Dying patients’ wishes ignored nearly 40 percent of time

Nearly 40 percent of chronic illness patients nearing the end of life who had physician orders limiting treatment received intensive care that was inconsistent with those orders, according to a study published in the Journal of the American Medical Association.

Patients with chronic illness frequently use physician orders for life-sustaining treatment to document their wishes with regard to end-of-life care.

For the study, researchers examined 1,818 chronic illness patients at a two-hospital academic health system who died between Jan. 1, 2010, and Dec. 31, 2017. The patients were hospitalized for up to six months before they died.

Of the 1,818 patients:

• 401 had physician orders for “comfort measures only”
• 761 had orders for “limited additional interventions”
• 656 had orders for full treatment

Researchers found 31 percent of patients with comfort-only orders, 46 percent of patients with limited-interventions orders and 62 percent with full-treatment orders were admitted to the intensive care unit.

Among patients with comfort-only and limited-interventions order, 38 percent received ICU care not in line with their orders.

Researchers also found patients admitted for traumatic injury were significantly more likely to receive care not in line with their orders, but cancer patients were more likely to receive care in line with their physician orders.

https://www.beckershospitalreview.com/patient-experience/dying-patients-wishes-ignored-nearly-40-percent-of-time-in-study.html

Youth opioid overdoses increasingly common, fatal

More than 25 percent of opioid overdoses involve youth as overdoses become increasingly severe, according to an analysis presented at the Society of Critical Care Medicine’s 49th Critical Care Congress.

Researchers analyzed 753,592 opioid overdoses reported to the National Poison Data System between 2005 and 2018 and determined 207,543 (27.5 percent) involved individuals younger than 19.

The analysis found almost 10 percent of youth who overdosed in 2015-18 were admitted to a critical care unit. For that same time period, more than 20 percent of overdoses were classified as an attempted suicide, a percentage that has increased over the last 14 years. From 2005-18, youth opioid-related deaths increased from .18 percent to .28 percent.

https://www.beckershospitalreview.com/opioids/youth-opioid-overdoses-increasingly-common-fatal-study-finds.html

Coronavirus could break Medicare-for-all: single-payers struggle with outbreaks

On Jan. 31, Health and Human Services Secretary Alex Azar, the head of the president’s Task Force on the Novel Coronavirus, declared a public health emergency in response to the global outbreak of the pathogen. The coronavirus has claimed more than 900 lives around the world so far, including that of Dr. Li Wenliang, the Chinese doctor who first warned of its potential dangers.

There are more than 40,000 reported coronavirus cases worldwide, including 12 in the United States. Though the pathogen has reached our shores, U.S. health officials have told Americans they don’t need to worry.

Countries with single-payer health care may have a more difficult time. In the not-too-distant past, Canada and the United Kingdom have struggled to handle outbreaks of everything from severe acute respiratory syndrome (SARS) to the seasonal flu.

That’s largely because these countries’ government-run, “Medicare-for-all”-style systems lack enough health care personnel, hospital beds and other resources to meet the needs of their populations even in good times. A public health threat like a pandemic can stretch single-payer health care to its breaking point.

First identified in Wuhan, China, the novel coronavirus causes a potentially deadly form of viral pneumonia. The pathogen belongs to the same family as SARS, which caused a global pandemic nearly two decades ago.

Containing pathogens like the novel coronavirus requires fast action and close coordination among physicians, hospitals and public health officials. That’s tough to do when there aren’t enough doctors or hospital beds to accommodate the sick.

During the first six months of 2019, nearly half of the Canadian province of Ontario’s acute care hospitals were over 100 percent capacity, according to an analysis conducted by CBC News. Almost one-fourth of the province’s hospitals averaged 100 percent capacity — or more — over that period.

As the CBC reported last month, “Overcrowding has become so common in Ontario hospitals that patient beds are now placed in hallways and conference rooms not only at times of peak demand, but routinely day after day.”

That kind of crowding could make quarantining patients difficult, if not impossible, in the midst of an outbreak. Leaving someone with coronavirus in a hallway could expose countless patients and staff to the highly contagious pathogen.

Canada has experienced this kind of thing firsthand, during the SARS pandemic of 2002-2003. Nearly 375 people contracted SARS in Ontario, 44 of whom died. For context, SARS infected just 27 people in the United States — and killed none.

According to the final report of the Canadian government’s SARS Commission, 72 percent of Canadians infected with SARS contracted the disease “in a health care setting.” Forty-five percent of that group were health care workers.

The report laid the blame squarely on Canada’s “public health and emergency infrastructures,” which “were in a sorry state of decay.” Another government report concurred, saying the Canadian health care system “lacked adequate resources, was professionally impoverished and was generally incapable of fulfilling its mandate.”

Single-payer systems don’t just struggle with pandemics. Every year, the United Kingdom’s National Health Service (NHS) struggles to treat patients during flu season.

Single-payer systems don’t just struggle with pandemics. Every year, the United Kingdom’s National Health Service (NHS) struggles to treat patients during flu season. The British press calls this perennial disaster “the winter crisis.”

During the 2018-2019 winter, one in four patients waited more than four hours in major emergency departments. That year those departments were so crowded that over 11 percent of ambulances carrying patients were kept waiting outside hospitals for more than 30 minutes.

In January 2018, the NHS postponed some 55,000 operations because of an outbreak of seasonal illnesses like the flu. One doctor in central England apologized for what he called “third-world conditions,” including 12-hour waits and patients being treated in corridors at his hospital. Another physician likened the scene in his London hospital to “battlefield medicine.”

The Canadian and British health care systems show just how hard it can be to battle an outbreak under single-payer. Let’s not replicate their experiences by adopting “Medicare-for-all.”

https://www.foxnews.com/opinion/sally-pipes-coronavirus-break-medicare-all

Home quarantine for travelers buys time as new virus spreads

On his return from China last week, Dr. Ian Lipkin quarantined himself in his basement. His wife now puts his food on the stairs. He’s run out of things to watch on Netflix. At odd hours, he walks in New York’s Central Park, keeping 10 feet away from others.

Lipkin is among hundreds of people in the U.S. and thousands around the world who, although not sick, live in semi-voluntary quarantine at home. With attention focused on quarantined cruise ships and evacuees housed on U.S. military bases, those in their own homes have largely escaped notice.

They, too, experts say, play a crucial role in slowing the spread of the new viral disease now called COVID-19.

Most cases and nearly all deaths have been in mainland China. Around the world, authorities are urging two weeks of home quarantine and symptom monitoring for travelers returning from there.

It’s the only tool they have.

“We don’t yet have a vaccine and we don’t have approved drugs for prevention of disease or treatment of disease. So all we have is isolation,” said Lipkin, who directs Columbia University’s Center for Infection and Immunity.

An expert virus hunter, Lipkin was invited by Chinese health authorities to help assess the risk posed by COVID-19. He did similar work in China during the SARS outbreak in 2003.

“This is my second time in the slammer,” said Lipkin, who spent time in quarantine then. He will end his confinement Tuesday, celebrating with a dry martini in public.

The numbers in home quarantine are constantly changing and hard to pin down. New York state, for instance, has received the names of more than 350 who recently returned from mainland China. Local health departments are monitoring them, recommending quarantine for those without known exposure to the virus.

State and U.S. guidelines sort people into high-, medium- and low-risk groups and have advice for each group, but local health departments have discretion in how to carry out the quarantines.

Authorities in Taiwan have fined those who violate quarantines, but so far U.S. officials are relying on people’s sense of responsibility, though they have the power to order a quarantine and get help from police to enforce it. Breaking a quarantine order is a misdemeanor in most states. Violating a federal quarantine order can mean fines and imprisonment.

Some have put themselves in quarantine without an order from health authorities. In Highland, Indiana, Ken and Annie Zurek finished 15 days of self-imposed home quarantine Thursday.

“We grew together as a couple,” Ken Zurek said. “I can’t think of any other person I’d want to spend in quarantine together.” Their confinement began after returning early from a trip to Chongqing, China, to meet their new granddaughter. Ken Zurek, a 63-year-old concrete business owner, had read up on the virus and added a 15th day to their quarantine “because I was a Boy Scout, always trying to be prepared and do the right thing.”

Pat Premick, a 57-year-old executive coach who had been living in China, has been in self-quarantine in the Pittsburgh area since returning to the U.S. early this month. On Friday, she said she has two days left.

To keep busy, she’s been doing puzzles, reading books and talking to friends in China who are going through the same thing. Since there aren’t many people in the area where she’s staying, she takes occasional walks. Friends have been leaving food for her outside, which she fetches after they walk away.

“I’m waving from the window,” she said.

In Seattle, public health workers buy groceries to make sure the people stay comfortable while in home quarantine, bringing one person blueberries, bananas and hair conditioner. Another person confined to a motel room asked for and received an instant teapot to heat soup. The health department workers make sure people have Wi-Fi so they can work and stay connected to family. They arrange calls with counselors for those with anxiety.

Several hundred returning travelers are staying away from others while they monitor their symptoms in Seattle’s King County, where the health department is spending about $200,000 a week on efforts to contain the virus.

“It’s a little bit crazy right now,” said Dr. Meagan Kay, who heads King County’s containment efforts.

In India, health authorities have advised a 28-day home quarantine for returning travelers, much longer than the two-week incubation period accepted elsewhere. In Kerala, a state in the southernmost tip of India with three confirmed cases of COVID-19, more than 2,300 people are quarantined at home. They are told to sleep wearing a medical mask and call a helpline if they feel stir crazy.

“It is absolutely boring to be in your room for 28 days,” said Dr. Amar Fetle, who heads the response in Kerala.

In Nordmaling, Sweden, the owners of a Chinese restaurant said they are following health authorities’ guidelines by voluntarily quarantining themselves after a trip to China. They are closing their restaurant until Feb. 27.

“It is to protect ourselves and our customers,” Stanislav Maid told the newspaper Aftonbladet. He runs the restaurant with his wife, Zhou Weixiang. “I have gotten quite a lot of positive reactions from people in the area who think it’s good we take our responsibility.”

In Shanghai, China, home quarantine for journalist Michael Smith of The Australian Financial Review newspaper, began when he returned from a trip to Hong Kong.

“I imagine this is how prison must feel,” Smith said in an email to The Associated Press on Friday, two days into a 14-day confinement. Smith can work at home, but no visitors are allowed and guards are monitoring the only entrance to the housing compound where he lives. He’s finding “an odd comfort” in not worrying about appointments and wearing track pants all day. “I’m treating this as a rare opportunity to read some books, binge watch some Netflix series and get some rest.”

Israel’s Health Ministry on Sunday extended a two-week home quarantine for people arriving from mainland China to include those who have recently spent time in Thailand, Macau, Singapore and Hong Kong.

In New York, Lipkin finds in the COVID-19 outbreak echoes of the movie “Contagion,” for which he was chief science adviser. He has heard the movie has gained new popularity, and he hopes people are learning from it, washing their hands and listening to public health authorities.

He takes his temperature twice a day and reports by email to the medical officer at Columbia, which directed him into home confinement. Unlike others in his situation, he was able to send a swab sample from the back of his nose and throat to his own lab to test for the virus. The result was negative. No virus.

He uses an exercise bike, but most of the time, he works.

“There’s more work than I can possibly do because not only am I running the laboratory at Columbia and writing and dealing with media, but I’m also running programs in China,” he said. “I’m not getting a lot of sleep.”

Lipkin and his wife, Katherine Lewis, are keeping their sense of humor. “My wife is terrific,” he said. “She’ll make dinner for me and leave it on the stairs and say, ‘I’m putting it down here so I don’t have to get your cooties.’

“I hadn’t heard the term ‘cooties’ in probably 50 years.”

https://apnews.com/24f0467ead5541ccb228ff70c698eb91

Alibaba offers $2.86 billion in loans to firms hit by coronavirus outbreak

Alibaba Group Holdings (BABA.N) said on Monday its affiliate Ant Financial’s MYBank unit would offer 20 billion yuan ($2.86 billion) in loans to companies in China in light of the coronavirus outbreak, with preferential terms for Hubei firms.

Alibaba made the announcement in a statement posted on its official Weibo account.

It said 10 billion yuan will be made available for firms in Hubei, the central Chinese province that is the epicentre of the outbreak. They will be offered one-year loans on a zero interest rate basis for the first three months and a 20% discount on rates for the remaining nine months.

Firms across China can also get access to another 10 billion yuan of one-year loans, on which interest rates will be discounted by 20%, it added.

Other moves it announced included waiving platform fees for merchants on its Tmall marketplace for the first half of 2020 and the setting up of two 1 billion yuan funds to support restaurants, logistics and supply chain firms.

Workers were returning to offices and factories around China on Monday as the government eased some restrictions on working during a coronavirus epidemic that has killed more than 900 people, most of them on the mainland.

Chinese regulators have urged banks to lower the interest rates and extend loans to targeted companies that have been affected by the outbreak.

http://feeds.reuters.com/~r/reuters/businessNews/~3/zRthQVM4JRw/alibaba-offers-2-86-billion-in-loans-to-firms-hit-by-coronavirus-outbreak-idUSKBN20412G