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nrashkind

The Coronavirus Is Forcing American Hospitals to Ration Care - The Atlantic - 0 views

  • Hospitals are poised to face the kind of life-and-death decisions that industrialized countries typically encounter only in times of war and natural disaster.
  • wo weeks ago, a man came to an emergency room in New York with pain in the lower-right quadrant of his abdomen.
  • A CT scan showed inflammation around a fingerlike projection at the base of his colon.
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  • The next day, recovering upstairs, the man still had a fever. Doctors ordered a test for the coronavirus. A day later, his results came back positive.
  • Last week, the Illinois Department of Public Health sent a notice to clinics that only those people “hospitalized with severe acute lower respiratory illness” could be tested for the coronavirus
  • Today, if every hospital employee who had a close encounter with a COVID-19 patient disappeared for two weeks, the medical workforce would quickly become depleted
  • The virus has an average incubation period of five days, which means people can spread it in the absence of symptoms
  • After the man with appendicitis (a patient of one of the doctors I spoke with for this story) tested positive, the hospital implemented such precautions. And staff members who’d cared for him went into two weeks of isolation.
  • The majority of workers who keep America’s hospitals running don’t have the salary to afford extra bedrooms, much less extra properties
  • During World War II, Ford and General Motors rallied to the cause by building tanks and manufacturing ammunition instead of car
  • The ubiquitous curve is being flattened by shutdowns and social distancing, but it is not flat enough. Those who might end up in a hospital, which is to say all of us, can do at least one thing to help relieve pressure on the medical system and its overtaxed, dwindling workforce.
  • America rolled the dice. For just one example, the federal government has invested only about $500 million annually in the strategic stockpile, maintaining about 12 million N95 masks and 16,600 ventilators. This is enough to equip an area hit by a localized disease outbreak, natural disaster, or terrorist attack. But it is nowhere near what could be necessary in a Disease X pandemic.
  • In January of this year, some Chinese scientists warned that a Disease X had arrived, based on genetic sequencing they’d performed.
  • When we spoke by phone late Tuesday night, as he was driving home from the hospital, he sounded tired. I asked him to think back to the Disease X war game
rerobinson03

Teens Are Rarely Hospitalized With Covid, but Cases Can Be Severe - The New York Times - 0 views

  • The number of hospitalizations related to Covid-19 among adolescents in the United States was about three times as high as hospitalizations linked to influenza over three recent flu seasons, the study found.
  • Children have a much lower likelihood overall of becoming severely ill or dying from Covid-19, compared with adults, but the risks are thought to increase with age. According to the most recent data collected by the academy, nearly four million children have tested positive for the coronavirus since the pandemic began, compared with about 30 million cases among adults.
  • Still, about 16,500 children have been hospitalized for Covid-19 since the pandemic began, and at least 322 have died, making it one of the leading causes of death among children, Dr. Maldonado noted.
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  • The new C.D.C. report focused on hospitalizations from Covid-19 among children ages 12 to 17. The rate of hospitalizations in that group was a small fraction of that among adults, but still higher than the rate seen in children ages 5 to 11, the report found.
  • The number of adolescents hospitalized with Covid-19 declined in January and February of this year, but rose again in March and April.
  • None of the children died, but about one-third were admitted to the intensive care unit, and 5 percent required invasive mechanical ventilation. Roughly two-thirds of the hospitalized adolescents were Black or Hispanic, reflecting the greater risk posed by the virus to these populations.
sarahbalick

India hospital transfusions infect thousands with HIV - BBC News - 0 views

  • India hospital transfusions infect thousands with HIV
  • At least 2,234 Indians have contracted the deadly HIV virus while receiving
  • blood transfusions in hospitals in the past 17 months alone.
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  • India has around 2.09 million people living with HIV/Aids.The highest number of patients who had been infected with HIV as a result of contaminated blood in hospitals, were from the northern state of Uttar Pradesh with 361 cases, Mr Kothari's RTI (Right to Information) query revealed.
  • "This is the official data, provided by the government-run Naco. I believe the real numbers would be double or triple that," Mr Kothari told the BBC.
  • "But each such test costs 1,200 rupees ($18; £12) and most hospitals in India do not have the testing facilities. Even in a big city like Mumbai, only three private hospitals have HIV testing facilities. Even the largest government hospitals do not have the technology to screen blood for HIV," Mr Kothari said.
Javier E

What American Healthcare Can Learn From Germany - Olga Khazan - The Atlantic - 0 views

  • Every German resident must belong to a sickness fund, and in turn the funds must insure all comers. They’re also mandated to cover a standard set of benefits, which includes most procedures and medications. Workers pay half the cost of their sickness fund insurance, and employers pay the rest. The German government foots the bill for the unemployed and for children. There are also limits on out-of-pocket expenses, so it’s rare for a German to go into debt because of medical bills.
  • this is very similar to the health-insurance regime that Americans are now living under, now that the Affordable Care Act is four years old and a few days past its first enrollment deadline.
  • There are, of course, a few key differences. Co-pays in the German system are minuscule, about 10 euros per visit. Even those for hospital stays are laughably small by American standards: Sam payed 40 euro for a three-day stay for a minor operation a few years ago
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  • nearly five million Americans fall into what’s called the “Medicaid gap”
  • In Germany, employees' premiums are a percentage of their incomes, so low-wage workers simply pay rock-bottom insurance rates.
  • Germany actually pioneered this type of insurance—it all started when Otto von Bismarck signed his Health Insurance Bill of 1883 into law. (It’s still known as the “Bismarck model” because of his legacy, and other parts of Europe and Asia have adopted it over the years.)
  • You can think of this setup as the Goldilocks option among all of the possible ways governments can insure health. It's not as radical as single-payer models like the U.K.’s, where the government covers everyone. And it's also not as brutal as the less-regulated version of the insurance market we had before the ACA.
  • Since there are no provider networks in Germany, doctors don’t know what other providers patients have seen, so there are few ways to limit repeat procedures.
  • All things considered, it’s good to be a sick German. There are no network limitations, so people can see any doctor they want. There are no deductibles, so Germans have no fear of spending hundreds before their insurance ever kicks in.
  • There’s also no money that changes hands during a medical appointment. Patients show their insurance card at the doctor’s office, and the doctors' association pays the doctor using money from the sickness funds. "You don’t have to sit at home and sort through invoices or wonder if you overlooked fine print,”
  • That insurance card, by the way, is good for hospital visits anywhere in Europe.
  • of all of the countries studied, Germans were the most likely to be able to get a same-day or next-day appointment and to hear back from a doctor quickly if they had a question. They rarely use emergency rooms, and they can access doctors after-hours with ease.
  • And Germany manages to put its health-care dollars to relatively good use: For each $100 it spends on healthcare, it extends life by about four months, according to a recent analysis in the American Journal of Public Health. In the U.S., one of the worst-performing nations in the ranking, each $100 spent on healthcare resulted in only a couple of extra weeks of longevity.
  • those differences aside, it’s fair to say the U.S. is moving in the direction of systems like Germany’s—multi-payer, compulsory, employer-based, highly regulated, and fee-for-service.
  • The German government is similarly trying to push more people into “family physician” programs, in which just one doctor would serve as a gatekeeper.
  • like the U.S., Germany may see a shortage of primary-care doctors in the near future, both because primary-care doctors there don’t get paid as much as specialists, and because entrenched norms have prevented physician assistants from shouldering more responsibility
  • With limitations on how much they can charge, German doctors and hospitals instead try to pump up their earnings by performing as many procedures as possible, just like American providers do.
  • Similarly, “In Germany, it will always be an operation,” Göpffarth said. “Meanwhile, France and the U.K. tend to try drugs first and operations later.”
  • With few resource constraints, healthcare systems like America's and Germany's tend to go with the most expensive treatment option possible. An American might find himself in an MRI machine for a headache that a British doctor would have treated with an aspirin and a smile.
  • Perhaps the biggest difference between our two approaches is the extent to which Germany has managed to rein in the cost of healthcare for consumers. Prices for procedures there are lower and more uniform because doctors’ associations negotiate their fees directly with all of the sickness funds in each state. That's part of the reason why an appendectomy costs $3,093 in Germany, but $13,000 in the U.S.
  • Now, Maryland is going a step further still, having just launched a plan to cap the amount each hospital can spend, total, each year. The state's hospital spending growth will be limited to 3.58 percent for the next five years. “We know that right now, the more [doctors] do, the more they get paid,” John Colmers, executive director of Maryland’s Health Services Cost Review Commission, told me. “We want to say, ‘The better you do, the better you get paid.’”
  • certain U.S. states have tried a more German strategy, attempting to keep costs low by setting prices across the board. Maryland, for example, has been regulating how much all of the state’s hospitals can charge since 1977. A 2009 study published in Health Affairs found that we would have saved $2 trillion if the entire country’s health costs had grown at the same rate as Maryland’s over the past three decades.
  • “In Germany, there is a uniform fee schedule for all physicians that work under the social code,” Schlette said. “There’s a huge catalogue where they determine meticulously how much is billed for each procedure. That’s like the Bible.”
  • “The red states are unlikely to follow their lead. The notion that government may be a big part of the solution, instead of the problem, is anathema, and Republican controlled legislatures, and their governors, would find it too substantial a conflict to pursue with any vigor.”
  • no other state has Maryland’s uniform, German-style payment system in place, “so Maryland starts the race nine paces ahead of the other 46 states,” McDonough said.
  • the unique spirit of each country is what ultimately gets in its way. Germany’s more orderly system can be too rigid for experimentation. And America’s free-for-all, where hospitals and doctors all charge different amounts, is great for innovation but too chaotic to make payment reforms stick.
  • rising health costs will continue to be the main problem for Americans as we launch into our more Bismarckian system. “The main challenge you’ll have is price control,” he said. “You have subsidies in health exchanges now, so for the first time, the federal budget is really involved in health expenditure increases in the commercial market. In order to keep your federal budget under control, you’ll have to control prices.”
nrashkind

'That's when all hell broke loose': Coronavirus patients overwhelm US hospitals - CNN - 0 views

shared by nrashkind on 29 Mar 20 - No Cached
  • "We ended up getting our first positive patients -- and that's when all hell broke loose," said one New York City doctor.
  • "We don't have the machines, we don't have the beds," the doctor said.
  • "To think that we're in New York City and this is happening," he added. "It's like a third-world country type of scenario. It's mind-blowing."
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  • At first, patients skewed toward the 70-plus age group, but in the past week or so there have been a number of patients younger than 50.
  • "Two weeks ago, life was completely different."
  • There are simultaneous effort to procure ventilators for the most severe patients. According to Cuomo, New York has procured 7,000 ventilators in addition to 4,000 already on hand, and the White House said Tuesday that the state would receive two shipments of 2,000 machines this week from the national stockpile. But the state needs 30,000, Cuomo said.
  • "There is a very different air this week than there was last week."
  • Public health experts, including US Surgeon General Dr. Jerome Adams, have warned the US could "become Italy," where doctors in hospitals filled with Covid-19 patients have been forced to ration care and choose who gets a ventilator.
  • Cuomo also described the extreme measures hospitals are planning to take to increase their capacity for patients who need intensive care.
  • It's not just New York that's feeling the pressure. Hospitals across the country are seeing a surge of patients, a shortage of personal protective equipment such as masks and gowns, and health care workers who feel that they, their families and their patients are being put at risk.
  • Several nurses around the country also spoke to CNN on condition of anonymity, also fearing they could lose their jobs.
  • Judy Sheridan-Gonzalez, an ER nurse at Montefiore Medical Center and president of the New York State Nurses Association, said that "everybody is terrified" about becoming infected because many lack the proper protective gear, and many are being told to reuse the same mask between multiple patients.
  • to become sick and we also don't want to become carriers," she said. "In my own hospital -- and I don't think it's unique -- we have a nurse who is on a ventilator right now who contracted the virus."
  • The goal: to prevent hospitals from seeing a massive spike of patients arriving around the same time.
  • "Obviously, no one is going to want to tone down things when you see things going on like in New York City," Fauci said Tuesday.
Javier E

The Coronavirus Can Be Stopped, but Only With Harsh Steps, Experts Say - The New York T... - 0 views

  • Terrifying though the coronavirus may be, it can be turned back. China, South Korea, Singapore and Taiwan have demonstrated that, with furious efforts, the contagion can be brought to heel.
  • for the United States to repeat their successes will take extraordinary levels of coordination and money from the country’s leaders, and extraordinary levels of trust and cooperation from citizens. It will also require international partnerships in an interconnected world.
  • This contagion has a weakness.
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  • the coronavirus more often infects clusters of family members, friends and work colleagues,
  • “You can contain clusters,” Dr. Heymann said. “You need to identify and stop discrete outbreaks, and then do rigorous contact tracing.”
  • The microphone should not even be at the White House, scientists said, so that briefings of historic importance do not dissolve into angry, politically charged exchanges with the press corps, as happened again on Friday.
  • Americans must be persuaded to stay home, they said, and a system put in place to isolate the infected and care for them outside the home
  • Travel restrictions should be extended, they said; productions of masks and ventilators must be accelerated, and testing problems must be resolved.
  • It was not at all clear that a nation so fundamentally committed to individual liberty and distrustful of government could learn to adapt to many of these measures, especially those that smack of state compulsion.
  • What follows are the recommendations offered by the experts interviewed by The Times.
  • they were united in the opinion that politicians must step aside and let scientists both lead the effort to contain the virus and explain to Americans what must be done.
  • medical experts should be at the microphone now to explain complex ideas like epidemic curves, social distancing and off-label use of drugs.
  • doing so takes intelligent, rapidly adaptive work by health officials, and near-total cooperation from the populace. Containment becomes realistic only when Americans realize that working together is the only way to protect themselves and their loved ones.
  • Above all, the experts said, briefings should focus on saving lives and making sure that average wage earners survive the coming hard times — not on the stock market, the tourism industry or the president’s health.
  • “At this point in the emergency, there’s little merit in spending time on what we should have done or who’s at fault,”
  • The next priority, experts said, is extreme social distancing.If it were possible to wave a magic wand and make all Americans freeze in place for 14 days while sitting six feet apart, epidemiologists say, the whole epidemic would sputter to a halt.
  • The virus would die out on every contaminated surface and, because almost everyone shows symptoms within two weeks, it would be evident who was infected. If we had enough tests for every American, even the completely asymptomatic cases could be found and isolated.
  • The crisis would be over.
  • Obviously, there is no magic wand, and no 300 million tests. But the goal of lockdowns and social distancing is to approximate such a total freeze.
  • In contrast to the halting steps taken here, China shut down Wuhan — the epicenter of the nation’s outbreak — and restricted movement in much of the country on Jan. 23, when the country had a mere 500 cases and 17 deaths.Its rapid action had an important effect: With the virus mostly isolated in one province, the rest of China was able to save Wuhan.
  • Even as many cities fought their own smaller outbreaks, they sent 40,000 medical workers into Wuhan, roughly doubling its medical force.
  • Stop transmission within cities
  • the weaker the freeze, the more people die in overburdened hospitals — and the longer it ultimately takes for the economy to restart.
  • People in lockdown adapt. In Wuhan, apartment complexes submit group orders for food, medicine, diapers and other essentials. Shipments are assembled at grocery warehouses or government pantries and dropped off. In Italy, trapped neighbors serenade one another.
  • Each day’s delay in stopping human contact, experts said, creates more hot spots, none of which can be identified until about a week later, when the people infected there start falling ill.
  • South Korea avoided locking down any city, but only by moving early and with extraordinary speed. In January, the country had four companies making tests, and as of March 9 had tested 210,000 citizens — the equivalent of testing 2.3 million Americans.
  • As of the same date, fewer than 9,000 Americans had been tested.
  • Fix the testing mess
  • Testing must be done in a coordinated and safe way, experts said. The seriously ill must go first, and the testers must be protected.In China, those seeking a test must describe their symptoms on a telemedicine website. If a nurse decides a test is warranted, they are directed to one of dozens of “fever clinics” set up far from all other patients.
  • Isolate the infected
  • As soon as possible, experts said, the United States must develop an alternative to the practice of isolating infected people at home, as it endangers families. In China, 75 to 80 percent of all transmission occurred in family clusters.
  • Cellphone videos from China show police officers knocking on doors and taking temperatures. In some, people who resist are dragged away by force. The city of Ningbo offered bounties of $1,400 to anyone who turned in a coronavirus sufferer.
  • In China, said Dr. Bruce Aylward, leader of the World Health Organization’s observer team there, people originally resisted leaving home or seeing their children go into isolation centers with no visiting rights — just as Americans no doubt would.
  • In China, they came to accept it.“They realized they were keeping their families safe,” he said. “Also, isolation is really lonely. It’s psychologically difficult. Here, they were all together with other people in the same boat. They supported each other.”
  • Find the fevers
  • Make masks ubiquitous
  • In China, having a fever means a mandatory trip to a fever clinic to check for coronavirus. In the Wuhan area, different cities took different approaches.
  • In most cities in affected Asian countries, it is commonplace before entering any bus, train or subway station, office building, theater or even a restaurant to get a temperature check. Washing your hands in chlorinated water is often also required.
  • The city of Qianjiang, by contrast, offered the same amount of money to any resident who came in voluntarily and tested positive
  • Voluntary approaches, like explaining to patients that they will be keeping family and friends safe, are more likely to work in the West, she added.
  • Trace the contacts
  • Finding and testing all the contacts of every positive case is essential, experts said. At the peak of its epidemic, Wuhan had 18,000 people tracking down individuals who had come in contact with the infected.
  • Dr. Borio suggested that young Americans could use their social networks to “do their own contact tracing.” Social media also is used in Asia, but in different ways
  • When he lectured at a Singapore university, Dr. Heymann said, dozens of students were in the room. But just before he began class, they were photographed to record where everyone sat.
  • Instead of a policy that advises the infected to remain at home, as the Centers for Disease and Prevention now does, experts said cities should establish facilities where the mildly and moderately ill can recuperate under the care and observation of nurses.
  • There is very little data showing that flat surgical masks protect healthy individuals from disease. Nonetheless, Asian countries generally make it mandatory that people wear them.
  • The Asian approach is less about data than it is about crowd psychology, experts explained.All experts agree that the sick must wear masks to keep in their coughs. But if a mask indicates that the wearer is sick, many people will be reluctant to wear one. If everyone is required to wear masks, the sick automatically have one on and there is no stigma attached.
  • Also, experts emphasized, Americans should be taught to take seriously admonitions to stop shaking hands and hugging
  • Preserve vital services
  • Only the federal government can enforce interstate commerce laws to ensure that food, water, electricity, gas, phone lines and other basic needs keep flowing across state lines to cities and suburbs
  • “I sense that most people — and certainly those in business — get it. They would prefer to take the bitter medicine at once and contain outbreaks as they start rather than gamble with uncertainty.”
  • Produce ventilators and oxygen
  • The manufacturers, including a dozen in the United States, say there is no easy way to ramp up production quickly. But it is possible other manufacturers, including aerospace and automobile companies, could be enlisted to do so.
  • Canadian nurses are disseminating a 2006 paper describing how one ventilator can be modified to treat four patients simultaneously. Inventors have proposed combining C-PAP machines, which many apnea sufferers own, and oxygen tanks to improvise a ventilator.
  • One of the lessons of China, he noted, was that many Covid-19 patients who would normally have been intubated and on ventilators managed to survive with oxygen alone.
  • Retrofit hospitals
  • In Wuhan, the Chinese government famously built two new hospitals in two weeks. All other hospitals were divided: 48 were designated to handle 10,000 serious or critical coronavirus patients, while others were restricted to handling emergencies like heart attacks and births.
  • Wherever that was impractical, hospitals were divided into “clean” and “dirty” zones, and the medical teams did not cross over. Walls to isolate whole wards were built
  • Decide when to close schools
  • Recruit volunteers
  • China’s effort succeeded, experts said, in part because of hundreds of thousands of volunteers. The government declared a “people’s war” and rolled out a “Fight On, Wuhan! Fight On, China!” campaign.
  • Many people idled by the lockdowns stepped up to act as fever checkers, contact tracers, hospital construction workers, food deliverers, even babysitters for the children of first responders, or as crematory workers.
  • “In my experience, success is dependent on how much the public is informed and participates,” Admiral Ziemer said. “This truly is an ‘all hands on deck’ situation.”
  • Prioritize the treatments
  • Clinicians in China, Italy and France have thrown virtually everything they had in hospital pharmacies into the fight, and at least two possibilities have emerged that might save patients: the anti-malaria drugs chloroquine and hydroxychloroquine, and the antiviral remdesivir, which has no licensed use.
  • An alternative is to harvest protective antibodies from the blood of people who have survived the illness,
  • The purified blood serum — called immunoglobulin — could possibly be used in small amounts to protect emergency medical workers, too.
  • “Unfortunately, the first wave won’t benefit from this,” Dr. Hotez said. “We need to wait until we have enough survivors.”Find a vaccine
  • testing those candidate vaccines for safety and effectiveness takes time.
  • The roadblock, vaccine experts explained, is not bureaucratic. It is that the human immune system takes weeks to produce antibodies, and some dangerous side effects can take weeks to appear.
  • After extensive animal testing, vaccines are normally given to about 50 healthy human volunteers to see if they cause any unexpected side effects and to measure what dose produces enough antibodies to be considered protective.
  • If that goes well, the trial enrolls hundreds or thousands of volunteers in an area where the virus is circulating. Half get the vaccine, the rest do not — and the investigators wait. If the vaccinated half do not get the disease, the green light for production is finally given.
  • In the past, some experimental vaccines have produced serious side effects, like Guillain-Barre syndrome, which can paralyze and kill. A greater danger, experts said, is that some experimental vaccines, paradoxically, cause “immune enhancement,” meaning they make it more likely, not less, that recipients will get a disease. That would be a disaster.
  • One candidate coronavirus vaccine Dr. Hotez invented 10 years ago in the wake of SARS, he said, had to be abandoned when it appeared to make mice more likely to die from pneumonia when they were experimentally infected with the virus.
  • Reach out to other nations
Javier E

How to Negotiate Down Your Hospital Bills - The Atlantic - 0 views

  • A friend walked up and grabbed Lockett by the arm. A few people, noticing that something wasn’t right, walked Lockett to another room and called an ambulance. Lockett, who was 57 at the time and uninsured, didn’t know whether she could or should refuse the ambulance ride or decide which hospital it would take her to.Paramedics sped her a few miles to Emory University Hospital Midtown, where she was held overnight. It turned out that she had suffered a transient ischemic attack, or a mini-stroke. The hospital performed tests and sent her home, where she recovered fully.In May, the hospital bill arrived. Lockett had been charged $26,203.62 total for “observation,” which the bill instructed her to pay within 20 day
  • nearly 60 percent of people who have filed for bankruptcy said a medical expense “very much” or “somewhat” contributed to their bankruptcy
  • A 2016 study found that a third of cancer survivors had gone into debt as a result of their medical expenses, and 3 percent had filed for bankruptcy. According to a Consumer Financial Protection Bureau study from 2014, medical bills are the most common cause of unpaid bills sent to collection agencies. About a fifth of Americans have a medical claim on their credit report, and the same proportion currently has a medical bill overdue.
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  • half a dozen consumer advocates told me they are concerned that the problem will get worse, since the uninsured rate is going up, and more people are signing up for cheaper but skimpier health-insurance plans introduced by the Trump administration. More Americans are also now on high-deductible health plans, many of which require patients to pay thousands before insurance kicks in. Networks of doctors have grown narrower, meaning more providers are likely to be out of network.
  • Emergency-room visits and planned surgical procedures are the most common causes of large medical bills that patients simply can’t afford to pay
  • Often, a hospital might be covered by a person’s insurance network, but the individual doctors who work there and the ambulance company that services it aren’t
  • some patients do wind up with medical debt, which discourages them from seeking medical care, because they fear they will incur even more debt if they go to the doctor again
  • The debt can also worsen people’s credit, which can make it hard for them to live healthier lives by, say, moving to better neighborhoods. In the end, they get sicker, and risk plunging even further into debt.
  • “The reality is that medical costs are not objective, real costs,” says Berneta L. Haynes, the director of equity and access at Georgia Watch. One day, an MRI can cost $19,000. The next, it can cost nothing.
brickol

Georgia Covid-19 cases rise as Atlanta mayor warns hospitals are at capacity | US news ... - 0 views

  • The coronavirus crisis in Georgia is spiraling as the mayor of Atlanta has warned that intensive care unit (ICU) beds in the city have reached capacity even though the level of the virus in the state is probably still far from its peak.
  • With more than 1,200 cases across the southern state, according to Georgia’s department of health, the state’s largest hospital, Grady Memorial, has been down at least 200 ICU beds since December due to a flood, a hospital staff member with knowledge of the hospital’s situation tells the Guardian.
  • Nearly one out of six cases in the state are in the Atlanta metro area. Unlike other US centers of the crisis such as New York, where large convention facilities are being used to place more beds, ventilators and supplies, that has not been the case in Atlanta.
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  • People have to understand that when we overrun our healthcare – our hospitals – that people will still come in with heart attacks, people will still have car accidents. These things that happen every day on top of Covid-19 will make our healthcare system collapse in the same way that you’re seeing that happen in New York and you’re seeing it happen across the globe,”
  • Until Wednesday morning, Georgia also had the fourth-highest death toll of coronavirus patients, until Louisiana’s cases soared. With over half a dozen Georgia hospitals shutting down during the past decade across rural communities, much of the state’s healthcare has been lacking. In 2017, a study found Georgia had one of the worst healthcare systems in the country, ranking it 49th for access.
Javier E

A German Exception? Why the Country's Coronavirus Death Rate Is Low - The New York Times - 0 views

  • They call them corona taxis: Medics outfitted in protective gear, driving around the empty streets of Heidelberg to check on patients who are at home, five or six days into being sick with the coronavirus.They take a blood test, looking for signs that a patient is about to go into a steep decline. They might suggest hospitalization, even to a patient who has only mild symptoms; the chances of surviving that decline are vastly improved by being in a hospital when it begins.
  • Heidelberg’s corona taxis are only one initiative in one city. But they illustrate a level of engagement and a commitment of public resources in fighting the epidemic that help explain one of the most intriguing puzzles of the pandemic: Why is Germany’s death rate so low?
  • According to Johns Hopkins University, the country had more than 92,000 laboratory-confirmed infections as of midday Saturday, more than any other country except the United States, Italy and Spain.
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  • But with 1,295 deaths, Germany’s fatality rate stood at 1.4 percent, compared with 12 percent in Italy, around 10 percent in Spain, France and Britain, 4 percent in China and 2.5 percent in the United States. Even South Korea, a model of flattening the curve, has a higher fatality rate, 1.7 percent.
  • There are several answers experts say, a mix of statistical distortions and very real differences in how the country has taken on the epidemic.
  • The average age of those infected is lower in Germany than in many other countries. Many of the early patients caught the virus in Austrian and Italian ski resorts and were relatively young and healthy, Professor Kräusslich said.“It started as an epidemic of skiers,
  • “The reason why we in Germany have so few deaths at the moment compared to the number of infected can be largely explained by the fact that we are doing an extremely large number of lab diagnoses,”
  • Another explanation for the low fatality rate is that Germany has been testing far more people than most nations. That means it catches more people with few or no symptoms, increasing the number of known cases, but not the number of fatalities.
  • But there are also significant medical factors that have kept the number of deaths in Germany relatively low, epidemiologists and virologists say, chief among them early and widespread testing and treatment, plenty of intensive care beds and a trusted government whose social distancing guidelines are widely observed.
  • TestingIn mid-January, long before most Germans had given the virus much thought, Charité hospital in Berlin had already developed a test and posted the formula online.
  • By the time Germany recorded its first case of Covid-19 in February, laboratories across the country had built up a stock of test kits.
  • the average age of contracting the disease remains relatively low, at 49. In France, it is 62.5 and in Italy 62, according to their latest national reports.
  • At the end of April, health authorities also plan to roll out a large-scale antibody study, testing random samples of 100,000 people across Germany every week to gauge where immunity is building up.
  • Early and widespread testing has allowed the authorities to slow the spread of the pandemic by isolating known cases while they are infectious. It has also enabled lifesaving treatment to be administered in a more timely way.
  • Medical staff, at particular risk of contracting and spreading the virus, are regularly tested. To streamline the procedure, some hospitals have started doing block tests, using the swabs of 10 employees, and following up with individual tests only if there is a positive result.
  • If it slows a little more, to between 12 and 14 days, Professor Herold said, the models suggest that triage could be avoided.
  • One key to ensuring broad-based testing is that patients pay nothing for it, said Professor Streeck. This, he said, was one notable difference with the United States
  • By now, Germany is conducting around 350,000 coronavirus tests a week, far more than any other European country
  • Tracking
  • In most countries, including the United States, testing is largely limited to the sickest patients, so the man probably would have been refused a test.
  • Not in Germany. As soon as the test results were in, the school was shut, and all children and staff were ordered to stay at home with their families for two weeks. Some 235 people were tested.“Testing and tracking is the strategy that was successful in South Korea and we have tried to learn from that,” Professor Streeck said.Germany also learned from getting it wrong early on: The strategy of contact tracing should have been used even more aggressively, he said.
  • All those who had returned to Germany from Ischgl, an Austrian ski resort that had an outbreak, for example, should have been tracked down and tested, Professor Streeck said
  • A Robust Public Health Care System
  • Before the coronavirus pandemic swept across Germany, University Hospital in Giessen had 173 intensive care beds equipped with ventilators. In recent weeks, the hospital scrambled to create an additional 40 beds and increased the staff that was on standby to work in intensive care by as much as 50 percent.
  • “We have so much capacity now we are accepting patients from Italy, Spain and France,”
  • All across Germany, hospitals have expanded their intensive care capacities. And they started from a high level. In January, Germany had some 28,000 intensive care beds equipped with ventilators, or 34 per 100,000 people
  • By comparison, that rate is 12 in Italy and 7 in the Netherlands.
  • By now, there are 40,000 intensive care beds available in Germany.
  • The time it takes for the number of infections to double has slowed to about eight days
  • “A young person with no health insurance and an itchy throat is unlikely to go to the doctor and therefore risks infecting more people,” he said.
  • Trust in Government
  • many also see Chancellor Angela Merkel’s leadership as one reason the fatality rate has been kept low.
  • Ms. Merkel has communicated clearly, calmly and regularly throughout the crisis, as she imposed ever-stricter social distancing measures on the country.
  • The restrictions, which have been crucial to slowing the spread of the pandemic, met with little political opposition and are broadly followed.
  • “Maybe our biggest strength in Germany,” said Professor Kräusslich, “is the rational decision-making at the highest level of government combined with the trust the government enjoys in the population.”
hannahcarter11

Why Lagging COVID Vaccine Rate At Rural Hospitals 'Needs To Be Fixed Now' : NPR - 0 views

  • President Biden on Tuesday is set to announce new steps to reach rural Americans in the push to get as many people as possible vaccinated for the coronavirus
  • It has prioritized a list of doctors enrolled in the vaccine system based on a "social vulnerability index" used by the Centers for Disease Control and Prevention — including doctors in many rural communities — and has been asking state government to send vaccine doses to those doctors, the official said.
  • The administration also plans to work with states to enroll more pediatricians and family doctors in their vaccine systems so they can begin giving people vaccines, a step that becomes "particularly critical" if the Food and Drug Administration gives emergency authorization for adolescents ages 12-15 to start getting the Pfizer vaccine, the official said.
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  • "So if you've got a quarter of the nation's rural hospitals having less than 50% of their staff vaccinated, you have a problem that needs to be fixed now."
  • 30% of the 160 rural hospital executives who responded said less than half of their employees had been vaccinated — even though health care workers have been eligible for months now
  • The new steps come as some rural hospitals are finding that their own staff members are reluctant to get the shot.
  • The Washington Post that found 29% of health care workers in rural areas didn't plan to get the COVID-19 vaccine. That's a greater well of hesitancy than the poll found among health care workers in urban and suburban areas.
  • He cited studies showing vaccines were effective and that the worst side effects were comparable to the vaccine for shingles, which is widely used.
  • There were also Zoom sessions for staff, led by doctors, leaving plenty of time for questions. Having trusted doctors and nurses vaccinated has been reassuring to others in the broader community, said chief nursing officer Kris Dascoulias, whose roots in the community are so deep that she was born in Memorial Hospital, where she now works.
  • The White House knows that doctors and other trusted local leaders will be the way to break through pockets of hesitancy in rural communities, said Bechara Choucair, the White House vaccinations coordinator.
Javier E

Covid-19 Vaccine's Slow Rollout Could Portend More Problems - WSJ - 0 views

  • the federal government came nowhere close to vaccinating 20 million people by the end of 2020, as it had promised.
  • Three weeks into the most ambitious vaccination campaign in modern U.S. history, far fewer people than expected are being immunized against Covid-19, as the process moves slower than officials had projected and has been beset by confusion and disorganization in many states.
  • Of the more than 12 million doses of vaccines from Moderna Inc. and Pfizer Inc. with BioNTech SE that have been shipped, only 2.8 million have been administered, according to federal figures
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  • as the federal government has left it to states to determine what to do with the vaccines it ships to them, and with some states pushing decision-making to local health departments and hospitals, the process has gone far from smoothly.
  • “There may have been an expectation from Operation Warp Speed or others that we’d give everyone the vaccine overnight.…It was a logistics equation for them. If you’ve been in vaccines for a long time, you know that’s the easy part. Getting it into actual arms is the hard part.”
  • Sen. Mitt Romney (R., Utah) criticized the vaccine rollout, saying in a statement that the lack of a comprehensive federal plan to be shared with states “is as incomprehensible as it is inexcusable.”
  • Public health officials and states say uptake is lagging for several reasons, beginning with holiday seasons that have kept staff of hospitals and nursing homes away from work. They also note they are facing high percentages of people, including some health-care workers, who are skeptical of taking the shots.
  • Hospitals and other sites are staggering appointments to avoid pulling too many workers from caring for patients amid a nationwide surge in Covid-19 cases, officials say. Administration of the vaccines also takes more time than a typical flu shot, particularly since they are being done in a socially distant way and may be preceded by a Covid-19 test.
  • Different state policies have led to confusion and shipment delays for hospitals, said Michael Wascovich, vice president of field pharmacy services for Premier Inc., a group purchasing organization whose members include 4,100 hospitals, 80% of which received doses.
  • “Every state is doing what they want to do,” he said. “You could be in Philadelphia and it’s completely different across the river if you’re in Trenton or Camden.”
  • Many states are following CDC guidelines to start with front-line medical workers and people in long-term care facilities, but not all. Florida Gov. Ron DeSantis on Dec. 23 extended eligibility to people aged 65 and older. Because each county and hospital in the state implemented its own approach, many people didn’t know whether to call, log on or show up in person to secure a spot.
  • CVS has begun administering doses at nursing homes and facilities in 48 states and Washington, D.C., with most eligible residents agreeing to be vaccinated, said Chris Cox, a CVS executive who is overseeing the vaccination rollout for the pharmacy chain.
  • In some cases, residents haven’t been vaccinated because of active outbreaks at facilities, while other facilities have taken longer than others to schedule their vaccination clinics, a challenge exacerbated by the holiday season, Mr. Cox said.
aidenborst

US coronavirus: At this rate, January will be the deadliest month of Covid-19 in the US... - 0 views

  • It took about 90 days for the United States to reach its first 2 million cases of coronavirus last year.
  • But it took just 10 days to hit 2.2 million cases in 2021, according to data from Johns Hopkins University.
  • But officials say many Americans did the opposite over the holidays, gathering with friends or extended family. Now the consequences are becoming more evident in packed hospitals across the country.
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  • More than 27,000 new Covid-19 deaths have been reported in just the first 10 days of 2021, according to data from Johns Hopkins.
  • At this rate, more people could die from Covid-19 in January than any other month of this pandemic. December had a record high of 77,431 deaths due to Covid-19.
  • He also expressed concern about "the inevitable arrival of the more highly transmissible" strain of coronavirus that was first detected in the United Kingdom and has spread to at least eight US states, including California, Colorado, Connecticut, Florida, Georgia, New York, Pennsylvania and Texas.
  • There were 129,229 Covid-19 patients in US hospitals on Sunday, according to the COVID Tracking Project -- the sixth highest figure recorded. It was the 40th consecutive day that US Covid-19 hospitalizations remained above 100,000.
  • CNN medical analyst and emergency physician Dr. Leana Wen echoed that statement, telling CNN's Ana Cabrera Sunday, "The individuals who did not use masks or social distancing at the Capitol probably are also not following these guidelines when they go back to their home communities."
  • In Kentucky, Gov. Andy Beshear said his state was seeing a "real and significant increase in cases and our positivity rate from people's gatherings around the holiday."
  • "This surge that we're in right now is at least twice the rate, the seriousness, of the previous surges that we have seen," the governor said Friday. "This is our most dangerous time."
  • There were 7,497 Covid-19 patients in Florida hospitals on Sunday, according to the Florida Agency for Health Care Administration. That's about 3,000 patients more than were hospitalized in the state about a month ago, on December 12, when the AHCA reported 4,343 hospitalizations.
  • "The speed with which we are reaching grim milestones of COVID-19 deaths and cases is a devastating reflection of the immense spread that is occurring across the county," Los Angeles County Director of Public Health Barbara Ferrer said.
  • "The best way to protect ourselves, slow the spread, and stop overwhelming our hospitals, is to pause participating in any activities that aren't absolutely essential," she said.
  • Meanwhile, the nation's Covid-19 vaccine rollout "is absolutely not working as intended," said Dr. Megan Ranney, a CNN medical analyst and an emergency physician.
  • "We have three times as many doses that have been distributed to states as have actually gotten in arms," she said. "We have to do something different, and we have to do something different now."
  • President-elect Joe Biden will aim to release nearly all available doses of Covid-19 vaccines in an effort to quickly ramp up the US vaccine rollout, a spokesman for his transition team said.
  • But it could also be risky, because the vaccines by Pfizer/BioNTech and Moderna require two doses administered weeks apart to be about 95% effective, and vaccine manufacturing has not ramped up as rapidly as many experts had hoped.
  • Officials aren't recommending patients delay receiving their second doses, she said. People should still plan to receive the second dose of Pfizer's vaccine 21 days after the first dose, and the Moderna vaccine 28 days after the first dose.
  • "Right now, the issue is not so much supply, but it's actually that last mile of getting (vaccines) from the distribution sites to, actually, people's arms," she said. "If we have more supply, that's not actually solving for the right problem."
  • If there isn't enough vaccine in reserve for people to received second doses, she said, "I think that could really fuel vaccine hesitancy and further erode public trust in these vaccines."
lmunch

Opinion | We Came All This Way to Let Vaccines Go Bad in the Freezer? - The New York Times - 0 views

  • America did not sufficiently plan for how to get millions of people vaccinated.
  • How poorly? Untold numbers of vaccine doses will expire before they can be injected into American arms, while communities around the country are reporting more corpses than their mortuaries can handle.
  • Operation Warp Speed has failed to come anywhere close to its original goal of vaccinating 20 million people against the coronavirus by the end of 2020.
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  • That’s an astonishing failure — one that stands out in a year of astonishing failures. The situation is made grimmer by how familiar the underlying narrative is: Poor coordination at the federal level, combined with a lack of funding and support for state and local entities, has resulted in a string of avoidable missteps and needless delays.
  • The implementation of these shots is complicated by a number of factors, including cold-storage requirements, which in turn necessitate special training for nurses and doctors. Training takes time and money, both of which are in short supply in most states. Some hospitals have said they don’t know which vaccine they are going to receive, or how many doses, or when.
  • It’s been two weeks since U.S. officials launched what ought to be the largest vaccination campaign in the nation’s history. So far, things are going poorly.How poorly? Untold numbers of vaccine doses will expire before they can be injected into American arms, while communities around the country are reporting more corpses than their mortuaries can handle.
  • Of the 14 million vaccine doses that have been produced and delivered to hospitals and health departments across the country, just an estimated three million people have been vaccinated.
  • The rest of the lifesaving doses, presumably, remain stored in deep freezers — where several million of them could well expire before they can be put to use.
  • The vaccine has been billed as the solution to this crisis — an incredible feat of science that would ultimately save us from the government’s widespread incompetence. But in the end, vaccines are a lot like other public health measures. Their success depends on their implementation.
  • In state after state, the results have been chaotic. In one Kentucky community, doses were nearly wasted when one nursing home ordered more than it needed. (Pharmacists saved the shots from the garbage bin by offering them to lucky customers on the spot.) In Palo Alto, Calif., faulty algorithms initially excluded frontline hospital residents from getting vaccinated. In New York and Boston, doctors who are at low risk have been caught cutting ahead of those at high risk. In Wisconsin, some 500 doses were deliberately wasted by a hospital employee. In Florida, seniors are waiting in line overnight in some cases.
  • Other countries are trying to offer the vaccine to as many people as possible. In Britain and Canada, for example, officials are planning to deploy all of their current vaccine supply immediately, rather than reserve half of it so those who get a first shot can quickly get their booster.
  • Whatever the solutions are to the vaccine challenge, the root problem is clear. Officials have long prioritized medicine (in this instance, developing the coronavirus vaccines) while neglecting public health (i.e., developing programs to vaccinate people). It’s much easier to get people excited about miracle shots, produced in record time, than about a dramatic expansion of cold storage, or establishment of vaccine clinics, or adequate training of doctors and nurses. But it takes all of these to stop a pandemic.
aleija

Officials Warn of Cyberattacks on Hospitals as Virus Cases Spike - The New York Times - 0 views

  • Government officials warned that hackers were seeking to hold American hospitals’ data hostage in exchange for ransom payments.
  • The Russian hackers, believed to be based in Moscow and St. Petersburg, have been trading a list of more than 400 hospitals they plan to target, according to Alex Holden, the founder of Hold Security, who shared the information with the F.B.I. Mr. Holden said the hackers claimed to have already infected more than 30 of them.
  • linics and medical complexes are intended to take those facilities offline and hold their data hostage in exchange for multimillion-dollar ransom payments
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  • Hundreds of American hospitals are being targeted in cyberattacks by the same Russian hackers who American officials and researchers fear could sow mayhem around next week’s election.
  • Employees at that hospital, in Klamath Falls, Ore., were told, “If it’s a P.C., shut it down,” said Thomas Hottman, the public information officer at Sky Lakes.
  • The hackers are also the same group behind TrickBot, a vast conduit for ransomware attacks that government hackers and technology executives have targeted in two takedowns over the past month.
  • The hackers also made higher ransom demands of hospitals than they have in previous attacks. In one attack on an unnamed private clinic, Mr. Holden said, the hackers held systems hostage for the Bitcoin equivalent of more than $5 million, more than double the typical ransom the group asked for months earlier.
katherineharron

US Coronavirus: A top official says hospitalizations and deaths will keep climbing as C... - 0 views

  • An end to the Covid-19 pandemic may be in sight with more good news on vaccine candidates, but for now "this will get worse," a top US official said Wednesday.
  • "We have had one million cases documented over the past week, our rate of rise is higher than it even was in the summer, we have hospitalizations going up 25% week over week,"
  • "There are so many more cases that we have, that deaths are going up."
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  • Infection numbers in Massachusetts are eight times what they were on Labor Day and hospitalizations have quadrupled.
  • In Illinois, the virus is now the third leading cause of death behind heart disease and cancer.
  • More than 250,000 Americans have so far died of the virus -- a higher death toll than any other country -- and a forecast by the US Centers for Disease Control and Prevention projects that number could rise up to 298,000 by December 12.
  • "It's all about absolute adherence to wearing a mask, avoiding crowds, and yes, we can keep the economy open but we're going to have to diminish indoor places like indoor dining and restaurants."
  • Only one US state, Hawaii, is showing a decrease in new cases greater than 10% compared to the previous week. Five others -- Idaho, North Dakota, Iowa, Illinois and Arkansas -- are holding steady, while the remaining 44 states are showing increases in new cases greater than at least 10% compared to the week prior.
  • the 7-day average of new cases is at its highest ever: 161,165 cases a day. That's up 27% compared to last week.
  • "Virtual gatherings remain the safest way to bring friends and family together from distant points. Outdoor settings can reduce the risks of gatherings with people outside of your household," the group said, also highlighting the importance of face coverings.
  • New Jersey Gov. Phil Murphy told CNN he wanted people to stay with their immediate family on Thanksgiving and to keep gatherings small -- "not just for next Thursday ... but for the next couple of months."
  • "This is not a normal year, it's not a normal Thanksgiving, Hanukkah, Christmas, New Year's. Folks have got to stay small, stay within the bubble of their own loved ones, and if we do that, that will be a down payment on a back-to-normal holiday season next year."
  • There were 79,410 hospitalizations reported on Wednesday, a record high for the United States, according to the Covid Tracking Project. The country is now averaging 72,120 hospitalizations over the last 7 days -- a 19.76% increase compared to last week.
  • "As a health care provider we are on 250 days of having a Covid patient in our ICU right now,"
  • "So every day, you walk into work, someone is super sick, someone is potentially dying that day."
  • "On a normal day, I don't have people dying every day," she said, adding that first week she had three people die in one day -- two of them, from Covid-19.
  • Students in the country's largest school district are transitioning to remote learning on Thursday following the closure of New York City schools. The decision came after the city's test infection rate reached 3%, a threshold Mayor Bill de Blasio said would trigger such a closure.
  • Kentucky Gov. Andy Beshear also announced new measures that will go into effect Friday, including limiting social gatherings to a maximum of two people from no more than two households, and prohibiting indoor service for restaurants and bars. And starting Monday, schools should begin remote learning, the governor said.
  • In Minnesota, the governor said the state is at a "breaking point" and announced a four-week dial back that will "help prevent more families from losing a loved one and ensure our hospitals can treat those who fall ill."
  • "As hospitals near the crisis of turning away new patients, continuing as things are is simply not sustainable," Gov. Tim Walz said.
  • A final analysis of the Phase 3 trial of Pfizer's Covid-19 vaccine shows it was 95% effective in preventing infections, even in older adults and caused no serious safety concerns, the company said Wednesday. It said it will seek a US Food and Drug Administration emergency use authorization "within days."
  • The Pfizer analysis came just days after a separate vaccine maker, Moderna, released early data showing its vaccine was about 95% effective.
  • Distribution is expected to begin within 24 hours after a vaccine receives the green light, according to Gen. Gustave Perna, who is helping oversee Operation Warp Speed.
  • "We'll be more ready next week, and if the vaccine is available, we have to go with what we have. We may not be perfect, but every day we're more prepared than we were the day before," he added.
Javier E

'Tragic Battle': On the Front Lines of China's Covid Crisis - The New York Times - 0 views

  • China was the first country to experience the panic of Covid when it emerged from Wuhan in 2019. Then, for the past three years, the country largely suppressed the virus with a costly mix of mass testing, strict lockdowns and border closures. The government could have used the time to bolster its health system by stockpiling medicine and building more critical care units. It could have launched a major vaccination drive targeting the millions of vulnerable older adults who were reluctant to receive a jab or booster. China did little of that, however, plunging into crisis mode again like in the early days of Wuhan.
  • A Shanghai hospital predicted half of Shanghai’s 25 million residents would eventually be infected and warned its staff of a “tragic battle” in the coming weeks, according to a now-deleted statement the hospital posted last week on the social media platform WeChat.
  • “In this tragic battle, all of Shanghai will fall, and all the staff of the hospital will be infected! Our whole families will be infected! Our patients will all be infected!” the statement read. “We have no choice, and we cannot escape.”
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  • Medical staff say they could have avoided the medicine shortages that have forced some facilities to ration drugs. There also could have been more time to set up a more effective triage system to avoid overcrowding
  • ne of the fundamental problems with China’s health system is its overreliance on hospitals for even the most basic care.
  • “In the U.S. people have their own primary physicians, but there are few ways in China to get care from the medical system except to go to an E.R. at a big hospital,” said Dr. Qiao Renli, a pulmonary and critical care doctor at the University of Southern California, who has taught and practiced medicine in both China and the United States.
  • The deluge of Covid patients is not the only challenge hospitals are facing. One of the ripple effects of the outbreak has been a widespread shortage of blood for transfusions because of the shrinking pool of eligible donors.In the southwestern city of Kunming, a blood bank said in a statement that the city was getting a fraction of the 500 donors per day it needs to keep up with demand, and that the shortage had started to affect pregnant women and patients in intensive care units.
Javier E

Kaiser Permanente Is Seen as Face of Future Health Care - NYTimes.com - 0 views

  • Kaiser has sophisticated electronic records and computer systems that — after 10 years and $30 billion in technology spending — have led to better-coordinated patient care, another goal of the president. And because the plan is paid a fixed amount for medical care per member, there is a strong financial incentive to keep people healthy and out of the hospital, the same goal of the hundreds of accountable care organizations now being created.
  • Kaiser has yet to achieve the holy grail of delivering that care at a low enough cost. He says he and other health systems must fundamentally rethink what they do or risk having cost controls imposed on them either by the government or by employers, who are absorbing the bulk of health insurance costs. “We think the future of health care is going to be rationing or re-engineering,”
  • the way to get costs lower is to move care farther and farther from the hospital setting — and even out of doctors’ offices. Kaiser is experimenting with ways to provide care at home or over the Internet, without the need for a physical office visit at all.
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  • lower costs are going to be about finding ways to get people to take more responsibility for their health — for losing weight, for example, or bringing their blood pressure down.
  • there are other concerns, such as whether an all-encompassing system like Kaiser’s can really be replicated and whether the limits it places on where patients can seek care will be accepted by enough people to make a difference.
  • Or whether, as the nation’s flirtation with health maintenance organizations, or H.M.O.’s, in the 1990s showed — people will balk at the concept of not being able to go to any doctor or hospital of their choice.
  • its integrated model is in favor again. Hospitals across the country are buying physician practices or partnering with doctors and health insurers to form accountable care organizations, or A. C.O.’s, as a way of controlling more aspects of patient care. Doctors are also creating so-called medical homes, where patient care is better coordinated.
  • The days when doctors, hospitals and other providers are paid separately for each procedure will disappear eventually, health experts say. Instead, providers will have financial incentives to encourage them to keep people healthy, including lump sums to care for patients or provide comprehensive care for a specific condition. “All of care is going to move down this path, and it has to,” Mr. Halvorson said. “Medical homes are doing it; the very best A. C.O’s are going to figure out how to do it.”
  • there are downsides to the creation of large health care systems that may be motivated by the desire to increase their clout in the market, making it easier to fill beds and charge the insurers more for care. “They become these huge local monopolies,”
  • “We have all the pieces,” said Philip Fasano, Kaiser’s chief information officer. “Anything a patient needs you get in the four walls of our offices,
  • its plans are typically at least 10 percent less expensive than others, especially where they control all the providers
  • Kaiser has also been using the information to identify those doctors or clinics that excel in certain areas, as well as those in need of improvement. The organization has also used the records to change how it delivers care, identifying patients at risk for developing bed sores in the hospital and then sending electronic alerts every two hours to remind the nurses to turn the patients. The percentage of patients with serious pressure ulcers, or bed sores, dropped to well under 1 percent from 3.5 percent.
Maria Delzi

Afghanistan's Worsening, and Baffling, Hunger Crisis - NYTimes.com - 0 views

  • In the Bost Hospital here, a teenage mother named Bibi Sherina sits on a bed in the severe acute malnutrition ward with her two children. Ahmed, at just 3 months old, looks bigger than his emaciated brother Mohammad, who is a year and a half and weighs 10 pounds.
  • Afghan hospitals like Bost, in the capital of war-torn Helmand Province, have been registering significant increases in severe malnutrition among children. Countrywide, such cases have increased by 50 percent or more compared with 2012, according to United Nations figures. Doctors report similar situations in Kandahar, Farah, Kunar, Paktia and Paktika Provinces — all places where warfare has disrupted people’s lives and pushed many vulnerable poor over the nutritional edge.
  • Reasons for the increase remain uncertain, or in dispute. Most doctors and aid workers agree that continuing war and refugee displacement are contributing. Some believe that the growing number of child patients may be at least partly a good sign, as more poor Afghans are hearing about treatment available to them.
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  • What is clear is that, despite years of Western involvement and billions of dollars in humanitarian aid to Afghanistan, children’s health is not only still a problem, but also worsening, and the doctors bearing the brunt of the crisis are worried.
  • Nearly every potential lifeline is strained or broken here. Efforts to educate people about nutrition and health care are often stymied by conservative traditions that cloister women away from anyone outside the family. Agriculture and traditional local sources of social support have been disrupted by war and the widespread flight of refugees to the cities. And therapeutic feeding programs, complex operations even in countries with strong health care systems, have been compromised as the flow of aid and transportation have been derailed by political tensions or violence.
  • Perhaps nowhere is the situation so obviously serious as in the malnutrition ward at Bost Hospital, which is admitting 200 children a month for severe, acute malnutrition — four times more than it did in January 2012, according to officials with Doctors Without Borders, known in French as Médecins Sans Frontières, which supports the Afghan-run hospital with financing and supplementary staff.
  • One patient, a 2-year-old named Ahmed Wali, is suffering from the protein deficiency condition kwashiorkor, with orange hair, a distended belly and swollen feet. An 8-month-old boy named Samiullah is suffering from marasmus, another form of advanced malnutrition in which the child’s face looks like that of a wrinkled old man because the skin hangs so loosely.
  • Médecins Sans Frontières helped Bost Hospital nearly double the number of beds in the pediatric wing at the end of last year, and there are still not enough — 40 to 50 children are usually being treated each day, mostly two to a bed because they are so small. Nearly 300 other children, less severely malnourished, are in an outpatient therapeutic feeding program.
  • “It’s quite an unusual situation, and it’s difficult to understand what’s going on,” said Wiet Vandormael, an M.S.F. official who has helped coordinate with Bost Hospital.
zachcutler

Florida dumps hospital standards after gifts to GOP - CNN.com - 0 views

  • The state of Florida is putting thousands of children with heart defects at risk, a group of cardiac doctors say, because of a change in policy that came after Tenet Healthcare contributed $200,000 to Florida Republicans.
  • Less than two months later, the state decided to get rid of those standards.
  • The whole situation is outrageous. It's just outrageous," said Louis St. Petery
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  • The standards have been in place and uncontested for 38 years.
  • Pediatric heart experts appointed by the state to look out for children with heart defects took exception.
  • Jacobs recommended the hospital stop performing heart surgery on babies younger than 6 months
  • Those babies had surgery at St. Mary's, but when their health spiraled downward, they were transferred to other hospitals.
  • In 2013 and 2014, Tenet contributed $50,000 each year to Let's Get to Work, Scott's political action committee. The next largest Tenet contribution those years to a state candidate's PAC was $25,000.
  • Doctors outside the state said they were surprised that Florida would move to repeal its own safety standards for children
  • An internationally renowned cardiac expert agreed that the standards are necessary
  • In December, a judge ruled in the state's favor and said the standards for pediatric heart hospitals could be taken off the books.
brookegoodman

Hotels being converted into coronavirus hospitals and shelters | CNN Travel - 0 views

  • (CNN) — The Ayre Gran Hotel Colón is a four-star, 365-room design hotel in downtown Madrid close to Retiro Park and one of the city's largest hospitals.
  • With global travel at a standstill -- and millions of people projected to contract Covid-19 in the coming months -- governments around the world are looking to otherwise closed hotels as a way to alleviate stresses on overburdened health systems.
  • The latter was a strategy utilized by officials in Wuhan, China, who erected specialized facilities -- or in some cases, commandeered hotels -- to isolate doctors and nurses. Health workers, of course, are at a higher risk of contracting the illness and subsequently passing it on to their families or fellow commuters.
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  • Europe's largest hospitality company, Accor, opened up 40 of its hotels in France for nursing staff, vulnerable populations and anyone fighting the spread of coronavirus.
  • The US Army Corps of Engineers announced Friday it was working to create more than 10,000 hospital beds in hard-hit New York City by converting hotel rooms and college dormitories into makeshift care facilities. It's considering similar initiatives in California and Washington.
  • Under the plan, contractors would use air-conditioning units to create negative pressure rooms that could suck air outside the room through a vent, minimizing airborne contaminants. Plastic seals would also be placed by the doors, while nursing stations would be set up in the halls.
  • Hotels around the world have seen occupancy rates plummet in recent weeks. Industry experts hope models such as Chicago's could be a way for them to both weather the storm and maintain a skeleton staff.
  • The American Hotel & Lodging Association (AHLA) estimates that, since mid-February, US hotels have lost $2.4 billion in room revenue. Worse still, they're on pace to lose more than $200 million in room revenue per day going forward.
  • The Four Seasons has offered up its iconic property in midtown Manhattan to provide five-star rooms with a $0 price tag for doctors and nurses toiling away at nearby hospitals.
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