Category: Corona Virus

A nurse protests Chile's handling of the coronavirus pandemic. The country now has the highest per capita infection rate of any major country 13,000 cases for every 1 million people. Marcelo Hernandez/Getty Images hide caption

A nurse protests Chile's handling of the coronavirus pandemic. The country now has the highest per capita infection rate of any major country 13,000 cases for every 1 million people.

Chile looked as if it were well prepared to deal with the new coronavirus.

It's a rich country classified as high income by the World Bank. Life expectancy is roughly 80 years better than the United States'. It has a solid, modern health care system, and when the outbreak began spreading, officials made sure they had plenty of ventilators and intensive care beds at the ready.

But the virus exploited the cracks in Chilean society. The country now has the highest per capita infection rate of any major country 13,000 cases for every 1 million people. That's more than 10 times the rate in neighboring Argentina and twice the rate in Brazil.

Like many well-to-do countries, Chile saw its first cases of COVID-19 among its elite people who'd recently traveled to Europe and the United States. That was in April. The government quickly rolled out a plan to provide testing and treatment. Health officials quarantined hard-hit neighborhoods. Residents had to apply for a pass online before they could go out of their homes even to buy groceries. In late April, things were going so well that Chile was starting to talk about reopening.

"And then May started bringing more cases and more cases. Currently we have, in my opinion, more cases than we are able to handle," says Thomas Leisewitz, a physician in Santiago. Leisewitz is a professor at Pontificia Universidad Catlica de Chile and heads up strategic development at Red de Salud UC Christus, a nonprofit Catholic health care network.

Since May, the number of cases has been rising steadily, with the country recording at one time 5,000 to 6,000 new cases a day in June. The virus spread out of the affluent parts of Santiago to low-income neighborhoods where many residents don't have the luxury of being able to work from home.

And the high numbers are not just a reflection of an efficient testing infrastructure. Chile's per capita testing rate is lower than most European nations' and almost half the rate in the United States.

So how did this particular virus come to spread incredibly rapidly in wealthy, well-prepared Chile?

Andrea Insunza, a journalist in Santiago, says the reason is something unrelated to the virus itself. That something is social inequity.

"In Chile, there are two countries," says Insunza, who runs the center for investigative journalism at Universidad Diego Portales. "There's a country for people like me. I have a good education. I have a good salary, and all my social security is privatized."

By this she means she has access to high-quality private hospitals and clinics.

But there's another Chile.

"And that Chile is poor and you depend on the public health [system]," says Insunza.

Last October, violent street protests erupted in Santiago over a fare hike on the subway of 30 pesos, or less than 5 U.S. cents.

The protests became about far more than the price of a subway ride. Chile is one of the most unequal countries in Latin America, according to the World Bank. The elite, the top 10%, controls more than half the country's wealth. And while extreme poverty has been driven down significantly over the last decade, the social unrest in October centered on the frustrations of lower- and middle-class Chileans who view their economic opportunities as unfairly limited.

Insunza says part of the frustration is driven by the elite often not even seeming to recognize their privileged lifestyles.

"Santiago, it's a very segregated place," Insunza says. "You can actually live your whole life and don't see poverty. Never."

Chile's initial plan to deal with the coronavirus outbreak which at first affected mainly the elite in Santiago failed to recognize that the affluent have maids, gardeners and cooks who might also get infected.

The country's response went well in those early weeks. Case numbers were holding steady. The fatality rate was low.

Then the virus started spreading in lower-income neighborhoods and quickly got out of control.

"One thing that's interesting about Chile is that it probably has more state capacity in a technical way than any place in Latin America," says James Robinson, a professor at the University of Chicago and co-author of Why Nations Fail. He has written extensively about Latin America and, in particular, Chile.

"It's good at raising taxes and building roads and infrastructure," he says. "And there's not much corruption and things like that, but it's also a very polarized place."

Robinson says large segments of the public don't trust the state. They are wary of cooperating with government, which may be part of what has hindered Chile's response to the coronavirus outbreak.

In June, the health minister stepped down over his handling of the crisis and discrepancies over the case numbers he reported domestically, which were lower than the counts given to the World Health Organization.

President Sebastin Piera caused an uproar last week when he attended the funeral of his uncle along with more than 30 other people, while the government's coronavirus rules allow only 20 people at funerals.

Despite the government offering cash support and food to people who've lost work because of the lockdowns, Robinson says many Chileans feel that the system is stacked against them. And that's impeding the country's ability to tackle this virus.

"There's a real problem with the social contract in Chile," he says. "And the way they tried to manage this thing just seems to have sort of exacerbated a lot of those problems."

Chile has now extended lockdowns to more areas and put in tougher limits on movement to try to rein in the surging outbreak. In Santiago, residents who are not deemed essential workers are only being allowed to leave their houses twice a week, including trips for grocery shopping.

The regional office of the World Health Organization, the Pan American Health Organization, predicts that cases will continue to rise in Chile at least into the middle of July.

Link:

Social Divisions Drive Astronomical COVID-19 Rate In Chile : Goats and Soda - NPR

On any given day, somewhere in the United States, someone is going to wake up, leave the house and get in a huge argument with a stranger about wearing masks.

Grocery store managers are training staff on how to handle screaming customers. Fistfights are breaking out at convenience stores. Some restaurants even say theyd rather close than face the wrath of various Americans who believe that masks, which help prevent the spread of coronavirus, impinge on their freedom.

Joe Rogers, 47, a resident of Dallas, said that just last week, he had gotten in a physical fight over masks.

In line at a Mini-Mart, he spotted a customer behind him not wearing a mask, he said, and he shook his head. The man asked why Mr. Rogers had been looking at him and Mr. Rogers, again, shook his head.

I wear a full face guard, the mask that they use when they spray pesticides, he said. He reached for my mask and tried to pull it off. Mr. Rogers said his natural instinct came out and he put his hand up and knocked the man to the floor.

In Dallas, beginning June 19, businesses were required to ensure customers and staff wore masks. Mr. Rogers said that though he had not hit another person in a decade or so this was not the first altercation hed had over masks.

Ive already been in several, he said. Ive been in shouting matches with people at CVS. People just dont understand it. If everyone just wore a mask, this would be over.

Mr. Rogerss brother, Jason Rogers, a Democratic candidate in Texas 57th House District, said that he was aware of the confrontation and expressed support for his brother. This is Texas, you know, he said. Stand your ground.

Masks were already a political flash point, and months of mixed messages about their usefulness have contributed to the confusion. Now, theyre also fodder for viral videos.

A surge of reported cases of coronavirus in states like California, Texas and Florida has led authorities in those states to issue new guidance on masks. Evidence suggests masks can help prevent transmission of the virus even when worn by seemingly healthy people.

Early in the pandemic, the Centers for Disease Control and Prevention said several times that those without symptoms did not have to wear masks. On April 3, the agency shifted, saying that masks should be worn in public.

But President Trump, announcing the new guidance, said, Somehow, I dont see it for myself and has continued to appear in public without a mask. On Sunday, after months of shunning a mask himself, Vice President Mike Pence urged Americans to wear them.

Orders regarding masks that carry the force of law have been left to individual states. And in states where altercations over masks have been reported, those orders have recently changed.

Gov. Gavin Newsom of California ordered the mandatory wearing of masks in public on June 18. A little more than a week later, Hugos Tacos, a taqueria with two locations in the Los Angeles area, announced that it would close temporarily because its staff was exhausted by the constant conflicts over guests refusing to wear masks.

The chief executive of Hugos, Bill Kohne, said that it was only in the last few weeks that the encounters had become so vitriolic. His staff had been confronted with racist language, he said, and he was concerned for their safety. Recently, one of Mr. Kohnes facility managers supervising one of the storefronts observed five confrontations over masks in a single hour.

The one that we most viscerally remember is that a customer at the pickup window who was asked to wear a mask literally threw a cup of water through the window at the clerk, Mr. Kohne said.

He provided The New York Times with an email from a customer that he said was representative of many customers attitudes.

Why is it the responsibility of a taco stand to dictate to its customers a personal freedom of choosing to wear or not wear a mask! it said, concluding: Go to hell taco man. Close permanently! Do us all a favor!

(The person who sent the email did not respond to a request for comment from The Times.)

Public fights over masks have occurred with extraordinary frequency, service workers say, and far exceed the large number of those already captured by smartphones in viral videos.

Confrontations are taking place even in states that have been more consistent in guidance about masks. Massachusetts required that residents wear masks in grocery stores starting in early May. Still, Alli Milliken, 20, who returned to her job at a grocery store chain in the state several weeks ago, has already seen a conflict. She said that recently a customer wearing a mask called out another customer who was not.

The unmasked guy shrugged at him and was like, Its a free country. The virus isnt real. I can do what I want, Ms. Milliken said. The masked guy then says, I work in a hospital. Ill be seeing you soon, buddy.

Ms. Milliken said that she had not been given any training or direct instruction on de-escalating conflict between customers.

I dont know how to go about saying, Oh you should be wearing a mask, she said. I dont know what my place is.

The conflicts over masks have been particularly difficult for essential workers, who have been working long shifts and dealing with frazzled and frenzied customers throughout the pandemic.

Londyn Robinson, 26, a medical student in Minnesota, said that her mother, a manager at a big box store in South Florida, was now having to instruct her staff on how to defuse tense situations, along with working long shifts and sanitizing the store.

I never in a million years would have thought that working in a grocery store would have been considered a high-risk job, she said. It breaks my heart.

Ms. Robinsons mother, who asked to be kept anonymous for fear of losing her job, said that in the last two to three weeks, fights over masks had become astonishingly frequent. It was not uncommon for the police to be called to her store three to four times a day, she said.

Weve had shoppers go after each other, she said. Pushing matches, running carts into each other, running over peoples feet, ankles.

She said that many of the staff members she supervised were already working 12 to 14 hour days and had been doing so since March. (There were physical conflicts with shoppers then, too; Ms. Robinsons mother said she was slapped in the back of a neck by a customer who was frustrated that the store had run out of toilet paper.)

Even offering masks to customers did not work, she said: Theyll outright decline or theyll show you a fraudulent card that says, You cant ask me to do this.

The fighting between customers creates a tension that does not dissipate once the altercation has ended, she said. She no longer feels comfortable walking to her car alone after the store closes, concerned that an aggravated customer may be waiting for her there.

Now we go two to three employees at a time, she said.

In Florida, where cases of the virus have been rising rapidly, the state had not issued any official rules on masks as of Tuesday morning, leaving the decision in the hands of counties, localities and small businesses. (The states department of health issued a public advisory on June 20 recommending masks.)

Chris McArthur runs Black and Brew coffee in Lakeland, Fla., which is in a county where Mr. Trump won 55 percent of the vote in 2016. Mr. McArthur decided on Monday to begin requiring customers to wear masks at the businesss two locations.

We had actually been mulling it over for a couple of weeks, he said. We were hoping that our city commission would pass an ordinance that would require it locally. Our fear was that if we went out on a limb, because it wasnt the norm, we would receive a lot of backlash from our customers.

Still, Mr. McArthur made the decision. We felt like if we did that, other businesses might follow our lead and our customers might appreciate the extra precautionary measures that we were taking, he said.

He said that he hoped that conflicts would not arise. But he expects them to, and has coached staff on how to respond. If a customer becomes belligerent, he said, We would have to call the nonemergency line and hope that the police are available to come help us out.

Read the original here:

Viral Videos Capture Fights Over Masks and Coronavirus - The New York Times

Coronavirus updates Thursday: Coronavirus death toll in US might be 35% higher, new study says  The Register-Guard

Read the rest here:

Coronavirus updates Thursday: Coronavirus death toll in US might be 35% higher, new study says - The Register-Guard

A virus testing site in Beijing in June. Kevin Frayer/Getty Images. The New York Times. Live Coronavirus Updates: Global Death Toll Surpasses Half a Million. The worldwide toll is continuing to rise, with more than 10 million confirmed cases. More than a quarter of deaths have been in the United States.

See the original post:

Coronavirus (COVID-19) - Google News

Even before a coronavirus vaccine becomes available, some activists are ready to attack it; this woman attended a Reopen Virginia protest in Richmond in April.

By Warren CornwallJun. 30, 2020 , 4:25 PM

Sciences COVID-19 reporting is supported by the Pulitzer Center.

Within days of the first confirmed novel coronavirus case in the United States on 20 January, antivaccine activists were already hinting on Twitter that the virus was a scampart of a plot to profit from an eventual vaccine.

Nearly half a year later, scientists around the world are rushing to create a COVID-19 vaccine. An approved product is still months, if not years, away and public health agencies have not yet mounted campaigns to promote it. But health communication experts say they need to start to lay the groundwork for acceptance now, because the flood of misinformation from antivaccine activists has surged.

Such activists have kicked into overdrive, says Neil Johnson, a physicist at George Washington University who studies the dynamics of antivaccine groups on social networks. He estimates that in recent months, 10% of the Facebook pages run by people asking questions about vaccines have already switched to antivaccine views.

Recent polls have found as few as 50% of people in the United States are committed to receiving a vaccine, with another quarter wavering. Some of the communities most at risk from the virus are also the most leery: Among Black people, who account for nearly one-quarter of U.S. COVID-19 deaths, 40% said they wouldnt get a vaccine in a mid-May poll by the Associated Press and the University of Chicago. In France, 26% said they wouldnt get a coronavirus vaccine.

The Centers for Disease Control and Prevention (CDC) is now working on a plan to boost vaccine confidence as part of the federal effort to develop a vaccine, Director Robert Redfield told a Senate committee this week. Advocates urge campaigns that include personal messages and storytelling. We better use every minute we have between now and when that vaccine or vaccines are ready, because its real fragile ground right now, says Heidi Larson, an anthropologist and head of the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine (LSHTM).

Even before the pandemic, public health agencies around the world were struggling to counter increasingly sophisticated efforts to turn people against vaccines. With vaccination rates against measles and other infectious diseases falling in some locations, the World Health Organization (WHO) in 2019 listed vaccine hesitancy as one of 10 major global health threats.

Any coronavirus vaccine will face additional hurdles, especially the lack of a long-term safety record, Johnson says. The frenetic pace of vaccine development may play into that concern. Even advocates have worried that the rush for a vaccine raises the risk it could be ineffective or have harmful side effects. Consider the very name for the U.S. vaccine initiative, Operation Warp Speed, says Bruce Gellin, president of the nonprofit Sabin Vaccine Institute. What is a worse name for something thats supposed to give you trust in a product that you want everybody to take?

For some in the United States, the answer is no, according to a survey of 1056 people in mid-May.

OverallUnder age 60Age 60 and olderWhiteBlackHispanic493120403523672112562716253240373723YesNot sureNoDid not answer

(GRAPHIC) V. ALTOUNIAN/SCIENCE; (DATA) Associated PressNORC Center for Public Affairs Research at the University of Chicago

Del Bigtree, a U.S.-based vaccine critic, claims scientists are pursuing one of the most dangerous vaccines ever attempted, for a virus that poses little risk to most people. He says he spreads his message through an online talk show, Twitter, and presentations, and that we have seen incredible growth since the pandemic started.

In addition to safety concerns, activists have embraced a plethora of other antivaccine messages. In May, a documentary-style video, Plandemic, purporting that COVID-19 related deaths were exaggerated and a vaccine could kill millions, got more than 7 million views on YouTube before it was removed because of its unsubstantiated claims. U.S. activists in late April hosted an online Freedom Health Summit featuring antivaccine leaders and railing against medical tyranny during shutdowns. Other outlandish claims include that vitamin C can cure COVID-19 and that the disease is a conspiracy involving philanthropist Bill Gates. Statements by French doctors that coronavirus vaccines might be tested in Africa led to fears of Africans being exploited in trials.

Social media posts that create the impression of a real debate over vaccine safety can tap into psychological habits that make people think doing nothing is safer than taking action, says Damon Centola, a sociologist at the University of Pennsylvania. He fears such concerns could spread more easily among people already suspicious of medical authority, including minority communities. For example, many Black people are keenly aware of the history of medical experiments such as the infamous federal Tuskegee Study, which failed to treat Black men with syphilis. That, to me, is the major issue of the day that Im very worried about, Centola says.

Accuracy and authority are at a disadvantage in a media environment that favors speed, emotion, and memorable stories, says Peter Sheridan Dodds, a complex systems scientist at the University of Vermont who studies how ideas move through social media. Antivaccine activists have used those factors to attract followers, Dodds says. In the end, its story wars.

Vaccine promoters say they need to start now to counter all this, because epidemiologists estimate that to break the pandemic, 70% of the population may need to develop immunity, either by getting a vaccine or becoming infected. Health communication experts suggest taking some pages from the antivaccine playbook. When more than40 experts from around the world gathered online for a strategy session organized by experts with the City University of New York and LSHTM, a top recommendation was to develop faster, more creative ways to communicate with the public that speak more directly to the emotions.

Traditional messages promoting vaccinationauthoritative and fact-filledjust dont cut it with people worried about vaccine safety, says Larson, who helped organize the 20 May meeting. We dont have enough flavors of messages, adds Larson, whose book about vaccine rumors is about to be released. Ive had people say to me, All these social media platforms can send us to WHO or CDC. Weve been there, but it doesnt have the answers to the questions we have.

Some current initiatives have pioneered a more story-based approach. The National HPV Vaccination Roundtable, which promotes vaccination against the human papillomavirus, a leading cause of cervical cancer, uses YouTube videos of women who survived cervical cancer. We need to get better at storytelling, says Noel Brewer, a behavioral scientist at the University of North Carolina, Chapel Hill, and chair of the HPV roundtable. We need to carry positive stories and also negative stories about the harms of not vaccinating. The downsides of refusing a coronavirus vaccine might include not visiting grandparents and continuing to traverse the produce aisle as if it were a minefield.

In West Africa, officials are deploying the same tools that spread rumors about vaccines to counter them, says Thabani Maphosa, who oversees operations in 73 countries for Gavi, the Vaccine Alliance, which supplies and promotes vaccines around the world. In Liberia, for example, officials are using Facebooks WhatsApp messaging app to survey people and to address the rumors behind a drop in routine vaccinations. We need to use this as a teachable moment, Maphosa says.

In the United States, the nonprofit Public Good Projects plans to recruit volunteers to swarm outbreaks of vaccine misinformation online and eventually develop memes and videos, says CEO Joe Smyser.

But the most effective tools may lie outside the digital realm. Real-world nudges and infrastructure, such as phone call reminders to come in for a shot, may be more powerful than any social media campaign, Brewer says. Social media doesnt have as much of an effect as you would imagine from the noise its generating, he adds.

Public health agencies should consider taking vaccinations out of medical settings and into places where people work or shop, adds Monica Schoch-Spana, a medical anthropologist at Johns Hopkins University. That also means talking to leaders in various communities to understand their views. Such outreach could prove particularly important with minority communities. You really do have to meet people where they are both figuratively and literally, she says.

See original here:

Just 50% of Americans plan to get a COVID-19 vaccine. Here's how to win over the rest - Science Magazine

Carmen Quintero works as a supervisor at a distribution center for N95 masks. She owes $1,840 for other care she received when she tried to get a coronavirus test. Heidi de Marco/KHN hide caption

Carmen Quintero works as a supervisor at a distribution center for N95 masks. She owes $1,840 for other care she received when she tried to get a coronavirus test.

Carmen Quintero works an early shift as a supervisor at a 3M distribution warehouse that ships N95 masks to a nation under siege from the coronavirus. On March 23, she had developed a severe cough, and her voice, usually quick and enthusiastic, was barely a whisper.

A human resources staff member told Quintero she needed to go home.

"They told me I couldn't come back until I was tested," said Quintero, who was also told that she would need to document that she didn't have the virus.

Her primary care doctor directed her to the nearest emergency room for testing because the practice had no coronavirus tests.

The Corona Regional Medical Center is just around the corner from her house in Corona, Calif. They didn't have any tests either, but there a nurse tested her breathing and gave her a chest X-ray. For testing, the nurse told her to go to Riverside County's public health department. There, a public health worker gave her an 800 number to call to schedule a test. The earliest the county could test her was April 7, more than two weeks later.

At the hospital, Quintero got a doctor's note saying she should stay home from work for a week and she was told to behave as if she had COVID-19, the disease caused by the coronavirus, isolating herself from vulnerable household members. That was difficult Quintero lives with her grandmother and her girlfriend's parents but she managed. No one else in her home got sick, and by the time April 7 came, she felt better and decided not to get the coronavirus test.

Then the bill for the ER visit came.

The patient: Carmen Quintero, 35, a supervisor at a 3M distribution warehouse who lives in Corona, Calif. She has an Anthem Blue Cross health insurance plan through her job with a $3,500 annual deductible.

Total bill: Corona Regional Medical Center billed Quintero $1,010, and Corona Regional Emergency Medical Associates billed an additional $830 for physician services for her visit attempting to get a test. She also paid $50 at Walgreens to fill a prescription for an inhaler.

Service provider: Corona Regional Medical Center, a for-profit hospital owned by Universal Health Services, a company based in King of Prussia, Pa., which is one of the largest health care management companies in the nation. The hospital contracts with Corona Regional Emergency Medical Associates, part of Emergent Medical Associates.

Medical service: Quintero was evaluated in the emergency room for symptoms consistent with COVID-19: a wracking cough and difficulty breathing. She had a chest X-ray and a breathing treatment and was prescribed an inhaler.

What gives: Quintero knew she had a high-deductible plan yet felt she had no choice but to follow her doctor's advice and go to the nearest emergency room to get tested. She assumed she would get the test and not have to pay. Congress had passed the CARES Act just the week before, with its headlines saying coronavirus testing would be free.

That legislation turned out to be riddled with loopholes, especially for people like Quintero who needed and wanted a coronavirus test but couldn't get one early in the pandemic.

Insurers do have to cover tests, but when a patient goes to see a doctor to be checked out for COVID-19 symptoms, if no test is ordered or administered, insurers aren't required to cover the appointment without cost sharing.

So Quintero was on the hook for the copay.

"I just didn't think it was fair because I went in there to get tested," she said.

Some insurance companies are voluntarily reducing copayments for coronavirus-related emergency room visits. But Quintero said her insurer, Anthem Blue Cross, would not reduce her bill. Anthem would not discuss the case until Quintero signed its own privacy waiver; it would not accept a signed standard waiver KHN uses. The hospital would not discuss the bill with a reporter unless Quintero could also be on the phone, something that has yet to be arranged around Quintero's workday, which begins at 4 a.m. and ends at 3:30 p.m.

Three states have gone further than Congress to waive cost sharing for testing and diagnosis of pneumonia and influenza, given these illnesses are often mistaken for COVID-19. California is not one of them, and because Quintero's employer is self-insured the company pays for health services directly from its own funds it is exempt from state directives anyway. The U.S. Department of Labor regulates all self-funded insurance plans. In 2019, nearly 2 in 3 covered workers were in these types of plans.

Related health care hurdle: On that day in late March when her body shook from coughing, Quintero's immediate worry was infecting her family, especially her girlfriend's parents, both older than 65, and her 84-year-old grandmother.

"If something was to happen to them, I don't know if I would have been able to live with it," said Quintero.

Quintero wanted to isolate in a hotel, but she could hardly afford to for the week that she stayed home. She had only three paid sick days and was forced to take vacation time until her symptoms subsided and she was allowed back at work. At the time, few places provided publicly funded hotel rooms for sick people to isolate, and Quintero was not offered any help.

As lockdown restrictions ease and coronavirus cases rise around the country, public health officials say quickly isolating sick people before the virus spreads through families is essential.

But isolation efforts have gotten little attention in the U.S. Nearly all local health departments, including Riverside County where Quintero lives, now have these programs, according to the National Association of County and City Health Officials. Many were designed to shelter people experiencing homelessness but can be used to isolate others.

Raymond Niaura, interim chairman of the Department of Epidemiology at New York University, said these programs are used inconsistently and have been poorly promoted to the public.

"No one has done this before and a lot of what's happening is that people are making it up as they go along," said Niaura. "We've just never been in a circumstance like this."

Resolution:

The bills have been a constant worry. Quintero called the hospital and her insurance company and complained that she should not have to pay since she was seeking a test on her doctor's orders. Neither budged, and the bills labeled "payment reminders" soon became "final notices." She reluctantly agreed to pay $100 a month toward her balance $50 to the hospital and $50 to the doctors.

"None of them wanted to work with me," Quintero said. "I just have to give the first payment on each bill so they wouldn't send me to collections."

On top of that, Quintero still worries about bringing the virus home to her family and fears being in the same room with her grandmother. Quintero returns from work every day now, puts her clothes in a separate hamper and diligently washes her hands before she interacts with anyone.

The takeaways:

At this point in the pandemic, tests are more widely available and federal law is very clearly on your side: You should not be charged any cost sharing for a coronavirus test.

Be wary, though, if your doctor directs you to the emergency room for a test, because any additional care you get there could come at a high price. Ask if there are any other testing sites available.

If you do find yourself with a big bill related to suspected coronavirus, push beyond a telephone call with your insurance company and file a formal appeal. If you feel comfortable, ask your employer's human resources staff to argue on your behalf. Then, call the help line for your state insurance commissioner and file a separate appeal. Press insurers and big companies that offer self-insured plans to follow the spirit of the law, even if the letter of the law seems to let them off the hook.

If you suspect you have COVID-19 and need to isolate to protect vulnerable members of your household, call your local public health department. Most counties have isolation and quarantine programs, but these resources are not well known. You may be placed in a hotel, recreational vehicle or other type of housing while you wait out the infection period. You do not need to have a positive coronavirus test to qualify for these programs and can use these programs while you await your test result. But this is an area in which public health officials repeatedly offer clear guidance 14 days of isolation which most people find impossible to follow.

Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

View original post here:

She Had COVID-19 Symptoms And Wanted To Get Tested. Now She Owes $1,840 : Shots - Health News - NPR

About 25% of New York City-area residents have probably been infected with the coronavirus by now, former Food and Drug Administration Commissioner Dr. Scott Gottlieb told CNBC on Tuesday.

Researchers at the Mount Sinai Health System in New York City published a study Monday, which suggested that 19.3% of people in the city had already been exposed to the virus through April 19.

Even if that many people have Covid-19 antibodies in New York City, the initial epicenter of the U.S. outbreak, the researchers noted that would still be well below the estimated 67% needed to achieve herd immunity which is necessary to give the general public broad protection from the virus. The study has not yet been peer-reviewed nor accepted by an official medical journal for publication.

Based on their findings, the researchers concluded that about 0.7% of everyone infected with the virus in New York City died due to Covid-19. However, Gottlieb said the infection-fatality rate,which factors in asymptomatic patients who never develop symptoms,has likely risen since mid-April.

"If you probably took that out to now, you did a seroprevalence study now, you'd probably see that the infection-fatality rate's a little higher because more people succumbed to the infection over the course of time from April to now," he said on CNBC's "Squawk Box." "And you'd probably see that the seroprevalence is a little higher because more people have gotten infected, so my guess is probably around 25% of New York has now been infected with Covid."

The infection-fatality rate is likely lower than the case-fatality rate, which looks at the percent of people who have symptoms and end up dying. Gottlieb said the case-fatality rate might be closer to 1.1% or 1.2%.

The findings of the study are in line with what other researchers, including those for New York state who conducted their own seroprevalence study, have found, Gottlieb said, which helps bolster confidence in such studies.

"We can start to believe that this probably represents an approximation of what the real result is," he said.

The relationship between the presence of antibodies and immunity when it comes to the coronavirus remains unclear. The authors of the study noted that previous research into other coronaviruses has indicated that antibodies confer immunity. However, health officials, including Gottlieb and White House health advisor Dr. Anthony Fauci, have warned that the level and duration of immunity provided by antibodies is still unclear.

The researchers said the antibody test used in the study has a sensitivity rate of 95%, meaning it picks up positive cases 95% of the time, and a specificity of 100%, meaning it accurately reflects negative cases 100% of the time. That means the tests could produce a false negative result, but not a false positive antibody test. All tests were analyzed in a research laboratory setting.The sample of patients used to determine the prevalence of the virus in the general population was composed of patients who presented at Mount Sinai for a regular medical procedure or check up, unrelated to Covid-19.

The authors of the Mount Sinai study acknowledged some factors might have biased their sampling of the general population, but said "it nevertheless provides a window into the extent of seroprevalence in NYC." The study waspartially funded by the National Institute of Allergy and Infectious Diseases, theCollaborative Influenza Vaccine Innovation Centers, the JPB foundation and other donors.

Since April, New York and the tri-state region have managed to significantly drive down their level of spread, which means the "seroprevalence would likely not change significantly unless new infections rise again or vaccines would become available," the researchers said.

Disclosure: Scott Gottlieb is a CNBC contributor and is a member of the boards of Pfizer, genetic-testing start-upTempus and biotech company Illumina.

Continued here:

Roughly 25% of New York City has probably been infected with coronavirus, Dr. Scott Gottlieb says - CNBC

More than 125,000 people have died from Covid-19 in the US, and more than 2.5 million Americans have been infected.

American life has been irrevocably altered by the worst pandemic in a century. And as the country struggles to reopen, cases of Covid-19 have surged again -- this time in young people and in states that had previously avoided the brunt of the virus.

Here, in dollars, percentages and most tragically lives, is the pandemic's devastating toll on the US.

More people are infected with and die from coronavirus in the US than anywhere else in the world.

Coronavirus has now killed nearly 126,000 people in the US since the first death was reported in February, according to Johns Hopkins University's case count. That's an average of around 1,039 deaths per day.

The number shot up from the end of May, when an average of fewer than 900 people died every day in the US from Covid-19.

More Americans also have died of coronavirus in less than five months than in all of World War I. That conflict took the lives of 116,516 American soldiers.

With more than 2.5 million official diagnoses in the US, Redfield's estimate could mean more than 25 million Americans have been infected.

The lag in reporting is due in part to limited testing during the first few weeks of the pandemic. Now, as more people are getting tested, it's become clear that a large percentage of those who tested positive did not have any symptoms or had only mild symptoms, Redfield said.

Not all states are reporting infections and deaths in nursing homes and long-term care facilities, so these numbers may be higher on a national scale.

Black Americans' coronavirus death rate is 2.3 times higher than that of White & Asian Americans and twice as high as the death rate for Latinos.

By comparison, White Americans represent over 62% of the US population but account for just about half of all coronavirus deaths. One in 3,600 White Americans has died, the lab reported.

Since mid-March, 47.3 million workers have filed for first-time unemployment benefits.

America's first-quarter GDP, the most expansive measure of the US economy, fell at a 4.8% annualized rate, the US Bureau of Economic Analysis reported in May.

CNN's Ben Tinker, Maggie Fox, Holly Yan, Andrea Kane, Paul LeBlanc, Flora Charner, Stephen Collinson, Marshall Cohen, Anneken Tappe, Zamira Rahim and Veronica Stracqualursi contributed to this report.

Link:

The US has 4% of the world's population but 25% of its coronavirus cases - CNN

Coronavirus patients are showing up in emergency rooms after calling 911 from the US-Mexico border.

"They'll literally come to the border and call an ambulance," says Van Gorder, president and CEO of Scripps Health, a hospital system in southern California.

The rise in ambulance traffic from the border, which several officials described to CNN, is a symptom of the pandemic's spread in the region -- and a sign of the many connections between communities in both countries.

"There just is not a wall for viruses at the border," says Josiah Heyman, director of the Center for Inter-American and Border Studies at the University of Texas at El Paso. "The wall is an illusion, because the two sides are really woven together."

An increase in cross-border coronavirus cases, which began getting public attention in May, overwhelmed some California hospitals and spurred the state to create a new patient transfer system to help.

"It's an unprecedented surge across the border," says Carmela Coyle, president and CEO of the California Hospital Association.

In the past five weeks, more than 500 patients have been transferred to hospitals across the state from California's Imperial County, which has the state's highest per capita rate of coronavirus cases -- and, according to officials, has seen a large number of patients crossing from Mexico.

But Van Gorder, Coyle and other officials in California say this isn't an immigration issue.

Most of the coronavirus patients crossing the border, they say, are Americans.

In a call with state hospital leaders earlier this month, the head of California's emergency medical services authority, Dr. David Duncan, described the steady stream of patients coming to Imperial County as "gas on the fire."

"We've got this continual flow of Covid coming across the border in the form of US citizens that carry and continue to escalate and fuel the Covid pressures that we see," Duncan said.

The view from the border

Officials estimate about a quarter of a million US citizens live across the border in the Mexican state of Baja California. Many work in the US and have family members there. Some regularly go to US hospitals when they need medical attention. Others decided to cross this time because Mexican hospitals were overwhelmed by a crush of coronavirus cases.

"What has happened as the situation has worsened on the Mexican side of the line is that a number of the US citizens are returning to the United States to seek care for Covid-19," says Coyle of the California Hospital Association.

Sergio A. Beltrn, US Customs and Border Protection's officer in charge for the Calexico ports of entry, said in a statement to CNN that he started to see an increasing flow of people coming across the border for medical care a few months ago.

"While it varies from day to day, and shift to shift, we have experienced a significant increase in medical-related calls at the Calexico ports of entry that can be directly linked to the COVID-19 pandemic over the last couple of months," he said. "We're definitely seeing people on a daily basis. And we still have our regular medical-related calls that aren't COVID-related from people in accidents or having other medical issues and are coming for medical treatment in the US."

Sometimes people walk to the port of entry or drive themselves to the border crossing, then call for an ambulance to get them to a US medical facility when they arrive. And sometimes, he said, travelers arrive at the border in Mexican ambulances and have already arranged for US ambulances to meet them there.

What happened in California hospitals as more coronavirus patients crossed

At El Centro Regional Medical Center in Imperial County, coronavirus cases started to climb in early May as the situation across the border in Mexicali worsened, says Adolphe Edward, the hospital's CEO.

"That uptick just took a fast, escalating move," Edward says.

At one point that month, the 161-bed hospital saw so many coronavirus cases that it had to stop accepting any new patients in its emergency room.

Edward says he heard first-hand from his own staff one reason the numbers were going up.

"I've got over 60 staff members that travel back and forth every day. They live in Mexicali, but they come to work here," he says. "They told me it took Mexicali a while to get to the point where they put (social distancing) restrictions. I think that's one reason why the number is as high as it is now."

About 90 miles to the west, Scripps Mercy Hospital Chula Vista, which is across the border from Tijuana, was also seeing cases starting to climb.

Officials began tracking the travel histories of patients there, and quickly spotted a trend: Many had recently been in Mexico.

"About half the patients that are testing positive are indicating they've crossed the border within the previous week," Van Gorder says.

"The patients that cross the border appear to be sicker than the patients that we've normally been seeing," he says. "It may be that they waited in Mexico too long, or they went to a Mexican hospital and decided to get their care here."

'It's almost like a waterfall cascading'

The flow of patients across the border has been steady for weeks, says Coyle of the California Hospital Association. And now hospitals across the state -- including as far north as Sacramento -- are taking in coronavirus patients from Imperial County as part of a new patient transfer system set up to ease the pressure, Coyle said.

A challenge across the region, she says, is that so many patients are sick with the same condition, requiring the same equipment for treatment, at the same time.

"That is what driving the shortages of service and supply in Mexicali, driving these expats back to the United States and then driving a very unique movement of patients into and more broadly across the state of California," she says. "It's almost like a waterfall cascading."

Van Gorder says he's concerned that officials are moving too quickly towards reopening.

"We still don't have our arms completely around Covid and the Covid spread," he says. "And as a border community, I think we have a double risk."

What's happening in other parts of the border

Heyman, of the University of Texas at El Paso, says there's one thing that's important to remember about coronavirus -- and other issues -- along the vast US-Mexico border.

"The two sides can't be kept separate," he says. "If there's a problem on one side of the border, it flows to the other side."

In earlier days of the pandemic, Mexican officials expressed concern about travelers from the US bringing coronavirus into the country.

"I don't know what they thought they were doing," says Arturo Garino, the mayor of the sister city on the US side of the border, Nogales, Arizona. But Garino says he's concerned about the flow of people traveling across the border, too.

While coronavirus cases are surging, particularly in two Arizona counties along the border -- Santa Cruz and Yuma -- Garino says officials haven't pinpointed the cause.

"It has to do a lot with social distancing. It has to do a lot with gatherings," he says. "And I know a lot of residents here go into Mexico and vice versa."

Garino, who recently signed an order requiring people in his city to wear masks in public places, says he's worried about the frequent cross-border travel that's a part of daily life there intensifying the spread of the virus.

"I'm concerned because of the spike in cases that we have," he says. "We're trying to do our best to curb this virus, and we continuously keep on going up and up and up."

CNN's Cheri Mossburg contributed to this report.

Originally posted here:

People with coronavirus are crossing the US-Mexico border for medical care - CNN

The Trump administration has taken steps to limit patients out-of-pocket costs for coronavirus testing and treatment, using relief funds to reimburse providers for uninsured patients bills. Insurers are required to cover patients coronavirus tests with no cost-sharing or co-payments. Alex Azar, the health and human services secretary, reiterated that commitment in a Sunday interview on CNN, saying, If you are uninsured, it will be covered by us.

The testing experience of the Texas group suggests that it doesnt always work out that way. Some emergency rooms charge cash prices and tack on testing fees that insurers are not required to cover. In this case, the patient who paid cash actually got the best deal. Mr. Harvey has health insurance but felt it would be a hassle to use it for the coronavirus test. So he paid for his test with two $100 bills after receiving the nasal swab, and was on his way.

Updated June 30, 2020

Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.

A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise comes with issues of potential breathing restriction and discomfort and requires balancing benefits versus possible adverse events. Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. In my personal experience, he says, heart rates are higher at the same relative intensity when you wear a mask. Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.

The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.

The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who dont typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the countrys largest employers, and gives small employers significant leeway to deny leave.

So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was very rare, but she later walked back that statement.

Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus whether its surface transmission or close human contact is still social distancing, washing your hands, not touching your face and wearing masks.

A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.

The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nations job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.

If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)

If youve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

Ms. LeBlanc let the emergency room take a photograph of her insurance card. She ended up with $6,408 in charges, mostly from an outside lab called Genesis Laboratory that handled her testing. She received explanation-of-benefit statements suggesting she would owe more than $1,000.

Jay Lenner, who also got a drive-through test from the same provider, used his insurance and received a similarly long list of charges. He recalls a provider saying hed be tested only for coronavirus, but bill records show he was also screened for Legionnaires disease, herpes and enterovirus, among other things.

The emergency room also charged him $1,684 for using its facility and $634 to see one of its doctors. All told, he ended up with $5,649 in bills, of which his insurance plan paid $4,914. Mr. Lenner didnt end up on the hook for any of it, but hes still frustrated. Ultimately, we pay for this in higher premiums, he said.

Michelle Tribble, a spokeswoman for Austin Emergency Center, said it needed to charge high prices because insurers often pay only a small share of their fees.

For emergency room visits, the reimbursement to us by insurance companies is typically a fifth or a third of total charges, she said. If an insurance company were to bill a patient for an out-of-network visit to our emergency room, our billing company would go to bat for that patient and would appeal on their behalf.

Follow this link:

Two Friends in Texas Were Tested for Coronavirus. One Bill Was $199. The Other? $6,408. - The New York Times