TheBiden administration on Wednesday launched a new information system to map emergency medical services (EMS) responses to heat-related illness across the country.
The online dashboard is run by the Department of Health and Human Services in partnership with the National Highway Traffic Safety Administration. The agencies said the system is meant to help public health officials ensure that outreach and medical aid reach the people who need it most during heat emergencies.
“Heat is no longer a silent killer. From coast-to-coast, communities are battling to keep people cool, safe and alive due to the growing impacts of the climate crisis,” Health and Human Services Secretary Xavier Becerra said in a statement.
“The EMS HeatTracker is a powerful tool from the Biden-Harris Administration that brings actionable information to prioritize outreach and interventions, helping prevent heat-related illnesses and death and build resilience across the nation,” Becerra added.
The rollout comes as extreme summer heat is increasing in the United States. Climate projections indicate that extreme heat events will be more frequent and intense in coming decades.
In addition to showing state and county-level heat-related EMS activations, the dashboard breaks down patient characteristics by age, race, gender and urbanicity so officials can see which populations experience heat-related health risks most severely.
According to the agencies, the tracker also provides national-level information on the number of heat-related EMS activations and the number of heat-related deaths among patients who were alive when medical officials arrived on the scene.
The tracker does not include information for patient fatalities that occurred prior to EMS arrival on scene or fatalities with no EMS response, making it an underestimate of the number of heat-related deaths in the U.S. The data will be updated weekly and will be about two weeks behind real time. The new system unveiled Wednesday is not the only way the federal government tracks heat illness.
The Centers for Disease Control and Prevention (CDC) has been collecting national data on heat-related illness from emergency departments since 2018.
The CDC’s portal tracks the rate of emergency department visits associated with heat-related illness and releases it daily, using data from electronic health records shared by participating medical facilities.
A major fight is brewing between the Biden administration and the powerful nursing home industry over a proposed minimum staffing requirement for the nation’s 15,500 nursing homes.
President Biden last year announced a slate of nursing home reforms and vowed staffing minimums would be among them. The new rules are still under review and could be released any day.
“After 20 years, it’ll make a huge difference to have a minimum standard — assuming that the standard is reasonable,” said Charlene Harrington, a professor emeritus at the University of California at San Francisco who researches the impact of nursing home staffing on care quality.
Advocates have been calling for such a requirement for more than two decades, arguing that residents are safer and have better care with more staff, but the industry has successfully resisted.
Then the coronavirus pandemic hit. More than 200,000 nursing home residents and staff died from the virus, exacerbating the existing concerns and forcing federal officials into action.
“Nursing homes were getting so much attention during COVID. And the impact on residents was getting so much attention that it really did lay bare the issues that have really been long-standing areas of concern,” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care.
The rule has yet to be released, so it’s not clear what will be proposed. The Centers for Medicare and Medicaid Services (CMS) has been conducting a study since last year to inform its minimum staffing proposal.
The agency initially said it planned to release the rule in the spring. It has been under review by the White House Office of Management and Budget since May 30.
But industry groups say any federal standard is unfeasible because of a nationwide staffing shortage made worse by the pandemic. They say it also amounts to an unfunded federal mandate because Medicaid reimbursement rates are too low.
“This discussion of mandated staffing ratios cannot be divorced from the current reality: There are too few people available to hire,” Janine Finck-Boyle, vice president of health policy at LeadingAge, which represents nonprofit nursing homes, said in a statement.
LeadingAge doesn’t specifically oppose a federal standard but wants the government to meet a very specific set of criteria before setting a minimum ratio. For instance, the group wants Medicaid to cover at least 95 percent of the cost of care, as well as federal assurances there are no long-term care workforce shortages.
Advocates contend the workforce shortage and high turnover rates can be solved by making the job more attractive with higher pay and better benefits.
“You don’t have a staff shortage, you’ve got a good job shortage. You have to pay these people, have to provide them support,” said Mark Miller, Washington, D.C.’s, long-term care ombudsman.
“There are people out there that want to work,” Smetanka added. “It’s just right now they’re not wanting to work in nursing homes.”
But the industry groups said wages aren’t the only issue, and the pandemic has led to historic caregiver shortages.
Most nursing home residents rely on Medicaid, but labor costs keep increasing, and the program only pays about 86 cents on the dollar, the American Health Care Association said.
The group, which represents 14,000 long-term care facilities, has said nursing homes would be forced to close without any federal workforce help.
Nursing home staffing rules haven’t changed since 1987, and there are no formal federal standards.
Under federal law, facilities are required to provide 24-hour licensed nursing services that are “sufficient” to meet the nursing needs of residents. Facilities must also use the services of a registered nurse at least eight consecutive hours a day, seven days a week.
The “sufficient” rule is too vague, experts and advocates said, and facilities have not been held to a high enough standard.
A key study by CMS in 2001 found that at a minimum, facilities should provide 4.1 hours of direct care per resident per day to ensure they’re safe from falls and other harms. CMS recommends nursing homes meet that level, but it’s not a formal policy.
But most U.S. nursing homes don’t meet that standard, and advocates said residents are generally sicker and need more care now than 20 years ago.
Most states have their own requirements, but they’re almost all lower than the federal recommendation. Only D.C. requires 4.1 hours; some are less than half that.
Miller said 60 to 70 percent of the complaints his office receives are staffing-related.
“Staffing is at the root of the issue, whether it’s a care issue or a resident rights issue,” Miller said.
Miller said his office is currently investigating a facility that was only giving residents water during mealtimes, because they didn’t have enough staff to take people to the bathroom through the course of the day. Facilities are required to have fresh water at every residents’ bedside
Miller recalled another situation where a woman tried to get up on her own to go to the bathroom because nobody was answering the call bell. She fell, and suffered an injury.
“I think that happens with staff here in the District, they are wanting to do a good job, but it’s really hard and it takes a toll on you when you know you’re not getting to everybody. You know when you’ve got 20 people to take care of and you’re not responding to them as they need, that takes a moral toll,” Miller said.
David Grabowski, a long-term care expert and professor of health policy at Harvard Medical School, said that reality was playing out across the country.
“Far too many nursing homes have staffed at levels that haven’t been safe for residents,” he said. “So we’ve had a lot of unfortunate examples of facilities really putting residents’ care and sometimes even their lives at risk by staffing below what a lot of experts would consider to be safe and acceptable standards.”
The sacking of an Australian insurance worker after her company used keystroke technology to monitor her activity highlights a chilling rise in employee surveillance tools, experts warn.
She received a formal warning in November 2022 about her output and was put on a performance improvement plan.
Cheikho was subject to a detailed review of cyber activity, which analyzed the number of times she physically pressed her keyboard on 49 working days from October to December.
Suzie Cheikho, a former consultant at Insurance Australia Group, was fired for missing deadlines and meetings, and failing to complete a task that caused the industry regulator to fine IAG.Facebook/Suzie Cheikho
The review found she had “very low keystroke activity”, averaging 54 strokes per hour over the duration of her surveillance, which showed “she was not presenting for work and performing work as required.”
Cheikho, who told her employer she did “not believe for a minute” the data was true, took her case to the Fair Work Commission (FWC).
The tribunal this week sided with IAG, finding she was fired for a “valid reason of misconduct.”
Cheikho has been contacted for comment.
Cheikho’s final review found she was averaging 54 strokes per hour over the duration of her surveillance, which showed “she was not presenting for work and performing work as required.”Linkedin/Suzie Cheikho
Uri Gal, professor of business information systems at the University of Sydney, said more than 50 percent of organizations globally now used some form of online monitoring of their workforce.
“Over the years it’s become much more common,” he said.
“And the phenomenon has grown during Covid just because more people were working from home and the anxiety levels amongst managers were heightened because they wanted to make sure people were still performing as they were supposed to.”
Prof Gal said there was a huge industry of companies that developed these technologies.
“There are many types out there that offer different types of capabilities,” he said.
“Some of these tools are very comprehensive. The most extreme versions basically install some sort of silent agent on the machine, like a fly on the wall, everything you do is recorded — what websites you’re going to, what you’re typing, what applications are open, at any point in time they can take a screenshot. So pretty pervasive and comprehensive.”
It was surprising and concerning, he added, that many employees seemed unaware that what they were doing on their work laptops was so closely monitored by their company.
“Many employees don’t know what’s installed on their machines and that to me raises an added layer of concerns,” he said.
“Because it’s one thing to monitor your employees — I think we all expect to be monitored in one form or another in the workplace — but to monitor without telling them is ethically questionable. We have a right to know to what degree our actions are being surveilled and it also raises questions about the integrity of our employers if they’re not willing to tell us they’re monitoring us — not being given the benefit of the doubt, being treated as a criminal.”
Uri Gal, a professor at the University of Sydney, said more than 50% of organizations globally use some form of online monitoring of their workforce.
Prof Gal said employers may like their staff to know they were being monitored due to the powerful effect of the “digital panopticon,” referring to a hypothetical prison where all inmates can be seen at all times.
“Once we start assuming we’re being watched, the most effective form of control is if we have no idea [when] we’re being watched — we have to assume we’re being watched all the time,” he said.
“It’s an extremely powerful and relatively affordable form of control.”
“And the phenomenon has grown during Covid just because more people were working from home and the anxiety levels amongst managers were heightened because they wanted to make sure people were still performing as they were supposed to,” Gal said.Getty Images/iStockphoto
But Prof Gal argued that while it might benefit organizations in the short term, it was not a “healthy long-term approach just from a practical perspective.”
“I think managers have to ask themselves what sort of organizational culture they want to build,” he said.
“One of trust and nurturing healthy relationships and giving agency to do the right thing, struggle with difficult questions and grow and as a result become better employees — or do we want to treat them like children, essentially?”
He added, “When you’re being treated like a child you start acting like a child.”
Working-from-home expert Dr. Daniel Schlagwein, associate professor at the University of Sydney Business School, said his research into fully remote companies showed that “lazy, looking over the shoulder” in-person management styles did not translate well to the new environment.
“It’s much better to develop more modern management techniques such as by particular project outcomes,” he said.
“What these [remote organizations] are doing is often pooling the work and letting workers self-select what they are working on, so in a sense they are motivated.”
Underperforming workers can still be managed through more traditional KPIs without resorting to “spying”, Dr. Schlagwein argued.
“It might technically be my employer’s computer, but given how much we use our devices and how much private and professional spaces are intermingling for most knowledge workers, I think that’s a bit too invasive,” he said.
Fiona Macdonald, social and industrial policy director with the Centre for Future Work at the Australia Institute think tank, said employee monitoring was “quite widespread” and “expanding rapidly” but it was difficult to know the true extent because “we don’t actually have any requirement for employers to make known what technology they’re using.”
Dr. Daniel Schlagwein (not pictured) said his research into fully remote companies showed that “lazy, looking over the shoulder” in-person management styles did not translate well to the new environment.Getty Images/iStockphoto
“You do hear increasingly workplaces where somebody is employed just to monitor the data coming from workers’ computers to see what they’re doing,” she said.
Ms Macdonald said in addition to obvious privacy concerns, the increasing use of technologies including surveillance and artificial intelligence in workforce management — particularly in Europe and the US — raised broader ethical and legal issues.
“It’s increasingly used to make decisions and that’s really problematic, because here you have AI doing the tracking, assessing, hiring, and firing, and it can lead to some really unjust outcomes,” she said.
Unfortunately, she added, “workers don’t have a lot of rights” around on-the-job surveillance.
“When you are on your employer’s time, managerial prerogative rules,” she said.
In May, the COVID-19 emergency wasofficially declared over— but the coronavirus is still a significant concern, according to some in the medical community.
The latest data from the New York state Department of Health, released Aug. 2, shows that COVID cases spiked by 55% since the prior week, with an average of 824 reported cases per day across the state.
And hospital admissions for the disease increased by 22% compared to the previous week, which translates to more than 100 admissions a day.
Meanwhile, a new variant — dubbed EG.5, or eris — has arisen as the dominant strain, causing about 17% of COVID cases nationwide, according to a new alert from the Centers for Disease Control and Prevention.
However, Dr. Ashwin Vasan, the NYC health commissioner, has said “the good news is that we’re not seeing anything in the virus that suggests it’s getting more transmissible or more lethal. What this really is, is just waning immunity … This is part of living with COVID and these fluctuations are to be expected.”\The rise in COVID-19 cases isn’t limited to New York: The CDC recorded 8,000 US hospital admissions for COVID-19 in the week ending July 22, a 12% increase from the week before.
CDC data also shows that each year since the pandemic began in 2020, an annual winter spike in cases — such as when the omicron variant caused a leap in infections in the winter of 2021-22 — is followed by a smaller increase in the middle of the summer.
“The most frightening thing to me is, we don’t know where that [omicron] variant came from,” Bershteyn said, adding that an even deadlier variant could arise without warning.
“That event could happen anytime,” she added. “That thought sends chills down my spine.”
“The most frightening thing is if the virus was more deadly,” Anna Bershteyn, assistant professor in the Department of Population Health at NYU’s medical school, told The Post.
“That’s really scary,” Bershteyn added, “if a virus had the transmissibility of COVID and was as deadly as the MERS coronavirus,” referring to Middle East respiratory syndrome, a disease with a fatality rate of over 30%.
Lack of testing frustrates health experts
Even as cases increase and people gather for summer travel, popular movies and other events, tests for COVID-19 aren’t as readily available as they once were.
Despite a rise in COVID-19 cases, testing and test kits are in short supply.REUTERS In June, the Biden administration stopped mailing out free test kits, and the ones people stockpiled over the past year or two are either expired or will be soon.
Without testing, “it will be hard for people to know if what they have is COVID,” Bershteyn said.
Because of the availability of the antiviral Paxlovid, “we actually have no supply problems” when it comes to treating cases of COVID-19, Bershteyn added. “Testing is really the key way to take advantage of these medications.”
And even though the number of COVID-19 deaths has dropped, “1 out of every 100 deaths is still something,” Bershteyn noted, referring to the CDC’s estimate that 1% of US deaths are due to the disease.
Moreover, many health insurance plans stopped paying for over-the-counter test kits once the requirement to do so ended when the emergency declaration was lifted.
The lack of available test kits could add to a rise in COVID hospitalizations and deaths, say health experts.
“We are going to continue to see people hospitalized for COVID … that could have been prevented had testing been freely and widely available,” Dr. William Schaffner, an infectious diseases specialist at Vanderbilt University Medical Center in Nashville, Tennessee, told the Washington Post.
Testing sites, like this one in New York City, are harder to find today than during the first years of the COVID-19 pandemic.REUTERS New booster shots available this autumn
Fortunately, this summer’s rise in cases isn’t caused by a virulent strain of the coronavirus.
NYC health commissioner Vasan and other public health experts are encouraging people to get the updated booster shot when it becomes available.
“We’re gonna have a new booster coming online in September or early October, per the CDC, and that’s gonna be updated to match the current variants, and it’ll give us protection going into the winter and fall season,” Vasan said.
Again, “this is part of living with COVID,” Vasan added, “and these fluctuations are to be expected.”
“As we once again see an increase in cases of COVID-19 in the state, I urge all New Yorkers to remember COVID is a treatable disease,” New York state Health Commissioner Dr. James McDonald said in a news release.
“COVID tests are easy to use as well as highly accurate. If you test positive, speak with a health care provider about treatment, which can prevent hospitalization and death,” McDonald said.
