Dozens of countries risk running out of vaccines for diseases like
measles because of restrictions on flights brought in to tackle the new
coronavirus, the United Nations warned on Friday.
The UN children’s agency UNICEF called for support to unlock a massive backlog in vaccine shipments.
It said the delays had been caused by “unprecedented logistical
constraints” linked to lockdowns and other measures put in place to halt
the spread of COVID-19, which has killed more than 233,000 people and
infected nearly 3.3 million in a matter of months.
But UNICEF and other organisations have warned that a drop in routine
vaccinations could fuel other, potentially deadlier outbreaks of a
range of diseases.
UNICEF said in 2019 it had procured 2.43 billion doses of vaccines
for 100 countries, to reach around 45 percent of all children worldwide
under the age of five.
But since the week of March 22, the agency has seen a 70-80 percent
reduction in planned vaccine shipments because of the sharp decline in commercial flights and limited availability of charter flights, spokeswoman Marixie Mercado told journalists in an online briefing.
“Dozens of countries are at risk of stock-out due to delayed vaccine shipments.”
She warned that 26 countries, mainly in Africa but also several Asian
countries like North Korea and Myanmar, were particularly at risk.
The cost of securing space on the few flights available has soared,
with freight rates now up to 200 percent above normal prices, she said.
“Countries with limited resources will struggle to pay these higher prices, leaving children vulnerable to vaccine-preventable diseases,” Mercado said, citing polio and measles.
Five of the countries most at risk were hit with outbreaks of
measles—a highly contagious, sometimes fatal viral infection, she said.
Mercado warned that even before the pandemic, vaccines for measles,
polio and other diseases were out of reach for some 20 million children
under the age of one every year.
“Disruptions in routine immunisation, particularly in countries with
weak health systems, could lead to disastrous outbreaks in 2020 and well
beyond,” she said.
https://medicalxpress.com/news/2020-05-grounded-flights-threaten-routine-vaccine.html
Sunday, May 3, 2020
How to help essential workers avoid burnout
We are six weeks into the COVID-19 pandemic life and our front line workers are growing weary.
Not only are our essential personnel—doctors, nurses, grocery store cashiers, and transportation workers—working under intense pressure to keep the world running and save lives, they have the extra-added stress of trying not to contract the coronavirus. Or worse, bringing the virus home to their loved ones.
The impact of living under such professional and emotional strain is starting to become evident. On Monday, a top emergency room surgeon at New York-Presbyterian Allen Hospital hospital died by suicide. Dr. Lorna M. Breen, the medical director in the hospital’s emergency room department, didn’t have a history of mental illness, according to her father. But Breen recently described to her family how taxing it was to witness the toll the coronavirus took on her patients. “She tried to do her job, and it killed her,” said Breen’s father, Dr. Phillip C. Breen.
“It’s a different kind of work pressure, one that maybe hard for others to understand,” said Dr. Rochelle Teachy, a pediatrician at Children’s Hospital of Pennsylvania Primary care in Delaware County. You are fearful for your health, your household’s health and your contact’s health. Everyday. That’s a lot to handle,” Teachy said.
A big stress factor lies in the unknowns, said Dr. Lynette Charity, an Arizona-based physician who lectures on the effect of mental stress and burn out on physicians. We don’t fully understand how the virus is transmitted. Symptoms vary from person to person. It’s not clear how long it will take to develop a vaccine. With the number of confirmed U.S. cases at more thanone million and the death toll nationwide topping 56,000, we’re still in the middle of this crisis even as states make plans to reopen. “Our essential workers are at the end of their rope,” Charity said.
There are, however, things we can do to help the front line workers in our lives. Here are some ideas to help you help them cope.
Have you noticed your friend or loved one, who is on the front lines every day, is becoming more forgetful? Has his hygiene changed or slipped? Is she spending too much time alone? These are all signs that his or her mental health may be comprised, Charity said. “Burnout is a mental exhaustion and when people lose interest in taking care of themselves, it’s time to pay attention.” Don’t, however, launch into a series of 20 questions, because that will only make them shut down more, Charity cautions. Instead, let them know you are there for them. Simply ask: “Are you okay?” If they do open up, do more listening than talking. “It’s important that people who are on these front lines have their concerns heard.”
If you fear a true mental health crisis is underway, call the city’s 24-hour crisis hotline at 215-685-6440. You can also call the 24-hour National Suicide Prevention Hot Line 800-273-8255.
When Kayleigh Lawrence gets home from work as registered nurse at Virtua Willingboro Hospital, she often times just wants to take a shower, eat and retreat to her room. “Sometimes I just need to be silent,” said Lawrence. The coronavirus’ intensified every aspect of her job. Each day she must put on layers of protective gear to help her patients and if she’s not careful in the removal, she is at risk of exposing herself. “We are so overwhelmed that we need a delicate balance of care that includes hearing us out, but also letting us be quiet,” Lawrence said.
The essential worker in your life should not be the one to do the grocery shopping, replacing the toilet paper or filling up he car up with gas, or picking up the prescriptions, Charity said. “This is not the time to add responsibility to their loads,” Charity said.
Karen Driben and her husband, Ian Driben, both veterinarians who live in Vorhees, have been working the full six weeks. They’ve arranged their schedules so someone is home with their two kids while the other one works. The one who stays home, Karen Driben said, usually runs the errands and cooks so the other can get ample rest. Balance is important to maintaining sanity in their household, Driben said. “We are on high alert all of the time,”Driben said. “One minute people are seemingly healthy and then they are real sick and since we are dealing with these stresses day in and day out we have to make sure that each of us has time to compress.”
It seems like a small thing, said DuJuan Scott, a conductor on SEPTA regional rail, but when I get home, it would be nice to have a hot meal ready. If you live with an essential worker—whether you’re their spouse, sibling, parent or child—you should have their lounge wear ready for them so they can slip into it as soon as they get out of the shower. “Have something they like ready for them: a desert something they really love when they come through that door to make them smile,” Charity said. “When they are out there working, people just see a body working for the them. No one sees who they are really are. So you—their family and friends have to appreciate them.” And probably the most important thing you can do is leave a mask and gloves by their keys so they can grab it and go.
If you don’t live with them, but still want to support, send them a pizza, or a lasagne, or cookies: something to make them feel like they’re getting the hug you can’t give them in person right now.
Schedule a game night. Go for a walk in the park (away from others). Work on a puzzle together. Make a fun meal together. “When people are distraught, it helps to bring them back to a pleasant moment.” Charity says. And by working in downtime you are effectively telling them not to sweat the small stuff, because play in this moment is more important than finishing the basement or any other ‘honey do’ chores on the list. “You want to keep that person in your life healthy, not just physically but mentally.”
“Some of the nicest notes of encouragement I got were short texts from friends,” said Rebecca Jacobs, a nurse at Jefferson Health in Vorhees. Scott said that phone calls from friends and family have brightened his day because it shows that people care. “We feel like no one cares about us.” For friends that don’t live with you, you might want to send a thank you card with a gift card to a favorite local restaurant, Charity said. Or maybe put together a care package of the things they need: like the ingredients of an easy to make dinner, Clorox wipes and toilet paper. “Heroes need help too,” Charity said. “It’s the very least we can do to thank them for keeping our new normal running steady.”
https://medicalxpress.com/news/2020-05-essential-workers-burnout.html
Not only are our essential personnel—doctors, nurses, grocery store cashiers, and transportation workers—working under intense pressure to keep the world running and save lives, they have the extra-added stress of trying not to contract the coronavirus. Or worse, bringing the virus home to their loved ones.
The impact of living under such professional and emotional strain is starting to become evident. On Monday, a top emergency room surgeon at New York-Presbyterian Allen Hospital hospital died by suicide. Dr. Lorna M. Breen, the medical director in the hospital’s emergency room department, didn’t have a history of mental illness, according to her father. But Breen recently described to her family how taxing it was to witness the toll the coronavirus took on her patients. “She tried to do her job, and it killed her,” said Breen’s father, Dr. Phillip C. Breen.
“It’s a different kind of work pressure, one that maybe hard for others to understand,” said Dr. Rochelle Teachy, a pediatrician at Children’s Hospital of Pennsylvania Primary care in Delaware County. You are fearful for your health, your household’s health and your contact’s health. Everyday. That’s a lot to handle,” Teachy said.
A big stress factor lies in the unknowns, said Dr. Lynette Charity, an Arizona-based physician who lectures on the effect of mental stress and burn out on physicians. We don’t fully understand how the virus is transmitted. Symptoms vary from person to person. It’s not clear how long it will take to develop a vaccine. With the number of confirmed U.S. cases at more thanone million and the death toll nationwide topping 56,000, we’re still in the middle of this crisis even as states make plans to reopen. “Our essential workers are at the end of their rope,” Charity said.
There are, however, things we can do to help the front line workers in our lives. Here are some ideas to help you help them cope.
Have you noticed your friend or loved one, who is on the front lines every day, is becoming more forgetful? Has his hygiene changed or slipped? Is she spending too much time alone? These are all signs that his or her mental health may be comprised, Charity said. “Burnout is a mental exhaustion and when people lose interest in taking care of themselves, it’s time to pay attention.” Don’t, however, launch into a series of 20 questions, because that will only make them shut down more, Charity cautions. Instead, let them know you are there for them. Simply ask: “Are you okay?” If they do open up, do more listening than talking. “It’s important that people who are on these front lines have their concerns heard.”
If you fear a true mental health crisis is underway, call the city’s 24-hour crisis hotline at 215-685-6440. You can also call the 24-hour National Suicide Prevention Hot Line 800-273-8255.
When Kayleigh Lawrence gets home from work as registered nurse at Virtua Willingboro Hospital, she often times just wants to take a shower, eat and retreat to her room. “Sometimes I just need to be silent,” said Lawrence. The coronavirus’ intensified every aspect of her job. Each day she must put on layers of protective gear to help her patients and if she’s not careful in the removal, she is at risk of exposing herself. “We are so overwhelmed that we need a delicate balance of care that includes hearing us out, but also letting us be quiet,” Lawrence said.
The essential worker in your life should not be the one to do the grocery shopping, replacing the toilet paper or filling up he car up with gas, or picking up the prescriptions, Charity said. “This is not the time to add responsibility to their loads,” Charity said.
Karen Driben and her husband, Ian Driben, both veterinarians who live in Vorhees, have been working the full six weeks. They’ve arranged their schedules so someone is home with their two kids while the other one works. The one who stays home, Karen Driben said, usually runs the errands and cooks so the other can get ample rest. Balance is important to maintaining sanity in their household, Driben said. “We are on high alert all of the time,”Driben said. “One minute people are seemingly healthy and then they are real sick and since we are dealing with these stresses day in and day out we have to make sure that each of us has time to compress.”
It seems like a small thing, said DuJuan Scott, a conductor on SEPTA regional rail, but when I get home, it would be nice to have a hot meal ready. If you live with an essential worker—whether you’re their spouse, sibling, parent or child—you should have their lounge wear ready for them so they can slip into it as soon as they get out of the shower. “Have something they like ready for them: a desert something they really love when they come through that door to make them smile,” Charity said. “When they are out there working, people just see a body working for the them. No one sees who they are really are. So you—their family and friends have to appreciate them.” And probably the most important thing you can do is leave a mask and gloves by their keys so they can grab it and go.
If you don’t live with them, but still want to support, send them a pizza, or a lasagne, or cookies: something to make them feel like they’re getting the hug you can’t give them in person right now.
Schedule a game night. Go for a walk in the park (away from others). Work on a puzzle together. Make a fun meal together. “When people are distraught, it helps to bring them back to a pleasant moment.” Charity says. And by working in downtime you are effectively telling them not to sweat the small stuff, because play in this moment is more important than finishing the basement or any other ‘honey do’ chores on the list. “You want to keep that person in your life healthy, not just physically but mentally.”
“Some of the nicest notes of encouragement I got were short texts from friends,” said Rebecca Jacobs, a nurse at Jefferson Health in Vorhees. Scott said that phone calls from friends and family have brightened his day because it shows that people care. “We feel like no one cares about us.” For friends that don’t live with you, you might want to send a thank you card with a gift card to a favorite local restaurant, Charity said. Or maybe put together a care package of the things they need: like the ingredients of an easy to make dinner, Clorox wipes and toilet paper. “Heroes need help too,” Charity said. “It’s the very least we can do to thank them for keeping our new normal running steady.”
https://medicalxpress.com/news/2020-05-essential-workers-burnout.html
As Coronavirus Strikes, Crucial Data in Electronic Records Hard to Harvest
When President Donald Trump started touting hydroxychloroquine as
“one of the biggest game changers” for treating COVID-19, researchers
hoped electronic health records could quickly tell them if he was on the
right track.
Yet pooling data from the digital records systems in thousands of hospitals has proved a technical nightmare thus far. That’s largely because software built by rival technology firms often cannot retrieve and share information to help doctors judge which coronavirus treatments are helping patients recover.
“I’m stunned at EHR vendors’ inability to consistently pull data from their systems,” said Dale Sanders, chief technology officer of Health Catalyst, a medical data analytics company. “It’s absolutely hampering our ability to understand and react to COVID.”
Over the past decade, federal officials have spent some $36 billion
switching from paper to electronic health records, or EHRs, expecting,
among other things, to harness volumes of medical data to reveal which
treatments work best.
EHRs document every step doctors or other health care workers take in treating a COVID patient, from medicines prescribed to signs of progress or setbacks. Data collected from large numbers of patients could quickly yield answers about which treatments are succeeding.
But the pandemic is bringing into stark relief just how far the nation is from achieving the promised benefits, critics say.
Dr. Richard Cook, a research scientist and health care safety specialist, traces the data problems to missteps dating to the rollout of EHR, which began in earnest in 2009 and has been controversial ever since because commercial players produced ― and hospitals bought — systems that have proved more suited to billing than public health. “This was a boondoggle from the get-go, and the promoters knew it at the time,” Cook said.
Although some health systems are beginning to draw on EHR data to spot coronavirus trends and beneficial treatments, most health organizations around the country cannot readily do so.
“If we had a national database, we’d get a readout quickly about responses to [COVID-19] treatments,” said Dr. Eric Topol, director of the Scripps Research Translational Institute.
Medical researchers favor studies that test the efficacy of a drug in a formal clinical trial, and trials are underway for a variety of possible COVID-fighting medicines, including hydroxychloroquine. The results could take months or more, however, and doctors treating critically ill patients have few options in the meantime.
Topol said “real-world” evidence drawn from computerized records of COVID patients, while not as reliable as a clinical trial, is “still very useful” to help guide medical decisions.
Medical data has been hard to tease out because much of it resides in electronic “silos,” which government officials have not required technology companies to open up and eliminate.
“We’ll see piecemeal readouts of small numbers from individual health systems,” Topol said, but “don’t have the important data that we need.”
Sanders, whose firm is a member of the COVID-19 Healthcare Coalition, a business-sponsored group promoting coronavirus data-sharing and analysis, said federal health officials lost precious time by failing to address this need as early as mid-January.
He said the federal Centers for Disease Control and Prevention, or
CDC, should have devised a COVID data-collection plan using standardized
terminology so hospitals with incompatible EHRs could compare notes on
the fast-paced pandemic.
The CDC did not respond to written requests seeking comment. A spokesman for the Health and Human Services office that coordinates health information technology policy said: “This is a novel disease so the health care system did not know what data we needed to collect ― we are learning that the system needs to build out reporting information on multiple clinical features.”
Still, several of the top EHR manufacturers have joined the data-sharing coalition, which is pledging to at least partially fill the information void. The group has access to COVID data from about two dozen health systems and is expecting to add more.
“This is the first attempt at this that I’m aware of where inherently
competitive EHR vendors have come together to work together with
clinical researchers,” said Dr. Brian Anderson, chief digital health
physician with the MITRE Corp., a nonprofit technology group that formed
the coalition in late March.
Anderson said the coalition is “getting close” to being able to share some results from reports of treating people with convalescent plasma recovered from patients who have survived COVID-19. The group is also examining treatment data on the drug remdesivir as it irons out some of the technical difficulties that complicated its analysis of hydroxychloroquine. Last week, the Food and Drug Administration warned that hydroxychloroquine could cause heart problems and should be used only in a hospital or clinical trial.
There are other signs the EHR industry is relaxing its grip on medical data in response to the emergency. Major EHR vendor Cerner Corp. has offered researchers access to some types of COVID-19 data, including “clinical complications and outcomes that could help drive important medical decisions.”
And some health systems have begun publishing data drawn from EHRs. One study
released this month, for instance, tracked the outcome of 5,700
coronavirus patients treated at 12 hospitals in a New York City health
system and found that 88% of patients placed on ventilators had died.
All the hospitals shared the same records vendor.
“In crisis, people seek data and authorities demand it,” said Cook, the health care safety specialist. But, he said, “it is not possible to build such a system on demand.”
Ross Koppel, a professor at the University of Pennsylvania and longtime EHR safety expert, said that the COVID-19 pandemic illustrates both “strengths and disappointments” of the digital systems.
While health systems using a single vendor have been able to pool data, Koppel said, the industry has battled regulators seeking to adopt common standards, a practice known as interoperability.
“That failure to mine these oceans of invaluable data reflects the power of the vendors to prevent government requirements for data standards and interoperability,” he said.
Limits in electronic data collection systems also are hindering COVID-19 public health and surveillance efforts.
Officials said they are sometimes required to manually fill out and fax some forms, wasting valuable time. Some information must be printed out from EHRs and reentered by public health authorities because it cannot be sent electronically.
Certain CDC forms, such as Person Under Investigation COVID case reports, can take up to 30 minutes to complete. Other forms exchanged between hospitals and laboratories often are missing critical information, leading to delays in contacting patients and identifying people they had close contact with. In some states, demographic information on race and ethnicity is missing 85% of the time, and patients’ addresses, half the time, according to Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists.
“We’re using yesterday’s technology for the biggest public health emergency in our lifetimes,” Hamilton said. “COVID has demonstrated for people what we’ve known all along. You can’t leave public health at the end of the line.”
The government’s health IT chief says a new administrative rule to promote interoperability and bar EHR manufacturers from impeding the flow of information will take time to change behavior.
“If this were to have happened three or four years in the future when we have interoperability … we would be in a much better spot here. But unfortunately, that’s not quite the case, but we’re still keeping our work going,” Donald Rucker, national coordinator for health information technology, said during an April 15 virtual meeting.
https://www.medscape.com/viewarticle/929841#vp_1
Yet pooling data from the digital records systems in thousands of hospitals has proved a technical nightmare thus far. That’s largely because software built by rival technology firms often cannot retrieve and share information to help doctors judge which coronavirus treatments are helping patients recover.
“I’m stunned at EHR vendors’ inability to consistently pull data from their systems,” said Dale Sanders, chief technology officer of Health Catalyst, a medical data analytics company. “It’s absolutely hampering our ability to understand and react to COVID.”
EHRs document every step doctors or other health care workers take in treating a COVID patient, from medicines prescribed to signs of progress or setbacks. Data collected from large numbers of patients could quickly yield answers about which treatments are succeeding.
But the pandemic is bringing into stark relief just how far the nation is from achieving the promised benefits, critics say.
Dr. Richard Cook, a research scientist and health care safety specialist, traces the data problems to missteps dating to the rollout of EHR, which began in earnest in 2009 and has been controversial ever since because commercial players produced ― and hospitals bought — systems that have proved more suited to billing than public health. “This was a boondoggle from the get-go, and the promoters knew it at the time,” Cook said.
Although some health systems are beginning to draw on EHR data to spot coronavirus trends and beneficial treatments, most health organizations around the country cannot readily do so.
“If we had a national database, we’d get a readout quickly about responses to [COVID-19] treatments,” said Dr. Eric Topol, director of the Scripps Research Translational Institute.
Medical researchers favor studies that test the efficacy of a drug in a formal clinical trial, and trials are underway for a variety of possible COVID-fighting medicines, including hydroxychloroquine. The results could take months or more, however, and doctors treating critically ill patients have few options in the meantime.
Topol said “real-world” evidence drawn from computerized records of COVID patients, while not as reliable as a clinical trial, is “still very useful” to help guide medical decisions.
Medical data has been hard to tease out because much of it resides in electronic “silos,” which government officials have not required technology companies to open up and eliminate.
“We’ll see piecemeal readouts of small numbers from individual health systems,” Topol said, but “don’t have the important data that we need.”
Sanders, whose firm is a member of the COVID-19 Healthcare Coalition, a business-sponsored group promoting coronavirus data-sharing and analysis, said federal health officials lost precious time by failing to address this need as early as mid-January.
The CDC did not respond to written requests seeking comment. A spokesman for the Health and Human Services office that coordinates health information technology policy said: “This is a novel disease so the health care system did not know what data we needed to collect ― we are learning that the system needs to build out reporting information on multiple clinical features.”
Still, several of the top EHR manufacturers have joined the data-sharing coalition, which is pledging to at least partially fill the information void. The group has access to COVID data from about two dozen health systems and is expecting to add more.
Anderson said the coalition is “getting close” to being able to share some results from reports of treating people with convalescent plasma recovered from patients who have survived COVID-19. The group is also examining treatment data on the drug remdesivir as it irons out some of the technical difficulties that complicated its analysis of hydroxychloroquine. Last week, the Food and Drug Administration warned that hydroxychloroquine could cause heart problems and should be used only in a hospital or clinical trial.
There are other signs the EHR industry is relaxing its grip on medical data in response to the emergency. Major EHR vendor Cerner Corp. has offered researchers access to some types of COVID-19 data, including “clinical complications and outcomes that could help drive important medical decisions.”
“In crisis, people seek data and authorities demand it,” said Cook, the health care safety specialist. But, he said, “it is not possible to build such a system on demand.”
Ross Koppel, a professor at the University of Pennsylvania and longtime EHR safety expert, said that the COVID-19 pandemic illustrates both “strengths and disappointments” of the digital systems.
While health systems using a single vendor have been able to pool data, Koppel said, the industry has battled regulators seeking to adopt common standards, a practice known as interoperability.
“That failure to mine these oceans of invaluable data reflects the power of the vendors to prevent government requirements for data standards and interoperability,” he said.
Limits in electronic data collection systems also are hindering COVID-19 public health and surveillance efforts.
Officials said they are sometimes required to manually fill out and fax some forms, wasting valuable time. Some information must be printed out from EHRs and reentered by public health authorities because it cannot be sent electronically.
Certain CDC forms, such as Person Under Investigation COVID case reports, can take up to 30 minutes to complete. Other forms exchanged between hospitals and laboratories often are missing critical information, leading to delays in contacting patients and identifying people they had close contact with. In some states, demographic information on race and ethnicity is missing 85% of the time, and patients’ addresses, half the time, according to Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists.
“We’re using yesterday’s technology for the biggest public health emergency in our lifetimes,” Hamilton said. “COVID has demonstrated for people what we’ve known all along. You can’t leave public health at the end of the line.”
The government’s health IT chief says a new administrative rule to promote interoperability and bar EHR manufacturers from impeding the flow of information will take time to change behavior.
“If this were to have happened three or four years in the future when we have interoperability … we would be in a much better spot here. But unfortunately, that’s not quite the case, but we’re still keeping our work going,” Donald Rucker, national coordinator for health information technology, said during an April 15 virtual meeting.
https://www.medscape.com/viewarticle/929841#vp_1
Roche’s COVID-19 antibody test gets FDA emergency use approval
Roche (OTCQX:RHHBY) says the U.S. Food and Drug Administration issued an emergency use authorization for its new Elecsys antibody test to help determine if people have been infected with the coronavirus.
Roche says the new test, which has a specificity
greater than 99.8%, is designed to help determine if a patient has been
exposed to the SARS-CoV-2 virus and if the patient has developed
antibodies against the virus.
The company says it has already started shipping
the test to laboratories globally and will ramp up production capacity
to high double-digit millions per month for countries accepting the CE
mark as well as the U.S.
https://seekingalpha.com/news/3567991-roches-covidminus-19-antibody-test-gets-fda-emergency-use-approvalSaturday, May 2, 2020
How Can We Make Lasting Changes In Our Lives?
There are many approaches to change in the world of psychology, but a robust research literature suggests that these ultimately work for similar reasons. For instance, the quality of the relationship between the helper and the person seeking help accounts for a surprising amount of the change that occurs. The big takeaway from this work is that how techniques are implemented is every bit as important as what those techniques are.
When we attempt to make changes in our lives, whether it’s losing weight, improving our relationships, or becoming more productive, our tendency is to turn to self-help techniques. Not uncommonly, we try these techniques and see only modest results, leading us to backslide and return to where we started. For example, this is very common among the newer traders I encounter as a performance coach. They bounce from one method of trading financial markets to another, ultimately failing to climb the ladder of expertise.
A look at research in psychotherapy finds that change indeed occurs among a majority of people seeking help, but that change requires a significant number of sessions, often more than 20. Yes, brief therapies have been found to be effective, but even in those cases we commonly find sessions spread over time to allow for changes to be rehearsed and internalized. Without repetition and time, the results of our efforts at change too often fall into relapse.
A great example of how we can make lasting changes is Alcoholics Anonymous. In A.A., the primary emphasis is not on change techniques per se, but on consistent meetings over time with the guidance and support of the group and sponsors. When I worked in a community mental health center, it was common for people seeking treatment for alcohol-related concerns to attend 90 meetings in 90 days. “Bring the body and the mind will come”, was the A.A. slogan. Addiction problems are notoriously susceptible to relapse. The key effective ingredient of change was the frequent repetition of emotionally-impactful experiences. Doing the same things the same way with meaningful impact creates new and lasting habit patterns. This is an important common effective ingredient of change.
So what does this mean for those of us seeking changes in our lives?
A deceptively simple formula for making changes in our lives is to begin change efforts by making very small, doable changes the same way each day and in novel states of mind and body. This is a very powerful principle.
Whether it’s in traditional therapy or self-help such as A.A., change
efforts occur when we are in modes of experiencing different from our
norm. In therapy or in a group, we are socially connected and more
emotionally connected. We enter states of consciousness very different
from our norms. As a rule, in our habitual states of mind and body, we gravitate to our habitual thoughts and behaviors. That is relapse. If we’re looking to make changes, we want to anchor
those changes to fresh cognitive and emotional states. It is the
consistency of our anchoring efforts that allows us to internalize
changes and make them part of us.
Here’s a practical example:
Mike Bellafiore of SMB Capital and I recently spoke with members of the BearBull Trading Community, many of whom are developing traders of financial markets. A common concern of these traders is that they become so caught up in profits and losses that they fail to follow their own trading rules and plans. This leads to inconsistent decision-making and little progress on the ladder of development. An idea that we explored in our discussion was making the “discipline” process a social one by sharing best practices, establishing teams within the community, and making ourselves accountable to people we care about—not unlike A.A. This taps into wholly new sources of motivation and mind states, as the social connection adds a fresh sense of commitment to change efforts. Anchoring developmental efforts to teamwork and social support transforms every team meeting into experiences of insight and inspiration with everyone acting as teacher and student.
But even such anchoring only works if change is pursued one small step at a time, with each change undertaken in the same way at the same time each day. Changes in our states of consciousness can open us to change, but it is repetition and the internalization of success experiences that creates new habits. As Charles Duhigg explains, there is a science of habit that can change behavior in radical ways through seemingly small shifts in our environment and in our physical states. When we join in teams, sharing ideas and reviewing performance each and every day, the change process literally becomes part of us. As we see with very successful traders, we make quantum leaps in our performance and sizable life changes by climbing the ladder one consistent step at a time, in fresh mindsets that energize our ascent.
https://www.forbes.com/sites/brettsteenbarger/2020/04/30/how-can-we-make-lasting-changes-in-our-lives/#adb0a7519d9a
When we attempt to make changes in our lives, whether it’s losing weight, improving our relationships, or becoming more productive, our tendency is to turn to self-help techniques. Not uncommonly, we try these techniques and see only modest results, leading us to backslide and return to where we started. For example, this is very common among the newer traders I encounter as a performance coach. They bounce from one method of trading financial markets to another, ultimately failing to climb the ladder of expertise.
A look at research in psychotherapy finds that change indeed occurs among a majority of people seeking help, but that change requires a significant number of sessions, often more than 20. Yes, brief therapies have been found to be effective, but even in those cases we commonly find sessions spread over time to allow for changes to be rehearsed and internalized. Without repetition and time, the results of our efforts at change too often fall into relapse.
A great example of how we can make lasting changes is Alcoholics Anonymous. In A.A., the primary emphasis is not on change techniques per se, but on consistent meetings over time with the guidance and support of the group and sponsors. When I worked in a community mental health center, it was common for people seeking treatment for alcohol-related concerns to attend 90 meetings in 90 days. “Bring the body and the mind will come”, was the A.A. slogan. Addiction problems are notoriously susceptible to relapse. The key effective ingredient of change was the frequent repetition of emotionally-impactful experiences. Doing the same things the same way with meaningful impact creates new and lasting habit patterns. This is an important common effective ingredient of change.
A deceptively simple formula for making changes in our lives is to begin change efforts by making very small, doable changes the same way each day and in novel states of mind and body. This is a very powerful principle.
Here’s a practical example:
Mike Bellafiore of SMB Capital and I recently spoke with members of the BearBull Trading Community, many of whom are developing traders of financial markets. A common concern of these traders is that they become so caught up in profits and losses that they fail to follow their own trading rules and plans. This leads to inconsistent decision-making and little progress on the ladder of development. An idea that we explored in our discussion was making the “discipline” process a social one by sharing best practices, establishing teams within the community, and making ourselves accountable to people we care about—not unlike A.A. This taps into wholly new sources of motivation and mind states, as the social connection adds a fresh sense of commitment to change efforts. Anchoring developmental efforts to teamwork and social support transforms every team meeting into experiences of insight and inspiration with everyone acting as teacher and student.
But even such anchoring only works if change is pursued one small step at a time, with each change undertaken in the same way at the same time each day. Changes in our states of consciousness can open us to change, but it is repetition and the internalization of success experiences that creates new habits. As Charles Duhigg explains, there is a science of habit that can change behavior in radical ways through seemingly small shifts in our environment and in our physical states. When we join in teams, sharing ideas and reviewing performance each and every day, the change process literally becomes part of us. As we see with very successful traders, we make quantum leaps in our performance and sizable life changes by climbing the ladder one consistent step at a time, in fresh mindsets that energize our ascent.
https://www.forbes.com/sites/brettsteenbarger/2020/04/30/how-can-we-make-lasting-changes-in-our-lives/#adb0a7519d9a
States ordered nursing homes to take COVID-19 residents. Thousands died.
On March 29, as New York and other states began ordering nursing
homes to admit medically stable residents infected with the coronavirus,
national trade groups warned it could unnecessarily cost more lives.
The health directives put “frail and older adults who reside in nursing homes at risk” and would “result in more people going to the hospital and more deaths,” the American Health Care Association and affiliates said at the time.
A month later, it appears government officials should have heeded the dire call to pursue different pandemic emergency plans.
The deadly virus has spread like wildfire through many nursing homes across the Northeast, and state officials are scrambling to better protect those most vulnerable to COVID-19, the disease caused by the virus.
The death toll is devastating:
At least 3,043 people have died inside New York nursing homes due to COVID-19 complications, or about 17% of the state’s 18,015 deaths as of Wednesday.
In Pennsylvania, about 65% of coronavirus deaths were nursing-home residents, and New Jersey had 3,200 residents of long-term care homes die due to complications from the virus, about 40% of the statewide total.
About 58% of the deaths in Delaware lived in nursing homes, and 46% of the fatalities in Maryland were at nursing homes, prompting Gov. Larry Hogan to order residents and staff members at nursing homes be tested for coronavirus.
Meanwhile, advocates and residents’ relatives have criticized state and federal officials, as well as some nursing homes, for failing to address the crisis as deaths mounted.
“To have a mandate that nursing homes accept COVID-19 patients has put many people in grave danger,” said Richard Mollot, executive director of the Long Term Care Community Coalition in New York.
“We know facilities have a lot of infection-control problems, we know that facilities have low staff, so what do you think was going to happen when the staff were further strained in caring for these patients?”
Amid the pushback, New York Health Commissioner Dr. Howard Zucker on Wednesday issued an advisory warning nursing homes they could face fines or lose their license if they didn’t properly isolate COVID-19-infected residents, citing state health law.
The letter noted nursing homes incapable of isolating contagious residents should transfer them to other medical facilities and stop admitting additional residents.
New Jersey’s Health Commissioner Judith Persichilli took a similar step on April 13, clarifying how the state’s nursing homes could deny admitting infected patients.
“People just can’t go back until the spread in the nursing homes slows down and until they can take care of their residents appropriately,” Persichilli said the day the revised guidelines were distributed.
A grieving daughter’s COVID-19 nursing home story
Yet the efforts have come too late for some family members, many of whom complained of being kept in the dark about risks at nursing homes since visitors were banned in March to combat the virus.
One is Kathleen Cole, who said her 89-year-old mother, Dolores McGoldrick, died April 17 after contracting COVID-19 at Ferncliff Nursing Home in Rhinebeck, New York.
McGoldrick, a former teacher, was infected shortly after a fellow nursing home resident was re-admitted from a hospital in late March, Cole said.
The nursing home staff said the other resident didn’t have COVID-19 when re-admitted but didn’t provide many other details about the case, she added.
Cole, who is a nurse, cast blame for her mother’s death on the entire nursing home system. It spanned from Ferncliff’s inability to contain the virus to state officials’ refusal to release many details about infections and deaths at the facility and others.
“The whole thing has just been handled awfully … by everybody in regard to nursing homes,” she said. “It’s like a slaughterhouse at these places.”
Cole recounted calling nursing home staff about her mother and being told repeatedly that she was stable since testing positive on April 2. But at one point, several phone calls went unanswered, which Cole chalked up to understaffing over the holiday weekend in mid-April.
Cole said she only learned of the true situation after her mother was transferred to a local hospital’s emergency room on April 14.
“My mother’s hands were blue — it wasn’t like a dusky shade blue, her nail beds were blue, her feet were blue, she was ice cold,” Cole said, recalling the scene at the hospital.
“She never opened her eyes for anybody to speak with, and she was just in a horrible, horrible state,” she said. “I know that didn’t occur over the course of several hours; that was something that was accumulating over time.”
Cole has countless unanswered questions, including how her mother contracted the virus. She was in a private room, and staff said there was an isolation unit set up for COVID-19-positive residents, suggesting lapses in containment efforts, Cole said.
“I just felt that she wasn’t being evaluated appropriately, and that actions should have been taken sooner and maybe my mother would have made it through,” she said.
Jon Goldberg, a spokesman for Ferncliff, which had reported six deaths as of Thursday, declined to discuss a specific resident’s case, citing health privacy laws.
In general, Goldberg disputed that staffing shortages existed. He noted the facility was providing sufficient protective gear and COVID-19 testing for its residents and staff despite supply challenges caused by state and federal issues.
In an email, Goldberg wrote that Ferncliff “has no higher priority than the health and lives of our residents and care members.
“We will continue to do everything in our power to protect, care and advocate for them, and to communicate truthfully and candidly with the people who love them and the communities we serve,” he added.
What states are doing about COVID-19 in nursing homes
Central to the nursing home crisis was the early focus on preventing coronavirus patients from overwhelming hospitals.
Massive convention centers and college buildings were converted into temporary hospitals in New York and New Jersey as infections mounted, and hospitals in other states braced to handle surges in COVID-19 patients.
On March 31, the New Jersey Department of Health told the state’s long-term care facilities that they could not deny admission or re-admission based on a confirmed diagnosis of COVID-19.
The state needed to make room in its hospitals for the growing number of COVID-19 cases and turned to nursing homes to take over the care of some patients.
At the time, Persichilli said there were restrictions in place to prevent the spread of the virus, such as placing asymptomatic residents on their own wings or floors.
“What we were encountering was that a resident would go to the hospital, be treated, recover, and [the nursing home] would not accept the resident back,” Persichilli said at the time.
“Part of the directive is that this is that resident’s home. We keep forgetting that. They should be accepted back with the appropriate precautions,” she added.
At the time, there were fewer than 1,000 known cases in long-term care facilities, which includes nursing homes, assisted living facilities and other care homes.
Not even two weeks later, the number of cases had climbed to more than 5,200, prompting the state to provide additional guidance.
Persichilli on April 13 clarified that the state allowed for re-admission of suspected COVID-19 patients only if they could be placed in isolation.
The order required nursing homes to separate residents in groups and designate staff for each, preventing employees from moving between patients who could spread the virus.
The separate groups are residents who have tested positive for or show symptoms of COVID-19; residents who might have been exposed to the virus; and residents who are not ill and have not been exposed.
On Wednesday, New York’s health commissioner outlined similar guidelines for separating nursing home residents and staff. The advisory also reinforced prior measures taken to protect nursing homes, such as banning visitors and requiring temperature checks of staff.
New York Gov. Andrew Cuomo has said the coronavirus has proven an efficient predator that preys upon nursing homes staff and residents, despite the precautions. He has also urged some nursing homes to reach out to the Health Department to help relocate patients.
“If a nursing home has a patient that they can’t handle, COVID, or whatever the reason, they must refer that patient out of that facility,” he said during a press briefing Monday.
But state Assemblyman Ron Kim, D-Queens, on Wednesday asserted the
virus has exposed the poor state of many nursing homes after decades of
governmental funding cuts and harmful regulatory changes.
“These tragedies in nursing homes are not accidents, they’re the outcome of bad policy decisions,” he said during a press briefing to announce new legislation seeking to improve care and transparency at nursing homes.
In Pennsylvania, 461 — one quarter of the state’s roughly 1,900 long-term care centers —- had at least one COVID-19 case, according to state health data.
Pennsylvania is among the states where health officials are allowing licensed long-term care facilities to continue admitting new patients, including those discharged from hospitals but unable to go home, and to readmit current patients after hospital stays.
“This may include stable patients who have had the COVID-19 virus,” according to a copy of March 18 guidelines the state department of health issued.
The reasoning for allowing readmissions, according to the guidance, was “to alleviate the increasing burden in the acute care settings.”
State health officials also directed long-term care centers to employ “normal discharge-to-home” criteria to assist in long-term care bed availability.
Pennsylvania Health Department spokesman Nate Wardle said the department is aware of the “significance” of COVID-19 in long-term care facilities and is working to assist them as individuals are discharged from hospitals.
What nursing homes say about COVID-19 crisis
Nursing home leaders contend state and federal officials have failed to provide adequate resources and guidance during the pandemic.
From insufficient coronavirus testing and personal protective equipment shortages, they said the dereliction of duty helped ignite and fuel the outbreak in nursing homes.
“Frankly, I think we’ve been neglected, and we’re still neglected,” said Dr. Elaine Healy, vice president of the New York Medical Directors Association.
“When the focus started being put on us through the efforts of the press, the response has been to sort of look at us in a negative way,” she said, citing New York authorities launching investigations into COVID-19 deaths at nursing homes.
“This is really a series of forest fires burning in different facilities that we didn’t start,” she added.
Strikingly, Italian officials issued similar orders for nursing homes to admit coronavirus patients on March 8, a move under investigation by authorities for contributing to potentially preventable deaths, according to the Associated Press.
Despite push back on state decisions to send infected patients into nursing homes, some administrators say there was no other option.
“Our facilities were ultimately the release valve” for overwhelmed hospitals, said Jordan Strohl, the administrator at The Actors Fund Home in Englewood in Bergen County, the epicenter of the outbreak in New Jersey.
“When we heard from them how bad it was and how bad things were there, I felt like it was our obligation to step up and do the right thing,” he added.
Strohl converted half of the 25-bed sub-acute care building to care for COVID-19 cases, hiring a contractor to install airlocks to prevent contamination. He offered hazard pay and incentives to keep his staff on the job and had nurses volunteering to work with residents on the COVID-19 wing, he said.
Strohl said The Actors Fund Home was likely better prepared than some other nursing homes in the state, and still residents’ relatives were concerned about the state’s order to admit patients with known cases.
One person suggested flying sick residents out to the U.S.N.S. Comfort, the U.S. Navy hospital ship docked in New York Harbor at the time, he said. But that was outside of Strohl’s authority, so he did what he could.
“I tried to write back to every single person,” he said. “I said, ‘I understand your concern, but I will tell you this is the best way to take care of them.’”
Nurse practitioner Lisa Kaplewicz at the Tarrytown Hall Care Center in Westchester Couty said an issue for residents is when they have to leave the nursing to go a medical appointment.
“That’s a concern because they have the exposure to other people in the community that might potentially be asymptomatic carriers, so we have to presume that there’s been an exposure,” she said.
“We have to isolate these residents within our facility to prevent transmission to the other residents that are here.”
Some nursing homes in New Jersey also adjusted to care only for COVID-19 patients, according to Theresa Edelstein, senior vice president of the New Jersey Hospital Association.
“Nursing homes that care for COVID-19 patients are playing a very important role in preserving access to care,” she said.
“Not every COVID patient discharged from the hospital can go directly home. For those who need additional skilled nursing care, our nursing homes have been there.”
Some experts have called on New York to pursue COVID-19 only facilities for infected nursing home residents, such as those in New Jersey, Massachusetts and Connecticut.
Cuomo this week said some hospitals are designated as COVID-19 only, but the state has not released any details on them.
And others want the state to at least test everyone in every nursing facility for coronavirus. Dutchess County in the Hudson Valley said it will look to test all residents at its 13 homes.
“We have seen the ravaging toll COVID-19 has taken on nursing homes throughout our nation, and we are taking proactive steps to ensure we save lives,” said Dutchess County Executive Marc Molinaro, whose father recently died from the virus.
How nursing homes are testing, staffing during COVID-19 pandemic
In Maryland, Gov. Larry Hogan enacted an executive order on Wednesday requiring universal testing of all residents and staff at Maryland nursing homes, regardless of whether they are symptomatic.
Nursing home outbreaks represent 19% of all total positive cases in Maryland and 46% of all deaths. There have been outbreaks or clusters of cases at 278 different facilities across the state, including 4,011 confirmed cases at 143 different Maryland nursing homes.
“Even when best practices and care is in place, this virus may still be transmitted by asymptomatic staff, meaning that every patient interaction comes with some risk,” Hogan said at a press briefing.
Impacted facilities are also required to provide regular updates to their residents, resident representatives and staff regarding COVID-19 infections, a measure that New York officials required this month amid calls for improved transparency.
Under the executive order, any nursing home staff who test positive will be immediately discharged into isolation. It will also be mandatory for facilities to cooperate with strike teams deployed by the state.
The strike teams will be supplemented with newly-created “bridge teams,” which will provide emergency clinical staffing to facilities in crisis.
Meanwhile, New York on Wednesday revised guidelines preventing COVID-19 positive nursing home employees who are asymptomatic from returning to work for 14 days from the first positive test date.
Previously, the workers could return in seven days based on Centers for Disease Control and Prevention guidance, according to a letter issued by the health commissioner.
Health experts asserted improved testing and clearer guidance on isolation will be key to limiting the death toll in nursing homes.
As the virus is spreading, it is very hard to know what the threshold for stopping admissions should be particularly if adequate COVID-19 testing is not available for residents and staff, said Summer Johnson McGee, the dean of the School of Health Sciences at the University of New Haven in West Haven, Conn.
But McGee believes if new admissions were stopped after the first positive case was identified, it may have given facilities better ability to contain its spread.
“Many facilities are at 100% capacity, which means there were no beds to create isolation units,” she said.
“Nursing homes should be working to create excess beds to be able to isolate healthy patients in local hotels or surge capacity venues.”
https://www.recordonline.com/news/20200501/states-ordered-nursing-homes-to-take-covid-19-residents-thousands-died-heres-what-happened
The health directives put “frail and older adults who reside in nursing homes at risk” and would “result in more people going to the hospital and more deaths,” the American Health Care Association and affiliates said at the time.
A month later, it appears government officials should have heeded the dire call to pursue different pandemic emergency plans.
The deadly virus has spread like wildfire through many nursing homes across the Northeast, and state officials are scrambling to better protect those most vulnerable to COVID-19, the disease caused by the virus.
The death toll is devastating:
At least 3,043 people have died inside New York nursing homes due to COVID-19 complications, or about 17% of the state’s 18,015 deaths as of Wednesday.
In Pennsylvania, about 65% of coronavirus deaths were nursing-home residents, and New Jersey had 3,200 residents of long-term care homes die due to complications from the virus, about 40% of the statewide total.
About 58% of the deaths in Delaware lived in nursing homes, and 46% of the fatalities in Maryland were at nursing homes, prompting Gov. Larry Hogan to order residents and staff members at nursing homes be tested for coronavirus.
Meanwhile, advocates and residents’ relatives have criticized state and federal officials, as well as some nursing homes, for failing to address the crisis as deaths mounted.
“To have a mandate that nursing homes accept COVID-19 patients has put many people in grave danger,” said Richard Mollot, executive director of the Long Term Care Community Coalition in New York.
“We know facilities have a lot of infection-control problems, we know that facilities have low staff, so what do you think was going to happen when the staff were further strained in caring for these patients?”
Amid the pushback, New York Health Commissioner Dr. Howard Zucker on Wednesday issued an advisory warning nursing homes they could face fines or lose their license if they didn’t properly isolate COVID-19-infected residents, citing state health law.
The letter noted nursing homes incapable of isolating contagious residents should transfer them to other medical facilities and stop admitting additional residents.
New Jersey’s Health Commissioner Judith Persichilli took a similar step on April 13, clarifying how the state’s nursing homes could deny admitting infected patients.
“People just can’t go back until the spread in the nursing homes slows down and until they can take care of their residents appropriately,” Persichilli said the day the revised guidelines were distributed.
A grieving daughter’s COVID-19 nursing home story
Yet the efforts have come too late for some family members, many of whom complained of being kept in the dark about risks at nursing homes since visitors were banned in March to combat the virus.
One is Kathleen Cole, who said her 89-year-old mother, Dolores McGoldrick, died April 17 after contracting COVID-19 at Ferncliff Nursing Home in Rhinebeck, New York.
McGoldrick, a former teacher, was infected shortly after a fellow nursing home resident was re-admitted from a hospital in late March, Cole said.
The nursing home staff said the other resident didn’t have COVID-19 when re-admitted but didn’t provide many other details about the case, she added.
Cole, who is a nurse, cast blame for her mother’s death on the entire nursing home system. It spanned from Ferncliff’s inability to contain the virus to state officials’ refusal to release many details about infections and deaths at the facility and others.
“The whole thing has just been handled awfully … by everybody in regard to nursing homes,” she said. “It’s like a slaughterhouse at these places.”
Cole recounted calling nursing home staff about her mother and being told repeatedly that she was stable since testing positive on April 2. But at one point, several phone calls went unanswered, which Cole chalked up to understaffing over the holiday weekend in mid-April.
Cole said she only learned of the true situation after her mother was transferred to a local hospital’s emergency room on April 14.
“My mother’s hands were blue — it wasn’t like a dusky shade blue, her nail beds were blue, her feet were blue, she was ice cold,” Cole said, recalling the scene at the hospital.
“She never opened her eyes for anybody to speak with, and she was just in a horrible, horrible state,” she said. “I know that didn’t occur over the course of several hours; that was something that was accumulating over time.”
Cole has countless unanswered questions, including how her mother contracted the virus. She was in a private room, and staff said there was an isolation unit set up for COVID-19-positive residents, suggesting lapses in containment efforts, Cole said.
“I just felt that she wasn’t being evaluated appropriately, and that actions should have been taken sooner and maybe my mother would have made it through,” she said.
Jon Goldberg, a spokesman for Ferncliff, which had reported six deaths as of Thursday, declined to discuss a specific resident’s case, citing health privacy laws.
In general, Goldberg disputed that staffing shortages existed. He noted the facility was providing sufficient protective gear and COVID-19 testing for its residents and staff despite supply challenges caused by state and federal issues.
In an email, Goldberg wrote that Ferncliff “has no higher priority than the health and lives of our residents and care members.
“We will continue to do everything in our power to protect, care and advocate for them, and to communicate truthfully and candidly with the people who love them and the communities we serve,” he added.
What states are doing about COVID-19 in nursing homes
Central to the nursing home crisis was the early focus on preventing coronavirus patients from overwhelming hospitals.
Massive convention centers and college buildings were converted into temporary hospitals in New York and New Jersey as infections mounted, and hospitals in other states braced to handle surges in COVID-19 patients.
On March 31, the New Jersey Department of Health told the state’s long-term care facilities that they could not deny admission or re-admission based on a confirmed diagnosis of COVID-19.
The state needed to make room in its hospitals for the growing number of COVID-19 cases and turned to nursing homes to take over the care of some patients.
At the time, Persichilli said there were restrictions in place to prevent the spread of the virus, such as placing asymptomatic residents on their own wings or floors.
“What we were encountering was that a resident would go to the hospital, be treated, recover, and [the nursing home] would not accept the resident back,” Persichilli said at the time.
“Part of the directive is that this is that resident’s home. We keep forgetting that. They should be accepted back with the appropriate precautions,” she added.
At the time, there were fewer than 1,000 known cases in long-term care facilities, which includes nursing homes, assisted living facilities and other care homes.
Not even two weeks later, the number of cases had climbed to more than 5,200, prompting the state to provide additional guidance.
Persichilli on April 13 clarified that the state allowed for re-admission of suspected COVID-19 patients only if they could be placed in isolation.
The order required nursing homes to separate residents in groups and designate staff for each, preventing employees from moving between patients who could spread the virus.
The separate groups are residents who have tested positive for or show symptoms of COVID-19; residents who might have been exposed to the virus; and residents who are not ill and have not been exposed.
On Wednesday, New York’s health commissioner outlined similar guidelines for separating nursing home residents and staff. The advisory also reinforced prior measures taken to protect nursing homes, such as banning visitors and requiring temperature checks of staff.
New York Gov. Andrew Cuomo has said the coronavirus has proven an efficient predator that preys upon nursing homes staff and residents, despite the precautions. He has also urged some nursing homes to reach out to the Health Department to help relocate patients.
“If a nursing home has a patient that they can’t handle, COVID, or whatever the reason, they must refer that patient out of that facility,” he said during a press briefing Monday.
“These tragedies in nursing homes are not accidents, they’re the outcome of bad policy decisions,” he said during a press briefing to announce new legislation seeking to improve care and transparency at nursing homes.
In Pennsylvania, 461 — one quarter of the state’s roughly 1,900 long-term care centers —- had at least one COVID-19 case, according to state health data.
Pennsylvania is among the states where health officials are allowing licensed long-term care facilities to continue admitting new patients, including those discharged from hospitals but unable to go home, and to readmit current patients after hospital stays.
“This may include stable patients who have had the COVID-19 virus,” according to a copy of March 18 guidelines the state department of health issued.
The reasoning for allowing readmissions, according to the guidance, was “to alleviate the increasing burden in the acute care settings.”
State health officials also directed long-term care centers to employ “normal discharge-to-home” criteria to assist in long-term care bed availability.
Pennsylvania Health Department spokesman Nate Wardle said the department is aware of the “significance” of COVID-19 in long-term care facilities and is working to assist them as individuals are discharged from hospitals.
What nursing homes say about COVID-19 crisis
Nursing home leaders contend state and federal officials have failed to provide adequate resources and guidance during the pandemic.
From insufficient coronavirus testing and personal protective equipment shortages, they said the dereliction of duty helped ignite and fuel the outbreak in nursing homes.
“Frankly, I think we’ve been neglected, and we’re still neglected,” said Dr. Elaine Healy, vice president of the New York Medical Directors Association.
“When the focus started being put on us through the efforts of the press, the response has been to sort of look at us in a negative way,” she said, citing New York authorities launching investigations into COVID-19 deaths at nursing homes.
“This is really a series of forest fires burning in different facilities that we didn’t start,” she added.
Strikingly, Italian officials issued similar orders for nursing homes to admit coronavirus patients on March 8, a move under investigation by authorities for contributing to potentially preventable deaths, according to the Associated Press.
Despite push back on state decisions to send infected patients into nursing homes, some administrators say there was no other option.
“Our facilities were ultimately the release valve” for overwhelmed hospitals, said Jordan Strohl, the administrator at The Actors Fund Home in Englewood in Bergen County, the epicenter of the outbreak in New Jersey.
“When we heard from them how bad it was and how bad things were there, I felt like it was our obligation to step up and do the right thing,” he added.
Strohl converted half of the 25-bed sub-acute care building to care for COVID-19 cases, hiring a contractor to install airlocks to prevent contamination. He offered hazard pay and incentives to keep his staff on the job and had nurses volunteering to work with residents on the COVID-19 wing, he said.
Strohl said The Actors Fund Home was likely better prepared than some other nursing homes in the state, and still residents’ relatives were concerned about the state’s order to admit patients with known cases.
One person suggested flying sick residents out to the U.S.N.S. Comfort, the U.S. Navy hospital ship docked in New York Harbor at the time, he said. But that was outside of Strohl’s authority, so he did what he could.
“I tried to write back to every single person,” he said. “I said, ‘I understand your concern, but I will tell you this is the best way to take care of them.’”
Nurse practitioner Lisa Kaplewicz at the Tarrytown Hall Care Center in Westchester Couty said an issue for residents is when they have to leave the nursing to go a medical appointment.
“That’s a concern because they have the exposure to other people in the community that might potentially be asymptomatic carriers, so we have to presume that there’s been an exposure,” she said.
“We have to isolate these residents within our facility to prevent transmission to the other residents that are here.”
Some nursing homes in New Jersey also adjusted to care only for COVID-19 patients, according to Theresa Edelstein, senior vice president of the New Jersey Hospital Association.
“Nursing homes that care for COVID-19 patients are playing a very important role in preserving access to care,” she said.
“Not every COVID patient discharged from the hospital can go directly home. For those who need additional skilled nursing care, our nursing homes have been there.”
Some experts have called on New York to pursue COVID-19 only facilities for infected nursing home residents, such as those in New Jersey, Massachusetts and Connecticut.
Cuomo this week said some hospitals are designated as COVID-19 only, but the state has not released any details on them.
And others want the state to at least test everyone in every nursing facility for coronavirus. Dutchess County in the Hudson Valley said it will look to test all residents at its 13 homes.
“We have seen the ravaging toll COVID-19 has taken on nursing homes throughout our nation, and we are taking proactive steps to ensure we save lives,” said Dutchess County Executive Marc Molinaro, whose father recently died from the virus.
How nursing homes are testing, staffing during COVID-19 pandemic
In Maryland, Gov. Larry Hogan enacted an executive order on Wednesday requiring universal testing of all residents and staff at Maryland nursing homes, regardless of whether they are symptomatic.
Nursing home outbreaks represent 19% of all total positive cases in Maryland and 46% of all deaths. There have been outbreaks or clusters of cases at 278 different facilities across the state, including 4,011 confirmed cases at 143 different Maryland nursing homes.
“Even when best practices and care is in place, this virus may still be transmitted by asymptomatic staff, meaning that every patient interaction comes with some risk,” Hogan said at a press briefing.
Impacted facilities are also required to provide regular updates to their residents, resident representatives and staff regarding COVID-19 infections, a measure that New York officials required this month amid calls for improved transparency.
Under the executive order, any nursing home staff who test positive will be immediately discharged into isolation. It will also be mandatory for facilities to cooperate with strike teams deployed by the state.
The strike teams will be supplemented with newly-created “bridge teams,” which will provide emergency clinical staffing to facilities in crisis.
Meanwhile, New York on Wednesday revised guidelines preventing COVID-19 positive nursing home employees who are asymptomatic from returning to work for 14 days from the first positive test date.
Previously, the workers could return in seven days based on Centers for Disease Control and Prevention guidance, according to a letter issued by the health commissioner.
Health experts asserted improved testing and clearer guidance on isolation will be key to limiting the death toll in nursing homes.
As the virus is spreading, it is very hard to know what the threshold for stopping admissions should be particularly if adequate COVID-19 testing is not available for residents and staff, said Summer Johnson McGee, the dean of the School of Health Sciences at the University of New Haven in West Haven, Conn.
But McGee believes if new admissions were stopped after the first positive case was identified, it may have given facilities better ability to contain its spread.
“Many facilities are at 100% capacity, which means there were no beds to create isolation units,” she said.
“Nursing homes should be working to create excess beds to be able to isolate healthy patients in local hotels or surge capacity venues.”
https://www.recordonline.com/news/20200501/states-ordered-nursing-homes-to-take-covid-19-residents-thousands-died-heres-what-happened
SF had the 1918 flu under control – then it lifted restrictions
When the clock struck noon, the masks came off.
It was Nov. 21, 1918, and San Francisco
residents gathered in the streets to celebrate not only the recent end
of World War I and the Allies’ victory, but also the end of an onerous
ordinance that shut down the city and required all residents and
visitors to wear face coverings in public to stop the spread of the
so-called Spanish flu.
A blaring whistle alerted gratified residents
across the city and, as the San Francisco Chronicle reported at the
time, “the sidewalks and runnels were strewn with the relics of a
torturous month,” despite warnings from the health department to
maintain face coverings. As celebrations continued and residents flocked
to theaters, restaurants and other public spaces soon thereafter, city
officials would soon learn their problems were far from over.
Now, amid the coronavirus pandemic, as President Donald Trump urges the reopening of the country and some states, such as Georgia, move to resume normal business
even as new cases emerge, how officials acted during the 1918 flu
pandemic, specifically in cities such as San Francisco, offers a
cautionary tale about the dangers of doing so too soon.
Alex Navarro, the assistant director of the Center for the History of Medicine at the University of Michigan, which detailed historical accounts
of the 1918-19 flu pandemic in 43 cities, told NBC News in a phone
interview that officials often acted quickly at the time but
restrictions were eased to varying degrees.
“There was a lot of pressure in pretty much
all of these American cities to reopen,” said Navarro, whose research
was done in conjunction with the Centers for Disease Control and
Prevention. “When they removed those restrictions too soon, then many
cities saw a resurgence in cases.”
The center’s research found
that cities that used “early, sustained and layered” practices such as
social distancing, closing public events and stay-at-home orders “fared
better than those that did not.”
‘A lot of stock in masks’
Just two months earlier, in September, the
first case of the so-called Spanish flu was identified in San Francisco
and city health officials sprung into action.
Dr. William C. Hassler, the city’s health
officer, ordered the local man who apparently brought the disease to the
city after a trip to Chicago into quarantine to stop the disease from
finding another human host, according to the center’s research of
reported accounts.
But it was too late as the virus had already
begun to make its way through the city. By mid-October, the cases jumped
from 169 to 2,000 in just one week. Later that month, Mayor James Rolph
put in place social distancing practices and met with Hassler, other
health officials, local business owners as well as officials from the
federal government to discuss a plan to close the city.
Some officials demurred at the idea, worried
about damage to the city’s economy and the risk of causing public panic.
Eventually, on Oct. 18, the city voted to shut down “all places of
public amusement.”
City officials also strongly advocated for
face coverings, which were at first optional and soon required by a
mayoral order — the country’s first at the time, Navarro said.
“They were the one city that put a lot of stock in masks,” he said.
With the pandemic still raging across the globe during World War I, the mask also became a symbol of “wartime patriotism.”
“The man or woman or child who will not wear a
mask now is a dangerous slacker,” a public service announcement from
the American Red Cross said at the time, according to Navarro’s
research.
m defying the order — 110 people were arrested
and given a $5 fine in one day in October shortly after the measure
went into place, improperly wearing a mask or not wearing one entirely,
according to the center’s research. Over time, the jails were
overcrowded with people failing to adhere to the rules. However, most
cases were later dismissed.
By the end of October, there were 20,000 cases
and more than 1,000 deaths. However, as the days went on, the city saw a
dip in newly reported cases, which prompted officials to begin to
reopen the city and rescind the mask order. By the end of November,
officials believed the city had stabilized.
‘They were flattening that curve’
But three weeks after that celebration of
removing their masks, the city saw a dramatic resurgence. Officials at
first rejected the idea of reopening the city and suggested residents
could voluntarily wear face coverings.
But shortly after the New Year in 1919, the
city was hit with 600 new cases in one day, prompting the Board of
Supervisors to re-enact the mandatory mask ordinance. Protests against
the mandate eventually led to the formation of the Anti-Mask League. The
detractors eventually got their way when the order was lifted in
February.
San Francisco’s ambivalence to quarantine
measures ran counter to other U.S. cities, though. Navarro said Los
Angeles, for instance, implemented strict social distancing and face
coverings about a week before San Francisco did and its measures stayed
in place for weeks longer.
Navarro said that many cities often became
complacent once they saw a dip in cases, and when a resurgence happens
residents often question the public health guidance.
“They were flattening that curve; they just
weren’t realizing it,” Navarro said. “A lot of people thought, ‘Well,
what did we go through that for? It did have an impact, they just didn’t
know it.”
As Dr. Anthony Fauci, the nation’s top
infectious disease expert, put it in March, “If it looks like you’re
overreacting, you’re probably doing the right thing.”
Back during the Spanish flu, San Fransisco’s
failure to take swift action and the decision to ease restrictions after
only a few weeks had huge ramifications. With 45,000 cases and more
than 3,000 deaths, the city was reported to have been one of, if not,
the hardest-hit big city.
Roughly a century later, the San Francisco Bay
Area imposed the nation’s first stay-at-home order and other
restrictions when coronavirus cases were rapidly growing, placing a
spotlight on its pandemic response again. Those aggressive actions are
credited with saving lives, avoiding the scale of the tragedy found in
New York City.
Mayor London Breed said she took heed of history and implemented an order last week requiring anyone setting foot on the streets of San Francisco, outside their homes, to wear a face covering.
Breed told MSNBC’s Chris Hayes in an
appearance in mid-April that she has considered the city’s history with
past pandemics, such as the HIV/AIDS crisis and the Spanish flu when
deciding to ease restrictions.
“Just because San Francisco is being praised for flattening the
curve, we’re not there yet,” she said. “And so we cannot let up just
because for some reason we believe that we’re in a better place.”https://www.nbcnews.com/politics/politics-news/san-francisco-had-1918-flu-under-control-then-it-lifted-n1191141
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