Tag: coronavirus
“We Don’t Even Know Who Is Dead or Alive”: Trapped Inside an Assisted Living Facility During the Pandemic
“Less than 1% of Americans reside in long-term care facilities — a category that includes nursing homes and assisted living residences — but these facilities account for around 40% of the country’s COVID-19 deaths.”
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“Gov. Andrew Cuomo has boasted about the relatively low death toll in the state’s nursing homes, despite the fact that no other state counts these deaths as New York does. As of mid-November, there have been more than 6,619 virus-related deaths within the state’s nursing homes and 179 in its adult care facilities, according to official data. Bronxwood, however, has never appeared in that tally.
“The public list is incomplete and misleading,” said Geoff Lieberman, the executive director of the Coalition of Institutionalized Aged and Disabled, an organization that advocates on behalf of adult home residents in New York City. “Either everyone at Bronxwood died at the hospital, or the information isn’t being accurately reported.” Before the August hearing, Lieberman and his colleagues at CIAD interviewed residents at 28 adult homes in New York City, including Bronxwood, and tallied around 250 deaths from their accounts — a stark contrast to the 53 deaths that facilities had self-reported to the state. Bronxwood employees likewise sounded the alarm: In April, six staff members told local news that by their count more than a dozen residents had died.”
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“People talked about leaving Bronxwood almost as soon as they arrived, but the truth was that they were there because they had nowhere else to go. The elderly are typically steered to places like Bronxwood after a stay in the hospital. They have taken a fall or needed a surgery, and while they’re recovering, lose their apartment. Others, like Glenda, are recommended by a caseworker at a shelter. It’s not uncommon for such homes to hire recruiters to help fill their beds.
While many assisted living facilities cater to a wealthy clientele, who pay out of pocket, Bronxwood primarily serves low-income seniors. (It is, technically speaking, an adult home with an assisted living program.) Most residents sign over their supplemental security income to pay for the room and board — and out of that sum the facility gives them a $207 “personal needs allowance” each month. The money runs out quickly, since it often goes toward phone bills, toiletries, transportation and more nutritious food.
Out of Bronxwood’s 270 or so residents, more than half are enrolled in its assisted living program, whose costs are covered by Medicaid. In theory, the program offers an extra level of care to those who need it. In practice, it functions as a “huge financial boon” to the adult home industry, said Tanya Kessler, a senior staff attorney with Mobilization for Justice, a legal services organization. Bronxwood can charge Medicaid between $78 and $154 per enrolled resident each day, depending on his or her needs. But Kessler said there’s little oversight into whether this additional funding results in additional care. Bruno, the spokesman, said that the Health Department conducts regular inspections of assisted living programs “to ensure all applicable laws, regulations and guidelines are being followed.”
Healthier residents at Bronxwood told me that they seemed to be roomed with those who were more infirm, effectively placing them in the role of an extra aide. “One of the big complaints we hear is, ‘I’m not well myself, but they put this person in here that they expect me to look after,’” said Sherletta McCaskill, who, as the training director of CIAD, helps adult home residents organize councils and independent living classes. “It speaks to the lack of services that these homes are providing.” The most recent audit by New York’s Office of the Medicaid Inspector General found that Bronxwood had overbilled Medicaid by $4.4 million in 2006 and 2007. (Bronxwood requested an administrative hearing to challenge the findings, according to an OMIG spokesperson; the date is pending.)”
Mitch McConnell Agrees To Pass $2,000 COVID-19 Checks—in a Bill That Would Also Eliminate Section 230
“Section 230 essentially functions as the internet’s First Amendment by protecting private companies from being held liable for most forms of user-generated content. This is the second time in very recent history that lawmakers have sought to sneak Section 230 changes into legislation that otherwise has nothing to do with Section 230.”
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“Section 230 has attracted bipartisan enmity, although for completely different reasons: Republican critics say that online giants such as Facebook and Twitter are too heavy-handed with content moderation, at least when it comes to conservative speech, while their Democratic counterparts want platforms to scrub more hate speech and fake news. 230’s critics range from Sen. Josh Hawley (R–Mo.) to Vice President-Elect Kamala Harris, though one wonders if either would be happy with the result of the rollback once the other party was in power.
McConnell’s bill would also create a committee to investigate election fraud and the impact of COVID-19 on voting practices, as Trump keeps pushing the conspiracy theory that President-elect Joe Biden stole the 2020 election.”
Covid-19 vaccine efficacy results are not enough
“If people can get a vaccine that is quite effective in preventing Covid-19 symptoms but still carry the virus, they could still potentially spread SARS-CoV-2. This is an important issue because there will only be very limited doses of the vaccine available once it’s cleared for emergency use — and it will likely be many months after that before a sizable amount of the US population will be able to be vaccinated. That means people who have received the injections might need to maintain precautions like wearing masks and social distancing to prevent further spread of the virus before the vast majority of people have been vaccinated.”
Hospital ICUs are filling up. It’s even worse than it sounds.
“bed capacity numbers don’t tell the whole story.
Adding extra critical-care beds in other departments or buildings takes precious time, resources, and space. But adding trained staff is much more difficult, especially deep into a pandemic.
When trained staff are in short supply, it’s even harder for hospitals to best meet the needs of critical-care patients. These patients include people very sick with Covid-19, but also many who need to be in the ICU for other reasons, such as those who have had a heart attack or stroke, are recovering from major surgery, or are sick with the flu, among others”
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“it is not just ICU physicians and nurses who are in short supply. “Critical care is more of a team sport,” Garner said. “This means physician-delivered care and interventions, but also careful medication selection dosage with pharmacists, skilled nursing care, respiratory therapists, midlevel providers, nutritionists, early mobilization with physical therapists.” To that list, Nagle also adds all of the other hospital staff needed to perform other essential tasks in ICUs, including bathing patients, changing linens, and other functions.”
Everyone failed on Covid-19
“In June, just three states reported daily new coronavirus cases higher than 12 per 100,000 people. Today, every state except Hawaii exceeds that threshold. Some of that is due to greater testing capacity, but the climbing toll of hospitalizations and deaths, which have reached record highs nationally in the last month, show this is not merely a “casedemic” of sick people who might have gone undetected earlier in the year, but a rising tide of Covid-19 across the US.
So how did America get here?
The primary answer lies in President Donald Trump and Republican leaders in Congress, who have collectively abdicated the federal government’s role in addressing the outbreak or even acknowledging its severity. From Trump’s borderline denialist messaging on Covid-19 to Congress’s inability to pass more economic relief, the country has been left in a place where states, local governments, and the public have to fend for themselves — and none of them have the resources to deal with the coronavirus on their own.
Trump and his allies have also actively worked to sideline the Centers for Disease Control and Prevention, crippling the agency’s ability to provide guidance to states and others that have now been left out on their own.
At the same time, there are serious structural issues that hindered states’ and the public’s ability to act. Experts have long argued that the US’s public health infrastructure is underresourced and ill prepared for a serious crisis, and the pandemic has exposed this many times over: Nearly a year into the pandemic, no state has capacities for testing and contact tracing that most experts would consider adequate.
And the lack of economic relief has made it much harder for people to stay home and business owners to close down, faced with the decision of mitigating the coronavirus’s spread or failing to pay their mortgage and other bills.”
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“over time, as fatigue around the pandemic set in, governors became less proactive toward the coronavirus and more reactive — and they increasingly pushed short-term economic interests over public health concerns.
That was clear as the entire country, over the summer and fall, reopened schools, indoor dining, bars, and other risky indoor spaces, even as experts warned that the consequences could be dire. Now we’re seeing the effects.
That includes states led by Democrats and ones led by Republicans”
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“The public has eased up too. The US has generally gotten better at masking, based on public opinion surveys, but has also gotten much worse at social and physical distancing than in the spring. We’ve patronized the restaurants, bars, and other risky indoor areas that have reopened. We’ve gathered with friends and family over Labor Day, Halloween, and Thanksgiving, even as public health officials and experts have pleaded that we don’t.
As a result, the US is now among the worst performers on Covid-19 in the world. Despite recent surges in Europe and elsewhere — which were largely the result of similar failures — America remains within the top 20 percent for most coronavirus deaths per person among developed nations, with more than twice the death rate as the median developed country. If the US managed the same Covid-19 death rate as Canada, nearly 190,000 Americans would likely be alive today.
While the story behind those numbers lies mostly in what Trump and much of the federal government have wrought, it’s also on the rest of the US. From the president to governors to mayors to the public, America has failed on Covid-19 — and only by learning from those mistakes can we ensure they don’t happen again.”
Corporate America would like the vaccine now
“Companies and industry groups from across the economy are undertaking efforts at the federal and state level to make the case that when it comes to the limited-supply Covid-19 vaccine, their employees should get priority. The meat industry, airlines, banks, retail, exterminators, restaurants, and zoos are among the myriad groups lobbying decision-makers. So are specific companies such as Amazon, Lyft, DoorDash, and Perdue. Unions are trying to get their members vaccines. Even professional sports leagues, like the NHL, are making a play.”
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“Ultimately, it is up to states to decide what to do with federal recommendations and decipher which people, including workers, go where. States could deviate from those guidelines — theoretically, a place like California could say entertainers should be higher up on the list, or in New York, bankers. Companies may have an easier time influencing decisions at the state and local level. But in general, states take the guidelines seriously and could face enormous backlash if they ignore them.”
Congress has finally reached a deal on coronavirus stimulus
“After eight months of back and forth, Democratic and Republican leaders announced on Sunday that they’ve arrived at an agreement on a roughly $900 billion plan. The House of Representatives will vote on the bill Monday, according to House Majority Leader Steny Hoyer.”
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“The legislation contains much-needed coronavirus relief including a weekly $300 enhancement in unemployment insurance, a new round of $600 stimulus checks, and renewed support for small businesses.
Lawmakers in both chambers will have a chance to review the bill — which is being attached to the annual government spending package — before they take a vote.”
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“The $900 billion legislation ultimately offers far less aid than a prior $2.2 trillion proposal House Democrats had put forth, and significantly more than the narrow $550 billion bill that Senate Republicans have favored. Democrats signaled Sunday that this wasn’t the last of the relief they planned to send out.”
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“$325 billion is dedicated to small-business aid including repurposed funding for the Paycheck Protection Program, a forgivable loan program that business owners can apply for to cover payroll and operational costs. These loans are aimed at businesses that have seen revenue declines this year. For many, however, this aid comes too late — according to a Fortune report, almost 100,000 small businesses have already closed permanently during the pandemic.”
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“$25 billion in rental assistance is included as well as the establishment of a federal eviction moratorium.”
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“$13 billion for food aid to help fund a monthly 15 percent increase in individual SNAP benefits, aid for children who received food support at school, and money for other programs including Meals on Wheels and WIC (the Special Supplemental Nutrition Program for Women, Infants, and Children). Demand for such aid has spiked dramatically during the pandemic”
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“There is an extension of paid leave tax credits for businesses, which continues a policy established in the Families First Coronavirus Response Act”
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“other provisions as well, including $82 billion to help schools reopen; $15 billion in aid for airlines — which would be required to bring furloughed employees back — according to Reuters; and language that bans surprise medical bills for emergency care.
It also has new guidelines for the Federal Reserve after Republicans — led by Sen. Pat Toomey (R-PA) — demanded emergency lending programs at the Fed be canceled in any final version of the bill.
As Vox’s Emily Stewart has explained, the Fed will be forced to eliminate several emergency lending programs created with CARES Act funding in the spring, and will be barred from restarting them without congressional approval. It will also return the unused portion of the $454 billion Congress allotted it under the CARES Act to the Treasury Department, something the Fed had agreed to do in November.”
Why America can’t rely solely on individuals to stop Covid-19
“Americans have spent much of the Covid-19 pandemic blaming one another for the coronavirus’s spread.
Don’t go to that beach or park. Don’t go to that bar or restaurant. Don’t do anything for Thanksgiving or Christmas. Wear a mask! You don’t want to kill Grandma, do you?
Public officials have joined in. Increasingly, they are blaming private gatherings, not the restaurants and bars they insist on keeping open, for the spread of the disease. In some places, such as the Dakotas, framing Covid-19 prevention as an individual responsibility became the core of the strategy to fight Covid-19. As cases and deaths climbed to among the highest rates in the world, South Dakota’s leaders preached “personal responsibility” and refused to require masks, much less stricter measures. Ian Fury, a spokesperson for Gov. Kristi Noem (R), told me his boss gave citizens “up-to-date science, facts, and data, and then trusted them to make the best decisions for themselves and their loved ones.”
It’s true that individuals have an important role in fighting Covid-19. Everyone should wear a mask, and, unfortunately, everyone should reconsider big family gatherings this holiday season. But relying on individual action to fight a deadly virus — an approach that the US has leveraged for problems ranging from the opioid crisis to global warming — simply hasn’t worked.
Today, America is among the worst performers at fighting Covid-19. Despite recent surges in Europe and Israel, the US remains within the top 20 percent for most coronavirus deaths per person among developed nations, with more than twice the death rate as the median developed country. If the US managed the same Covid-19 death rate as Canada, more than 190,000 Americans would likely be alive today.”
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“But it’s not just Trump and friends. Every state in the country, Democratic or Republican, has at some point reopened restaurants or bars, allowing people to congregate in indoor areas that experts widely agree are breeding grounds for Covid-19. While resisting shutting down such places, local and state officials have argued that it’s on people to wear masks, cancel private gatherings for the holidays, and avoid nonessential activities — while leaving room for people to not follow at least some of those guidelines. Every state in the country has also, subsequently, seen surges in the coronavirus this fall.”
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“Meanwhile, much less attention has gone to addressing Covid-19 from a truly structural perspective. The coronavirus has revealed America’s pathetic public health infrastructure — there’s still no national testing-and-tracing program, and no state has an adequate contact tracing program, if they have such a program at all. Businesses and workers have been left to fend for themselves, as Congress failed to pass an economic relief bill before the last one started to expire. For all the talk about outdoor activities being safer during the coronavirus pandemic, there’s been next to no action in most of the country on getting people outside — at times, governments have even eliminated outdoor venues by closing parks or beaches.”
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“It’s easy to yell at people over their Covid-19 failures — simply log on to Twitter and blast away. It’s costless for a governor to tell people that it’s on them to stop the spread of the coronavirus by voluntarily giving up things they love, especially if the same governor doesn’t even plan on following his own advice.
So rather than do anything about it, Americans are stuck blaming each other for Covid-19. But until we truly realize this is a collective failure, not an individual one, the problems will linger.”
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“Since the start of America’s epidemic, experts have warned that indoor dining and bars are among the worst places for the spread of Covid-19: People are in poorly ventilated indoor areas where the virus spreads more easily sit close for possibly hours, can’t wear masks as they eat or drink, and spew germs at each other as they shout, sing, and laugh.
So many experts have called on governments to close bars and restaurants. Acknowledging the economic toll of this, economists and public health experts have also asked for a bailout of the industry to make employers and their workers whole until the pandemic resides.
None of that happened. Instead, America started to reopen before Covid-19 cases were under control — at the US’s best point in the spring and summer, it still had more than 60 times the daily new cases of Australia, New Zealand, and South Korea — with bars and restaurants reopening in every state by the fall. Public officials acknowledged the risks but merely moved to limit capacity and called on everyone to be responsible by physical distancing, wearing a mask, and limiting contact with people from other households.
This has not gone well. Coronavirus cases have shot up across much of the country, with the US in the middle of its third and biggest surge of Covid-19 yet. At the same time, we’ve gotten more data showing how dangerous bars and restaurants can be for the spread of Covid-19: A study published in the Journal of Korean Medical Science found that a person in South Korea may have been infected with Covid-19 in a restaurant in as little as five minutes. Another study in Nature found, “Reopening full-service restaurants was associated with a particularly high risk.
Despite that, officials across the country have by and large resisted shutting down again. Many of them, instead, have cited another culprit for Covid-19 spread: private gatherings. New York, for example, put out a PSA to stop “living room spread,” and the state published data suggesting households and private gatherings are driving 74 percent of coronavirus spread.
It’s true private gatherings and households are driving some transmission. Most experts agree Thanksgiving dinners likely led to a surge on top of a surge, and similar Christmas and New Year’s events likely will too.
But that’s why at least some experts believe there’s a need for more focus on systemic action, not the individualistic approach. “People, in general, are horrendous risk assessors — we’re awful at assessing risk,” Daniel Goldberg, a medical historian and public health ethicist at the University of Colorado, told me. “I hate to say people can’t be trusted, but.”
There are other problems with this framing. For one, the New York data doesn’t separate within-household transmissions from social gatherings — so the 74 percent figure includes someone spreading Covid-19 to the husband he lives with (not as avoidable) and someone spreading the virus to someone he invited over for drinks one night (very avoidable). This also only includes the cases that New York could actually contact trace, and it’s much easier to trace transmission between family and friends in a household than strangers in a bar.”
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“there’s nothing unusual about Covid-19 spreading among people who live together. It’s typical for the bulk, even the majority, of the transmission of any disease to happen within households. If you’re infected, the people you live with or come into close contact with at home are simply likely to get it too. That’s how pathogens work. What matters most, though, is where that virus originated from in the first place.
To put it another way: People couldn’t infect others in their homes if they hadn’t picked up the coronavirus in bars, restaurants, or other public spaces. So if these places weren’t open, individual choices to gather — including over Thanksgiving and Christmas — would be of far less concern. There would simply be much less virus out there jumping from person to person.”
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“If officials want people to wear masks, they can mandate masks and actually enforce those mandates. If they want more adults to stay home, they can replace any income individuals might lose by not going into work, or take steps to make work-from-home life more bearable, like deeming schools “essential” or subsidizing day care. If they want people to stay outdoors and not indoors, they can do things that can encourage people to go outside instead of congregating inside — like offering free outdoor activities like ice skating or art installations, or even just places to eat (with some heating during the winter) — rather than shutting down parks.”
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“Otherwise, we’re going to be stuck with relying on people to make decisions — almost always against their own social, cultural, and economic interests — to do the right thing. So far, that just isn’t working.”
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“The alternative to not taking collective action is more death. The countries that have done the best against Covid-19 — including Australia, New Zealand, South Korea, and, to a now lesser degree, Germany — all approached the issue collectively, leveraging government aid and public health systems to let people stay home without losing as much income or health insurance, to test and trace infections, and, when necessary, to close down to stop the spread.”
The FDA Continues To Drag Its Feet on Vaccine Approval
“the FDA’s approval is coming nearly two weeks after British regulators greenlighted the same vaccine, and almost a month since Pfizer/BioNTech submitted its final data for the agency to review.
Had the FDA acted more swiftly—say by bumping up the December 10 meeting it held to recommend approval of the Pfizer vaccine—Monday’s good news could have arrived a few weeks earlier. Meanwhile, the advisory committee tasked with evaluating another vaccine developed by Moderna is not set to meet until Thursday.
Given the slow rollout of these vaccines (slow, at least, when considered against the number of people needing to be vaccinated), it’s easy to think that the delay of a few days or weeks isn’t all that consequential.
Not so, says George Mason University economist Alex Tabarrok, who deploys some back-of-the-envelope math to argue that a few thousand people will die for every day the FDA dawdles in approving new vaccines.”