residents, the changes brought on by COVID-19, the disease caused by the coronavirus, are disconcerting. Retirees drawn to the warm climate (and zero state income tax) said the past weeks have felt more like an odd vacation than their usual lifestyle — and they don’t know when it will be over.

Many of the Palm Beach deaths were of people from the southern part of the county, including three in the upscale Polo Club of Boca Raton, a gated community where many retirees enjoy five full-service restaurants, two golf courses, a fitness center and card rooms that host poker and bridge games daily.

Jerry Levy, 87, a 20-year resident of the Polo Club with wife Thelma, said the outbreak and Gov. Ron DeSantis’ order for people to stay home have disrupted his lifestyle, which most days used to include tennis, poker and often dinner with friends.

“Mentally, people are breaking down,” said Thelma, 88. “Two weeks was fine, but it’s hard to accept that this is how it’s going to be for a while. And people are getting cranky.”

Jerry and Thelma Levy, residents of the Polo Club of Boca Raton, Florida, say they are having to give up many of their usual activities to stay safe from the coronavirus outbreak, which has hit their community hard. “It’s hard to accept that this is how it’s going to be for a while,” Thelma Levy says.(Courtesy of Jerry and Thelma Levy)

The Levys pass most days reading, walking in their community of 3,000 people, watching movies on television and videoconferencing with friends and family. They still go to grocery stores but are now wearing gloves and face coverings.  When their housekeeper visited last week, they gave her a mask and gloves before she started working.

At Century Village, a large retirement community in West Palm Beach, residents are adjusting gradually to their new lifestyles. “We are bored, anxious and would love to have an indication when this will be over,” said Bobbi Levin, 80, who works on several social committees at her condo complex.

“It feels like we are on a forced vacation,” said Levin, who moved from New York 20 years ago. “I do crossword puzzles and catch up with Netflix.”

Lately, Levin said, she stays home and waves to people from a distance while standing in the outdoor hallway. It helps having her sister next door.

Dr. Joseph Ouslander, a professor of geriatric medicine at Florida Atlantic University in Boca Raton, said he worries about many seniors in the county who live alone and cut off from others.

“We see so many vulnerable people who are living on the edge by themselves and do not have any close family in the area, and they are not able to get the things they need,” he said.

Ouslander, who works at a medical clinic serving several retirement communities and nursing homes, recommends that seniors do anything they can to stay active — even walking around their house or neighborhood — as well as use social media to reach out to friends and family.

Dr. Joel Rosenberg, a retired heart doctor who lives at the Polo Club in Boca Raton, has played “amateur disease detective” in recent weeks talking to many of the 20 residents who have tested positive and are still at home. He said all three deaths were of people with underlying lung or heart disease. Most of the rest have already recovered.

Many who were infected had either traveled recently to New York or been in close contact with people from there, he said.

No one is inviting guests into their homes anymore. It’s becoming common to see people holding happy hours in their driveways, with one resident sitting in each corner at least 15 to 20 feet away from the others.

“Humans are social animals, so it’s hard not to be social,” Rosenberg said.

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