Deaths from COVID -19 Continue to Rise

Today the New York Time has an extraordinary front page, there were no photos, no articles of interest, no headlines.  There are just names – 1000 names, to be precise – about one percent of the total deaths from COVID-19 seen so far this year. These names cover the front page and tumble inside for a few more pages. This is an effort to show that these deaths are not numbers or statistics alone, they represent lifetimes lived sometimes courageously, sometime outrageously, but lived each in its own unique way.  Americans are proud of their individualism and it shows in these descriptions which were culled from obituary pages in papers across the nation and briefly noted here: last names omitted by me: “(Susan, 74 – Palm Beach Florida – loyal and generous friend to many; Morris, 90 – Northbrook Illinois – Endlessly curious, never really finished; April, 33 – Baton Rouge, Louisiana, advocate for disability rights; Cornelius, 84, -  Bellevue Washington, sharecroppers son)”. These are strangers, friends or neighbors, people just around the corner, perhaps, others whom we never knew but who helped make our country what it is today.

Tidbits from here and there:

This weekend The White House noted both Memorial Day and the COVID-19 deaths approaching the 100,000-total mark by flying flags at half staff and ordering that this be done nationwide.  It seems a bit of a tardy response, but hey, better than nothing, as they say. But by Tuesday it will be back to opening up for business everywhere.  The odd declaration by the President that all states must open churches, synagogues and mosques this weekend seemed more political than politic, as religious gatherings at close quarters have presented some of the most often noted sources of infections.  Of course, as was swiftly noted by many commentators, he does not have that right, constitutionally, anyway!

Beaches were crowded along the East Coast as formerly locked down sunseekers headed for the surf and sand nearby.  There were reports of crowds, few masks or social distancing in many places.  This is far too early to break free; it seems to me.

Doctors Without Borders have arrived in the southwest to assist in the virus outbreak in the Navajo Nation and other tribal areas. They are usually known for arriving in third world hot spots with famine and disease outbreaks.  What does this say about American healthcare?

GO Fund Me efforts by these Native Americans have been aided by an outpouring of donations from the country of Ireland which was giving payback for the aid these tribes sent to Ireland during the 1840’s potato famine. So far, the Irish have donated more than $600,00 to support the struggling nations.

COVID-19 Totals from the Centers for Disease Control: 5-24-20 

Total number of cases – US = 1.622,114.   Total number of Deaths = 97,049 about 7,000 more than last week.

Total number of cases in MD = 46,313.      Total number of Deaths = 2,162 approximately 700 more than a week ago.

Return to a problem:

Last week I mentioned that approximately 30% of the deaths in the United States came from patients in nursing homes. That means 30,000 people who could have been protected from infections with a better care system! The first major US COVID-19 outbreak happened in a nursing home in the State of Washington and eventually accounted for 37 deaths in that facility.  Later tests revealed that there were multiple deficiencies in this center, which is part of a nationwide chain of nursing homes.  This home has been fined for inadequately providing for its residents.  Senator Ron Wyden (D-WA) asked the General Accounting Office (GAO) to do a study of incidence of infections in the homes and how Medicare was monitoring this care.  The findings will be summarized below.  

But Senator Wyden was critical of the way HHS is monitoring this care: “This new report shows that warning signs were ignored and nursing homes were unprepared to face a pandemic,” Wyden said. “For years nursing home surveys pointed out areas where federal standards for nursing home safety and enforcement efforts should be improved, but the Trump administration chose not to correct them. Too many seniors and their families have suffered as a result of this pandemic, and there need to be big changes in the way nursing homes care for seniors.”

The report included a pie chart noting that 18% of the homes were not cited for infection control problems.  However, 82% were noted for having infection control prevention deficiencies in one or more years.

The report goes on to note that improper techniques for infection control such as lacking masks and personal protective equipment, while important, were not cited as important an offense as was the inability to isolate a patient with Methicillin Resistant Staph Aureus (MRSA), which is contagious.  It did note that a home was cited in New York State for failure to contain an outbreak of respiratory illness in a previous year which sickened 38 residents. That report went on to say that homes need to isolate persons who are sick with symptoms away from other residents and keep the staff who care for them away from communal areas such as dining rooms.  These are not new concepts, but with lax enforcement and trivial penalties, when cited, many homes do not make the efforts necessary to comply.  For a home of the average size – which is only 108 beds, it may not be easy to set up a separate wing for sick patients as they operate usually at about 80% capacity. Unlike acute care facilities which have gone over to single occupancy rooms, many nursing homes still have rooms which have 2 to 4 occupants. This increases the ease of infection spread and makes it more difficult to relocate patients. Staff turnover is high as the wages are low and new staff is not always well educated on infection control processes.  Medicare (CMS) sets standards and states are required to enforce them; however, homes are usually visited only once a year unless deficiencies are found, which need corrections right away. GAO plans to review these CMS standards more deeply in a future report.

Many do not realize that Medicare only covers and pays for nursing home care in limited circumstances, such as rehabilitation after a hip replacement, for example.  Medicaid, which is jointly funded by the Federal government matching funds with each state individually, accounts as the payer for 62% of nursing home costs; 69% of the nursing homes are for profit businesses.

According to the Kaiser Family Foundation, there were approximately 1.6 million people in nursing home care in the US recently living in some 16,000 facilities. Annual costs without extras – and everything is an extra – averages about $80,000; far beyond the ability of most seniors or their families to afford. Many of the patients in long term care facilities need personal care as 60% have issues with mobility, meaning that they need help getting up and around and may need help using the bathroom, with bathing and getting in a wheelchair or using a walker. This population needs to be protected from falling, as they are often on many medications and have balance and visual perception deficits. These matters require hands on care.  Those who have issues with dementia, or need Alzheimer’s care, have cognition problems and may not comprehend what they need to do or even where they are, which makes their care more difficult.  There are many other concerns such as incontinence, bedsores, over medication and fragility which factor into the need for knowledgeable caring personnel to be able to meet the needs of these often helpless, elderly and keep them safe.  

I do not have a solution for these issues. It seems that there must be a way to take care of these senior citizens who need such direct care and often cannot look after themselves. The physical demands of caring for such ill or debilitated patients is often beyond the capacity of many families, which creates the need. As a society, we have made many medical advances as some people are indeed living to extreme ages; medicine has not, however, helped us learn how to protect these patients and meet their needs in a manner which respects their dignity and treats them as fellow humans.

Until next week, the news keeps driving the agenda.  Who do you think VP Biden should choose as a running mate? Let me hear from you!  Do you have a solution for long term care? What is your opinion on opening up vs. staying home?  What do you think about AG Barr?

Stay safe!

The Faces of COVID-19

Carl Sandburg famously wrote that “fog comes in on little cat feet”, it is silently, suddenly around us. A virus is much like fog; it gives no warning, does not signal its arrival nor does it indicate when it is gone. In New York City its’ presence was noted by the silencing of a busy metropolis, broken only by the omnipresent wail of ambulance sirens and the beeping of the machines keeping patients alive in ICUs and Emergency Departments. It was also known by the faces of those whose lives it took away from our families, nursing homes, neighborhoods, country lanes and city streets. Those faces are old, their heads are gray, they may occasionally be immigrants or young, but most often they are people of color. The statistics are startling.

Another study with partial data indicates Black Americans are approximately 13% of the total population, but are accounting for 27% of the deaths. American Public Media (APM) also reports: “White Americans are dying at elevated rates in eight states (Oklahoma, Rhode Island, Connecticut, Idaho, Texas, Washington, Minnesota and Delaware); Asians in Alaska alone; and Latinos in New York, Missouri and New Hampshire.” A third of all deaths are from people who resided in nursing homes or assisted living facilities. The United States currently has about 1.5 million people living in nursing homes. The variability of care in these homes is a topic for another time.

Research by APM research documents deaths per 100,000 population by the following percentages: (note – not all states are reporting cases with a breakdown by race; Native American deaths will be noted below.)

Asian - 18.4%

Black - 42.8%

Latino - 19.1%

White – 16.6 %

Currently COVID-19 deaths in the United States are right around 90,000 as of this weekend; the number of confirmed cases here is about 1.52 million, making the US total about one-third of all cases in the world.

Last week Maryland (where I live) noted 29,374 cases with 1401 deaths; this week the totals are still rising with the latest reports noting 37,968 total cases with 1957 deaths.

Other studies have looked at Native American deaths in the southwest, primarily in Arizona, Utah and New Mexico and found that social cautions such as hand washing and social distancing do not work well on reservations where fresh water or hand sanitizer is not readily available and social distancing is very difficult in a small dwelling or trailer. Currently the Navajo nation is reporting deaths of 30 per 100,000 in those areas. New Mexico has noted that of the 23 tribal nations in the state, (which comprise 11% of the population), Native Americans account for 42% of the infections in that area.

Immigrants who come to America often take jobs that are less desired by local citizens. That is why meat packing and processing plants are often staffed by new arrivals, some of whom have no work permits. The lack of access to health care, which is often denied to those who do not have documents and passports, means that when they get sick they do not go to the hospital, because they cannot afford it; they stay at home until it is often too late to benefit from care. The clusters of cases around these plants was made worse when the President deemed them essential and decreed that, even in the face of mass outbreaks, these plants must stay open. The inability to understand healthcare warnings for communities with poor English is also another concern seen in these immigrant populations.

Many African Americans, Latinos and Native Americans have high rates of diabetes, obesity and hypertension which leads to other complications when trying to fight a respiratory or systemic disease.  One common factor in the treatment of disease in minority communities is the lack of adequate health care, whether it is on a reservation, an inner-city Hispanic neighborhood or a poor Black community in Mississippi; access to affordable services, follow-up care and medication is often lacking. Several of the states that did not expand Medicaid or placed restrictions on qualifications for its’ services are now seeing disproportionate illness in these communities across many healthcare fronts. Generally, most Americans are unaware that immigrants, or those without documentation, are denied legal access to Federal or State services, except in emergencies.

Black communities, especially, are seeing incidence of COVID-19 both in rural and urban centers, far greater than the proportion of their presence in these counties. The Commonwealth Fund noted that in the higher incidence counties mentioned above that Blacks accounted for one-third of the population, but 53% of the cases and 63% of the deaths. The authors of the study conclude that the United States needs to mandate collection of information about the race of the patients with COVID-19 and then determine how to adequately allocate resources to those affected communities.

Of course, much of this goes back to the absolute mismanagement of this health care pandemic crisis. The President noted we are testing too much as he realized that higher case numbers and continued closed businesses reflected badly on his happy talk agenda. He took none of the blame for his continued fight against the Affordable Care Act (ACA, also known as Obamacare) which has knocked many off the enrollment lists, either from closed clinics, reduced services and lack of access or increased costs, so lack of affordability. The Kaiser Family Foundation noted that the U.S. has now tested 10.7 million people, (not counting the daily tests for those in the White House, of course). We still have to go a long way to meet necessary international standards and do contact tracing and follow-up.

I have been lucky enough, through this crisis, to work from home. I do not have to work in food service, janitorial services or in a nursing home, where I must be exposed to a hostile environment, possibly without adequate protective gear. I do not have to leave my home and take public transportation to arrive at my city job. So, my exposure to COVID-19 is limited, while those mentioned above might have maximum exposures. Is it any wonder then, that one might fall ill?

My state has only opened some areas, my county is not among them, so I am not concerned about crowds of people suddenly streaming by my home or nearby parks and recreations centers, not to mention bars and restaurants. However, I remain concerned about those states that have opened up everything, where people are not wearing masks and some are putting the lure of the dollar for a few, over the health and safety for many.

Well, time to say good evening for now – so many topics I did not get a chance to cover tonight, but there is always next week.  Hope to see you back here and hope to hear from you.  Loved President Obama's remarks on Saturday, so much more to day; stay tuned as they say.

It is All in the Numbers (2)

Back in the Vietnam war era a draft lottery was instituted due to the unpopularity of that war and the reality that the draft was unfairly targeting the less fortunate, those who could not afford to go to college and get deferred, those who could not move to Canada or afford to get a doctors note for some type of injury or disability. So, those who did not serve - such as for heel spurs - perhaps, were spared eventually getting drafted and perhaps going to the war in southeast Asia. Consequently, to try for fairness, random numbers were assigned to birthdays arbitrarily drawn and given a ranking.  The first day drawn that year was number 258 which matched September 14^th and that became number 1.

A certain number of draftees were to be selected, based on projected troop needs and numbers of selectees and that year the numbers stopped at 195 so it was considered important for young men to know their “number” or briefly, their chance at being drafted and they could make some plans as a result. If the number was higher than 195, they essentially had a pass. (These changes to the draft were a first step towards what eventually became what we now know as an all-volunteer military.)

So, once again knowing your numbers has become an important issue for Americans. How is your state fairing against the Covid-19 viral pandemic?  Do you have high infection rates or low ones?  Are you living in an urban area with modest numbers or in a more rural area with high numbers due to meat packing plants, prisons or nursing homes?

Here are some important numbers for today.  

US Population 328.2 million - MD - 6.3 million

Total Covid-19 cases in the US: 1.36 million -  Maryland (where I live) - totals -29,374

Total recovered patients: 208,000                      Maryland - recovered - 2,029

Total Deaths: 80,562                                            Maryland – Deaths - 1401

In the United States statistically, based on previous years data, about eight thousand people a day die from all causes.  In the last flu season approximately 161 people died from influenza each day.  As of May 6, 2020 - 2528 deaths were attributed on that day alone to the Covid-19 virus, just in the US. According to studies done by the New York Times there were three times as many deaths in early April this year in New York, when compared to previous years.

So, one might ask, what is the point here – we know people are dying from this virus.  Well, what is important to know is that the US is having many more deaths proportionately than other countries because our response to this pandemic has been haphazard at best. We did not control the spread and we have not tested enough or tracked for contacts. Currently the Centers for Disease Control (CDC) indicates that only eight million tests have been reported to date. The Presidents touts a number indicating that we have done more testing than any other country, but when compared to our total population, that number is tiny. 

Now, the virus is even reaching the White House where they are rapid testing each day, yet members of the Secret Service and White House staffers have tested positive.  Yet the word from there is to say, we need to open up for the economy, so we’ll probably lose a few more patients that way, but that is the cost of doing business, the country is suffering.  Actually, what is suffering is the President’s re-election bid and he will do everything in his power to get re-elected.  The New York Times today indicated that senior citizens, who are disproportionately afflicted by this virus, are not looking favorably on this president and his lack of candor on the subject.

But never fear – the reason I suggested that you pay attention to these numbers and those in your area is this – there is now a concerted effort by many of those in the right wing media and members of the blogging world to accuse governors, mayors and scientists of overstating the numbers of sick and dying patients just to undermine the President. (Personally, I do not understand just which part of refrigerated trucks full of bodies and burials in mass graves, that they do not understand about an overwhelmed system.) There is a reason behind the “open it up movements” protests, and that is to make it seem that this is much ado about nothing and only scare tactics of the left, but the same people who tried to undermine the ACA, deny climate change and who supported the Tea Party are back again – and probably with Putin’s blessing.  Facebook and Twitter both report removing hundreds of fake accounts touting conspiracy theories on these topics.

The CDC website currently has statistics, which I suggest you keep an eye on, at least as long as the website is not censored.  Apparently the 15-page Guideline it recently sent out for states to use as they reduced restrictions is being held up from wide spread distribution by the Task Force which wishes to tweak it a bit. I wonder about the document that will result. In my opinion we will not, as Jared Kushner recently stated “be rocking as we head into July”. Is your state opening up; do you think it should? Personally, as much as I would love to eat out at a nice restaurant, as long as my state numbers continue to increase, I shall dine at home. There is indeed, much to be afraid of these days, so do stay informed.

So, what else have I not mentioned – there is just so much happening now – AG Barr going around the Rule of Law and attempting to free General Flynn who has pled guilty to a felony – what part of that is untrue?

A young African American jogger is gunned down in Georgia with an attempted cover up as a ‘legal citizen’s arrest’ – is this a Trayvon Martin incident all over again?

Voting by mail – just what tactics will be used to dilute this widespread effort; how will gerrymandering be used to undermine the votes of minorities?

How will we, as a country, deal with the 33 million workers who have filed for unemployment?  How will we feed these huge numbers of needy people?

Do let me know your thoughts.  If you like what I have to say please share this site with your friends.

Covid-19 Virus and us discussions

This blog has lain dormant for several years as life intervened and took up my time. 

However, I am now in a new phase and I have thought a lot about the changes around us regarding how the world has become so different since I last wrote entries in this blog.  In fact, so much was bubbling up in my consciousness that I felt compelled to renew my conversations with you out there, whomever you might be. 

We are now in the fourth – and – I hope, final year of the Trump Presidency.  It has been an experience far worse than I ever thought possible. From President Trumps’ inaugural address invoking American carnage and himself as the savior, the Women’s March the next day, the initial travel ban, and the firing of Sally Yates – we thought nothing could be worse.

After all we had made it through the Russian meddling, Wikileaks, tell all videos and absolute pandering to the far right; we thought we had seen it all.

But, as Slate recently discussed – the corono virus caretaking has been the worst sort of carnage itself and it has all been at Trumps’ bidding; the United States has not only been ill-prepared to address the pandemic, even when confronted with advance notice, it has taken ineffective actions and made inadequate preparations. Now the White House has moved into promoting feel good stories, applauding the well-armed advocates of intimidation for opening up and denouncing the very Governors who are following the guidelines established by the Covid-19 Task force. These well publicized suggestions, which advised opening businesses back up strategically and slowly only after there has been a two-week buffer period demonstrating a downturn in new infections were scientifically established by a panel of experts on contagious disease.

From the first notices back in January till now, I personally can see little that has been done correctly in the handling of this pandemic.  The very nature of a pandemic means that it is a happening of extra ordinary circumstances and requires comprehensive measures to keep it as limited as possible.  None of this has happened in this instance.  We, as a country, have not tracked the outbreak nor stepped in front of its path.  We did not adequately quarantine, test travelers to our shores nor define contacts – the first step in public health options for containing infectious diseases.  None of the safety net measures, such as stockpiles of emergency equipment, masks and medications were on hand for rapid distributions to outbreak centers.  No one was prepared for the virulence of this virus and how it attacked multiple body organs and systems; that I do not fault the administration for, but they should have been prepared for a lesser illness and they could not even address those needs.  So now, in about eight short weeks, we have suffered more than 68 thousand deaths and counted more than 1.1 million infections in the US alone, and seen the unemployment figures rise to 30 million people – real people who have lost real jobs abruptly. How will they survive and care for their loved ones? The stock market has tanked and dropped billions from elderly adults’ retirement accounts; how will they survive in the future when these funds do not return?

College students are graduating into an uncertain world with new parameters. Current students do not know what kind of academia they will return to – yet our government wants to compel workers who are ill to return to jobs in contaminated meat packing plants and Republican governors threaten to deny benefits to those who say they fear returning.  What kind of a world is being created here as Senate Leader Mitch McConnell cheerfully muses about making blue states declare bankruptcy and deny pension benefits to retirees and union members?  I am curious to hear what is happening in the real world, away from TV cameras and news stories.

So - How are you weathering the stay at home guidelines? Are you able to work from home and have a seamless transfer of job duties or has your job shut down because it can only be done face to face in close contact with customers or clients? Do you find yourself bouncing between job duties, teaching chores and child care?  Do you find yourself trying to cook a dinner from the remnants found in your freezer and food pantry because you fear a trip to the grocery store?

Have you or your family become afflicted by this virulent virus?  Have you lost an elderly grandparent who resided in a nursing home? Maybe your state did not shut down at all; would you have felt safer if it did? Are you in a state such as Georgia and Florida, opening up in some places and closed in others?  Or is all okay in your world?

Have you tried to obtain one of those small business loans from the government without success; or have you tried to reach your local unemployment office but given up?  Do you feel that it is right for big companies to get billions of taxpayer dollars, yet red tape ties your application up?

There is so much more that I want to say, but I know that I cannot say it all at once – such as what abut protective equipment for nurses, doctors and first responders, or adequate numbers of ventilators, or widespread testing – yes I know, so much to have questions for with few answers.

I’ll try to get to each of these soon, but first let’s get this new post out there and let me hear back from you.