How States Actually Determine Reopening

The White House’s “gating” criteria for states to reopen of their economies as the COVID-19 pandemic eases are less prescriptive than those released quietly by the CDC nearly a month later — but the discrepancy matters little, as many states forge ahead using their own standards.
The result has been a patchwork of approaches, some stricter than the federal recommendations and many far more lax. For some, like New York, it’s easy to find real-time data on whether criteria have been satisfied. Other states have made it more difficult to see where they stand on meeting their own criteria.

Here’s a look at each state’s benchmarking, or lack thereof, for reopening. For comparison, the White House included five metrics in its gating criteria, over a timeframe of 14 days, all of which were to be met before progressing to the next phase:

• Downward trajectory for influenza-like illness
• Downward trajectory for COVID-like illness
• Downward trajectory for documented cases or for positive tests as a percentage of total tests
• Adequate ability of hospitals to treat patients without crisis care
• Robust testing program in place for healthcare workers

Alabama
No published gating criteria for reopening.
Alaska
Four metrics guided its phased reopening: a consistently declining or stable number of new cases and hospitalizations; adequate testing availability; contact tracing capabilities; and sufficient healthcare capacity, particularly ICU beds and ventilators.
Arizona
The state tracked four criteria for its phased reopening: declines in hospitalizations for COVID- and influenza-like illness; declining percentage of positive tests; lack of need for crisis care; and ample testing for healthcare workers.

Arkansas
No published gating criteria for reopening.
California
The state tracked six key metrics for its phased reopening: stability of hospitalizations; sufficient personal protective equipment; healthcare surge capacity; testing capacity; contact tracing capability; sufficient public health guidance.
Colorado
The state mapped five indicators to restart the economy: sustained decrease in cases for at least 14 days; sufficient hospital capacity; testing for all patients with COVID symptoms; active monitoring and isolation of cases; social distancing guidelines in place.
Connecticut
Six criteria guide its phased reopening: decline in hospitalizations for 14 days; widespread testing; contact tracing; protections for at-risk population; adequate PPE supply; sufficient hospital capacity.
Delaware
The state used three criteria for reopening: a 14-day decline in symptoms and presumed positive cases; hospitals’ ability to treat patients without crisis care; testing programs for healthcare workers.
District of Columbia
The district lists four criteria for reopening: a decrease in community spread; maintenance of health system capacity; increased testing; improvement in public health system capacity. Originally, D.C. was going to use a 14-day decline in infections, but Mayor Muriel Bowser switched the metric to community spread after an increase in infections over Memorial Day weekend.

Florida
The state matched the White House criteria for its phased reopening.
Georgia
The state reopened before meeting federal benchmarks. No published criteria for reopening.
Hawaii
With one of the lowest case counts and death rates in the nation, the state started reopening when it had 40+ days of a downward trajectory in new cases, 90% of cases had recovered, and hospitals had significant surge capacity available. Its roadmap calls for a minimum of 14 days between its five stages, but doesn’t list specific benchmarking criteria.
Idaho
Gating criteria tracked with federal criteria and the state satisfied them through each of three phases of reopening.
Illinois
Every region met criteria to enter phase 3 of reopening; to move to phase 4, regions need to meet five metrics: 20% or lower positivity rate increasing by no more than 10% over a 14-day period; stable or declining hospital admissions for 28 days; surge capacity of at least 14% of ICU beds and ventilators; testing available regardless of symptoms or risk factors; able to contact trace within 24 hours of index case for more than 90% of cases in region.
The state will go back a phase if there’s a sustained rise in test positivity rate, an increase in hospital admission, inadequate hospital surge capacity, or a worse outbreak.
Indiana
The state is focused on four criteria: the number of COVID hospitalizations has decreased for 14 days; surge capacity is available; testing is in place for all symptomatic patients as well as healthcare workers, essential workers, and first responders; sufficient contact tracing.
Iowa
The state never issued a stay-at-home order and hasn’t published its criteria for loosening restrictions.
Kansas
According to its reopening plan, “The Governor will evaluate the state’s disease spread, testing rates, death rates, hospitalizations, ability of state and local public health authorities to contain outbreaks and conduct contact tracing, and availability of personal protective equipment when determining if the state should move to the next phase.”
The state also recommends that local governments monitor three criteria to determine if they need additional restrictions: COVID cases stable or declining over a 14-day period; decreasing number of new hospital admissions; downward trajectory of deaths over a 14-day period.

Kentucky
The state lists seven benchmarks for its phased reopening: 14 days of decreasing cases; increased testing capacity; availability of PPE; ability to protect at-risk populations; ability to social distance; prepare for a future spike; status of vaccine and treatment. However, it didn’t specify how it used them to extend openings to additional businesses through May and June.
Louisiana
The state used three criteria for reopening: a decline in COVID-like illnesses; decline in cases per capita; decline in hospitalizations.
Maine
The state’s criteria track with federal guidance: a downward trajectory in influenza-like illness and COVID-like illness; downward trajectory of documented cases and hospitalizations; and lack of need for crisis care and robust testing for healthcare workers.
Maryland
While specific gating criteria aren’t listed, the state said in a press release that advancing its reopening was due to its positive case rate dropping to single digits and total current hospitalizations falling to the lowest level in more than 7 weeks.
Massachusetts
The state is monitoring six key indicators in its phased reopening: positive test rate; deaths; hospitalizations; healthcare system readiness; testing capacity; and contact tracing capabilities. None of these indicators have changed since the beginning of phase 1 on May 18.
Michigan
The state identified six stages of the outbreak, beginning with “uncontrolled growth” in cases and ending with stoppage in community spread with the expectation that it won’t return. At each stage, different strategies are to be applied until the state meets criteria for the next stage. For example, while the state is in the “flattening stage,” gatherings are banned, people should continue social distancing and masking, and most businesses must remain closed; but when “cases, hospitalizations, and deaths are clearly declining,” the state enters the “improving” stage during which small gatherings and more business activities can resume.
Minnesota
No published gating criteria for reopening.
Mississippi
No published gating criteria for reopening.
Missouri
The state hasn’t published any criteria for its phased reopening, but lists four “guiding principles“: expanded testing capacity; expanding reserves of PPE; monitoring hospital capacity; and improving the state’s ability to predict outbreaks.
Montana
Four indicators enabled the state to move ahead with reopening: a downward trajectory of positive tests as percent of total tests within a 14-day period; ability to contact trace; ensuring healthcare workers have adequate supplies; ramping up testing capacity.
Nebraska
The state didn’t have a formal stay-at-home order and never published gating criteria for reopening.
Nevada
The state said it was in line with White House gating criteria but listed only two separate benchmarks: decline in percentage of positive tests and in hospitalization trends; and the ability to maintain hospital capacity without crisis care.
New Hampshire
No published gating criteria for reopening.
New Jersey
The state has a six-point plan for reopening: sustained 14-day trend toward reduction in new cases and hospitalizations; expanded testing; robust contact tracing; places to isolate patients with disease; economic advisory commission; prepare for resurgence.
New Mexico
Four gating criteria: rate of transmission of 1.15 or less; ability to do 3,000 tests a day; contact tracing and isolation capacity; sufficient healthcare capacity.
New York
Each region must meet seven metrics before reopening: 14-day decline in hospitalizations; 14-day decline in hospital deaths; fewer than 2 new hospitalizations per 100,000 residents; at least 30% of total beds available; at least 30% of ICU beds available; monthly testing rate of 30 per 1,000 residents; 30 contact tracers per 100,000 residents.
North Carolina
The state is watching four metrics to ease restrictions, all over a 14-day period: reductions in COVID-like cases; reductions in lab-confirmed cases; a falling percentage of positive tests; declining hospitalizations.
North Dakota
Three criteria guided its reopening, all over a 14-day period: a downward trajectory of influenza-like illness; downward trajectory in COVID-like illness; downward trajectory of newly identified cases.

Ohio
No published criteria for reopening.
Oklahoma
Four criteria must be satisfied before advancing: hospitalizations are at a “manageable level” that hospitals can treat without alternate care sites; sufficient testing levels; ability to conduct contact tracing; adequate PPE and other critical equipment to handle a surge.
Oregon
News reports list three criteria: declining symptoms; declining cases; adequate hospital capacity. Phase 1 needed to be at least 21 days. Needed declining level of COVID-19-like illnesses and hospital admissions, “adequate” contact tracing system and isolation facilities, “sufficient” PPE, adequate “minimum” testing regimen, and sufficient hospital capacity to accommodate a 20% surge in hospitalizations. Phase 2 criteria meant tracing 95% of new cases within 24 hours, tracing at least 70% of cases to an existing recent case, no significant increase in the rate of positive cases, no increase of 5% or greater in new cases over the previous week.
Pennsylvania
The lone specific criterion to advance is having a daily average of 50 or fewer cases per 100,000 residents over a 14-day period. Phase advancements are determined on a county-by-county basis. State also examining factors including ICU capacity risk, population density risk, population age risk, reopening contact risk.
Rhode Island
The state lays out wide-ranging criteria for moving between phases: a 14-day downward trend in the number of cases or a 14-day trend in stable or declining hospitalizations; ability to identify community spread especially via increased testing and contact tracing; meet the needs of those in quarantine and isolation; have at least 30% of ICU beds open and sufficient PPE; sufficient workplace guidance; plan to pull back if needed.
South Carolina
The governor revoked stay-home order and let restaurants open outdoors May 4 “because CDC guidance identifying “hotspots” throughout the country, which constituted the basis upon which short term rental companies were to deny reservations, has since lapsed and was not renewed.” No other metrics were found.
South Dakota
Four criteria determine advancing: downward trajectory of influenza-like illness in 14 days; downward trajectory of documented cases within a 14-day period with sustained community spread; no need for crisis care in hospitals; robust isolation and quarantine capabilities.

Tennessee
Officials said they closely tracked White House criteria: a downward trend in case growth; an increase in testing capability; sufficient hospital capacity.
Texas
No published criteria for reopening.
Utah
The state never had a stay-at-home order, but is monitoring four criteria for opening more businesses: a decreasing trend in cases for one week; targeted utilization not to exceed 90% of ICU bed utilization; maintain an average of 4,000 to 6,000 tests a week; keep case exposure below 15% from sources like travel, healthcare facilities, and community transmission for 7 to 14 days.
Vermont
The state is tracking four key metrics: syndromic surveillance; viral growth and reproductive rate; percentage of new positive tests; hospital and critical care bed capacity.
Virginia
Four criteria determine next steps: a downward trend in percent positive tests over 14 days; downward trend in hospitalizations over 14 days; enough hospital beds and intensive care capacity; increasing and sustainable supply of PPE.
Washington
The state is monitoring four criteria: healthcare system readiness (adequate beds and critical care beds, enough ventilators, plenty of PPE); testing capacity; case and contact investigations; ability to protect high-risk populations.
West Virginia
The state’s lone criterion is having three consecutive days of a statewide cumulative percentage of positive test results below 3%.
Wisconsin
The state’s criteria match the White House guidance.
Wyoming
Its two main groups of criteria are a reduction in COVID cases, percent of cases attributed to community spread, and percentage of positive tests; and a reduction in hospitalization and sufficient availability of hospital and ICU beds.
https://www.medpagetoday.com/publichealthpolicy/healthpolicy/86916

COVID-19 in Nursing Homes: CMS Names Names

The public can now see — for each of 13,600 nursing homes in the country by name — which ones had suspected versus confirmed cases of COVID-19, which had COVID-19 deaths, and whether they were residents or staff.
With 88% of 15,400 Medicare and Medicaid-eligible nursing homes reporting as of May 31, Medicare officials yesterday rolled out a federal database showing how the nation’s 95,515 confirmed COVID-19 cases, 58,288 suspected cases, and 31,782 deaths among nursing home residents were distributed.
Of the facilities that reported, 25% reported cases or deaths.
“This sort of national data from nursing homes is unprecedented and constitutes the backbone of a national COVID-19 virus surveillance system,” Centers for Medicare & Medicaid Services (CMS) Administrator Seema Verma said Thursday during a press call. The data, along with focused infection control inspections of nursing homes, Verma said, will “inform a number of new regulatory policies to protect nursing home residents.”
The link to the data, which will be updated weekly, can be accessed on the CMS’s Nursing Home Compare website or downloaded as a spreadsheet and filtered or sorted.
Verma emphasized that a prior problem with getting good data was that “every state was doing this a little bit differently, and now we have a national standard way of looking at nursing homes.”
For example, some states count a COVID-19-infected nursing home patient who was transferred to a hospital and died there as a death in one of their residents, while other states attribute that resident’s in-hospital death to that hospital. Some states include residents of assisted living facilities, while others do not.

These federal data, which the nursing homes send directly to the CDC and from there to CMS, and not through their states, only includes information from skilled nursing facilities under CMS’s regulatory purview, Verma said. “That’s part of the reason we built this system.”
Verma cautioned that the dataset has limitations and errors. There may be confusion with some nursing homes confusing numbers of cumulative cases with numbers they had in the prior week, which should go in separate columns and may result in an overcount.
She expects a lot more cases to appear in coming weeks because states have been asked to test all nursing home residents and staff. “These and other factors should really prompt us to use caution when interpreting the data at this early stage,” she said.
A member of the CMS technical staff, who spoke on background during the press briefing, noted that those nursing homes with higher numbers of cases and deaths from COVID-19 were more likely to have been given a low “one star” rating in the agency’s system. “What that means is that facilities with a poor compliance history or poor survey history were more likely to have larger outbreaks,” he said.

Verma said that CMS teams are working to get reports from the other 12% of nursing homes with missing data. After a grace period, she said, CMS will issue financial penalties to those facilities of $1,000 for the first week of delay. If it fails to report for a second week, the fine is another $1,500 for a total of $2,500, and more the longer the facility delays. That grace period ends June 7.
The CMS technical official said that the agency is encouraging family members to make it known if a loved one was diagnosed with COVID-19 in a facility and the facility hasn’t reported that to CMS. “Families can be a very powerful motivating factor,” he said.
Verma was asked by a reporter why so many facilities show a large number of cases and deaths, though state inspectors found no infection control violations and gave the facilities a clean bill.

She responded that inspections occur at “a point in time…. When you (inspectors) go into the nursing home, the staff know they’re being observed and particularly on that day they go in, they’re looking for things they may not see on that particular visit, but when the inspector leaves the nursing home, things can change, right?”
“There are some staff that may not be washing their hands at the frequency we suggest, or in the situations we suggest. There could be some lax practices around isolating patients.”
Additionally, CMS is asking states to conduct focused infection control surveys or inspections whenever a nursing home facility has three diagnosed cases of COVID-19. It has also increased the penalties and fines around deficiencies found during such investigations.
The CMS technical official on the call also noted that just finding COVID-19 in a nursing home does not automatically mean the facility was non-compliant with infection control guidelines. For example, “many facilities were intentionally admitting residents from hospitals,” he said.

During testimony Thursday before a House committee, CDC Director Robert Redfield, MD, touted the new website. “CMS and myself are working very closely together; one of our key priorities is to combat the impact on nursing homes. We now have the ability to require all nursing homes to report their data to us… so America knows what nursing homes are doing well and what ones aren’t doing well, and we know so we can help them more with infection control.”
The new website also shows the rates of COVID-19 cases per 1,000 residents, number of residents, whether nursing home residents have access to COVID-19 testing in the facility, whether the facility has a shortage of nursing staff, clinical staff or aides, and the current supply of N95 masks, surgical masks, eye protection, gowns, gloves, hand sanitizer, ventilators, and ventilator supplies.
In response, Pat McGinnis, executive director of California Advocates for Nursing Home Reform, said that while the CMS data have “too many qualifiers,” it shows “that almost one-third of the residents with confirmed cases have died and that is a very shocking number, but not a surprise given all the problems with lax enforcement, lack of staff, proper PPE and infection control.”

“But still, to have 32,000 nursing home residents die within the past three months, is a pretty terrible indictment of how we warehouse our ill elders,” McGinnis added.
In a statement Thursday, Katie Smith Sloan, president and CEO of LeadingAge, an advocacy group for nonprofit nursing homes, called the numbers “devastating” and “a reminder of how this virulent virus has been allowed to rage on without protection or regard for older people and their care workers.”
She criticized the Trump administration for appearing to “walk away from any substantive leadership role” in preventing COVID-19 among older people.
“Aging services providers have been promised little more than token personal protective equipment (PPE) assistance to care for vulnerable residents and staff, and many haven’t even received that,” her statement said.
https://www.medpagetoday.com/publichealthpolicy/healthpolicy/86911

University Leaders Are Failing

My university, Johns Hopkins, recently announced a series of exceptional measures in the face of a coronavirus-related fiscal crisis. Suddenly anticipating losses of over $350 million in the next 15 months, the university imposed a hiring freeze, canceled all raises, and warned about impending furloughs and layoffs. Most extraordinarily of all, it suspended contributions to its employees’ retirement accounts. “Many of our peers are grappling with similar challenges,” wrote our president, Ronald Daniels.

That is true. The University of Michigan recently announced anticipated losses of at least $400 million this calendar year. George Washington University likewise anticipates losses in the hundreds of millions of dollars. Stanford University, meanwhile, predicted a $200 million reversal in its consolidated budget. But while many colleges face challenges, no major research university moved with as much haste or revealed as acute vulnerabilities as Johns Hopkins did.
How does a university with a $6-billion endowment and $10 billion in assets suddenly find itself in a solvency crisis? How is one of the country’s top research universities reduced, just a month after moving classes online, to freezing its employees’ retirement accounts?
With its gigantic corporate medical complex and its lucrative government contracts, Johns Hopkins has emerged as the canary in the coal mine of elite research universities. It offers important lessons for the industry as a whole. The vulnerabilities it has revealed result from disturbing trends that have left the broader world of higher education dangerously ill-equipped to confront the looming challenges.

For years, the AAUP and other faculty critics have wrung their hands as norms of shared and deliberative governance disappeared, replaced by the consolidation of administrative power in the hands of corporate executives. With little appreciation for transparency or inclusiveness, and little understanding of the academy’s mission, these managers increasingly make decisions behind closed doors and execute them from above.
For those who have bemoaned these trends, the coronavirus crisis is a moment of truth — confronting us with the consequences of these transformations.
Consider the process that led to Johns Hopkins’s decision to freeze employee retirement contributions, which came as a surprise to nearly everyone affected. In his announcement, the president explained that the decision had been taken after consultation “with our trustees, deans and cabinet officers, and a subcommittee of the Faculty Budget Advisory Committee.” There was no mention of consulting employee unions, staff associations, or other institutions of faculty governance. There was no mention of possible alternatives, or of careful, deliberative assessments about who should bear the financial sacrifices. Certainly, there were no meaningful faculty votes. (The faculty budget committee is composed of a small number of members handpicked by administrators, and lacks formal authority.)

This decision-making process followed a series of measures taken over the last decade in the pursuit of what the university’s leadership has called a One University policy. During that time, financial and administrative authority has been centralized under the president and his highly paid advisers. Major decisions are made in the president’s “cabinet,” a body comprising more than a dozen vice presidents and other senior advisers.
This administrative centralization has come at a serious cost to the university’s sense of community. In the last few years, decisions taken by the upper administration have generated a series of controversies, over-policing, the power to grant tenure, and government contracts, to name a few. Last spring, students frustrated with the university’s governance occupied the university’s central administration building.
The result is an erosion of trust among the university’s most essential constituencies on the eve of the coronavirus pandemic.

The president’s cabinet is a curious body — one that has proliferated throughout higher education, as the values of corporate America infiltrate university administrations. One would hardly think, based on the cabinet’s makeup, that it comprises the senior leadership team for an eminent research university. It looks much more like the C-suite at a public corporation, with two senior vice presidents, 12 vice presidents, an acting vice president, a vice provost, a secretary, and three senior advisers. Of the vice presidents, it seems that only the provost has significant classroom and research experience. Good as he is, he can hardly provide a counterweight to the rest of the cabinet members, who mostly have government, business, finance, or law backgrounds. Collectively, the number of JDs and MBAs far exceeds the number of PhDs. As with most universities, the president reports to a Board of Trustees. But this body, like many across the country, has become a funhouse mirror of corporate America. At Johns Hopkins, 36 members sit on the board, almost all hailing from outside academia.

Johns Hopkins executives are paid much like their counterparts in the corporate world. According to the latest available public information, from 2018, the university’s president earned $1.6 million in salary plus $1.1 million in deferred and other compensation for a total of $2.7 million. That tidy sum doesn’t include the money he receives for serving on other boards, including the $310,000 he received that year from T. Rowe Price — whose chief executive happens to serve on the Johns Hopkins Board of Trustees.
But the president is hardly alone. That same year, the university’s senior vice president for finance earned $1.2 million, its vice president for development made over $1 million, the vice president for investments made over $950,000. Even the president’s chief of staff earned over $670,000. Although he earns a salary high in the six figures, the provost, ostensibly in charge of the university’s academic mission, did not rank even in the top 10 earners at the university.

All told, the compensation of the 28 key employees reported to the IRS in 2018 amounted to over $29 million. That sum alone exceeds by nearly 50% the costs of the pay raises the university would have granted this year to all of its employees.
Then there is the issue of deferred compensation for top executives. According to the university’s latest audit, total liabilities related to deferred compensation amounted to over $130 million — or $30 million more than the institution will save by suspending contributions to its thousands of employee retirement accounts this year.
While a handful of top administrators will take a modest pay cut this year, the university has not said whether any of its executives will forfeit the sums accumulated in their deferred-compensation plans. I assume they won’t. There is a searing irony in the fact that these well-paid officers may keep their lucrative deferred-compensation packages even as staff and faculty sacrifice the value in their retirement funds — which are deferred compensation on a far more modest level. Altogether, these practices do not paint a portrait of an institution with robust mechanisms of oversight and accountability.

Large research universities are dedicated to the mission of teaching and research. But they also function like multinational corporations with tens of thousands of workers, multi-billion-dollar budgets, and sprawling real-estate empires. So they have brought in experts in finance, management, and law to help run operations. The problems arise when these outsiders take primary control of the institution. Alas, we now learn that Johns Hopkins’s managers failed to position the institution to weather unanticipated disruptions in its revenue streams.
That charge might seem unfair. The coronavirus, after all, caught the entire economy flat-footed, from airlines to meat-packing plants to toilet-paper suppliers. Clearly this particular threat could not have been anticipated.
But a university is not a corporation that must maximize its profitability for the next quarterly earnings call. It is, or should be, an institution with far longer time horizons. Johns Hopkins has weathered two world wars, a Great Depression, a global flu pandemic, and multiple economic crashes, the last barely a decade old. Some American universities are older than the nation itself. These institutions exist for the long term.

If a president and his leadership team have one principal responsibility, it is to ensure that the university is on sound enough financial footing to weather unanticipated crises. Ours have not.
By the way, not everyone was unprepared. Dozens of scholars right here at Johns Hopkins have spent years studying and preparing for events like the ones we are now experiencing. So good are these people at their jobs, millions of people today turn to them for data and guidance about how to navigate the pandemic. The Johns Hopkins Hospital has had an Office of Critical Event Preparedness and Response for nearly 20 years.
Meanwhile, what plans did the university’s senior leadership have for a financial crisis? We now learn that the university was operating on the thinnest of margins, its finances exquisitely vulnerable to disruptions at the hospital. With the cancellation of lucrative elective procedures, huge losses appear inevitable. No one, it seems, thought to prepare for such a financial disruption — even though all that pandemic planning took place within the halls of Johns Hopkins itself.

The last financial crisis happened just 12 years ago. Did the university’s leadership believe another would never come? Then there are the losses in federal grant money and foreign tuition revenues. Did anyone think to prepare in the event these were disrupted?
The university set virtually nothing aside in anticipation of these or any other risks. Instead, the leadership began recklessly expensive building projects, including the purchase of a $372.5-million building in Washington, D.C., — a white elephant that had already brought a large foundation to the brink of collapse.
Perhaps that is to be expected: university leaders, like their corporate counterparts, are rewarded for their splashy acquisitions and grandiose construction projects, not for cautious stewardship. In this short-term thinking, university executives resemble the airline executives who spent years buying back their own company’s stock only to find they had no cash on hand when a crisis arrived. People are told to set aside money to cover 6 months of expenses in case of emergency. It took just 1 month for Johns Hopkins to launch its dramatic cuts.

What about that $6-billion endowment? “Unfortunately, we cannot rely on our endowment or philanthropic support to fill the breach,” Daniels wrote in his announcement. Much of it is held in illiquid investments. But exceptional times call for exceptional actions. Is it really better to fund current deficits with employee retirement accounts than to damage the university’s credit rating with further borrowing? Do those in a position of power even bother asking what the purpose of an endowment is? Shouldn’t it serve as a bulwark of financial stability? Or did that idea disappear with the gradual accumulation of financiers on university boards and in senior management?
Today, university endowments all too often function like giant casinos, putting more than 75% of their capital in risky and illiquid assets. Some wealthy universities pay far more in fees to investment managers than they do in scholarships to students. We’ve entered a world where, instead of having an endowment to support a university, the university serves as a tax shelter for the endowment.

Johns Hopkins does not publicly reveal its investments. Available IRS filings do, however, show that over 9 years it paid more than $88 million in fees to an investment firm whose founder formerly served as chair of the university’s board. Quite possibly, our endowment pays out more to its investment managers than our university contributes, annually, to employee retirement accounts. Was there ever much doubt which would be cut in a crisis?
The crisis should serve as a moment of clarity. Even as they continue enriching themselves, university executives have revealed themselves ineffective in one of the most basic corporate responsibilities: managing financial risk. In a few short weeks, astonishingly wealthy institutions across the country were reduced to slash-and-burn strategies to maintain their solvency. Having consolidated power in their hands over the last generation, leaders of America’s wealthiest universities lacked financial reserves — while also squandering the reserves of their communities’ trust and goodwill. A research university’s central mission is teaching and research and the production of knowledge. As faculty, students, and other essential constituencies have become sidelined, so have academic values and priorities.

University hospitals now operate as money-generating conglomerates, rather than for research, teaching, and public health. Degree programs are converted to branded and outsourced revenue machines staffed by subcontracted labor. Faculty research is valued for its potential to be monetized and commercialized. In short, our leaders have lost sight of an essential truth: A university exists for values different from those that dominate the for-profit world. A university governed by long timelines and long-term thinking grows conservatively and cautiously and prepares itself prudently for potential crises. If you turn a university into a giant corporation, on the other hand, it will rise and fall with the business cycle.
No doubt the lawyers and MBAs who run Johns Hopkins and so many other universities are acting sincerely in the best interest of the institutions as they see it. The problem is that, by freezing out alternative perspectives and voices from their decision-making bodies, they have forgotten what a university is and ought to be about.

As the financial tsunami washes over the landscape of higher education, we urgently need to ask whether we have the right leaders in place. Are university presidents, their cabinets, and their hand-picked boards of trustees — all of them so detached from the day-to-day work of teaching and research — in a position to confront the hard choices that lie ahead with wisdom and prudence? Can they act with their eye to the long term? Can they resist using the current crisis to enact further assaults on the university’s central mission and its norms of governance?
If not, are we prepared to advocate for a change?
Reform should begin at the top. At a time when major politicians are proposing that corporate boards include workers, it is astonishing how few university boards of trustees have seats for faculty, staff, and students. From there, reform could work its way through the top-heavy and well-compensated layers of university administration who too often treat faculty and students like obstreperous nuisances rather than essential partners in university governance. The decisions we make in the next few years will have long-term repercussions on what kind of academic system we are left with when the tide recedes. Those who drove us into this ditch cannot be expected to pull us out.
François Furstenberg, PhD, is a professor of history at the Johns Hopkins University.
https://www.medpagetoday.com/publichealthpolicy/healthpolicy/86818

Fujifilm says COVID-19 drug research may drag on into July

Fujifilm Holdings Corp’s (4901.T) research on Avigan as a potential treatment for COVID-19 may drag on until July, the company said on Sunday, a further setback in the Japanese firm’s race to find a vaccine.
“There is a possibility that clinical trials will continue in July,” a Fujifilm spokesman said, responding to a Nikkei report that any approval will be delayed until July or later, due to a lack of patients for trials.
After the government of Prime Minister Shinzo Abe gave up on getting approval for the drug by the end of May, the aim was to complete clinical trials this month.

But researchers have only been able to get around 70% of the patients needed for the trials, and because it takes 28 days to get results, the process will continue until at least July, the Nikkei business daily said, citing an unnamed source.
The spokesman said Fujifilm does not make public details of the progress of clinical trials but it has expanded the number of medical institutions that are cooperate in the trials. “We aim to complete clinical trials as soon as possible.”
Drugmakers around the world are scrambling to develop a vaccine for the new coronavirus, which has infected nearly 7 million people globally, while the disease it causes, COVID-19, has killed nearly 400,000.

Many countries are focusing on drugs like Gilead Sciences Inc’s (GILD.O) antiviral remdesivir and some are using the anti-malaria drug hydroxychloroquine, touted by U.S. President Donald Trump. Abe’s government has championed Japanese candidate Avigan, also known as Favipiravir.
Countries that have succeeded in curbing infections have sometimes paradoxically found it difficult to sustain clinical trials because of dwindling sample sizes for patients.
Japan has avoided the explosive outbreaks seen in some other nations, with about 17,000 infections, and the number of daily infection has been falling, according to public broadcaster NHK and the health ministry.
https://www.reuters.com/article/us-health-coronavirus-avigan/fujifilm-says-covid-19-drug-research-may-drag-on-into-july-idUSKBN23E05T

Global coronavirus cases near 7 million as outbreak grows in Brazil, India

Global cases of the novel coronavirus neared 7 million on Saturday, as case numbers surge in Brazil and India, according to a Reuters tally.
About 30% of those cases, or 2 million infections, are in the United States, though the fastest growing outbreak is in Latin America, which now accounts for roughly 16% of all cases.

Globally, deaths from the novel coronavirus are approaching 400,000.
The United States accounts for about one-quarter of all fatalities but deaths in South America are rapidly rising.
The number of deaths linked to COVID-19 in just five months is now equal to the number of people who die annually from malaria, one of the world’s most deadly infectious diseases.
The first COVID-19 death was reported on Jan. 10 in Wuhan, China but it was early April before the death toll passed 100,000, according to the Reuters tally of official reports from governments. It took 23 days to go from 300,000 to 400,000 deaths.

The United States has the highest death toll in the world at almost 110,000. Fatalities in Brazil are rising rapidly and the country may overtake the United Kingdom to have the second-largest number of deaths in the world.
The total number of deaths is believed to be higher than the officially reported 400,000 as many countries lack supplies to test all victims and some countries do not count deaths outside of a hospital.
https://www.reuters.com/article/us-health-coronavirus-casualties/global-coronavirus-cases-near-7-million-as-outbreak-grows-in-brazil-india-reuters-tally-idUSKBN23E05P

‘Terminator’ protein halts cancer-causing cellular processes

Essential processes in mammalian cells are controlled by proteins called transcription factors. For example, the transcription factor HIF-1 is triggered by a low-oxygen situation to cause the cell to adapt to decreased oxygen.

Transcription factors operate in healthy cells, but cancer cells can co-opt transcription factors such as HIF-1 into promoting tumor growth.
New research from the lab of Hening Lin, professor of chemistry and chemical biology in the College of Arts and Sciences, finds that a protein called TiPARP acts as a terminator for several cancer-causing transcription factors, including HIF-1, which is implicated in many cancers, including breast cancer. The research demonstrates that TiPARP, therefore, is a tumor suppressor.
The paper “TiPARP Forms Nuclear Condensates to Degrade HIF-1α and Suppress Tumorigenesis,” published in PNAS, establishes TiPARP as a turning-off mechanism for several important transcription factors — including HIF-1, C0-Myc and estrogen receptor — and shows how TiPARP itself is degraded during this process. The study also shows the mechanism through which TiPARP terminates these factors, another new discovery.
Co-authors are graduate student Lu Zhang; former postdoctoral fellow Ji Cao; and Longying Dong, former director of the Immunopathology Research and Development Laboratory in the College of Veterinary Medicine’s Department of Biomedical Sciences.
HIF-1 is important for cancer because a lot of tumors thrive in low-oxygen conditions, said Lin, a Howard Hughes Medical Institute Investigator and corresponding author of the paper.
“For these tumors to survive, they have to rely on HIF-1,” Lin said. “TiPARP is a terminator of HIF-1. Therefore, if you can activate TiPARP, then you can suppress [tumor growth].”
Lin and co-authors are also excited by the discovery of the mechanism through which TiPARP brings about the termination of HIF-1 and other transcription factors. This mechanism, called “liquid-liquid phase separation” or “phase condensation,” is a topic of great interest in biology.
Imagine drops of vinegar in oil: The vinegar forms distinct droplets suspended in the more viscous oil.
Similarly, when TiPARP is activated in a cell nucleus, it forms the so-called “phase separation” that recruits HIF-1-alpha and HUWE1 (an ubiquitin protein ligase) in the cell nucleus. This starts a process through which HIF-1-alpha and TiPARP both deactivate and degrade.
Through phase separation, TiPARP terminates not just HIF-1 but several different transcription factors implicated in different types of cancer, Lin said.
In fact, TiPARP may already be at work in Tamoxifen, a widely used breast cancer drug. Lin thinks Tamoxifen, which successfully treats estrogen receptor-positive breast cancers, works because TiPARP is actively terminating estrogen receptor, HIF-1 and c-Myc in tumors.
“When Tamoxifen and similar compounds were developed as estrogen receptor agonists or antagonists, we did not even know what compounds would be better,” he said. “Now we think the idea will be, what compound can activate TiPARP better?”
This research received support from the Howard Hughes Medical Institute, Cornell’s College of Arts and Sciences, and the National Institutes of Health.

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Story Source:
Materials provided by Cornell University. Original written by Kate Blackwood. Note: Content may be edited for style and length.

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Journal Reference:

1. Lu Zhang, Ji Cao, Longying Dong, Hening Lin. TiPARP forms nuclear condensates to degrade HIF-1α and suppress tumorigenesis. Proceedings of the National Academy of Sciences, 2020; 201921815 DOI: 10.1073/pnas.1921815117

https://www.sciencedaily.com/releases/2020/06/200603122946.htm

Nicotine promotes spread of lung cancer to the brain

Among people who have the most common type of lung cancer, up to 40% develop metastatic brain tumors, with an average survival time of less than six months.

But why non-small-cell lung cancer so often spreads to the brain has been poorly understood.
Now scientists at Wake Forest School of Medicine have found that nicotine, a non-carcinogenic chemical found in tobacco, actually promotes the spread, or metastasis, of lung cancer cells into the brain.
“Based on our findings, we don’t think that nicotine replacement products are the safest way for people with lung cancer to stop smoking,” said Kounosuke Watabe, Ph.D., professor of cancer biology at Wake Forest School of Medicine and lead author of the study.
In the study, published in the June 4 edition of the Journal of Experimental Medicine, Watabe’s team first examined 281 lung cancer patients and found that cigarette smokers exhibited a significantly higher incidence of brain cancer.
Then, using a mouse model, the researchers discovered that nicotine enhanced brain metastasis by crossing the blood-brain barrier to change the microglia — a type of immune cell in the brain — from being protective to supporting tumor growth.
Watabe and colleagues then looked for drugs that might reverse the effects of nicotine and identified parthenolide, a naturally occurring substance in the medicinal herb feverfew, which blocked nicotine-induced brain metastasis in the mice.
Because feverfew has been used for years and is considered safe, Watabe believes parthenolide may provide a new approach to fight brain metastasis, particularly for patients who have smoked or still smoke.
“Currently, the only treatment for this devastating illness is radiation therapy,” Watabe said. “Traditional chemotherapy drugs can’t cross the blood-brain barrier, but parthenolide can, and thus holds promise as a treatment or possibly even a way to prevent brain metastasis.”
Watabe said he hopes to work with oncologists at Wake Forest School of Medicine, part of Wake Forest Baptist Health, to develop a clinical trial to test parthenolide in the near future.

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Story Source:
Materials provided by Wake Forest Baptist Medical Center. Note: Content may be edited for style and length.

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Journal Reference:

1. Kounosuke Watabe, Andrew Dothard, Thomas W. Lycan, Jimmy Ruiz, Michael Chan, Wei Zhang, Tamjeed Ahmed, Yusuke Shiozawa, Ravindra Pramod Deshpande, Dan Zhao, Yin Liu, Abhishek Tyagi, Kerui Wu, Sambad Sharma, Fei Xing, Shih-Ying Wu. Nicotine promotes brain metastasis by polarizing microglia and suppressing innate immune function. Journal of Experimental Medicine, 2020; 217 (8) DOI: 10.1084/jem.20191131

https://www.sciencedaily.com/releases/2020/06/200604095615.htm