Category: Covid-19

"I smell blood," Alexander told fellow staff members on a recent Sunday at Brookdale University Hospital Medical Center in New York City.

The scent hung in the air, something that he had always noticed at the Brooklyn hospital. Lately the smell of blood has been more prevalent, a sign that the gun violence that has gripped the city perhaps has its tightest hold on the communities surrounding his hospital.

"It has a little bit of a metallic smell. And it kind of just lingers with you," said Alexander, 36, who added that on particularly violent days he can't stop smelling blood, even after he's gone home and showered. "You know it when you smell it."

Brookdale, a level two trauma center, has been a lifeline for shooting victims from East New York and Brownsville -- neighborhoods that have been the most ripped apart by gun violence in thet city. And after struggling to help their community survive the Covid-19 outbreak, Alexander and the rest of the staff now find themselves dealing with another crisis.

'Broad daylight, people are getting shot'

Brookdale saw nearly 100 more gunshot victims in June, July and August of this year compared to the same period last year, according to data from the hospital.

There were 149 gunshot victims treated at Brookdale during those three months -- 38 in June, 66 in July, and 45 in August. Last year there were 55 gunshot victims -- 12 in June, 25 in July, and 18 in August.

And while shooting numbers continue to rise to levels not seen in New York City in years, staff at the hospital struggle to save victims, a task that has not only become more frequent but more problematic. It's a strong indicator that the violence isn't stopping.

"What we've noticed recently over the last couple of months is that 9 a.m, 10 a.m., 11 a.m., broad daylight, people are getting shot. People are getting murdered," Alexander said. "You're sometimes like, 'Wow, it's 10 o'clock in the morning. I got up at 5 a.m. to go to work. What time did this person get up to shoot somebody at 10 o'clock? People used to think in the daytime you have some safety."

And it's not just safety during the day that's in peril, Alexander says. He's seeing more and more come in with multiple gunshot wounds, which ultimately makes it harder to save a life.

In July, 81% of the patients who were shot were in critical condition, according to the hospital.

"Normally you'll get someone who was shot twice. Three times maybe. But we're talking about twenty, thirty times. One person," Alexander said. "So we know as physicians that our ability to save that person at that point is almost non-existent. There's just too much damage in too many places to be able to control anything."

New York City's summer explosion of gun violence

Gun violence has tightened its grip on the city as Covid-19 started to get under control. As of Aug. 27 there were 974 shooting incidents across New York City, which is almost twice that of the year prior, which had 527. There were also 1,174 shooting victims while last year there were 602, according to NYPD statistics.

East New York and Brownsville are two neighborhoods that have led the city in shootings. Year to date as of late August there have been 66 shooting incidents in Brownsville, compared to 25 the year before. Shooting victims are also higher, with 77 compared to 43 the year before. In East New York there were 84 victims compared to 50 the previous year. And 65 incidents compared to 41 last year.

And while shootings have skyrocketed in the city, gun arrests are still not yet at last year's pace, though they are climbing back up.

As of Aug. 23 there were 2,062 gun arrests, down from 2,221 from last year.

"Since June 1, the city has just exploded in gun violence," said NYPD Chief Michael LiPetri, chief of crime control strategies.

"We have large groups of people committing quality of life offenses, whether it be gambling street dice, whether it be drinking, that then, unfortunately, turns into violence after the fact. Mainly gang members, committing firearm related violence," said LiPetri, who added that narcotics related shootings are also another driver of the violence.

"There are many many factors and we can't just be focused on one of them," said LiPetri, who said the number of those released from jail was closer to 2,000.

'Regular people' are victims

LiPetri has been outspoken about how crime statistics are about the victims, not about numbers. Dr. Alexander also sees the people beyond the statistics.

"When you say gun violence the majority of people are thinking, oh, a TV gangster or something along those lines," said Alexander. "No. Regular folk. Regular people, 30s, 20s, teenagers, preteens, people less than 10 years old. Those are the people that we see. And the impact of that is profound to say the least."

Dr. Patricia O'Neill, the trauma medical director at Brookdale, said she recently had three gunshot wound victims that she treated. One was shot 10 times. The other had bullets rip into his neck and out through his face. The other serious injury was a teen who was shot only once and had a single bullet that tore through his chest but somehow sat neatly between his heart, aorta and esophagus.

"He was 19 years old and he still had braces," O'Neill said of the victim of the "magic bullet."

"It just sort of made me think he was so young."

But not to be ignored was the vicious cycle of violence spurred by a lack of cooperation and vengeance, she said.

"On these particular shootings people are unwilling to cooperate because they want to go out and take care of it themselves," Clark said. "One incident happens, you have an uncooperative victim so there's no arrest. That means the person that did that shooting is not being held accountable. But what you're also seeing is that the victim now is taking matters into their own hands, getting their own people involved and retaliating, and then you have another victim."

'A real deal miracle'

There are some victims Dr. Alexander will never forget.

There was the woman shot in the back of the head one time and the bullet was lodged in the middle of her brain. Not only was she alive, she was conscious.

"Arms and legs moving. Talking, communicating, blinking their eyes and with you. That is a real deal miracle," Alexander said.

Then there was the overnight shift on New Year's Eve 2019, where he had to break the news to the man's family that he did not survive the shooting. He was told afterward by a detective that his patient was the first homicide of the new year. What he remembers most is choking back tears while the family wailed.

"I told them I'm sorry for their loss," Alexander said. "Unfortunately that probably does sound routine and mundane and repetitive to people listening to this on the outside, but it's probably some of the most sincere words that we share as physicians."

And last month a young man was shot in the stomach, but he had enough wherewithal to brag about his injuries on Instagram.

"You see that from time to time," Alexander said. "They want to Instagram Live or go on Facebook and say, 'Hey I got shot. I'm a gangster.' No, you almost died. And your mother would have been mortified."

From Covid-19 patients to gunshot victims

And while gunshot victims continue to cycle in and out, Alexander tries to make sure he and the rest of the staff, already brutally taxed after dealing with Covid-19 patients, still have enough left in the tank for their patients.

The mere mention of Brookdale Hospital during the height of the Covid-19 outbreak was enough to make Alexander roll his eyes and shoot his head back in disbelief and exasperation. The ICU at Brookdale was overflowing with sick and scared Covid-19 patients only a few months ago: Indeed, East New York and Brownsville were two of hardest hit areas in the city, according to city data.

Patient beds lined the hospital's hallways and refrigerated trucks, designed to be emergency morgue space, were overflowing with victims who could not be saved.

Alexander said he slept four to six hours a night and didn't take a day off from February 20 until April 17.

"Although it was emotionally traumatizing and mentally anguishing it was something that was very different than the public health emergency of gun violence," the doctor said.

"I don't walk into work thinking, 'Oh, I'm going to have thirty people shot today.' I don't walk into work thinking that," Alexander said. "I walk into work thinking I'm going to help people and help those that I need to take care of. I don't know how traumatic that may be for me. Emotionally, mentally, physically, depending on what comes through that door."

Read more:

A hospital slammed by Covid-19 in spring sees a new wave of patients in summer -- gunshot victims - CNN

The official name for my new heart troubles, as Ive recently been diagnosed, is postural orthostatic tachycardia syndrome, or POTS. The condition, a puzzling dysfunction of both the heart and the nervous system, messes with how the body regulates involuntary functions, including pulse. POTS is known to affect approximately 500,000 people in the U.S., typically young women in their late teens or early 20s. But now, several cardiologists with whom Ive spoken say theyre noticing an unsettling trend. Previously fit and healthy women of all ages who have had COVID-19 are showing up at their offices, complaining of inexplicably racing hearts.

Read: COVID-19 can last for several months.

The more we learn about COVID-19, the stranger its effects appear to be. Beyond its telltale fever and cough, troubling early evidence has been mounting that the disease can damage many organs in the body, including the lungs, the brain, andyes, you guessed itthe heart. An array of cardiac dysfunctions has cropped up, confounding researchers and revealing that COVID-19 is a far more complicated and potentially long-lasting disease than people initially expected. These heart ailments have especially gained attention from sports: Some college football players who have had COVID-19 are sitting out this season with myocarditis, a rare condition that can be fatal if untreated. The Red Sox pitcher Eduardo Rodriguez is doing the same.

In a strange way, I feel lucky. POTS is not life-threateningat least, aside from the risk of head trauma from blacking out. But it is destabilizing, both physically and mentally, to wander around not knowing what my body has in store for me from one minute to the next. Like so many other aspects of this pandemic, this latest syndrome in my parade of illness is mysterious, disruptive, and scarily indefinite.

After my smoothie incident, I called my cousin Emily Wessler, a pediatric cardiologist at Stanford, and asked her what was going on in my body whenever I felt like I was going to pass out. Youre not getting enough blood to the brain, she told me, so the brain says, Shut down! Shut down! Emergency! Shed been reading more and more professional chatter about cases of POTS and other cardiovascular disorders post-COVID, so she urged me to make an appointment with a cardiologist. She added that I also might want to speak with a neurologist. There are a lot of doctors to call if your whole body feels like its malfunctioning, which is not ideal at a time when millions of Americans are losing their health insurance.

I started with a cardiologist. At NYU Langone, Seol Young Han Hwang hooked me up to an EKG that immediately spit out bad news. Sinus tachycardia, it read. Abnormal ECG. In other words, my heart was beating much faster than it should have been, given that I was reclining on an exam table. Han asked me to wear a Holter monitor for a week to trace my hearts vagaries. It showed abrupt daily spikes, during which my heart rate would jump from as low as 51 beats per minute, while at rest, to as high as 163.

Link:

Did COVID-19 Mess Up My Heart? - The Atlantic

BOISE (Idaho Statesman) Almost 2,200 cases of COVID-19 have been reported in Idahos nursing homes, assisted living facilities and group homes since the pandemic reached Idaho in March, according to Idaho long term care and federal nursing home records.

Idaho has just over 400 long-term care facilities. Of those, 173 have reported at least one case of suspected or lab-confirmed COVID-19, the records show. Most of the outbreaks 112 of them have settled down or stopped entirely, with no new suspected or confirmed cases among residents or staff. The other 61 outbreaks are growing.

Dozens of facilities have managed to halt the coronavirus before it could infect more than one resident or staff member, records show. Others have reported large outbreaks, with 50 or more people infected. COVID-19 has taken the lives of at least 212 people in Idahos long term care facilities.

Several nursing homes told the Centers for Disease Control and Prevention in mid-August that they lack adequate protective equipment to keep their staff and patients safe. Six nursing homes said they had no adequate supply of N95 masks, and at least one nursing home had no supply of hand sanitizer.

Many long-term care facilities are dealing with shortages of nursing staff, aides and other employees.

More than half the people with COVID-19 in Idahos nursing homes are the staff, according to CDC records.

Several nursing homes notified the CDC in August that they couldnt test their residents and staff for the coronavirus as often as necessary, citing a lack of supplies and lab capacity. Some told the CDC that it took more than a week to get test results.

Families have reported trouble getting information about outbreaks and coronavirus testing in their loved ones facilities. To help provide more transparency, the Idaho Statesman has created a searchable online database and map, using state and federal records.

Having trouble seeing this chart? Click here to open it in a new tab or window.

Having trouble seeing this chart? Click here to open it in a new tab or window.

There are likely to be some inaccuracies in the data. These may be due to reporting delays, data entry errors, clerical errors or faulty reporting.

The state records are based on information reported to the Idaho Department of Health and Welfare by local health districts. The federal records are based on information reported to the CDC by nursing homes.

The CDC record is more than a week behind the state record, so its data may be significantly delayed. In some cases, the CDC data may overstate the number of cases in a facility. For example, one nursing homes CDC record showed three infected residents for every one person who actually lived there. The Statesman has redacted CDC numbers that are likely to be inaccurate in the database.

On the other hand, some outbreaks that nursing homes reported to the CDC do not show up in state records, or they show up much later. A handful of nursing homes were reporting cases to the CDC for months before the states records showed any cases there.

While the CDC data includes all confirmed and suspected cases of COVID-19, the state only includes an outbreak when a facility has at least one case confirmed by a lab test.

The numbers in the Statesman database include confirmed and probable/suspected cases residents or staff who have symptoms and a known exposure to the coronavirus but didnt test positive or werent tested at all.

The state recently completed 115 inspections at nursing homes, looking specifically at COVID-19 infection control. They found 49 nursing homes had no deficiencies in their practices, 66 with at least one deficiency and nine nursing homes with deficiencies that put their residents in immediate danger.

The most common problems inspectors found included failing to properly isolate or separate patients with COVID-19, improper hand hygiene or use of PPE, screening people who entered the facility and not having dedicated staff for residents with COVID-19, according to the Idaho Department of Health and Welfare.

See an error in the database? Email reporter Audrey Dutton at adutton@idahostatesman.com. Have a story for us to investigate? Follow the instructions at idahostatesman.com/news/investigative-tips to communicate with our investigative team as safely and securely as possible.

More:

These 173 Idaho nursing homes and care facilities have had COVID-19 outbreaks - East Idaho News

Covid-19 could now be endemic in some parts of the country that combine severe deprivation, poor housing and large BAME communities, according to a highly confidential analysis by Public Health England.

The document, leaked to the Observer, and marked official sensitive, suggests the national lockdown in these parts of the north of England had little effect in reducing the level of infections, and that in such communities it is now firmly established.

The analysis, prepared for local government leaders and health experts, relates specifically to the north-west, where several local lockdowns have recently been put in place following spikes in numbers. But it suggests that the lessons could be applied nationally. Based on detailed analysis of case numbers in different local areas, the study builds links between the highest concentrations of Covid-19 and issues of deprivation, poor and crowded accommodation and ethnicity.

If we accept the premise that in some areas the infection is now endemic how does this change our strategy?

Produced in the last few weeks and containing data up to August, it states: The overall analysis suggests Bolton, Manchester, Oldham and Rochdale never really left the epidemic phase and that nine of the 10 boroughs [of Greater Manchester] are currently experiencing an epidemic phase.

The five worst-hit areas are all currently in the north-west. Bolton had 98.1 cases per 100,000 people last week, with 63.2 in Bradford, 56.8 in Blackburn and Darwen, 53.6 in Oldham and 46.7 in Salford. Milton Keynes, by comparison, had 5.9 per 100,000, and it was 5.2 in Kent and 3.2 in Southampton.

Comparing other English regions, the study says: Each region has experienced its own epidemic journey with the north peaking later and the NW [north-west], Y&H [Yorkshire and Humber] and EM [East Midlands] failing to return to a near zero Covid status even during lockdown, unlike the other regions which have been able to return to a near pre-Covid state.

It also questions, under a heading marked for discussion, why anyone should expect fresh local lockdowns to work in these areas now: If we accept the premise that in some areas the infection is now endemic how does this change our strategy? If these areas were not able to attain near zero-Covid status during full lockdown, how realistic is it that we can expect current restriction escalations to work?

The comments point to friction between Public Health England and the government over the strategy to tackle local outbreaks as a potential second wave of Covid-19 threatens.

Doing something about housing conditions for someone who has an active infection cannot be handled by a call centre run by a commercial company hundreds of miles away

Last night, Gabriel Scally, visiting professor of public health at the University of Bristol and a member of the independent Sage committee, described the findings of the leaked report as extremely alarming after being shown them by the Observer.

The only way forward is to build a system which provides much better, more locally tailored responses, Scally said. There is no integrated find, test, trace, isolate and support system at the moment. The data on housing is extraordinarily important. Overcrowded households are part of public health history. Housing conditions are so important and always have been, whether it was for cholera or tuberculosis or Covid-19.

Doing something about housing conditions for someone who has an active infection is extremely important and it is not something that can be handled by a call centre run by a commercial company hundreds of miles away.

Scally said that helping people to isolate by giving financial support was also crucial: Taking two weeks off if you are on a zero-hours contract is not an option for people.

Matthew Ashton, director of public health at Liverpool city council, said on seeing the study: This report shows a strong link between our most deprived areas, our BAME communities and poor housing communities, and that can lead to the virus becoming endemic. I absolutely agree with that. But I think it is also more complicated in that there are different types of outbreaks and different types of ways in which the virus could become endemic, such as opening the night-time economy and young people getting the virus asymptomatically and then passing it on.

Last night, amid continuing confusion over rules on quarantining when returning to the UK, Labour called for a rapid review to restore public confidence. In a letter to the home secretary, Labour is urging the government to consider introducing a robust testing regime in airports that could help to safely minimise the need for 14-day quarantine.

There have been more than 340,000 confirmed cases of coronavirus so far in the UK, and more than 40,000 people have died, according to government figures.

Local lockdowns are now being implemented or relaxed across the country in response to surges. The most recent have seen Norfolk, Rossendale and Northampton added as areas of enhanced support, meaning the government will work with local authorities to provide additional resources such as testing or contact tracing to help bring infection numbers down.

Improvements in Newark and Sherwood in Nottinghamshire, Slough in Berkshire and Wakefield. West Yorkshire, mean they have been removed from the watchlist. Restrictions already in place in parts of Greater Manchester, Lancashire and West Yorkshire have been eased.

In Scotland, restrictions on visiting other households were reintroduced this week in Glasgow, West Dunbartonshire and East Renfrewshire.

See the rest here:

Covid-19 could be endemic in deprived parts of England - The Guardian

The 83-year-old media magnate, who first became the country's leader in 1994, was admitted to hospital on Thursday with mild coronavirus symptoms. He subsequently tested positive for Covid-19.

"Berlusconi, after the appearance of some symptoms, was admitted to the San Raffale hospital in Milan as a precaution. The clinical picture does not cause concern," his press office told CNN.

It comes after his press office told CNN Wednesday that the former Italian Prime Minister had coronavirus but was not displaying symptoms.

"He did a precautionary swab test but was asymptomatic. He is currently in his Arcore home [near Milan, in the Italian region of Lombardy] where he will continue to work and give interviews remotely," his representatives said Wednesday.

Italy reported 996 new Covid-19 cases and six deaths on Monday, with the region of Campania recording 184 infections. This marked the first time a southern region had seen the highest daily rate of cases.

As of Monday, there were 94 coronavirus patients being treated in Italian Intensive Care Units across the country, more than at any date since June 29.

But despite the success story in beating back the virus, Italy has suffered tremendous economic losses, with GDP expected to contract by around 10% this year.

Read more here:

No cause for 'concern' after Berlusconi admitted to hospital with Covid-19 - CNN

The coronavirus outbreak, or COVID-19, has fundamentally transformed our lives and communities, contributing to economic declines, disruptions in schooling, and distressed hospital systems. However, the pandemic has generated some silver linings, including the widespread adoption of telehealth that has helped to mitigate the risk of community spread by reducing unnecessary hospital visits and ensuring real-time access to medical providers for millions of Americans. According to a report by McKinsey, in the aftermath of COVID-19 epidemic, medical providers have rapidly scaled their telehealth offerings and are seeing 50 to 175 times the number of patients via remote access platforms than they did before. Some patients have even come to prefer virtual office visits as medical providers have been less resistant to the change and even more willing to administer remote care from an internet-enabled device.

Last month, the Trump administration lauded their efforts to relax the legislative and regulatory restrictions limiting the use and adoption of remote medical care. And rightfully so. Early reports indicate various benefits from cost reduction in both medical and mental services to quality improvement, as well as increased patient satisfaction. But given the ravaging effects of the pandemic on U.S. citizens and the focus on health care leading up to the national election, will telehealth still be available, or potentially be made permanent, as an option for patients in need of immediate, primary, or secondary care? Will previous regulatory guardrails be reinstated on emerging models of health care delivery, potentially suppressing the number of providers and patients accessing such resources?

To start, certain conditions must be instituted to ensure long-term delivery of telehealth services, starting with access to high-speed broadband among patients and providers, national interoperability, new fraud detection methods, and more lenient and favorable federal and state policies towards its use. Further, as people of color, especially African Americans, become disproportionately impacted by COVID-19 in both infections and deaths, the adoption of telehealth practices to address and potentially reduce the immediate and long-term delivery of care will be important. Across the U.S., African Americans are dying at a rate of 88.4 deaths per 100,000 population, more than twice the rate of white Americans (40.4 deaths per 100,000 population).

The Federal Communications Commission (FCC) has reported that more than 18 million Americans do not have access to high-speed broadband networks. This lack of access to digital connectivity has far-reaching impacts on more vulnerable populations, including those with medical conditions or those who live in areas with limited access to quality health care facilities. Having access to broadband is a prerequisite in telehealths use. Patients require access to reliable internet connections that support high-speed transmissions to use remote health care services and attend virtual office visits.

Unfortunately, COVID-19 has revealed the relationship between poverty, geography, education and a host of other variables on ones access to broadband in the U.S. For rural populations, access to health care is constrained by the lack of local quality services and infrastructure, doctor workforce shortages, fewer dollars, and cybersecurity vulnerabilities. Low-income, urban populations experience similar problems, making the emergency room their first point of contact for service.

Given the historical effects of being socially distanced from medical care, telehealth can mitigate health care access, costs, and even remediate certain chronic diseases of vulnerable groups, including seniors, who were more likely to be both impacted and isolated by COVID-19. During the pandemic, Congress appropriated $200 million in funding as part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act to support the ability of health care providers to offer connected care. The COVID-19 Telehealth Program enabled reimbursements to the providers and last month, several lawmakers requested details on its progress and called for its continuation. But expanding the eligibility and payment of telehealth services are just parts of the larger problem of a widespread digital divide that forecloses on its use by vulnerable populations.

One specific area of broadband expansion that will be critically important to telehealth delivery will be the availability of 5G, which can enable mobile phones as the prime point of contact for providers and patients. Smart phones are now much more common and ubiquitous than personal computers and laptops. The type of latency and resiliency embedded in 5G networks can accelerate more reliable virtual connections as well.

Further, a virtual doctor visit is a very private exchange, which is a concern expressed by a large majority of Americans. While a PC is limited in portability and often shared by multiple members in a household, a smart phone typically has a single user, and allows for encrypted communications that enable a higher level of patient privacy over digital connections. In addition to incentivizing and reimbursing providers for telehealth use, it is imperative that next-generation mobile broadband networks be affordable and available in both rural and urban communities to accelerate adoption.

Physicians should be able to share medical information between themselves and their patients in order to enhance the quality of medical services and avoid redundancies. National efforts to enable interoperability between different healthcare providers have not been successful. Particularly, lack of interoperability between different electronic systems across the healthcare delivery system is one reason for delay in reporting of the COVID-19 test results. To enhance the quality of virtual visits, physicians need to have access to their patients medical data including medications, labs (such as COVID-19 testing), hospitalizations, and imaging data. For example, New York Citys Health Information Exchange (HIE) platform made it possible to merge the patients COVID-19 testing data with their prior medical data. This enables a much better understanding of patients clinical conditions and more importantly, allows providers to identify high-risk populations and prioritize them in their prevention efforts.

Despite their importance, interoperability efforts have not been successful in many parts of the U.S. This is in spite of the more than a decade of nationwide efforts, trying many different approaches to interoperability and billions of dollars of incentives and grants. While there are still some technical barriers to exchange of health information, the most important impediment to interoperability continues to be economic disincentives for providers to share data. COVID-19 has led to fundamental changes in expectations of patients, providers and payers about data exchange. Given the circumstances, patients are much more willing to receive their test results through online patient portals. It is now in the best interest of providers to willingly share clinical data with public health officials and other providers as part of a community effort to fight the epidemic.

The Department of Health and Human Services (HHS) has just provided effective guidelines to overcome the technical barriers to health information exchange and more importantly, has set specific rules to identify information blocking and sever penalties for violators. These significant economic, legal and technical changes have created the most favorable ecosystem for health information exchange platforms to emerge and expand. Healthcare organizations and IT vendors should take advantage of this environment to streamline their data exchange processes. Otherwise, demand and enthusiasm for telehealth services will wither as the epidemic gets under control and we go back to normalcy.

While telemedicine facilitates legitimate medical services, it can also make it easier for fraudsters to abuse the system. In one commonly-used scheme, fraudsters recruit Medicare patients to visit physicians for unnecessary reasons and get prescribed expensive medical devices which Medicare will ultimately pay for. In a recent incident, DOJ charged a network of telehealth companies, physicians, and patient recruiters in a $1.2 billion Medicare fraud scheme. Given that telehealth is a new medium for delivering health care, the areas of more susceptible to fraud may be unique and unknown to the federal agencies, making it more difficult to detect and stop.

DOJ and HHS may consider collaborations on new models or systems that proactively monitor, and audit unusual billing behaviors related to telehealth services. Considering that the pandemic suddenly increased patient demand for remote care, new fraud detection methods may also improve upon data collection, service coding, and move away from reimbursements based on parity laws to maintain the high quality of services.

The Centers for Medicare and Medicaid Services (CMS) has been extremely proactive to implement a wide variety of policies to expand telehealth services during the COVID-19 epidemic. These policies include waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services, allowing hospitals to bill for telehealth services to Medicare patients registered as hospital outpatients even when the patient is at home, increasing the payments for telephone visits to match those of in-person office visits, and expanding payments for telehealth services to rural health clinics and federally qualified health clinics. While these policies were implemented as emergency measures in response to COVID-19 epidemic, more than 5.8 CMS beneficiaries took advantage of remote office visits, especially in the areas of mental health.

While it has taken decades for Congress and state regulators to operationalize limited remote health care, it took just weeks to implement such changes nationwide. Bipartisan lawmakers are currently pushing for the permanence of telehealth options post-pandemic in a letter that continues to receive more signatures. Despite the last few months of provability in cost savings and care remediation, the fate of telehealth is still undetermined, especially in an election year where health care is often a partisan issue.

Finally, the challenges of being stricken by multiple health factors that impact is all too familiar among vulnerable populations. Lack of access to doctors, insurance, nutritious food, and safe workspaces, among other areas can all contribute to the persistent and growing health disparities impacting people of color, especially African Americans and Native Americans. These heightened risk factors for people of color can trigger a host of chronic ailments, including diabetes, pulmonary failures and disruptions, cancer, and other rare conditions. In cities where Black people comprised the majority of the population, COVID-19 related illnesses and deaths have been disproportionately high and correlated with such underlying medical conditions.

For all the reasons previously stated in a May 2020 Brookings report, telehealth can improve upon the health inequities that have debilitated communities of color through real-time delivery and availability of care, provided that broadband access and lenient CMS policies were still made available to these populations. Vulnerable populations would also benefit from the institution of new and improved fraud detection monitors to avoid the deceptive practices of bad actors in the medical community who prey upon people of color, the elderly, and their frail conditions.

In the end, measures to reduce the spread of COVID-19 have accelerated the availability and adoption of remote health care services. However, as the last six months have largely represented a national pilot to creatively redress the challenges of social contact, the federal government and the next administration must determine whether telehealth can continue to play a competitive and complementary role in health care. The regulatory conditions, the incentives for doctors, and the political will of the country to remedy health disparities and care fragmentations will largely determine if telehealth becomes permanent.

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How to make telehealth more permanent after COVID-19 - Brookings Institution

Some Ohio State students that have tested positive for COVID-19 being housed in hotel  ABC6OnYourSide.com

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Some Ohio State students that have tested positive for COVID-19 being housed in hotel - ABC6OnYourSide.com

Yesterday marked the 29th straight day that New York States COVID-19 positive test rate was under 1% statewide but about a dozen counties, including Suffolk and Nassau have positive rates over that benchmark.

Suffolk Countys positive rate was 1.5% yesterday and 1.6% Thursday, according to State Health Department data posted online today. Nassaus positive rate was 1.2% yesterday and 1.6% yesterday. Positive rates in both counties were 1.1% on a seven-day rolling average, according to the states numbers. Other downstate counties outside of New York City Rockland, Putnam, Orange and Sullivan reported similar positive rates.

Upstate Otsego County, where SUNY Oneonta is located, had a 4% positive rate 5.1% on a seven-day rolling average, the state reported today. A COVID-19 outbreak at SUNY Oneonta forced the university to send its students home for the semester during the second week of classes. The school announced the decision Thursday, when it said confirmed cases had risen to 389 since the start of the semester on Aug. 24. Oneonta had already begun a two-week pause on Aug. 30 in an attempt to limit the spread of the virus. As of today there were 559 confirmed cases among students there.

Oneonta is the most extreme example of community spread of COVID-19 on college campuses in New York, but it is by no means alone. SUNY Buffalo reported 91 confirmed cases as of late yesterday, just a handful of cases shy of the 100-case threshold requiring a two-week shutdown under rules announced by Gov. Andrew Cuomo last week.

Stony Brook University, which reported its first positive case on Aug. 28, on Wednesday announced 17 new cases. The university said it was retesting the 18 students whose tests came back positive and would have new test results within 24 hours. It has not updated the data on its COVID-19 dashboard since then. Stony Brook also reported two positive tests among employees. A university spokesperson could not be reached for comment.

Hofstra University said yesterday it had a total of 27 confirmed positive cases for students, including confirmed positive cases from on-campus testing and confirmed positive cases from off-campus testing confirmed through the Department of Health. Hofstra has had no positive tests among employees, according to its website.

SUNY Old Westbury has not had any confirmed cases, according to its website. Farmingdale State College is not posting the information on its website. St. Josephs College will begin on-campus classes after Labor Day.

Statewide, 801 additional coronavirus cases were confirmed yesterday a .8% positive rate bringing the states total to 438,772.

Suffolk County had 98 new confirmed cases yesterday, according to state data, bringing the overall county total to 45,200.

Riverhead Town has had 801 confirmed cases to date, or 23.78 positives per 1,000 people.

The hamlet of Riverhead has the highest total in the township, with 514 cases, or 36.6 cases per 1,000 people.

Case totals for other hamlets in Riverhead Town are as follows:Aquebogue 30Baiting Hollow 15Calverton 120Jamesport 17Northville 14Wading River 108

Across the river, the hamlet of Flanders, with 211 cases total to date, has a per-thousand rate of 44.1. Riverside has had 95 cases (30.2 per thousand) and Northampton has had just 20 cases, but a per-thousand rate of 33.2.

A state of emergency due to the coronavirus pandemic remains in effect in New York, Suffolk County and in Riverhead and Southampton towns, with restrictions on business, civic and social activities extended to at least the end of the month.

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COVID-19 update: Suffolk's positive rate among the highest in the state - RiverheadLOCAL

TheWest Virginia Department of Health and Human Resources (DHHR) reportsas of 10:00 a.m., on September 2, 2020, there have been 441,396 total confirmatory laboratory results receivedfor COVID-19, with 10,642 total cases and 230 deaths.

DHHRhas confirmed the deaths of an 88-year old female fromKanawha County, an 83-year old female from Taylor County, an 84-year old femalefrom Taylor County, a 72-year old male from Ohio County, a 67-year old femalefrom Logan County, a 67-year old female from Nicholas County, a 73-year oldfemale from Harrison County, and an 88-year old male from Jackson County. Weregret to report more deaths of our fellow West Virginians, said Bill J.Crouch, DHHR Cabinet Secretary. Each life lost to this disease is heartbreaking.We send our sympathies to these families.

CASESPER COUNTY: Barbour (34), Berkeley (808), Boone(143), Braxton (9), Brooke (95), Cabell (555), Calhoun (10), Clay (27),Doddridge (6), Fayette (365), Gilmer (19), Grant (141), Greenbrier (105),Hampshire (92), Hancock (121), Hardy (75), Harrison (272), Jackson (204), Jefferson(365), Kanawha (1,515), Lewis (33), Lincoln (123), Logan (501), Marion (219),Marshall (133), Mason (109), McDowell (71), Mercer (318), Mineral (144), Mingo(250), Monongalia (1,209), Monroe (126), Morgan (37), Nicholas (53), Ohio(289), Pendleton (45), Pleasants (15), Pocahontas (43), Preston (140), Putnam(294), Raleigh (372), Randolph (227), Ritchie (5), Roane (33), Summers (19),Taylor (106), Tucker (11), Tyler (15), Upshur (45), Wayne (259), Webster (7),Wetzel (46), Wirt (8), Wood (309), Wyoming (67).

Pleasenote that delays may be experienced with the reporting of information from thelocal health department to DHHR. As case surveillance continues at the localhealth department level, it may reveal that those tested in a certain countymay not be a resident of that county, or even the state as an individual inquestion may have crossed the state border to be tested.Such is the case of Jackson,Mineral, Ohio, Pocahontas, Summers, Wood, and Wyoming counties inthis report.

Pleasevisit the dashboard located at http://www.coronavirus.wv.gov for more information.

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COVID-19 Daily Update 9-2-2020 - West Virginia Department of Health and Human Resources

Technology may be part of the solution to stopping the spread of COVID-19, but apps alone will not save us. As more states develop COVID exposure notification apps, institutions and the people they serve should remain skeptical and remember the bigger picture. This is still experimental, unproven technology, both in terms of how it works under the hood and how humans will interact with it. And even the best-designed app will be no substitute for public health basics like widespread testing and interview-based contact tracing.

On top of that, any benefits of this technology will be unevenly distributed. Any app-based or smartphone-based solution will systematically miss the groups least likely to have a cellphone and more at risk of COVID-19 and in need of resources: in the United States, that includes elderly people, people without housing, and those living in rural communities.

Ultimately, exposure notification technology wont bail out poor planning or replace inadequate public health infrastructure, but it could misdirect resources and instill a false sense of safety.

Exposure notification apps, most notably those built on top of Apple and Googles Exposure Notification API, promise to notify a smart phone user if they have been in prolonged close contactfor instance, within 6 feet for at least 15 minuteswith someone who has tested positive for the virus. The apps use smartphones Bluetooth functionality (not location data) to sense how far away other phones are, and store random identifiers on the users device.

But Bluetooth was not made to assist with contact tracing and other public health efforts, and the differing hardware properties of various phones can make it hard to consistently measure distances accurately.

On top of technical shortcomings, it is also not yet clear how people will interact with the technology itself. How are people likely to react to a phone notification informing them that they were exposed to someone with COVID? Will they ignore it? Will they self-isolate? If they seek testing, will it be available to them? Public trust is fragile. A high rate of false negatives (or a perception thereof) could lead to people relaxing measures like social distancing and masking, while false positives could lead to users ignoring notifications.

Any app that promises to track, trace, or notify COVID cases will disproportionately miss wide swaths of the population. Not everyone has a mobile phone. Even fewer own a smartphone, and even fewer still have an iPhone or Android running the most up-to-date operating system. Some people own multiple phones to use for different purposes, while others might share a phone with a family or household. Smartphones do not equate to individuals, and public health authorities cannot make critical decisionsfor example, about where to allocate resources or about who gets tested or vaccinatedbased on smartphone app data.

In the U.S., smartphone ownership is only 80% to begin with. And the communities least likely to have a smartphone in the U.S.such as elderly people or homeless peopleare also the ones at higher risk for COVID-19. For people 65 years or older, for example, the rate of smartphone ownership declines to about 50%. Out-of-date smartphone hardware or software can also make it harder to install and use a COVID tracking app. For Android users in particular, many older phone models stop getting updates at some point, and some phones run versions of Android that simply dont get updates.

And smartphone penetration data and specs do not tell the whole story, in the U.S. or internationally. Overbroad surveillance hits marginalized communities the hardest, just as COVID-19 has. In addition to potentially directing public health resources away from those who need them most, new data collection systems could exacerbate existing surveillance and targeting of marginalized groups.

Even with these drawbacks, some will still ask, So what if its not perfect? Anything that can help fight COVID-19 is good. Even if the benefit is small, whats the harm? But approaching exposure notification apps and other COVID-related tracking technology as a magic bullet risks diverting resources away from more important things like widespread testing, contact tracing, and isolation support. The presence of potentially helpful technology does not change the need for these fundamentals.

Relying on unproven, experimental technology can also lead to a false sense of safety, leading to a moral hazard for institutions like universities that have big incentives to reopen: even if they do not have, for example, enough contact tracers to reopen, they might move ahead anyway and rely on an app to make up for it.

If and when public health officials conclude that spread of COVID-19 is low enough to resume normal activities, robust interview-based contact tracing is in place, and testing is available with prompt results, exposure notification apps may have a role to play. Until then, relying on this untested technology as a fundamental pillar of public health response would be a mistake.

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COVID-19 Tracking Technology Will Not Save Us - EFF