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Medical personnel are severely affected by COVID-19 and some even young of them died. The deaths of doctors in their 20s and 30s in China naturally sparks concern about the coronavirus' risk to younger people. But the reality is that the doctors' deaths highlight an unfortunate reality of any new and evolving outbreak: Healthcare workers on the front lines face a higher risk of contracting the disease due to very high expose to the virus aka "virus load" ( How Does the Coronavirus Behave Inside a Patient- - The New Yorker ):
Could the striking severity of their disease—twenty- and thirty-year-olds with covid-19 generally experience a self-limited, flu-like illness—be correlated with the amount of virus to which they were initially exposed? At least two E.R. doctors in the United States, both on the front lines of the pandemic, have also fallen critically ill; one of them, in Washington State, is only in his forties.
To go by available data from Wuhan and Italy, health-care workers don’t necessarily have a higher fatality rate, but do they suffer, disproportionately, from the most severe forms of the disease? “We know the high mortality in older people,” Peter Hotez, an infectious-disease specialist and vaccine scientist at Baylor College of Medicine, told CNN. “But, for reasons that we don’t understand, front-line health-care workers are at great risk for serious illness despite their younger age.”
For married medical personnel who are tested positive it might make sense to organize special quarters in order not to infect family members and to speed up recovery. That's what China actually did -- all tested positively went to hospitals not to self-isolation.
|For married medical personnel who are tested positive it might make sense to organize special quarters in order not to infect family members and to speed up recovery. That's what China actually did -- all tested positively went to hospitals not to self-isolation.|
Healthcare workers are particularly vulnerable to COVID-19 for a handful of reasons. First, the coronavirus is highly contagious, and medical staff members are exposed to more viral particles than the general public because they interact with so many sick people.
Exhaustion is another reason medical workers have high vulnerability to infection
Others include lack of training in personal protective equipment, contaminated surfaces, close contact with sick patients, and typical for situation during epidemics — medical personnel working outside their area of expertise.
In a crisis situation without proper training, medics rushing to the front then easily became infected, and spread infections to others.
Once you get an infected healthcare worker, then there’s extra workload on the others.
Only the people trained ... should be allowed to have access to sick pacients in highly infectionpous environment.
On early stages of epidemic in China out of 138 patients studied at one Wuhan hospital, 29% were healthcare workers. One coronavirus patient was initially sent to the wrong ward because they displayed atypical symptoms, so went on to infect at least 10 medical workers.
60% of of the initial set of Wuhan medics were infected. Number of critical cases was slight higher then in general population. More then a dozen died. Health workers fighting coronavirus in China die of infection, fatigue - Los Angeles Times by Alice Su (Feb 25, 2020)
Chinese health authorities and a team from the World Health Organization reported Monday evening that 3,387 health workers in China had been infected with COVID-19, more than 90% of whom were in Hubei province, the outbreak’s ground zero.
... ... ...
The Times counted at least 18 reported deaths of medical workers involved in the COVID-19 response as of Monday, including nurses and doctors who died not because of infection but because of cardiac arrest or other ailments due to overwork and fatigue. One victim was hit by a car while taking temperatures on a highway.
The most recent were three doctors who died in one day, all infected with COVID-19. One of them, Xia Sisi, a gastroenterologist in Wuhan, was 29. Another physician, Peng Yinhua, also 29, died in Wuhan of infection on Feb. 20. He had delayed his Feb. 1 wedding, promising his pregnant fiancee they’d have the ceremony after the outbreak had passed.
Most of the infected medical workers are in Hubei, many of them part of the initial response in Wuhan, when shortages of protective gear, understaffed hospitals and transportation shutdowns collided with an overwhelming number of patients. The stories of doctors and nurses tell of clever improvisation and quiet perseverance in a war against a mysterious virus.
A doctor in Wuhan told The Times in a phone interview Jan. 29 that 12 out of 59 doctors in his hospital were showing symptoms of the virus, including lung infections — but continued to treat patients while wearing insufficient protective gear.
Since then, he and other medical workers have been told to stop speaking to the press.
The death of Wuhan front-line nurse Liu Fan, 49, is a diary of how cruel and ravenous the virus is.
Liu’s brother, Chang Kai, a film director, wrote a final letter describing what had happened to his family. All four members were infected with the virus after being quarantined at home in close quarters. Unable to get a hospital bed amid Wuhan’s shortage, Chang’s father died at home Feb. 3. His mother died Feb. 8.
Addressing his son in London, Chang’s letter reads: “I went to hospitals begging and weeping, but I am too low and insignificant.... All my life I’ve been a faithful son, a responsible father, a loving husband, an honest person. Farewell! To those I love and those who love me.”
Chang died on Feb. 14; Liu hours later.
A doctor in Wuhan tends to a coronavirus patient
A doctor attends to a coronavirus patient in an isolation ward at a hospital in Wuhan. (Chinatopix)
There are also deaths from overwork. They include Song Yingjie, a 28-year-old pharmacist, who was single-handedly managing his hospital’s medicine prescriptions, then checking temperatures at a highway stop at night. He worked until midnight on Feb. 2, standing on the roadside in freezing wind, according to a colleague who was with him. It was his 10th consecutive day on the virus response team.
He was found dead in his hospital dormitory the next afternoon. The cause was cardiac arrest from exhaustion.
Another was Wang Tucheng, 37, a doctor in Henan’s Xinwangzhuang village who was found dead on Feb. 10 in his clinic. His diagnosis was also cardiac arrest due to overwork and fatigue.
In Nanjing, Xu Hui, leader of a hospital’s virus control group, worked for 18 days straight, then went home after a meeting on Feb. 6, “lay down and never got up,” according to state media. She was 51.
Exhaustion is one reason medical workers have high vulnerability to infection, said John Nicholls, a Hong Kong University pathologist who worked on the 2003 SARS outbreak (he never saw deaths from overwork during the fight against severe acute respiratory syndrome, though). Others include lack of training in personal protective equipment, contaminated surfaces, close contact with sick patients, and — perhaps most pertinent to China’s situation — people operating outside their area of expertise.
When SARS broke out, doctors from different departments were asked to join the front lines, Nicholls said. But many medical workers weren’t properly trained for procedures such as intubation in a high-risk infectious disease environment.
In a crisis situation without proper training, medics rushing to the front then easily became infected, and spread infections to others. Nicholls sees a similar pattern with COVID-19.
“I’m not surprised. I’m disappointed that people didn’t learn from SARS,” he said. “The worse thing is once you get an infected healthcare worker, then there’s extra workload on the others.”
“There has to be a sense that only the people trained ... should be allowed to have access, not to allow any people who are willing but maybe not properly trained with the skills,” he said.
China has sent tens of thousands of medical workers from all over the country to bolster relief efforts in Wuhan. It’s a major focus of state propaganda. The narrative features few details on whether the teams receive protective training or other safety measures. Instead, many state videos play inspirational music as doctors and nurses pump their fists, shout patriotic slogans, and prepare for “battle.”
Gaochao Zhang and Nicole Liu of The Times’ Beijing bureau contributed to this report.
Oct 06, 2020 | www.moonofalabama.org
bevin , Oct 4 2020 15:16 utc | 13
Discussion of Trump's illness tends to obscure the reality that he, unlike most Americans and others who suffer from the virus, is getting proper treatment and all the necessary care to deal with the virus.
Most of those who have died did not get anything like that treatment, indeed they were left to die by Healthcare systems which are almost all infected by obsessions with profit and efficiency which have led to the dismantling- often in 'socialised' systems such as those in the UK and Canada- of nursing staffs and ICU capacity.
The truth is that Covid has exposed the fault lines in capitalist class society and the result has been that a million people have died, many of them, it looks increasingly clear, because the capitalists regard them as expendable, and politicians are confident that even if they decimate the electorate and kill off the elderly in every family they will still be able to convince the survivors that such behaviour is acceptable.
In Ontario, disabled people are charging the hospital system with having adopted a triage protocol which, essentially, puts patients with disabilities at the bottom of the list when treatment is being rationed. This is a practice which long pre-dates the current pandemic, as do many of the administrative malpractices which have contributed to death tolls in the "west" far exceeding those in the Far East where life is more valued.
In the UK the SKAWKBOX blog has released an Amnesty report which it describes as having destroyed government claims
"..that the Tories 'threw a protective ring' around care homes during the first wave of the coronavirus pandemic."
It suggests that
"*the huge number of deaths caused by COVID-19 in care homes – well over 18,000 at the very least, but in reality almost 30,000 based on 'excess' deaths attributable to likely undiagnosed cases
breach of residents' human rights by the government's behaviour
"*the fact that the government knowingly put the people most at risk of the worst effects of the virus in the firing line
"*the fact that returning known-infected patients back to care homes on a huge scale was government policy (it still is, despite claims to have changed it)
*the government telling care homes not to use PPE (personal protective equipment) with asymptomatic infected patients
*blanket 'do not resuscitate' orders on elderly residents without regard for their or their family's wishes
*protected the NHS' by denying treatment to older and more vulnerable sufferers – condemning thousands to a hideous death – 'protection' that the Tories consistently boasted about.
"The report also details multiple ways in which government policies denied care home residents their human rights and put them at risk of inhumane treatment.... the report concludes – and says so in its title – that residents were treated as 'expendable'.
"That's geriatricide – the murder of our old and vulnerable."
Jun 22, 2020 | news.yahoo.com
PARIS (Reuters) - French protesters on Saturday doused the country's health ministry with red paint, to symbolize the blood of those who died from COVID-19 and to demonstrate against poor working conditions for public sector healthcare workers.
"For years, health workers have been alerting us to the fact they don't have enough resources with regards to staff, beds and equipment to be able to allow us to look after people decently," Aurelie Trouve, a spokeswoman for the 'Attac' activist group which was behind the protest, told Reuters.
They also placed a giant, medal-shaped banner dubbed 'Medal of Contempt' on the steps of the French health ministry, to highlight what they said was the government's failure to listen to the concerns of healthcare workers.
President Emmanuel Macron's government has decided to pay a 1,500 euros ($1,676) bonus to public sector healthcare workers, in recognition of their role during the coronavirus outbreak.
Yet many in the sector feel the government should do more for them, and violence broke out this week at another protest held by healthcare workers in Paris.
Jun 18, 2020 | angrybearblog.com
anne ,June 16, 2020 11:05 am
June 16, 2020
Most Coronavirus Tests Cost About $100. Why Did One Cost $2,315?
U.S. health care prices are unregulated, opaque and unpredictable. When Congress required insurers to cover Covid-19 testing, a few providers decided to take advantage.
By Sarah Kliff
In a one-story brick building in suburban Dallas, between a dentist office and a family medicine clinic, is a medical laboratory that has run some of the most expensive coronavirus tests in America.
Insurers have paid Gibson Diagnostic Labs as much as $2,315 for individual coronavirus tests. In a couple of cases, the price rose as high as $6,946 when the lab said it mistakenly charged patients three times the base rate.
The company has no special or different technology from, say, major diagnostic labs that charge $100. It is one of a small number of medical labs, hospitals and emergency rooms taking advantage of the way Congress has designed compensation for coronavirus tests and treatment.
"We've seen a small number of laboratories that are charging egregious prices for Covid-19 tests," said Angie Meoli, a senior vice president at Aetna, one of the insurers required to cover testing costs.
How can a simple coronavirus test cost $100 in one lab and 2,200 percent more in another? It comes back to a fundamental fact about the American health care system: The government does not regulate health care prices.
This tends to have two major outcomes that health policy experts have seen before, and are seeing again with coronavirus testing.
The first is high prices over all. Most medical care in the United States costs double or triple what it would in a peer country. An appendectomy, for example, costs $3,050 in Britain and $6,710 in New Zealand, two countries that regulate health prices. In the United States, the average price is $13,020.
The second outcome is huge price variation, as each doctor's office and hospital sets its own charges for care. One 2012 study found that hospitals in California charge between $1,529 and $182,955 for uncomplicated appendectomies.
"It's not unheard-of that one hospital can charge 100 times the price of another for the same thing," said Dr. Renee Hsia, a professor at the University of California, San Francisco, and an author of the appendectomy study. "There is no other market I can think of where that happens except health care."
There is little evidence that higher prices correlate with better care. What's different about the more expensive providers is that they've set higher prices for their services.
Patients are, in the short run, somewhat protected from big coronavirus testing bills. The federal government set aside $1 billion to pick up the tab for uninsured Americans who get tested. For the insured, federal laws require that health plans cover the full costs of coronavirus testing without applying a deductible or co-payment.
But American patients will eventually bear the costs of these expensive tests in the form of higher insurance premiums. In some cases, they are paying for additional tests, for flu and other respiratory diseases, that doctors tack onto coronavirus orders. Those charges are not exempt from co-payments and can fall into a patient's deductible.
Those kinds of bills could make patients wary of seeking care or testing in the future, which could enable the further spread of coronavirus. In an April poll, the Kaiser Family Foundation found that most Americans were worried they wouldn't be able to afford coronavirus testing or treatment if they needed it .
Jun 16, 2020 | turcopolier.typepad.com
Deap , 15 June 2020 at 11:49 AMWalrus, another topic doctors talk about privately are the well-known "bad doctors" who keep getting free passes mistake after mistake, and often sit on hospital quality review committees.
As well as talking among themselves about the large numbers of iatrogenic deaths, caused by the medical community itself, which have long exceeded the numbers of "corona" deaths, ginned up covid numbers or not.
Be well and thrive.
Jun 12, 2020 | www.bloomberg.com
- Leonard Green borrowed for dividends of more than $500 million
- Prospect Medical says has invested in hospitals, improved care
May 20, 2020 | www.bloomberg.com
Not long after Gavin Newsom, the governor of California, ordered the state's 40 million residents to stay home to stop the spread of the new coronavirus, Dr. Greg Morganroth called his team of doctors and said their dermatology group was staying open.
Morganroth is chief executive officer of the California Skin Institute , which he founded in 2007 as a single office in Mountain View. He's since expanded to more than 40 locations using a financing strategy that's become exceedingly common in American health care: private equity. In this case, he took out a loan from Goldman Sachs Group Inc. that could eventually convert to an equity stake. CSI is now the largest dermatology chain in California.
But the Covid-19 pandemic put Morganroth in a precarious position. Most medical procedures were characterized as nonessential by government officials and practitioners. Doctors were closing offices, and patients were staying away to limit their potential exposure to the virus.
CSI took a different approach. Morganroth explained his thinking on April 2 in a Zoom call with more than 170 dermatologists from around the country organized by the Cosmetic Surgery Forum, an industry conference. Contrary to what they might have heard, Morganroth told them, they should consider staying open during the pandemic. "Many of us are over-interpreting guidelines," he said.
For a moment there was an awkward silence. Doctors had thought they were signing up for advice on how to apply for government money that would help them meet payroll while they were shut down; they hadn't expected to be told not to shut down at all. Morganroth continued: "We are going to be in a two-year war, and we need to make strategic plans for our businesses that enable us to survive and to rebound."
Back at CSI, the company's front-office staff was working the phones, calling patients in some of the worst-hit areas and reminding them to show up for their appointments, even for cosmetic procedures such as Botox injections to treat wrinkles. During the videoconference, Morganroth argued that offering Botox in a pandemic wasn't so different from a grocery store allowing customers to buy candy alongside staples.
"If I had a food supply company and had to stay open, and I had meat, bread, and milk, would I stop making lime and strawberry licorice?" Morganroth asked. "I would make everything and go forward."
From a public-health point of view, some of the doctors believed, this was questionable. Common reasons for visiting a dermatologist's office -- skin screenings, mole removals, acne consultations -- aren't particularly time sensitive. Serious matters, such as suspected cancers and dangerous rashes, can be handled, at least initially, with telemedicine consultations . Then doctors can weigh the risks for their patients and determine who needs to come in. In a statement, CSI says that it followed local and state laws for staying open, while providing "necessary care" for patients, and that it had not required doctors to come to work.
"You can't serve two masters. You can't serve patients and investors"
Morganroth's defense of pandemic Botox might seem odd, but it made perfect sense within the logic of the U.S. health-care system, which has seen Wall Street investors invade its every corner, engineering medical practices and hospitals to maximize profits as if they were little different from grocery stores. At the center of this story are private equity firms, which saw the explosive growth of health-care spending and have been buying up physician staffing companies, surgery centers, and everything else in sight.
Over the past five years, the firms have invested more than $10 billion in medical practices, with a special focus on dermatology, which is seen as a hot industry because of the aging population. Baby boomers suffer from high rates of two potentially lucrative conditions: skin cancer and vanity. Some estimates suggest that private equity already owns more than 10% of the U.S dermatology market. And firms have started to expand into other specialties, including women's health, urology, and gastroenterology.
There's nothing inherently wrong with any of this. But some doctors say that the private equity playbook, which involves buying companies, drastically cutting costs, and then selling for a profit -- the goal is generally to make an annualized return of 20% to 30% within three to five years -- creates problems that are unique to health care. "I know private equity does this in other industries, but in medicine you're dealing with people's health and their lives," says Michael Rains, a doctor who worked at U.S. Dermatology Partners , a big private equity-backed chain. "You can't serve two masters. You can't serve patients and investors."
Investment firms, and the practices they fund, say these concerns are overblown. They point out that they're giving doctors a financial shelter from the rapidly changing medical environment, a particularly attractive prospect now, and that money from private equity firms has expanded care to more patients. But they've also made it next to impossible to track the industry's impact or reach. Firms rarely announce their investments and routinely subject doctors to nondisclosure agreements that make it difficult for them to speak publicly. Bloomberg Businessweek spoke to dozens of doctors at 10 large private equity-backed dermatology groups. Those interviews, along with information obtained from other employees, investors, lawyers, court filings, and company records, reveal how the firms operate, and why they sometimes fail patients.
The process is never exactly the same, but there are familiar patterns, which tend to play out in five steps.Step 1: Marriage
The strange thing about private equity money in medicine is that for-profit investors have long been prevented from buying doctor's offices. Corporate ownership goes against a doctrine set by the American Medical Association , the main trade group for doctors in the U.S., and is prohibited by law in many states, including Texas and New Jersey. For most of the past 100 years, if you wanted to make money on a medical practice, you needed to have a medical license.
Yet over the past decade, lawyers devised a structure that allows investors to buy a medical practice without technically owning it: the MSO, or management service organization. Today, when an investment firm buys a doctor's office, what it's actually buying are the office's "nonclinical" assets. In theory, physicians control all medical decisions and agree to pay a management fee to a newly created company, which handles administrative tasks such as billing and marketing.
In practice, though, investors expect some influence over medical decision-making, which, after all, is connected to profits. "When we partner with you, it's a marriage," said Matt Jameson, a managing director at BlueMountain Capital, a $17 billion firm that recently invested in a women's health company, while speaking at a conference in New York in September. "We have to believe it. You have to believe it. It's not going to be something where clinical is completely not touched." (When contacted by Businessweek , Jameson asked to clarify his comments. "Doctors and other qualified healthcare professionals at the providers we've invested in make medical decisions," he said in a statement.)
The typical buyout starts with the acquisition of a big, popular practice, often with multiple doctors and several locations, for as much as $100 million. (Investors typically pay between 9 and 12 times annual profit.) This practice functions as an anchor, like a name-brand department store at a shopping mall, attracting patients and doctors to the new group as it expands. Then comes the roll-up: The private equity firm purchases smaller offices and solo practices, giving the group a regional presence.
As part of the new structure, investors deal with paperwork and save money by buying medical supplies in bulk. Crucially they also negotiate higher insurance reimbursement rates. One dermatologist who sold her practice to the California Skin Institute says she was surprised to find out the bigger group's payouts from insurers were $25 to $125 more per visit.
When individual doctors sell, they generally receive $2 million to $7 million each, with 30% to 40% of that paid in equity in the group. After the acquisition, doctors get a lower salary and are asked to help recruit other doctors to sell their practices or to join as employees.
At first, doctors are generally thrilled by all of this. They have financial security and can focus on treating patients without the stress of running a business. Patients, for the most part, are in the dark. Unlike when your mortgage changes hands, you usually aren't notified when a big investment firm buys your doctor. Sometimes the sign on the door bearing the physician's name stays put, and subtle changes in operations or unfamiliar fees may be the only clues that anything has happened.
Step 2: Growth
The promise of more patients is a big draw for doctors. By sharing marketing costs and adding locations, the new companies can advertise more and attract customers. Private equity-owned practices have been diligent users of social media, announcing newly added doctors and posting coupons on Twitter and Instagram. But these practices can be aggressive in ways that make some doctors uncomfortable.
At Advanced Dermatology & Cosmetic Surgery , the largest private equity-backed group in the field, with more than 150 locations across the U.S., that sense of discomfort came shortly after Audax Group bought a controlling stake in what was then a much smaller chain in 2011. The new management team introduced a scorecard that rewarded offices with cash if they met daily and monthly financial goals, according to a lawsuit filed in 2013 against the company by one of its dermatologists. The doctor alleged that the bonus program encouraged staff to do as many procedures as possible, rather than strictly addressing patients' medical needs.
In some of the company's Florida offices, the doctor alleged, medical assistants responded to the bonus structure by ticking extra boxes on exam reports, stating that doctors checked many more areas of the body than they actually had. That led to higher patient bills, defrauding the government under its Medicare program, according to the lawsuit. The federal government declined to join the case, and it was dismissed about a year after it was filed. Advanced and Audax declined to comment.
One-Stop Skin Care
By buying up labs and adding specialists, private equity-owned dermatology groups get paid at every step of a patient's treatment.
Data: Estimated Medicare reimbursement rates for the Miami area, Sensus Healthcare sales presentation
Private equity-backed practices also try to increase revenue by adding more-lucrative procedures, according to doctors interviewed by Businessweek . In dermatology, this means more cosmetics, laser treatments, radiation, and especially Mohs surgeries -- a specialized skin cancer procedure that removes growths from delicate areas like the face and neck one layer at a time, to limit scarring. The surgery involves expensive equipment and specialized doctors, so some large medical groups keep costs down by assembling traveling Mohs teams, who fly in from other states. Others create mobile labs in vans that set up in clinics' parking lots.
Most dermatologists use outside labs and pathologists, but private equity-owned groups buy up existing labs and hire their own pathologists. Then doctors are encouraged to refer patients within the group and send biopsy slides to the company-owned labs, keeping the entire chain of revenue in-house. This takes advantage of a regulatory quirk that has made dermatology, and a handful of other specialties, attractive to private equity. Under the 1989 Stark Law, doctors aren't allowed to make patient referrals for their own financial gain. An exception was made for some fields because it's more convenient for patients, explains Dr. Sailesh Konda, a Mohs surgeon and professor at the University of Florida. "But that can be abused."Step 3: Synergy
Now comes the cost-cutting. This is supposed to be the hallmark of private equity, and, done right, it can work to the benefit of doctors and patients. But there are pitfalls unique to medicine, where aggressive cuts can lead to problems, some of them merely inconvenient and some potentially dangerous.
A doctor at Advanced Dermatology says that waiting for corporate approvals means his office is routinely left without enough gauze, antiseptic solution, and toilet paper. Even before the great toilet paper shortage of 2020, he would travel with a few rolls in the trunk of his car, to spare patients when an office inevitably ran out. The company declined to comment.
At the country's second-biggest skin-care group, U.S. Dermatology Partners , a former doctor says a regional manager switched to a cheaper brand of needles and sutures without consulting the medical staff. The quality was so poor, she says, they would often break off in her patients' bodies. Mortified, she'd have to dig them out and start over. She complained to managers but couldn't get better supplies, she says. Paul Singh, U.S. Dermatology's CEO, says the company uses a "reputable, global vendor for medical supplies." "While our group may have standardized purchasing processes, individual providers have the autonomy to procure specific supplies that they need for a particular patient situation or patient population," he says in a statement.
Doctors who join a private equity-backed group generally sign contracts that state they'll never have to compromise their medical judgment, but some say that management began to intervene there, too. Dermatologists at most of the companies say they were pushed to see as many as twice the number of patients a day, which made them feel rushed and unable to provide the same quality of care. Others were forced to discuss their cases with managers or medical directors, who asked the doctors to explain why they weren't sending more patients for surgery. Multiple practices also encouraged doctors to send home Mohs surgery patients with open wounds and have them come back the next day for stitches -- or to have a different doctor do the closure the same day -- because that would allow the practice to collect more from insurers.
That's if doctors are performing the procedures at all. At Advanced Dermatology, several doctors say they were asked to claim that physician assistants, or PAs, were under their supervision when they weren't seeing patients in the same building, or even the same town. Because PAs are paid less than dermatologists, this allowed the company to keep costs low while growing the business. In a statement, Eric Hunt, Advanced's general counsel and chief compliance officer says that having PAs on staff enables the company to "provide access to quality dermatological care to more patients."Step 4. Rolling Up the Roll-Up
Advanced Dermatology was sold in 2016 by Audax to Harvest Partners LP , following a pattern that's typical in the industry. At some point, after costs have been cut and profits maximized, most private equity-owned medical groups will be sold, often to another private equity firm, which will then try to somehow make the company even more profitable.
Having reduced most of the obvious costs, Advanced Dermatology began skimping on more important supplies, including Hylenex, according to doctors and other employees. The drug is an expensive reversal agent used when cosmetic fillers, which are supposed to make skin look plumper, go wrong. Not having enough is dangerous: Patients who get an injection that inadvertently blocks a blood vessel can be left with dead sections of skin or even go blind if they don't get enough Hylenex in a matter of hours. The company says that it stocks Hylenex in every office that performs cosmetic procedures, and that it "has no records of any provider being denied an order for this medication."
Advanced Dermatology also started giving even more authority to PAs, according to doctors and staff. Without enough oversight some were missing deadly skin cancers, they say. Others were doing too many biopsies and cutting out much larger areas of skin than necessary, leaving patients with big scars. Doctors who complained about the bad behavior say they saw PAs moved to other locations rather than fired or given more supervision. Hunt, the company's lawyer, says that all PAs get six months of training and are supervised by experienced doctors.
The staff coined a new medical diagnosis, "pre- pre- pre-cancer"
Advanced Dermatology also put more pressure on doctors to send biopsies to in-house labs. The move made sense financially, but some of the doctors didn't trust the lab. One of its two pathologists in Delray Beach, Fla., Steven Glanz, had a history of misdiagnosing benign tumors, which led patients to undergo surgeries that were later found to be unnecessary, according to doctors who worked with him. Dermatologists who warned that Glanz was a danger to patients say that their complaints to Dr. Matt Leavitt, the group's founder and CEO, were ignored. More procedures, doctors knew, brought in more money.
Glanz, who had been with the practice since its early days, was known to read slides under a microscope with a pistol on his desk. After he was arrested with a handgun, a folding knife, and a vial of methamphetamine crystals, he was fired and Florida's state medical board fined him $10,000, requiring him to complete a five-hour course on ethics before he could resume practicing. But his former colleagues were unsettled; they knew Glanz's signature was on years of reports that determined treatment for patients. Some slides were reevaluated, and pathologists noticed mistakes. Managers told some doctors and their staff that patients, even those who'd been misdiagnosed and had unnecessary procedures, were not to be told. Glanz pleaded guilty to stalking and a firearms violation and was sentenced to probation. When a reporter called his office and identified herself, the receptionist hung up. Further attempts to reach Glanz were unsuccessful. Advanced's Hunt says that he was "formally released from employment three years ago," but did not comment further.
Of course, some doctors pushed ethical boundaries long before private equity came into the picture. But critics of the industry, including doctors and investors, say management teams put in place by private equity firms tend to look the other way as long as a medical practice is profitable. Of the dermatologists with the highest biopsy rates in the country (between 4 and 11 per patient, per year), almost 25% were affiliated with private equity-backed groups, according to Dr. Joseph Francis, a Mohs surgeon and data researcher at the University of Florida.
Medical providers may have also been blurring ethical lines at U.S. Dermatology Partners, which was until recently on its second private equity owner, Abry Partners LLC . At four of the company's offices in Texas, a doctor and his PAs were doing more biopsies than necessary, according to employees. These employees say the staff routinely called patients with benign lichenoid keratosis, small brownish blotches that usually go away on their own, and told them the growths should be removed. Under instruction from the doctor, the staff coined a new medical diagnosis, "pre- pre- pre-cancer," and then talked patients into coming in for removal, employees say. Singh, the U.S. Dermatology CEO, says that the company trusts doctors to make the right decisions and that it monitors them through routine audits.Step 5: Sell-Off
In some cases the cost-cutting either becomes impossible or leads to compromises in care too obvious to ignore. In 2016 a DermOne LLC office in Irving, Texas, had been using a faulty autoclave machine to sterilize surgical equipment -- the state and county health departments identified 137 patients that needed to get tested for blood-borne diseases such as HIV and hepatitis. By 2018, DermOne's backer, Westwind Investors, wanted out.
Westwind had been one of the earliest firms to build a big dermatology business -- with practices in five states -- but others had grown larger. After the debacle in Irving, the Nevada-based firm sold DermOne's medical records and patient lists, as well as some of its offices, to other groups. It dissolved the remaining offices, leaving some patients abruptly without care. Westwind did not respond to repeated requests for comment. Two other private equity-backed groups, TruDerm and Select Dermatology LLC, have also gone out of business in the past two years.
The surviving chains have been saddled with large piles of debt they're now struggling to repay. In January, U.S. Dermatology Partners defaulted on a $377 million loan, meaning the private equity backer, Abry Partners, had to hand over the keys to its lenders, Golub Capital , Carlyle Group , and Ares Management , which will now oversee a chain with almost 100 locations, receiving 1 million visits from patients a year. Abry did not respond to requests for comment .
For the medical groups that make it, the game plan is to eventually sell to the largest players, such as KKR , Blackstone Group , and Apollo Global Management . Pioneering investors, including Audax, are now buying practices in other fields -- a concerning development to critics who note that the areas that are currently attracting investment, such as urology, generally involve more invasive procedures. Should doctors performing vasectomies be thinking about the dollar-rate returns for KKR -- or any private investor?
"It's ultimately going to backfire," says Dr. Jane Grant-Kels, a veteran dermatologist and professor at the University of Connecticut School of Medicine. "There's a limit to how much money you can make when you're sticking knives into human skin for profit."
One paradox of the Covid-19 pandemic has been that even as the virus has focused the entire country on health care, it's been a financial disaster for the industry. And so, while emergency room doctors and nurses care for the sick -- comforting those who would otherwise die alone, and in some cases dying themselves -- private equity-backed staffing companies and hospitals have been cutting pay for ER doctors. These hospitals, like the big medical practices, make a large portion of their money from elective procedures and have been forced into wrenching compromises.
For investors with capital, on the other hand, the economic fallout from the virus is a huge opportunity. Stay-at-home orders have left small practices more financially strained than they've ever been. That will likely accelerate sales to private equity firms, according to Marc Cabrera, an investment banker focused on health-care deals at Oppenheimer & Co. Independent doctors or groups that previously rebuffed offers from deep-pocketed backers "will reconsider their options," he says.
Many doctors may ultimately come to regret cashing out, but it's hard to get out once you're in. As part of an acquisition, the private equity groups typically require doctors to sign yearslong contracts, with noncompete clauses that prevent them from working in the surrounding area.
As governors throughout the nation ease restrictions on businesses, Advanced Dermatology is opening its most profitable offices first. The company received an undisclosed sum under the Cares Act, as part of the government relief package intended for health-care workers. Hunt, Advanced's chief compliance officer, told employees in an email earlier this month that the money would be used for protective gear, such as masks, and to replace "millions of dollars" in lost revenue.
The group had closed most of its offices since the stay-at-home orders were issued in March, cutting pay for doctors and furloughing staff. With cities and states beginning to consider reopening, doctors and PAs say they've been told they should be prepared for a full schedule. Hunt says the company is following the appropriate safety measures, but employees fear it will be nearly impossible to keep patients apart in waiting rooms. Opening in a reduced capacity, they understand, is not an option.
Read more: Private Equity Ate Finance, and Now It's Taking Over the World
The vast majority of America's nurses say they have not been tested for Covid-19, are reusing personal protective equipment (PPE), or have exposed skin or clothing while caring for Covid-19 patients, a new survey has shown.
The nationally representative survey finds that "dangerous healthcare workplace conditions have become the norm" since Covid-19 spread widely in the US, said the union which conducted the survey. More than 100 nurses have died since the beginning of the pandemic .
"We've known for years we're behind," said Jean Ross, president of National Nurses United. "Not because we couldn't have what we needed – because we are the richest country on the planet – but because of greed, because of the profit system that doesn't really look out for the welfare of patients. Therefore it couldn't possibly look out for the welfare of workers." ...
The survey asked more than 23,000 nurses across all 50 states and Washington DC about their working conditions since the pandemic began. The survey represents the period between 15 April and 10 May, and was conducted by National Nurses United. It included both union and non-union nurses.
In it, surveyors found 84% of nurses had not been tested for Covid-19, 87% are forced to reuse personal protective equipment designed to be single-use, such as N95 masks and face shields, and 72% of nurses have exposed skin or clothing while treating coronavirus patients.
May 19, 2020 | www.moonofalabama.org
oldhippie , May 18 2020 18:15 utc | 48Analysis begins with close reading.
The BMJ article in top post refers to mild and moderate cases. All cases are hospitalized cases. What exactly does it mean to hospitalize a mild case? Is that standard practice for covid? The article has some discussion on this point but it basically makes no sense. Patients excluded from study does not begin to include all those who would ordinarily be contraindicated for HCQ. Then dosages of 1200mg per day to start are flat twice what is recommended by Raoult. After 3 days dosage cut to 800mg, which is still high. Dosage continued for two to three weeks where others would end after ten days.
The Economist article from top post is so badly in need of basic copy editing it just makes no sense at all. Perhaps the publication has given up on editing since that interferes with the constant right wing propaganda onslaught. Currently owned by Rothschilds.
I could give some notes here on actual clinical practice as given to me by those treating patients but old friends and HIPPAA have a lot of conflicts. Suffice it to say that politics is altering clinical practice. Which reminds of the article above about Utah. Utah is a theocracy. A theocracy of cranks and cultists. No, that does not mix with science.
If this comment is not yet suitable for deletion some notes on the pandemic as seen from Cook County (Chicago). The current case count is up to 62,000, deaths nearing 3000. There is no panic in the streets. A heavy blanket of fear uncertainty and doubt covers the city, there is no panic. More than 1% of the population is supposedly positive but everyone is asking each other "Do you know anyone who is sick? Do you know anyone positive?" And most do not know a soul who is sick. Fatalities I know of are in NYC. Most lack even that sort of connection. One friend lives in zip 60639 where 2-1/2% of residents are positive and he hasn't heard a thing from neighbors. Supposedly there is a cluster of six deaths centered right around his house (neighborhood of single-family residences) and no one is talking about it
Finally I do personally know a case. Our mailman had it. Postal employees can be tested, most of us still can't. He was sick ten days. First retest at two weeks showed positive even though he felt fine.Second retest at three weeks was negative, immediately allowed to return to work. Wife and daughter also got sick, also recovered easily. No tests available for them so no stats. No medical treatment but stay home and rest. On his own he took high doses of Vitamin C plus some zinc, but he does that for any cold or flu. After discussing symptoms with him am fairly certain that my wife and I had it back in January but will never know for sure. An antibody test would be interesting and even helpful at this point, no expectation one will ever be offered.
May 03, 2020 | www.moonofalabama.org
VietnamVet , May 2 2020 23:31 utc | 50I want to thank b again for the best updates on current events on the internet.
The most astonishing thing is watching an Empire collapse with nobody in charge by self-immolation. China, Vietnam, South Korea, Taiwan, Singapore, New Zealand and Australia show that old fashion public health institutions by testing, tracing and isolation of the infected can defeat the Wuhan Coronavirus. The West cannot and will not do this. Testing and Tracking in the USA is a total SNAFU. Saving more lives would require the restoration of democracy and use of the Plutocrat's wealth to fight the pandemic. The Elite are quite unwilling to do this. The unprepared haphazard reopening of the economy will kill hundreds of thousands more Americans. If North America breaks apart into nuclear armed regional states, millions more will die. Together with Climate Change, Armageddon approaches. VP Mike Pence knows he has been selected to be uplifted. Besides stupidity, why else would he walk around Mayo Clinic without a face mask greeting COVID-19 patients and doctors?
Apr 30, 2020 | q13fox.com
In a Thursday address on "protecting America's seniors," President Donald Trump discussed new initiatives pertaining to COVID-19 and its impact on nursing homes and their residents. Prior to delivering his remarks on nursing homes, the president noted that he would sign a proclamation making May "Older Americans Month." ...Among the new initiatives were: Additional shipments of PPE to all Medicaid/Medicare nursing homes in the U.S; $81 million from the CARES act to increase inspections of nursing homes during the pandemic; Requiring nursing homes to inform residents and family members about new COVID-19 cases...
Coronavirus patients admitted to Queens nursing home - with body bags | 23 April 2020 | The first coronavirus patients admitted to a Queens nursing home under a controversial state mandate arrived along with some grim accessories - a supply of body bags, The Post has learned. An executive at the facility - which was previously free of the deadly disease - said the bags were in the shipment of personal protective equipment received the same day the home was forced to begin treating two people discharged from hospitals with COVID-19. "My colleague noticed that one of the boxes was extremely heavy. Curious as to what could possibly be making that particular box so much heavier than the rest, he opened it," the exec told The Post Thursday. "The first two coronavirus patients were accompanied by five body bags." Within days, three of the bags were filled with the first of 30 residents who would die there after Gov. Andrew Cuomo's Health Department handed down its March 25 directive that bars nursing homes from refusing to admit "medically stable" coronavirus patients , the exec said. Like clockwork, the nursing home has received five body bags a week - every week - from city officials.Governor's death sentences: Cuomo forced high-risk nursing homes to admit COVID-19 patients, spreading killer virus amongst the most vulnerable -- Some patients were transferred with body bags accompanying them . | 26 April 2020 | The New York State Department of Health made a deadly decision on March 25 when it forced nursing homes to take in people who held a positive diagnosis for coronavirus in certain cases. It was determined by the state of New York that these coronavirus patients were "medically stable," but in actuality, they were far from stable. They still carried the disease that could be easily passed to others in these crowded facilities. The New York Post reported that in one particularly morbid case, coronavirus patients were admitted to a nursing home in Queens with body bags accompanying them. ... Thirty residents would die from coronavirus-related in just days after the first COVID+ patients were admitted at one nursing home alone . "Cuomo has blood on his hands. He really does. There's no way to sugarcoat this," the health care executive said. "Why in the world would you be sending coronavirus patients to a nursing home, where the most vulnerable population to this disease resides?" they added. [ Cuomo wanted as many elderly people in his state to die as possible - to save New York money. Imagine if this was Trump's policy, he'd have already been executed - but Cuomo gets a pass.]
May 02, 2020 | www.dispatch.com
Nurses said working conditions have caused them to become infected with the coronavirus and to be quarantined away from work and their families. Union officials want administration to better protect them.
A union representing nurses at Ohio State University's Wexner Medical Center filed a formal complaint this week that alleges poor working conditions inside the hospital have caused 85 nurses to be infected with COVID-19 and many more exposed.
Rick Lucas, head of the Ohio State University Nurses Organization, filed the complaint Tuesday with the Occupational Safety and Health Administration
"Many have suffered serious illnesses and lost work time and may have also exposed or infected their families," Lucas wrote in the complaint.
In the filing, Lucas details 14 instances in which he says nurses were put in danger by medical emergencies handled without proper protection, and by decisions made by the administration. "Health care professionals are in imminent danger of infection and serious illness associated with SARS CoV-2 across the entire Medical Center," he wrote.
Dr. Andrew Thomas, the chief clinical officer for the medical center, said administrators had not received any complaints for OSHA. Thomas said the administration is doing all it can to support hospital staff.
"Nothing means more to us than the health and safety of our colleagues, our patients and their families," he said in an email.
Thomas said the hospital has taken numerous safety steps that follow recommendations from the Centers for Disease Control and Prevention.
"We continue to work tirelessly to purchase PPE and maximize usage of those we have," he said.
Among the allegations in the complaint:
- Failure to provide frontline health-care workers who are taking care of a suspected or positive COVID-19 patient a sufficient supply of N95 masks to minimize their risk of exposure.
- Those dealing with infected prisoners were exposed to patients with COVID-19 because they were not provided sufficient eye protection and masks. Nurses were forced to bring in their own goggles to try and provide some eye protection. The union said around 10 employees contracted COVID-19 and around two dozen employees were exposed and required to quarantine. Correction officers also suffered exposure and subsequent illness.
- There were outbreaks in Dodd Rehabilitation Hospital and Ross Heart Hospital, resulting in the need to quarantine staff. In another outbreak in the baby unit, 27 staff members were exposed. The union alleges they were not provided proper masks.
- The hospital has denied N95 respirators, foreign equivalents, or stronger respirators to workers providing care or cleaning patient rooms within 6 feet of patients with suspected or confirmed COVID-19.
- Management has refused to provide initial fit testing for workers using respirators. Management has claimed they do not have to provide fit testing for workers using new respirators such as when they change from one type of N95 mask to a different type.
- On or before April 1, the employer physically removed all N95 masks from James Comprehensive Cancer Hospital outpatient clinics despite patients still being seen in those clinics.
May 02, 2020 | sputniknews.com
https://widget.spreaker.com/player?episode_id=26527302&theme=light&playlist=false&playlist-continuous=true&playlist-loop=false&playlist-autoupdate=true&autoplay=false&live-autoplay=false&chapters-image=true&episode_image_position=right&hide-likes=false&hide-comments=false&hide-sharing=false&hide-logo=false&hide-download=true&hide-episode-description=false&hide-playlist-images=false&hide-playlist-descriptions=false&gdpr-consent=null&cover_image_url=https://d3wo5wojvuv7l.cloudfront.net/images.spreaker.com/original/a59b15ee9c65c3b2c6f944b30f3d12a1.jpg"It [the labor movement] has returned, and as you mentioned, it does commemorate a time in US labor history. But ironically, it's been all but washed away from our current culture, and that's what we're trying to do at US Labor Against the War, is to really bring back this holiday, because this is our day This is the real Labor Day, and this pandemic has really made clear how absolutely essential workers are to our economy," Zahra told Loud & Clear host Brian Becker on Friday.
Similar protests calling for additional safety measures and protective equipment for workers took place across the world on Friday in countries like Greece, Italy, Spain and Austria.
May 1 is known as May Day or International Workers' Day and was originally suggested in 1889 by the Marxist International Socialist Congress and pushed by the American Federation of Labor, which was then demonstrating for an eight-hour work day. May 1 eventually became a national holiday to celebrate workers and the working classes in most countries around the world, but not in the United States.In socialist countries such as China, Vietnam, the former Union of Soviet Socialist Republics, and Cuba, May Day is a national holiday during which the country showcased its industrial accomplishments, including military hardware.
"Our economy is global. We are all globally connected, and workers have the same issues here in the US that they do in Iran and Venezuela and Cuba and China, Sweden, Syria, all around the world. We just want to live dignified lives, but the same handful of super rich billionaires are the ones really getting in the way of that. And they don't want us to understand our solidarity across countries, across borders, race, gender lines, because then we will understand that we're the ones that have all the power as workers," Zahra explained.
A new report by the Institute for Policy Studies think tank has found that between March 18 and April 10, the collective wealth of American billionaires increased by $282 billion, or 9.5%. The country's richest have continued to become richer while tens of millions of Americans lose their jobs. The Coronavirus Aid, Relief, and Economic Security (CARES) Act, a $2 trillion bill signed into law by US President Donald Trump on March 27, provides tax cuts to wealthy Americans while only providing a $1,200 stimulus check to the average American."They're still giving bailouts to these major corporations, and when you're looking at what's happening from afar, we're getting crumbs thrown at us As the labor movement, we need our own party. We cannot depend on the Republicans or the Democrats. Both parties have been bought and sold for the rich," Zahra added.
Despite the resurgence in the labor movement, more work needs to be done regarding trade unions, Zahra pointed out.
"I do think this COVID crisis, this global pandemic, has really sent a shock through our entire system, throughout our unions, and has really exposed the inability for our government to protect its own workers. There are so many workers who are now struggling, both union and nonunion," Zahra added.
"There's definitely a lot of work to be done, a lot of growth to ensure our unions are democratic, are representative of our membership and that we're bringing the unorganized sector into the fold we have a lot of workers who are still unorganized across the country. In the private sector we only have about 10% of workers unionized. In the public sector, it's around 30%," Zahra explained.
The views and opinions expressed in the article do not necessarily reflect those of Sputnik.
Apr 28, 2020 | off-guardian.org
Media reports paint a picture of healthcare workers being hit very hard by the pandemic, but the statistics suggest otherwise
A recent statistical study published in the Health Services Journal (HSJ) provides some important facts and context:
Firstly, let's establish the data: As of 22nd April, 119 "NHS workers" were reported to have died of Covid19. Thirteen of them were excluded from the study for being either retired or never confirmed to work for the NHS.
That left 106 NHS staff who died of alleged Covid19.
Secondly, we should clear up the misconception that this represents just "frontline" healthcare workers. It doesn't.
This number includes 35 nurses, 18 doctors and 27 healthcare assistants (HCAs), they are all "frontline" workers. But it also includes 36 others (dentists, psychiatrists, porters, administrators, receptionists etc).
Finally, let's put these numbers in some context:
The NHS is the biggest single employer in the UK. NHS England, NHS Scotland and NHS Wales employ roughly 1.5 million people (Wikipedia estimates over 1.7 million ). That's over 4% of the 38 million working-age adults, or 2.5% of the entire population of the UK.
As such, you would expect roughly 2.5% of the Covid19 victims to be NHS employees (assuming proportionate distribution).
However, the 106 NHS employees represent only 0.58% of the UK's 18,200 total Covid19 casualties as of April 22nd.
To put it another way:Any randomly selected citizen of the UK has a 1/39 chance of being employed by the NHS. But any randomly selected "Covid19 related death" has a 1/172 chance of being employed by the NHS.
In summary: In direct contradiction of the media coverage, healthcare workers are NOT being disproportionately affected by Covid19. They are actually substantially under-represented .
Apr 26, 2020 | turcopolier.typepad.com
Colonel Lang sent me an eye opening link last night concerning the Hunter Holmes McGuire VA hospital in Richmond. Here are some excerpts from the Richmond Times-Dispatch article.
-- -- -- --
As of Thursday, 23 employees at the 4,000-employee VA hospital, had tested positive, according to an update the hospital director emailed to employees. Another 45 employees are home awaiting test results. The hospital declined to say how many of the employees who are positive or are awaiting results are nurses, or name which parts of the hospital they work in.
Three VA nurses said they were given N95 respirators for several days early in the crisis in March, but after that they were given surgical masks, which provide less protection from the coronavirus. Another nurse reported wearing only a surgical mask the entire time caring for coronavirus patients. The nurses, who work in a unit that treats COVID-19 positive patients or patients awaiting test results who are suspected to be positive, spoke on condition of anonymity because they were not authorized to speak to news media and their job security could be at risk if they spoke publicly.
The hospital had 73 confirmed coronavirus cases among patients as of Friday, and four inpatient deaths. "Currently every health care system is taking steps to conserve PPE. VA is no different," Hodge wrote in a series of responses by email to questions. Hodge also said that the hospital is issuing surgical masks to all staff who work in non-COVID-19 units. "Those staff are provided one surgical mask weekly to assist in protecting high-risk patients who are asymptomatic," he wrote. (Richmond Times-Dispatch)
-- -- --
I'm not surprised by the numbers. Richmond, itself, is a virus hot spot although that is mostly due to several deadly assisted living/nursing home outbreaks. What shocks me is the PPE situation. The fact that nurses have to treat known Covid-19 patients with hospital masks rather than the N95 respirators is only moderately better than third world conditions in my view. Hospital masks offer the wearer no protection against the aerosolized virus. If the patients were wearing those masks, it would be more helpful than the nurses wearing them.
Here's a tip. If you can still smell odors like onions or bacon while wearing the mask, the aerosolized virus can get into your lungs. Hospital masks and other improvised masks protect those around the wearer, not the mask wearer. The concept behind the universal wearing of such masks is mutual protection. For any of you who spent time in the infantry, it's the same concept behind the DePuy fighting positions where you are not defending yourself. You are forming interlocking fields of fire to protect your comrades to the left and right of you. Protecting those around you actually provides the best protection for all of you. We wear masks in grocery stores and other such places to protect the entire community, not just our own sorry asses.
But back to the situation at McGuire. In the early days of the pandemic in America, the hospital instituted a screening program at the hospital entrances consisting of temperature and health interview. We were told to expect delays and to be given a mask for wear in the hospital. Not long after that, we were called to reschedule our appointments to May or beyond. By mid-April, this was the COVID-19 testing situation.
Since the number of COVID-19 tests are limited nationwide, there is no COVID-19 testing capability at our CBOC locations. Please call your provider to determine whether you would be a candidate for testing. If so, then you may proceed to the Hunter Holmes McGuire VA Medical Center in Richmond, Virginia where Monday – Friday, 8:30 a.m. – 1:00 p.m., a Drive-Thru Clinic is available for screening and testing (if you need it); you will be triaged according to your symptoms. Also, Monday – Friday, 8:00 a.m. – 4:00 p.m., you may be directed to be seen in the medical center's High Consequence Infections (HCI) Clinic. Last, depending on your symptoms, you may go to the hospital's Emergency Department or to an Urgent Care Center or Emergency Department in your area.
McGuire seems to have had all its ducks in a row. It's what I expect. This VA medical center is well run. The professionalism, pride and morale among the staff is astoundingly high. It shows among us broke down old vets who show up for care. We are proud of McGuire. That this fine facility is now forced to ration out PPE to its staff is a travesty. The VA dropped the ball. The federal government dropped the ball for several administrations. PPE should have been stockpiled at all levels and those stockpiles should have been replenished by a push logistics system.
That's the long term screw up. In the more immediate term, the federal government should have been acquiring that PPE and forcing industry to massively produce supplies back in January. Trump should have invoked and used the Defense Production Act robustly in January rather than waiting until March and April to weakly wield that executive authority. Every hospital and every first responder should have had all the PPE needed. Every household could have been sent a dozen disposable masks with a note from President Trump telling us to keep these in case we need them. What a galvanizing message that would have sent across the nation. Even if Covid-19 proved to be a non-problem, it would have been a message of Churchillian defiance in the face of a potential threat. A missed opportunity for both the American people and Trump.
Terence Gore , 25 April 2020 at 01:16 PMSorry to read your post and hope everyone fares well. Many nursing homes may be in the same situation.Pj20 , 25 April 2020 at 02:19 PM
"The proning and the high-flow nasal cannulas combined have brought patient oxygen levels from around 40% to 80% and 90%, so it's been fascinating and wonderful to see," Spiegel said."
Possibly positive news.It isn't just the VA, hospitals all over the country are short of PPE. And that is one of the problems with opening up the country too soon. Unprotected staff in suddenly flooded hospitals become ill themselves risking the viability of local health systems.JoeC100 , 25 April 2020 at 04:57 PMTTG -JohninMK , 25 April 2020 at 05:02 PM
I read a while back that the key supply chain issue with N-95 masks is that their essential core material is a synthetic spun fiber that we are completely reliant on China for sourcing. In addition. the machines that make this fiber are complex, quite expensive and there is no capability to quickly and significantly ramp up their production. Further they are challenging to set up and operate.
And for perspective, of the 200 million masks China currently makes a day, only 600,000 are N95 standard masks, used by medical personnel,
So yet another "essential supply chain" item for a critical health system need that simply can't be ramped up out of this air.
Hopefully some one in the Federal system is looking for all similar needs and working on a plan to facilitate onshore manufacturing.
Full (scary/sobering) details are at: https://www.npr.org/sections/goatsandsoda/2020/03/16/814929294/covid-19-has-caused-a-shortage-of-face-masks-but-theyre-surprisingly-hard-to-mak
I see this as a long term "lack of US preparedness" problem vs. something that could have been easily addressed if the administration had moved a couple on months earlier..We have the same problems here in the UK. With people, mainly it seems like in the MSM, blaming the Government's leadership for the supply issues.Bobo , 25 April 2020 at 07:01 PM
Ignoring totally the management of our respective national health organizations who knew, at the latest in mid January, that there was probably a nasty contagious problem coming down the tracks, that would, based on already clear Chinese actions, need more PPE than was on their shelves.
Bear in mind that, in the UK at least, hundreds of these NHS bureaucrats earn twice what a Government minister earns and a few twice the PM's salary. In both nations they have failed their people dismally, seemingly like rabbits trapped in the headlights. None will be punished of course for failure, they are just pleased that the Government steps up and takes the blame.
Then we have the academics and think tank personnel. All accepted as impartial and offering honest opinions based on state of the art models. Again the Governments take what they are offered as gospel and acts on it. Only to discover that the models are more of the garbage in garbage out variety, not fit for purpose. Then we find how much funding the impartial academics are receiving from potentially very interested parties, as there are $Bs at stake. In the UK there was a Pandemic 2016 exercise to check things out. Result everything in NHS under control. In the real world under four years later, a shambles. Did you have a similar last autumn?
The real heroes and heroines in this saga are the doctors, nurses and their support and ancillary staff who are actually at the sharp end. Many working in appallingly unsafe conditions. Hats off to them.For 200 plus years our hospitals utilized laundries to cleanse their medical protection gear (PPE) until the advent of synthetic PPE. The present generation is taught to utilize the N95 mask and other gear once and then trash it. This was derived as a manner in reducing Sepsis and MRSA in hospitals and an effective one though those diseases are still present.optimax , 25 April 2020 at 11:00 PM
Our hearts went out to these young medical personnel without the plastic masks and gear as they were working outside of what they were taught and they were much more susceptible to the Covid-19.
Now we all saw every Chinaman walking around Wuhan with a N-95 mask in January and unfortunately those were our masks that were re-routed to the Chinese people. Hopefully we have now learned a very hard lesson that Just in Time Inventory does not work for medical diseases or viruses and that the USA needs to manufacture all PPE and medicine in the USA amongst other things.
Regarding the political implications I can only say that the guy in the hot seat made things happen when the chips were down something his predecessors nor his competitor had/have the ability to do in a timely manner. Coercion worked.Much of the federal stockpile of PPE sent to the states had passed their expire dates, 2010 for some, and was either useless or had to be repaired. I blame the failure on the person, or persons, charged with monitoring the wharehoused stockpiles. The president only knows what he's told. He can't micromanage the nation. He needs Jack Webb directing him to stick with the facts.
We have two groups of psychopaths vying for political power.
elaine, 26 April 2020 at 12:58 AM
I read somewhere the V.A. ordered the masks but F.E.M.A expropriated them on the directions of Jared Kushner, who will later decide who receives the masks...something about the National Emergency Stockpile...what a mess.
Apr 24, 2020 | www.nakedcapitalism.com
Cynthia , April 24, 2020 at 9:50 am
I know for sure that hospitals across the country are getting a significant bailout. However, the bailout has a definite "no strings attached" aspect to it. Which may explain the rather wide variation in how hospitals have decided how to use this money.
For instance, my hospital decided to use its bailout money to give thousands of its employees so-called "COVID" pay so that they can continue to get paid despite not working at all. Needless to say, there is indeed a very good thing about this and other similar forms of medical Keynesianism: it keeps the local unemployment rate regarding hospital workers much lower than it would otherwise be.
OTOH, a similar nonprofit hospital just to the north of me, both in terms size and function, as well as having an equally significant reduction in patient admissions due to COVID-19, has elected NOT to use any of its bailout money to keep its employees employed. That hospital is Huntsville Hospital. It has instead decided to furlough and even lay-off many of its employees.
As to how Huntsville Hospital is using its bailout money, I can't say for sure. Nor can anybody else, for that matters, due to its overall lack of spending transparency, which is very common among hospitals in general, BTW. Despite that, my guess would be that Huntsville Hospital is using its bailout money to pay for capital improvements. There's probably a good side to this as well: it keeps the local unemployment rate regarding non-hospital workers much lower than it would otherwise be. Therefore, it too can be described as medical Keynesianism, though it is a more indirect and somewhat weaker form of it since hospital workers don't benefit from it.
Apr 24, 2020 | consortiumnews.com
About 31 million people are today uninsured in America and 14 states have not even expanded Medicaid under the Affordable Care Act. The healthcare system is seemingly structured in defiance of the people it should serve, functioning as yet another way to maximize profits at the expense of millions.
In this coronavirus moment, many more Americans are finally awakening to the bitter consequences, the damage, wrought when even a single person does not have access to the resources he or she needs to live decently or, for that matter, survive.
With the spread of a pandemic, the cost to a nation that often treats collective care as, at best, an afterthought should become apparent. After all, more than 9,000 medical workers, many not adequately protected from the disease, have already contracted it.
Today, more than 38 million people officially live below the federal poverty line and, in truth, that figure should have shocked the nation into action before the coronavirus even arrived here. No such luck and here's the real story anyway: the official measure of poverty, developed in 1964, doesn't even take into account household expenses like health care, child care, housing, and transportation, not to speak of other costs that have burgeoned in recent decades. The world has undergone profound economic transformations over the last 66 years and yet this out-of-date measure, based on three times a family's food budget, continues to shape policymaking at every level of government as well as the contours of the American political and moral imagination.
...the 53 percent of every federal discretionary dollar that goes to the Pentagon , the trillions of dollars that have been squandered in this country's never-ending war on terror, not to speak of the unprecedented financial gains the wealthiest have made (even in the midst of the current crisis). Of course, this economic order becomes a genuine moral scandal the moment attention is focused on the three billionaires who possess more wealth than the bottom half of society.
Since the government began transferring wealth from the poor to the very rich under the guise of "trickle-down" (but actually gusher-up) economics, key public institutions, labor unions , and the electoral process have been under attack. The healthcare system has been further privatized, public housing has been demolished, public water and sanitation systems have been held hostage by emergency managers, and the social safety net has been eviscerated.
In these same years, core government functions have been turned over to the private sector and the free market. The result: levels of poverty and inequality in this country now outmatch the Gilded Age . All of this, in turn, laid the groundwork for the rapid spread of death and disease via the Covid-19 pandemic and its disproportionate impact on poor people and people of color.
When the coronavirus first became a national emergency, the Fed materialized $1.5 trillion in loans to Wall Street, a form of corporate welfare that may never be paid back. In the following weeks, the Fed and a congressional bipartisan stimulus package funneled trillions more in bailouts to the largest corporations. Meanwhile, tens of millions of Americans were left out of that CARES Act : 48 percent of the work force did not receive paid sick leave; 27 million uninsured people and 10 percent of the insured who couldn't even afford a doctor's visit have no guarantee of free or reasonably priced medical treatment; 11 million undocumented immigrants and their 5 million children will receive no emergency provisions; 2.3 million of the incarcerated have been left in the petri dish of prison; 3 million Supplemental Nutrition Assistance Program recipients saw no increase in their benefits; and homeless assistance funds were targeted at only about 500,000 people, although eight to 11 million are homeless or housing insecure. Such omissions are guaranteed to prove debilitating, even potentially lethal, for many. They also represent cracks in a dam ready to break in a nation without a guaranteed living wage or universal healthcare as debt mounts, wages stagnate, and the pressures of ecological devastation and climate change intensify.
... ... ...
Across the Black Belt of the southern states, the poor and black are dying from the coronavirus at an alarming rate . In many of those states, wages are tied to industries that rely on now interrupted regular household spending. They also have among the least resources and the most vehement anti-union and wage-suppression laws. That, in turn, leaves so many Americans all that more vulnerable to the Covid-19 crisis, the end of which is nowhere in sight. Chalk this up, among other things, to decades of divestment in public institutions and the entrenchment of extremist agendas in state legislatures. The Black Belt accounts for nine of the 14 states that have not expanded Medicaid and for 60 percent of all rural hospital closures.
Nor are these the only places now feeling the consequences of hospitals being bought up or closed for private profit. In Philadelphia, for instance, Hahnemann Hospital, which had served that city's poorest patients for more than 170 years , was recently bought and closed by a real-estate speculator who then attempted to extract a million dollars a month from the local government to reopen it. Now, as the coronavirus ravages Philadelphia, Hahnemann's beds sit empty, reminiscent of the notorious shuttering of New Orleans' Charity Hospital in the wake of Hurricane Katrina in 2005.
... ... ...
Liz Theoharis is a theologian, ordained minister, and anti-poverty activist. Director of the Kairos Center for Religions, Rights and Social Justice at Union Theological Seminary and co-chair of the Poor People's Campaign: A National Call for Moral Revival, she is the author of " Always With Us? What Jesus Really Said About the Poor ." She teaches at Union Theological Seminary in New York City.
Apr 20, 2020 | www.bbc.com
"Девочки-неврологи плакали и шли в красную зону": как работают врачи в московских Covid-больницах Олеся Герасименко, Светлана Рейтер Би-би-си
- 16 апреля 2020
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Скопировать ссылкуhttps://www.bbc.com/russian/features-52288837 О том, как поделиться
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Мэрия Москвы еще в двадцатых числах марта попросила столичные больницы оценить, сколько пациентов с коронавирусом они могут принять. На план перестройки и возведение необходимых перегородок им дали пять дней. Из больниц долечиваться домой отправили тысячи человек, оставив только тяжелых больных. Новых пациентов не с коронавирусом перепрофилированные клиники почти не принимают - разворачивают скорые в другие стационары."Реанимация заполнилась в течение одного дня, и рук перестало хватать"
Чтобы разграничить заразную зону от чистой, в больницах возвели новые стены, рассказывает главврач центра оказания медицинской помощи пациентам с подозрением на коронавирусную инфекцию НМЦХ им. Пирогова Виталий Гусаров. Устроили санпропускники, шлюзы, где сотрудники переодеваются перед входом в красную зону, и шлюзы, где они возвращаются из зоны.
Много сил при переделке клиник уходит на логистику: на каких лифтах будут ездить заболевшие пациенты, откуда будут уходить вылечившиеся, как медсестры будут передвигаться по корпусу, как вывозить медицинские отходы из красной зоны. По-другому теперь приходится даже простыни сдавать в стирку: все белье из Covid-отделения проходит дезинфекцию, и только потом его можно везти в прачечную.
В коронавирусный корпус Пироговского центра пошли работать неврологи, кардиологи, терапевты, хирурги, травматологи, говорит их главврач. "Мы все были заточены на помощь высокого уровня, - писал в "Фейсбуке" реаниматолог этой больницы, заведующий отделением анестезиологии-реанимации № 1 Борис Теплых. - Где-то слышались реплики, что использовать нас - все равно что микроскопом гвозди забивать. Но увидев в следующие дни бурю, ни у кого не осталось сомнений, что пришло время "засадных полков". Девочки-неврологи плакали, надевали защитные костюмы и шли в красную зону".
Правда, по словам Гусарова, коллега эмоции медиков преувеличил. "Все сотрудники с первого дня в красной зоне осознавали свою ответственность и были готовы к тяжелой работе, настоящие герои", - говорит он.
Но не все медики морально готовы работать с Covid-19. В Пироговском центре говорят о нехватке медсестер и санитарок. Медсестры отказывались из страха заразить своих близких, у кого-то сложная семейная ситуация и они не имеют возможности оставить свои семьи на время работы в госпитале, а многие пожилые ссотрудники оказались в группе риска из-за возраста.
- "Казалось, у меня кусок мяса, а не горло". Пять историй людей, вылечившихся от коронавируса
- "Задыхающиеся" лаборатории и подозрительные пневмонии. Как в России меняется подход к диагностике коронавируса
Согласившиеся лечить коронавирус медики, не имеющие нужной специализации, работают в отделениях, где лежат не самые тяжелые пациенты. Для них, не инфекционистов по профилю, в больнице разрабатывают пошаговые инструкции. По словам Гусарова, их составляют из рекомендаций минздрава, столичного департамента, ВОЗ, федерации анестезиологов-ревматологов и других источников.
Работает в красной зоне и сам главный врач стационара Пироговского центра.
- В первую неделю, когда мы открылись, реанимация заполнилась в течение одного дня - и рук перестало хватать. А у меня специальность такая. Надо было и трахеостомию делать, и к ИВЛ подключать, мы пошли помогать ребятам.
- Вы, будучи главврачом, уже так делали?
- Я регулярно приходил в реанимационную на проведение обходов и разбора сложных случаев. Но чтобы из-за вала пациентов пришлось встать и оказывать экстренную помощь как врачу реанимации - нет, такого еще не было. С таким мы столкнулись впервые и остро."К концу смены в защитных костюмах некоторые падают в обморок"
Перед входом в красную зону, где лежат инфицированные коронавирусом, каждый надевает специальный защитный костюм. Он одноразовый. Под него - одноразовый же хлопчатобумажный костюм, какие носят хирурги, шапочка, одноразовые носки, кроксы и бахилы.
"Снимаем с себя всё, оставляем часы, ключи, мобильные телефоны. Никаких предметов быта в зоне. Иногда нательный крестик оставляют, но я бы не рекомендовал на себе хоть что-то носить", - рассказывает Александр Левчук, бывший главный хирург Военно-морского флота, работающий в Пироговском центре уже 14 лет. Левчук - советник по хирургическим вопросам, врач-онколог, профессор кафедры, доктор медицинских наук, заслуженный врач РФ.
Это уже четвертый карантин за карьеру 61-летнего хирурга. Первые три были в военных частях при дизентерии, малярии и холере. В центре он отвечает за сортировку больных, которых привозят скорые. Через четыре часа работы с пациентами костюм надо менять.
- "Людей с тяжелыми пневмониями не вытянем". Как врачи в России борются с вирусом и дефицитом
- С мусорным мешком на голове. Рассказ врача, лечащего зараженных коронавирусом
В 15-й инфекционной больнице имени О. М. Филатова в санпропускном шлюзе работают около 30 человек, которые помогают врачам переодеваться. "Ещё пока всё это не началось, мы выбирали одного добровольца из коллектива и на него раз двадцать надевали защиту, чтобы запомнить, как, например, респиратор правильно надевать", - рассказывает главврач Валерий Вечорко.
В красной зоне нельзя расстегиваться и ничего снимать тоже нельзя - ни респиратор, ни очки. "В защите жарко, хочется воды, плохо видно. В туалет ходить нельзя, пить и есть тоже. На всякий случай у нас лежат взрослые памперсы, некоторые ими уже пользуются. Но в них под костюмом сразу становится еще жарче, появляются проблемы с кожей, опрелости", - говорит главврач центра имени Пирогова.
На руки медики надевают две пары перчаток и сверху третью - для осмотра пациента. Их сразу выбрасывают, а первые две пары остаются на руках. "Я вам как хирург могу сказать - снижается тактильность. Сложно осматривать. Ну зато слышимость хорошая - костюмы сделаны не из прорезиненной ткани, не то, что в 80-е годы. В тех водолазных костюмах было совсем тяжело работать", - объясняет Левчук.
В защите невозможно послушать дыхательные шумы и хрипы пациента - вместе с комплектом нельзя использовать фонендоскоп. Приходится ориентироваться на частоту дыхания, лихорадку и данные о насыщенности крови кислородом, говорит Гусаров. "Вообще в защите и в красной зоне оценить пациента сложнее раза в три, чем в обычной обстановке больницы", - рассказывает он.
В реанимации и на сортировке смены длятся по четыре часа, в коечных отделениях - по шесть. К концу смены в защитных костюмах некоторые падают в обморок, но встают и идут работать дальше. "Причем это не изнеженные создания, а, например, наша старшая сестра, которая любому мужчине даст фору по силам и здоровью", - говорит главврач Гусаров. Рассказывает о медсестре, которую накануне в красной зоне вырвало в респиратор от усталости, но она дорабатывала смену, не уходя от пациентов. "Это люди, перед которыми хочется встать на колени", - добавляет врач.
"Я люблю эту работу, я готов делать все, - говорит работающий в приемном покое Пироговского центра Левчук. - Вот я вообще военный хирург, а сейчас - на сортировке больных. Нужно - пойду носилки таскать".
Если соблюдать все санитарно-эпидемиологические нормы с самого начала и до самого конца, заразиться сложно, говорит Левчук. Но обычно, по его мнению, среди врачей заболевают люди, которые первые две недели о правилах помнят, а потом настает период самоуспокоения, и вот тогда совершаются ошибки - небрежно надевают костюм или маску или нарушают правило трех пар перчаток.
Тесты на коронавирус сотрудникам больниц делают раз в неделю. Почти все медики изолировались от семей, Гусаров снял квартиру, большинство других медиков его центра живут в гостинице напротив Пироговки - за них платит больница.
Главврач ГКБ №15 Валерий Вечорко рассказывает, что в больнице для врачей работают два кафе: одно с пальмами на месте старого бассейна, "как в Турции на пятизвездочном курорте", а второе под названием "Звезда" в двух армейских палатках на улице."Пока мы идем в потемках"
Что делают врачи с пациентами в красной зоне? Если человек в удовлетворительном состоянии, то ему нужно только наблюдение, жаропонижающее и обильное питье. Такие пациенты часто бывают недовольны. "Жалуются, что их не лечат. И капельниц не капают", - улыбается Гусаров. Но главная задача пребывания в стационаре - не пропустить ухудшения. Клиническая картина бывает скоротечной, утверждает хирург Левчук: пациенту может стать хуже за два-три часа, и он может оказаться на ИВЛ.
Пациенты в тяжелом состоянии получают противовирусные лекарства и препараты, направленные на уменьшение повреждений внутренних органов. "Мы пробуем тоцилизумаб, который блокирует человеческий интерлейкин-6. Этот противовоспалительный медиатор вырабатывает наша иммунная система, чтобы повреждать клетки, пораженные вирусом - вместе с тканями органов, куда он попал. В итоге страдают в первую очередь легкие и сердце".
Слишком сильный иммунный ответ на коронавирус и приводит к осложнениям, говорит Гусаров. "Так что распространенное сейчас пожелание сильного иммунитета как раз не очень подходит, - вздыхает он. - Есть ощущение, что все зависит от степени иммунной реакции на вирус. Чем она сильнее, тем хуже протекает болезнь. Препарат, к которому мы присматриваемся, блокирует эту сильную реакцию иммунитета. Но доказательной базы нет, и пока мы идем в потемках".
Весь персонал центра имени Пирогова для профилактики принимает противомалярийный иммуносупрессивный препарат. По поводу ультрафиолетовых ламп, которые сейчас покупают россияне для своих домов, врачи разводят руками: последние данные по ультрафиолету показали, что стандартные рециркуляторы воздуха не воздействуют на вирус.
Главврач больницы №15, после медицинского училища работавший в зоне Чернобыльской катастрофы, говорит, что тогда врачам было понятнее, с чем они столкнулись. "Там был один поражающий фактор, потом чётко отработанная помощь при этом факторе. А здесь, вот эта беда, она как снег на голову свалилась. Мы видели, что было в Китае, Италии, Испании, но никто до конца не понимает, что это за штука. Она очень подвержена мутациям".
"Многие не понимают самого главного - этот возбудитель постоянно мутирует, - согласен с Вечорко бывший военный врач Левчук. - Он становится всё сложнее и сложнее. Это не тот коронавирус, который был описан в 2005-м или в 2015 году. Это вирус, зло протекающий, вызывающий пневмонии, заканчивающиеся летальным исходом"."Эти очаги невооруженным глазом видны"
В большинстве больниц коронавирус уже ставят по результатам компьютерной томографии (КТ), не дожидаясь тестов - их чувствительность не идеальна, говорит главврач ГКБ №15 Валерий Вечорко. "Больной к нам приехал, мы сделали КТ, сразу видно, как изменена ткань лёгочная - по типу матового стекла. Эти очаги, они невооруженным глазом видны. Даже при отрицательном тесте на Covid мы лечим так, как будто он есть", - объясняет он.
Аппарат КТ после каждого пациента дезинфицируют - медсестра моет аппарат антисептиками с хлором и опрыскивает помещение из специального пульверизатора. В красной зоне больницы №15 - три аппарата. В зоне центра имени Пирогова - один. Нагрузка на него колоссальная, но "пока работает". Закупиться впрок сейчас не получится, потому что зарубежные производители в пандемию работают на больницы внутри своих стран, а в России серийного производства томографов пока нет, говорит Гусаров.
На ИВЛ в больницах лежат пациенты возрастом от 25 до 90 лет. "Один из наших молодых пациентов - мальчик с ДЦП. Но по опыту наших коллег, с которыми мы постоянно на связи, на ИВЛ с тяжелой формой много молодых и без сопутствующих заболеваний", - рассказывает Гусаров. Или люди с ожирением и сахарным диабетом, добавляет Левчук. Эти болезни намного утяжеляют состояние. Диабет не позволяет адекватно лечить больного - много осложнений на легкие и почки, говорит врач.
Пациентами, по словам медиков, становятся те, кто столкнулся с заболевшим на работе или в семье, или где-то проехался или кого-то навестил, либо натолкнулся на бессимптомного носителя в магазине. В центре Пирогова лечится семейная пара, которая навестила в самоизоляции родственника-носителя Covid-19. Теперь муж лежит на ИВЛ, а жена в палате этажом выше."После ИВЛ надо научить больного дышать самостоятельно"
Человек, дышать которому помогает аппарат ИВЛ, не может говорить. Если у него стоит интубационная трубка, введенная через рот, то он, скорее всего, не может переносить это спокойно и его седатируют. Такие пациенты лежат в медикаментозном сне, без сознания. "Закон такой - пациент должен быть спокоен - или сам, или под действием седативных препаратов", - объясняет заместитель главврача больницы №15 Борислав Силаев.
Если заболевшему для поддержания дыхания наложена трахеостома - трубка заведена через разрез на шее ниже голосовых складок - и пациент спокойно это переносит, то его можно оставить в сознании. Тогда он общается с врачами губами, жестами, кивками. Могут сказать "да" или "нет" и даже что-то написать. Такие пациенты могут даже есть привычным способом. Остальных кормят, отправляя питательную смесь прямо в желудок через зонд, или, если состояние тяжелое, есть смеси, которые вводятся прямо в вену, рассказывает Силаев.
Пациентам на ИВЛ чистят зубы, их моют, регулярно меняют белье и перестилают постель. Иногда все это делают по несколько раз в день - и все это силами санитарок и медсестер. Если уход ослабить, то повышается риск бактериальных осложнений. Если они присоединяются к вирусной пневмонии, это делает шансы на выздоровление в разы ниже.
Болеющим коронавирусом легче дышать, лежа на животе. "В больницах это протокольная процедура - если содержание кислорода в легких снижается ниже допустимых пределов, мы переворачиваем пациента на живот, - говорит Силаев. - Они так могут лежать по восемь часов. Чтобы их переворачивать, тоже нужны руки, у санитарки сил не хватает вертеть здоровых мужчин".
Везучие обходятся кислородной маской и на ИВЛ не попадают. Но если у заболевшего стояла трахеостома, то лечение на ИВЛ продлевается на 2-3 недели, рассказывает врач Левчук. "Потому что потом надо научить больного дышать заново, самостоятельно, а это тоже непросто - каждый день уменьшается время работы аппарата ИВЛ, больной на некоторое время от него отключается, тренируется дышать сам. Трудная процедура", - поясняет хирург.
- Им страшно? Ведь врачи должны давать надежду, а вы сами впотьмах передвигаетесь. Ведь, как мы поняли со слов врачей, человек может 10 дней лежать в нормальном состоянии, а потом - бабах и на ИВЛ.
- Ну, во-первых, мы им об этом не рассказываем - что может наступить резкое ухудшение, - отвечает главврач центра имени Пирогова Гусаров. - Мы их ободряем, говорим, что все будет хорошо, объясняем, какой где катетер установлен и зачем какая трубка. Призываем держаться и слушаться медперсонала."Разговаривайте со своей собакой"
К началу второй недели обе реанимации Пироговского центра заполнились, и пациентов стали класть в операционные палаты. Всего здесь 33 реанимационные койки и 33 аппарата ИВЛ, но открыть их все врачи пока не могут: не хватает анестезиологов и медсестер, идет набор.
В крупной Филатовской больнице рук пока хватает, недавно пришли пять новых реаниматологов. "Сегодня у меня нет проблем с медицинскими работниками, а что завтра будет - не знаю, не могу сказать. Одно могу сказать - завтра это не закончится", - рассказывает Вечорко.
Пациентов в больнице №15 стало в два раза больше. Обычно здесь принимают по 150 человек в день, на прошлой неделе - было 300 в сутки. В основном это люди в состоянии средней степени тяжести или совсем "тяжелые" - с дыхательной недостаточностью.
- Сколько все это продлится?
- По тем поступлениям, которые мы видим, а у нас 1,5 тысячи пациентов с вирусной пневмонией, это только самое начало пика, - говорит Вечорко.
- В Москве сейчас 8 тысяч пациентов с Covid-19. Все-таки это не 30 и не 50. Это много? Почему уже сейчас, как говорят в мэрии, все трещит по швам? - спрашиваем мы у главврача Пироговского центра.
- Ну вы же понимаете, что пациенты с другими заболеваниями никуда не делись. Это плюс восемь тысяч, которые требуют экстренной медпомощи и работы персонала в принципиально новых для них условиях. Это почти предел. Если поток увеличится, мы перестанем справляться, - отвечает Гусаров.
- Как это будет выглядеть?
- Итальянский сценарий. Интубация на полу. Выбор между молодым и пожилым при переводе в реанимацию. Невозможность нормально осмотреть всех при поступлении: то есть приехали и лежат, а если ухудшается - хватай и беги с ним на ИВЛ.
- Как решают, молодой или пожилой? Есть протоколы для такого выбора?
- С точки зрения медицинской этики, таких протоколов нет и не может быть, мы обязаны помогать всем.
- А как тогда?
- Ну как решают во время боевых действий, когда массовое поступление раненых? Идет сортировка по состоянию. Легкораненые оказывают помощь себе сами. Люди с ранениями средней тяжести - группа, которой оказывают особое внимание, чтобы спасти их и вернуть в строй. А тяжелораненые остаются без него.
Бывший военный врач Левчук, работающий на сортировке в Пироговском центре, говорит, что каждый третий их пациент уверен, что у него не коронавирусная инфекция: "У людей очень высокая степень недооценки ситуации. А потом, когда они понимают, что с ними, они уже молчат".
Его коллега Гусаров вспоминает панику в глазах отрицателей коронавируса, когда они попадают в больницу с симптомами ОРВИ и сталкиваются там с тяжелыми пациентами. "Понимаете, здесь это ощущается острее. Они могли вчера все это отрицать, а толку? - вздыхает он. - Мне хочется попросить отрицателей все равно сидеть дома. А если выходите по неотложной надобности, например, с собакой гулять - то не общайтесь ни с кем, разговаривайте со своей собакой. Если этого не делать, здравоохранение захлебнется. Мы не сможем оказывать медицинскую помощь всем нуждающимся, если из-за отрицателей и нарушителей карантина поток будет расти".
И тогда, говорит Гусаров, люди должны быть готовыми к тому, что их будет интубировать травматолог или патологоанатом. И возможно, это будет последняя манипуляция в их жизни, добавляет он.
Apr 19, 2020 | www.rt.com
Piers Morgan has lashed out at the UK government's care minister, branding her numbers on Covid-19 deaths in the health and care sector "complete nonsense" as anger grows over the apparent lack of protection for frontline workers. The 55-year-old Good Morning Britain TV presenter grilled Care Minister Helen Whately in a heated interview on Wednesday morning on the working conditions for health and care staff at the center of the coronavirus crisis.
Morgan asked Whately what the death toll was for health and care professionals who have fallen victim to the deadly Covid-19 disease. The stuttering minister replied: "So the latest figures we have for NHS workers is that 19 [NHS] workers have sadly died."
'We don't have a figure for that' - Helen Whately @piersmorgan questions the Care Minister over the number of healthcare workers that have died on the front line from the coronavirus. pic.twitter.com/VFcqFJX5SE-- Good Morning Britain (@GMB) April 15, 2020
Morgan, cutting in before Whately could finish her sentence, sniped: "That's complete nonsense." He added that the Mirror newspaper had reported as recently as Tuesday that 38 had died so far.
Apr 19, 2020 | twitter.com
Found the kid playing with her dog instead of Zooming with her teacher. She told me not to worry. She took a screenshot of herself "paying attention," then cut her video & replaced it with the picture. "It's a gallery view of 20 kids, mom. They can't tell." She is 10. #COVID19
-- Angie Maxwell (@AngieMaxwell1) April 15, 2020
Apr 19, 2020 | labornotes.org
[ Labor Notes ]. "More than 100 hospitals in the U.S. have laid off workers since the pandemic began. Tens of thousands of medical workers are furloughed at the exact moment hospitals should be staffing up and training everyone in intensive care. Expecting a tidal wave of very sick patients, many of whom could be unemployed and uninsured, many hospitals have ended all elective procedures, one of their most lucrative sources of revenue. Since insurance in the United States is primarily tied to having a job, hospitals anticipate being left with egregious costs they have no hope of ever being able to recoup."
Apr 13, 2020 | www.zerohedge.com
Authored by James Howard Kunstler via Kunstler.com,
The ruins of Mary McClellan Hospital stand on hill overlooking the village of Cambridge, New York, in what was a "flyover" corner of the country until the planes stopped flying. The hospital cornerstone was laid July 4 1917. The USA had entered the war against Germany a few months earlier. The "Spanish" flu pandemic kicked off in January, 1918. The hospital opened in January 1919. The flu burned out a year later. The hospital shut down for good in 2003.
I've lived around here for decades and never actually got a look at the place until I went up there on a blustery spring Saturday before Easter to look around. I like to read landscapes and the human imprint upon them. This one is a ghost story, not just of the bygone souls who came and went here, but of an entire society, the nation that we used to be and stopped being not so long ago.
This is the old main building today. It's astounding how quickly buildings begin to rot when the human life within them is gone. The style was Beaux Arts Institutional, seen everywhere across America in that period in schools, libraries, museums, and hospitals, an austere neoclassicism that radiated decorum in a confident and well-run society – because that is what we were then. Note especially, the entrance and the beautiful bronze marquee above it. The message is this: You enter through a portal of beauty to a place of hope and trust.
This is Mary McClellan Hospital not long after it opened.
The site itself, on its hill, with views east across the state line to the Green Mountains, speaks of authority and command.
The America of 1919 was a deeply hierarchical society. Today we regard hierarchy as a bane and a curse. The truth is, it is absolutely required if you expect to live in a well-run society, and proof of that is the disordered mess of bureaucratic irresponsibility we live in today, with virtually every institution failing – well before the Covid-19 virus arrived on the scene - and nobody called to account for anything anymore.
Hierarchy must be fit to scale to function successfully. In small institutions like this, everybody knows who is responsible for what. That's what makes authority credible.
These are the ruins of the nursing school associated with the hospital (and also associated with Skidmore College in Saratoga Springs, 25 miles west).
The nurses lived here, in Florence Nightingale Hall.
In the early 20th century, the profession favored young, unmarried women whose allegiance and attention to the patients would not be distracted by the needs of a family.
Was that exploitation? Or was it simply an intelligent way to organize a hospital subculture? The nurses lived here very comfortably. The institution cared for them, literally.
There's no record available of what exactly these buildings were for. The one in the foreground has a cut stone sign that says "The Junior" on it. I infer that this may have been where a couple of young, staff, resident physicians lived, young men probably, just out of their internships, close at hand and on-call for emergencies. The building in the background is a rather grand country cottage, possibly the residence of the chief surgeon or the hospital director. The hospital was, after all, a community unto itself, and it was important that authority have a visible presence there all the time. Both buildings display architectural grace-notes that humanized and dignify that resident authority. We no longer believe in grace-notes for the things we build, so is it surprising that we live in a graceless society?
This is the power plant for the whole operation, on the premises, ensuring that the electricity would stay on at all times. In the early 20th century, electric power was the new sine qua non of advanced civilization. America's rural electrification program really didn't get underway until the 1930s, so it's likely that many of the farms outside the village were not hooked up to a grid. The hospital generators must have been driven by coal, or perhaps oil. Somebody had to attend to all that machinery. The laundry – hospitals produce a lot of that – was also on-premises, as was all the meal preparation. The hospital maintained a large garden to furnish some of the food. All these tasks required crews of people working purposefully and getting paid. The hospital was a complex organism, a world within a nation within a world.
Things rise and self-organize beautifully into fully-formed systems and after while they run down, even while they over-grow; authority starts working more and more for its own sake and its own benefit; hierarchy breaks down into disrespect, lack of trust, fear; and then society loses its vital institutions, which is exactly what happened at Mary McClellan Hospital in little Cambridge, New York.
It dwindled and then quickly collapsed. The town lost a part of itself, the part that welcomed people in a particular kind of trouble and cared for them, as it cared for those who did the caring. By the way, in 1919, a private room was $7-a-day (a bed on a ward was $3). Imagine that! The town also lost a vital component of its economy. And that was all of-a-piece with its decline into the flyover place it became in our time.
American health care, as we call it today, and for all its high-tech miracles, has evolved into one of the most atrocious rackets the world has ever seen. By racket, I mean an enterprise organized explicitly to make money dishonestly. This is what we've become, and the fact that we seem to be okay with that tells you more about what we have become. The advent of Covid-19, along with the extreme economic disorders it has triggered, will probably be the beginning of the end of that racket. We have no idea how medicine will re-organize itself, but I'd guess that it will happen at a much more primitive scale – because that's usually what happens when human societies overshoot badly. Alas, history is not exactly symmetrical.
But read these photos and meditate on what we were once capable of putting together in this land, and maybe you will find some clues about what was truly admirable about the American condition before we stopped caring.
Apr 13, 2020 | scienceintegritydigest.com
The text message from Ai Fen (艾芬), the director of the emergency department of Wuhan Central Hospital, agreeing to be interviewed, was sent at 5 am on March 1. About half an hour later, at 5.32 am on March 1, her colleague and director of thyroid and breast surgery Jiang Xueqing, who was infected with new coronavirus pneumonia, died. Two days later, Mei Zhongming, deputy director of ophthalmology at the hospital, died. He and Li Wenliang were in the same department.
As of March 9, 2020, 4 members of the medical staff of Wuhan Central Hospital have died of new coronavirus pneumonia infection. Since the outbreak, this hospital, located just a few kilometers away from the Huanan Seafood Market, has become one of the hospitals in Wuhan with the largest number of employees that are infected. According to media reports, more than 200 employees in the hospital were infected, including three deputy deans and multiple working department directors. Multiple department directors are currently being maintained with ECMO [extracorporeal membrane oxygenation].
The shadow of death hangs over this, Wuhan's largest tertiary hospital. A doctor told People [a news site – EB] that in the social media group of hospital staff, almost no one spoke publicly; they mourned and discussed in private.
This tragedy could have been prevented. On December 30, 2019, Ai Fen received a virus test report for a patient with an unknown pneumonia. She circled the word "SARS coronavirus" in red. When asked by a college classmate who is also a doctor, she took a picture of the report and circulated it. That night, the report spread in doctor circles in Wuhan, and those who forwarded the report included the eight doctors who were disciplined by the police.
This caused trouble for Ai Fen. As the original source of the information, she was interviewed by the hospital disciplinary committee and suffered an "unprecedented and severe reprimand"; it was said that she was acting unprofessionally by creating false rumors (谣).
In the afternoon of March 2nd, Ai Fen did an interview with People in the Nanjing Road location of Wuhan Central Hospital. She was sitting alone in the emergency room office. The emergency department, which had been admitting more than 1,500 patients a day, had returned to quiet. There was only one tramp lying in the emergency hall.
Some previous reports called Ai Fen "another severely reprimanded female doctor who has emerged" and some people called her a "whistleblower". Ai Fen corrected this; she said she was not a whistleblower, but the one who distributed the "whistles".
During the interview, Ai Fen mentioned the word "regret" several times, and said she deeply regretted that she hadn't continued to whistle resoundingly after she was reprimanded at a disciplinary review meeting. She has especial regrets when it comes to her deceased coworkers. "If I knew then what I know now, I wouldn't care about the pressure (from my leader), and I would [expletive] speak everywhere, all right?"
What have Wuhan Central Hospital and Ai Fen experienced in the past two months or so? The following is what Ai Fen told us:
An unprecedented reprimand
On December 16, last year, we received a patient at the Nanjing Road emergency department. They had an inexplicably high fever, and they weren't responding to standard medications, their body temperature wasn't going down at all. On the 22nd, the patient was transferred to the respiratory department, a bronchoscopy was done, and bronchoalveolar fluid taken and sent out for high-throughput genetic sequencing. Afterwards, the coronavirus result was relayed verbally. At that time, the colleague who was responsible for the patient told me clearly: "Director [主任] Ai, that person's diagnosis is coronavirus". Later we learned that the patient worked in the Huanan Seafood Market.
Immediately afterwards, December 27th, another patient arrived at Nanjing Road. He was the nephew of a doctor in our department. He was in his 40s, without any preexisting conditions. His lungs were in a terrible state, and his blood oxygen saturation was only 90%. He was under hospital care for almost 10 days without any improvement, and was admitted to the respiratory department. A flexible bronchoscopy was also done, and the alveolar lavage fluid sent for testing.
At noon on December 30th, an old classmate at Tongji (同济) Hospital sent me a screenshot of a WeChat conversation, which said: "You don't want to go to Huanan [Market] just now, there are lots of people with high fever " He asked if it was true. At the time, I was watching a CT [scan] of a typical patient with pulmonary infection on the computer. I sent him a 11-second video of the CT and told him it was a patient who had come to our emergency department in the morning, a Huanan Seafood Market case.
Just after 4 pm that day, a colleague showed me a diagnostic report that said: "SARS coronavirus, Pseudomonas aeruginosa, 46 strains of bacteria [菌, bacteria and/or fungi] which colonize the oral cavity and/or respiratory tract". I read the report very carefully many times, and the supplementary information read: "SARS coronavirus is a single-stranded positive-strand RNA virus. The main mode of transmission of the virus is close-range droplet transmission or contact with respiratory secretions of patients, which can cause an unusual pneumonia that is highly contagious and can affect multiple organ systems, also known as atypical pneumonia."
At the time, the diagnostic report scared me, I broke into a cold sweat, this was a terrifying thing. The patient was admitted to the respiratory department, the situation needed to be reported to the respiratory department, but to ensure attention, I immediately phoned and reported it to the hospital's public health division and infectious disease [?院感] division. At that moment, the director of the respiratory department of our hospital happened to be passing my office door, someone who had been involved with SARS. I grabbed the director and said, "We found this in one of the patients in your department." The director took one look and said it was worrying. I knew the matter was worrying.
After calling the hospital, I also circulated this report to my fellow-learners (同学[; student or former classmate]). I purposely drew a red circle around the words "SARS coronavirus, Pseudomonas aeruginosa, 46 strains of bacteria [菌, bacteria and/or fungi] which colonize the oral cavity and/or respiratory tract" to bring the warning to their attention. I also sent the report to the doctors in the department to warn everyone to take precautions.
That evening, the message was spread widely; the screenshots of the transmission show the photos of the report I'd marked with a red circle, including the ones that I later learned that Li Wenliang passed on to the [chat] group. At the time, I was thinking it might be bad. At 10:20, the hospital passed on a message [reportedly on the Central Hospital WeChat group]. It was a relayed notification from the city Health Protection Committee (市卫健委). Their main point was that information on the pneumonia of unknown cause should not be arbitrarily released, to avoid causing panic among the public; if panic was caused by information leakage, there would be a thorough investigation (要追责).
I was very scared at the time and immediately passed this information on to my fellow-learners. About an hour later, the hospital sent another notice, again stressing that information the group had on this subject could not be leaked. One day later, at 11:46 pm on January 1st, the head of the hospital's disciplinary inspection committee sent me a message to come [for an employee review] the next morning.
I didn't fall asleep that night, I was worried and thought things through over and over again, but I felt that there are always two sides to everything; even if it had caused adverse effects, it was not necessarily a bad thing to remind medical staff in Wuhan to take precautions. At 8 o'clock the next morning, before I finished the shift, I was called in for the disciplinary review.
In that disciplinary review, I suffered an unprecedented and very severe reprimand.
At that time, the leader of the discussion said, "We can't afford to raise our heads when we go out for a meeting. The director of XX criticizes our hospital. As the director of the emergency department of Wuhan Central Hospital, you are a professional, how can there be this lack of principle, this lack of organizational discipline, this creating and spreading of false rumours (谣)?" This is the original sentence. So I should go back to the 200-odd people in the department to convey the news to them verbally, one by one; we can't send information by WeChat or SMS, we can only talk face-to-face or call, we can't say anything about this pneumonia, "you can't even tell your own husband", they said
I was utterly stunned. I hadn't been criticized for not working hard, but made to feel that what I'd done had ruined Wuhan's prospects and its future. I felt strong depair. I am a serious and hard-working person. I felt that everything I had done was in accordance with the rules and well-founded. What did I do wrong? After I read the lab result, I had also reported it to the hospital. My students and my colleagues had communicated among ourselves about how to handle the condition of a patient, we hadn't given out any of the patient's personal information; this is equivalent to discussing a medical case among medical students. As a clinical doctor, I already knew that a very important virus had been found in patients. When other doctors asked, how could you not say so? This is your instinct as a doctor, right? What did I do wrong? I have done what a doctor and a person should normally do. I think anyone would do the same.
I was very emotional at the time, saying that I had done this, and it had nothing to do with the rest of the people; you can just arrest me and jail me. I said that I was not suitable to continue to work in this position, and I wanted to take a break. The leader did not agree, saying that this was the time to test me.
I went home that night, I remember it quite clearly, I told my husband just after I walked in the door, if something goes wrong, you must care for and raise the child -- because my second treasure is still very young, only just over 1 year old. At the time, my husband was perplexed by this. I didn't explain.
On January 20th, after Zhong Nanshan [prominent Chinese epidemiologist] told people [about the epidemic], I told my husband what had happened that day. In the interim, I just warned my family not to go to crowded places, and to wear surgical face masks when going out.
Many people worried that I was among the eight people who were admonished [by police]. In fact, I wasn't warned by the Public Security Bureau. Later, a good friend asked me, are you a whistleblower? I said that I am not a whistleblower, I am the one who sent the whistle.
But that disciplinary review hit me hard, it affected me very severely. When I came back, I could see that everyone's morale had collapsed. We had been working with such drive and dedication, and doing our jobs conscientiously. Everyone kept asking me questions, and I couldn't answer.
All I could do was get the emergency department to focus on protection. We have over 200 people in the emergency department. From January 1st, I asked everyone to strengthen their protection. Everyone must wear masks, hats, and use gloves (用手快消). I remember one day, there was a nurse who did not wear a mask during the shift; I scolded him then and there, saying "Don't come to work without a mask in the future".
On January 9th, while off-shift, I saw a patient coughing on the pre-examination table. From that day on, I asked everyone to put a mask on both the patient and on anyone seeing the patient, one for each person; I said, don't try to save money at this time. At the time, they were still telling us that there was no human-to-human transmission, and I want to emphasize here that wearing a mask to strengthen protection was a big issue.
That time was really depressing and very painful. Some doctors proposed wearing and out layer of isolation clothing. The hospital's internal operations committee (医院里开会) said they wouldn't allow it; they said that wearing isolation clothing would cause panic. I asked the people in the department to wear an isolation gown inside a white coat. This was out-of-specification and ridiculous.
We watched more and more patients arrive, as the radius of the infection area became larger and larger. At first, they might be connected to the Huanan Seafood Market; then it spread, and the radius became larger and larger. Many of the cases were family-transmitted. Among the first seven people, there was a case of infection in which the mother had given the son food. The clinic [dispensary? 诊所] boss got sick, infected by the patients who came for injections. It was very serious, whether they got infected or not. I knew there must be human-to-human transmission. If there was no human-to-human transmission, well, the Huanan Seafood Market had been closed on January 1, so why were there more and more patients?
I often thought, if only they hadn't reprimanded me like that, if they'd asked for details calmly, and then asked other respiratory experts to communicate with them, maybe the situation would be better, and I could at least communicate a bit more in the hospital. If everyone had been as alert on January 1, there would not be so many tragedies.
On the afternoon of January 3, in the Nanjing Road Hospital, doctors of urology gathered to review the work of the senior director, 43-year-old Dr. Hu Weifeng (胡卫峰), who is now in emergency care; on the afternoon of January 8, the Nanjing Road Hospital Director [of thyroid and breast surgery] Jiang Xueqing (江学庆) also organized the first Wuhan City breast disease patient recovery get-together (武汉市甲乳患者康复联欢会), on the 22nd floor. On the morning of January 11, the department reported to me that Hu Ziwei (胡紫薇), a nurse in the emergency room of the emergency department, was infected. She'd be the first infected nurse in the central hospital. First-off, I called the Chief of the Medical Department to report it, and then the hospital held an emergency meeting. At the meeting we were instructed to change the report of "double lung infection, viral pneumonia?" to "scattered infection of both lungs" ("两下肺感染，病毒性肺炎？" to "两肺散在感染"). At the weekly meeting of January 16th, a deputy dean was still saying, "Everyone must have a little medical common sense, and certain senior doctors should not go about scaring people." Another leader spoke, and continued, "Human-to-human transmission is not possible; it can be prevented, treated and controlled." One day later, on January 17, Jiang Xueqing was hospitalized, and 10 days later he was intubated and put on ECMO.
The toll at the central hospital is so large, and it's connected to the lack of transparency for our medical staff. If you look at the people who fell ill, the emergency department and the respiratory department suffered less heavily, because we had a sense of the need for protection, and we knew we should quickly rest and get treatment as soon as we got sick. The worst cases are in the peripheral departments; Li Wenliang was an ophthalmologist, and Jiang Xueqing is a nail specialist.
Jiang Xueqing was really a very good person, with excellent medical skills. He held one of the two Chinese Physician Awards in the hospital. And yet we were neighbors, we were a unit; I'm located on the 40th floor, he was on the 30th floor, our working relationship was very good, but because I am too busy at work, I only met him during meetings and hospital activities. He was a workaholic, always either in the operating room or at the clinic. No one would go to tell him specifically, "Director Jiang, you have to pay attention and wear a mask". He didn't have the time and energy to inquire about these things, and he must have brushed it off with: "What's the matter? It's pneumonia." This was what people in that department told me.
If these doctors had been warned in time, perhaps this day wouldn't have come. So that's why, as one closely involved, I regret what I did. If I knew then what I know now, I wouldn't have cared about the reprimand, I would have [expletive] spoken of it everywhere, to everyone, wouldn't I?
Although I worked in the same hospital as Li Wenliang (李文亮) did before he died, I didn't know him, because the hospital had over 4,000 people on staff and was usually busy. The night before his death, the director of the ICU called me to borrow a cardiac press (心脏按压器; CPR device?) from the emergency department, and said it was Li Wenliang who was going to be resuscitated. The news shocked me. I do not understand everything that happened to Li Wenliang, but could his condition have been affected by his emotional state after being reprimanded? I have to ask, with my experience; I felt it myself.
Later, when things got to this point, it proved that Li Wenliang was right. I can understand his state of mind very easily. It could be my own. I don't feel excitement or happiness, but regret. Regret that I didn't continue to shout out loudly at the beginning, when people intervened and scolded us. I often find myself thinking, if only we could turn back time, and do it right.
Just surviving is good
On the night before the city was shut down on January 23, a friend from the relevant department called to ask me about the true situation of emergency patients in Wuhan. I said, are you asking in a private or public capacity? He said, private. [I said,] I will tell you the truth when I speak on my behalf: On January 21, our emergency department saw 1,523 patients, three times as many as usual, of which 655 had fever.
The situation in the emergency department during that time will never be forgotten by those who experienced it, it completely changes your outlook on life.
If this is a war, the emergency department is the front line. But at the time, the inpatient wards were saturated, and basically none of the patients were accepted, and the ICU was resolutely refused to accept them. They said that there were uninfected patients in them, and they became contaminated as soon as they entered. More patients kept rushing in to the emergency department, and the inpatient beds were not open, so they all piled up in the emergency department. Patients queued for a few hours to see a doctor. We couldn't take any time off work at all. There was no distinction between the fever clinic and the emergency department. The hall was full of patients. The emergency room, the IV room, everywhere was filled with patients.
Another patient's family came in, wanting a bed for their dad, who couldn't make it in from the car, because the underground garage was closed at the time, and the car couldn't get in. I couldn't do anything about that, but I ran to the car with people and equipment. I saw immediately that he was already dead. What can you say, it's very difficult to bear. The man died in the car, he didn't even get out of the car.
There was also an old man, his wife had just died at Jinyintan Hospital, her son and daughter were infected, and she was given an IV, her son-in-law was caring for her. As soon as I saw that she was very ill, I contacted the respiratory department to admit her to the hospital. Her son-in-law was obviously a cultured person. He came over and wished to thank the doctor and so on. As a result, she died. It only took a few seconds, but it was a delay of a few seconds. That quick "thank you" weighs heavily on me.
And yet there were many people who sent their families to the ward (监护室[; guardianship room]? in the sense of trustee), and that's the last time you'l see them, you'll never see them again.
I remember when I came to work on the morning of the Chinese New Year [Friday, January 24, 2020]. I said that we'd take a picture to commemorate the New Year. I also sent it to a circle of friends. No one wished anyone a happy new year that day. At the time, just surviving was good.
In the past, if you made a small mistake, for example, if you didn't give an injection in time, the patient might still be in trouble. Now there's no one, no one is to raise it with you, no-one is going to take issue with it. Everyone's overwhelmed by the sudden onslaught, we work blindly.
The patients died, and it was rare to see family members weeping and grieving, because there were too many, too many. Some family members didn't say "Doctor, please save my family", but said to the doctor, "Right, let's do this quickly"; it came to that. Everyone was afraid of being infected.
The queue at the fever clinic was 5 hours long, every day. A woman waiting in line collapsed, a woman in a leather coat, with a purse and high heels, very carefully dressed. A middle-aged woman; no one dared to step forward to help her, and she lay on the ground for a long time. I had to call the nurse and doctor to help her.
On the morning of January 30, I came to work. The son of a white-haired old man had died at the age of 32. He stared blankly at the doctor giving him the death certificate. There are no tears at all, how can one cry? There's no way to cry. From the style of his clothing, the old man might be a rural migrant worker, there's no way to be sure. Without a diagnosis, his son became a death certificate.
This is what I want to call for. The patients who died in the emergency department were all undiagnosed, and their causes of death could not be confirmed. After this epidemic has passed, I hope to give an explanation and give their families some comfort. Our patients wake compassion, a great deal of compassion.
Having been a doctor for so many years, I always felt that no difficulty could overwhelm me, not with my experience and personality.
When I was nine, my father died of gastric cancer. At that time, I thought of growing up to be a doctor, to save the lives of others. Later, when I did my the college entrance examination, all my preferences were in medicine, and I finally got to go to Tongji Medical College. After graduating from medical college in 1997, I went to the Central Hospital. I previously worked in cardiovascular medicine, and I became the director of the emergency department in 2010.
I feel the emergency department is one of my children. I built it up, I nurtured a tight-knit group, which really doesn't make this situation easier, but it's what makes this group such a treasure; I really cherish this team.
A few days ago, one of my nurses sent a message to a friends group saying "I really miss the old big busy emergency department"; that kind of busy and this kind of busy are totally different concepts.
Before this epidemic hit, our emergency department dealt with myocardial infarctions, cerebral infarctions, gastrointestinal bleeding, trauma and so on. That kind of busy gives a sense of accomplishment, it has a clear purpose, there's a smooth flow of procedures for all the various types of patients. There are very mature procedures, there's not a single wasted step, what to do next is not a problem. But in this time there were so many critically ill patients whom we had no way to deal with and who couldn't be admitted to hospital, and our medical staff was still at risk. This kind of busyness is desperate, it's deeply distressing.
One day at 8 in the morning, a young doctor in our department sent me a WeChat, and it was quite personal, saying they wouldn't come to work that day, not well. Since what we do here, if someone is not well, they need to tell me about it in advance; if they tell me at 8 o'clock, where do I go to find someone? The doctor lost their temper with me in WeChat, and said that a large number of highly suspect cases were put back into the community by the emergency department I led. We understand that this is sin! I understand this person, because this is a doctor's professional ethics, but I was also anxious, and I said you can denounce me, but tell me, what would you do if you were the director of the emergency department?
Later, the doctor came back to work after a few days of rest. The doctor didn't say that they feared death or feared harm; no, they were affected the conditions; suddenly having to deal with so many patients at once, they felt utterly overwhelmed.
And the work of the medics, especially for the many medics who came to support us, it was psychologically unbearable. There were doctors and nurses in tears. Some were crying for others, others were crying for themselves, because no-one knows when it will be their turn to become infected.
Around mid-to-late January, the hospital's leaders also became ill, one after another, including our director of the office and three vice-presidents. The daughter of the Chief of Medical Services was also ill and resting at home. So basically there was no administration or management; you just had to fight there, that was the feeling.
The people around me also started to come down with it one by one. On January 18, at 8:30 in the morning, our first doctor collapsed, saying "I caught it just like the director did", no fever, did a CT first off, and the lungs had a lump of ground-glass opacification (坨磨玻璃). Not long after, the duty nurse in charge of the isolation ward told me they'd fallen ill. That night, our head nurse fell ill. My very real first feeling at that time was -- good luck, because falling ill early, you could get off the battlefield for a little bit.
I've been in close contact with these three people. I just work every day with the belief that I must fall ill. Everyone in the hospital thought I was a miracle. I've thought about it myself, perhaps it's because I have asthma and I'm using some inhaled hormones, perhaps it inhibits the deposition of these viruses in the lungs.
I've always felt that the people who work in the emergency department have feelings, too. In Chinese hospitals, the status of the emergency department is relatively low among the departments, because everyone thinks that the emergency department is nothing more than a route into the hospital, it just needs to admit patients. During this epidemic, this sort of neglect has always been present.
In the early days, they're weren't enough supplies. Sometimes the quality of the protective clothing assigned to the emergency department was very poor. I was angry when I saw that our nurses wore such clothes to work and spoke up about it in Zhouhui Qun [a WeChat group for MDs in that hospital]. After that, many directors gave me all the protective clothing they kept in their departments.
There were also problems with food. When there are many patients, the management gets confused. They simply can't think that the emergency department still has to have something to eat. Many departments had food and drink after shift changeover, they had a big spread, and here, we had nothing. In the fever clinic's WeChat group, doctors complained: "Our emergency department has only disposable diapers " We were the front-line response, and we had to deal with that sort of thing, sometimes it made me really angry.
Our team is really good. Everyone held the line, they were only off work when they were sick. More than 40 people in our emergency department were infected. I built a group of all the sick people, originally called the "Emergency Department Sick Group"(急诊生病群); the head nurse said that was unlucky, and changed it to "Emergency Department Re-energizing Group" (急诊加油群). Even the people who are sick weren't thinking in terms of despair or blame. They were all very positive, that is, everyone had the attitude that we needed to help one another to get thorough the crisis together.
These kids, these young people are very good, it's just that they, like me, have to live with feeling slighted. I hope that after this epidemic, the country will also increase its investment in emergency departments. In many countries' medical systems, the emergency department is highly valued.
On February 17th, I received a WeChat message from the old classmate at Tongji Hospital. He said "Sorry" to me. I said: it's fortunate that you passed the message on and warned some people in time. If he hadn't passed it on, they might not have Li Wenliang and the eight others, but people would probably know less.
This time, we had the entire families of three female doctors get infected. Two female doctors had their father-in-law and mother-in-law infected, and their husbands, and another had her father, mother, sister, and husband infected, and five close relatives. Everyone thinks that the virus was discovered so early on, and yet this is the result, it caused us such great loss, took such a terrible toll.
It took this toll in many different ways, too. In addition to those who died, those who were sick also suffered.
In our "Emergency Department Re-energizing group", people often exchange physical conditions. Some people ask: a heart rate that's always 120 beats per minute, does it matter? Surely it matters, they panic as soon as they move. This will affect them for life, and is heart failure likely? It's hard to say. In the future, others will be able to go hiking and traveling, and they might not be able to, all that is possible.
And Wuhan. You said that our Wuhan is a lively place; now it's very, very quiet on the streets. Many things can't be bought and we have to support the whole country. A few days ago, a nurse of a medical team in Guangxi suddenly fell into a coma while at work, and was resucitated. Her heart restarted, but she is still in a coma. If she hadn't come to work, she could have had a good time at home, and this kind of thing wouldn't have happened. So, I think we owe everyone, really.
Having been through this epidemic, many people in the hospital have been hit hard. Several medical staff below me have thoughts of resignation, including some backbones of the department. Everyone's previous ideas, all the things everyone knows about this profession, they're are inevitably a little shaken -- it's that you work so hard, isn't it? Just like Jiang Xueqing, he worked too hard, he was too good to the patients, he was doing surgery every year during [Chinese] New Year. Today, someone sent a WeChat written by Jiang Xueqing's daughter, saying that her father's time was all given to his patients.
Myself, I've had countless thoughts of going back home to be a housewife. After the epidemic began, I basically didn't go home, I lived separately from my husband. My sister helped take care of my children at home. My second treasure didn't recognize me, didn't react to me when he saw me on video. I felt very lost. It wasn't easy for me to give birth to this second child. He was 10 kg at birth. I had to wean him abruptly -- when I made that decision, that was hard for me to do. My husband told me that these things happen in life, and you're not only a participant, you're also choosing to lead the team to fight this epidemic; that's also a very meaningful act, and when everything returns to normal for everyone, then you'll remember; it's a valuable experience to have had.
The leader (领导) talked to me on the morning of February 21st. Actually, I would have liked to ask a few questions, such as, do you think that that criticism was wrong that day? I hoped to be given an apology. But I dared not ask. No one said sorry to me on any occasion. I still feel that these events are an even clearer demonstation of why each person should stick to their own independent ideas, regardless, because if someone wants to stand up and tell the truth, there must be someone, and the world must hear a dissenting voice, right?
I'm Wuhanese, who doesn't love their own city? Now we remember what extravagant happiness we enjoyed in the most ordinary life. I now feel that holding the baby, going out to play with him on a slide, or going out to watch a movie with my husband, even things we never did all that often in the past, they are now all a kind of happiness, an unattainable happiness.
Apr 11, 2020 | nypost.comEnlarge Image NYPD officers give out food and beverages to working nurses and doctors at Montefiore Hospital. Richard HarbusMore On:Coronavirus in NY Business analysts see potential summer recovery for economy Now is not the time to play the partisan blame game over coronavirus: Goodwin Act of Car-trition: Church offers drive-thru confession amid pandemic Race and coronavirus: There are no easy answers New York State nurses and other hospital workers are being exposed to "dangerous working conditions" amid the coronavirus pandemic because of "critical shortages" of personal protective gear , and they want "urgent action" from Gov. Andrew Cuomo to provide them with the equipment they need.
That's the message in a blistering April 11 letter sent by the New York State Nurses Association's director to Howard Zucker, the state health commissioner, obtained by The Post.
The letter contradicts comments made by Melissa de Rosa, secretary to Gov. Cuomo, at a press briefing last week, in which she said that hospitals were receiving stockpiled PPE equipment and that no health care facilities in the state would have to resort to "crisis conservation."
That means the reusing of masks, hospital gowns and other equipment meant to guard against the spread of COVID-19.
"At this point most hospitals and nursing homes in the New York City metropolitan area, which is the national epicenter of the pandemic, continue to operate under 'crisis conservation' standards because they do not have enough PPE to distribute to our desperate staff," wrote Patricia Kane, the executive director of the Nurses Association, the union which represents 42,000 frontline nurses in the state.
In the letter, Kane went on to describe "widespread" crisis protocols for re-using scarce protective equipment.
She described how N95 masks are only being used by nurses and other staff in ICUs and the masks, designed for one-time use, must be recycled for up to five days before being discarded.
She described how the delay of delivery of PPEs to many hospitals have forced health care workers to collect and re-sterilize used PPE equipment which would be discarded under normal circumstances.see alsoPPE maker 3M sues New Jersey company for falsely claiming affiliation Personal protective equipment manufacturer 3M says a New Jersey company...
"If the state is in possession of stockpiles of PPE, they should be immediately distributed to our facilities so that our nurses and other staff can provide can provide care for patients under safe conditions," Kane said.
"We urge you to treat this matter with the urgency that the situation warrants and act to protect the safety and lives of the nurses and other direct care workers on the front lines of this fight.
"Our nurses do not need expressions of appreciation and promises. They need to see ample supplies of PPE on their units."
Apr 11, 2020 | www.rt.com
New York Governor Andrew Cuomo has launched a fund to support sick healthcare workers and their families, but some blame him for the dire working conditions facing the state's caregivers after nine years of hospital budget cuts. Cuomo announced the state is working on a "Covid-19 Heroes Compensation Fund" to support healthcare workers and their families who have been diagnosed with the coronavirus during his daily briefing on Friday. It was heralded by his growing Democratic fan club as a generous, thoughtful move from a politician who cares about the "frontline workers."
Absent from the lovefest was any mention of how the governor had - just the previous day - deferred 2 percent pay raises to some 80,000 state workers for 90 days, and potentially for longer. Many of those affected are healthcare workers in the state's prisons and mental health facilities.
Union leaders were outraged. "It's inexcusable to require our workers to literally face death to ensure the state keeps running and then turn around and deny those very workers their much-deserved raise in this time of crisis, " Civil Service Employees Association president Mary Sullivan told the Times Union, while NY Correctional Officers and Police Benevolent Association chief Michael Powers called the postponement a "slap in the face" to workers facing "some of the most dangerous conditions in the state."
While Cuomo is being praised for his leadership amid the coronavirus outbreak, the problems he is scrambling to solve are largely of his own making. Although aware of a 2015 report highlighting the desperately-depleted state stockpile of ventilators, he didn't take any actions on it, and has spent his tenure shuttering and downsizing hospitals across the state, mostly those serving low-income clients. The state has eliminated 20,000 hospital beds in the last two decades, at least half under his leadership.
The New York state budget passed at the beginning of the month included deep cuts to Medicaid and may have rendered the state ineligible for $6 billion in federal aid, infuriating liberal lawmakers who were less enchanted with the new #Resistance hero. State Senator Gustavo Rivera (D-Bronx) told the New York Daily News that Cuomo's latest budget "only offered harsh austerity for the poorest and most vulnerable" New Yorkers.
The state's Democrat-controlled senate called on Cuomo to tax the wealthy - New York has the highest economic inequality in the country, and a tax on the richest .01 percent has upwards of 90 percent approval among voters - only to be turned down by the politician who has earned the nickname "Governor One Percent."
The latest cost-cutting moves resulted in New York City deprived on $200 million in sales tax revenue when the big apple is at the epicenter of the US coronavirus outbreak.
The pandemic has hospitals so understaffed that NYC Health and Hospitals Corporation has apparently been reduced to contracting dodgy medical-temp agencies - one, Kansas-based disaster-staffing group Krucial Staffing, was sued earlier this week for luring out-of-state medical professionals to work in city hospitals under false pretenses, promising them cushy posts with ample protective equipment and no Covid-19 exposure - to fill vacancies. The suit alleges Krucial's misrepresentation of working conditions placed healthcare workers' medical licenses and lives in danger.
It's unclear how many medical workers have contracted and died of the disease in the state, as New York, along with several other states, does not tract infections among medical staff. According to a BuzzFeed News review of the reports by 12 states, which made their data public, at least 5,400 nurses and doctors tested positive nationwide, while dozens have succumbed to the lethal illness. Among them, Kious Kelly, an assistant nurse manager at Mount Sinai West, whose death from the coronavirus on March 24 sparked protests among the personnel and led to the hospital eventually allowing workers to receive tests – but only those already showing symptoms.
Some 7,887 New Yorkers have died with coronavirus since the beginning of the outbreak, the majority of them - 5,820 - in New York City.
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Mar 17, 2020 | www.truthdig.com
... ... ...
Instead of a public health system, we have a private for-profit system for individuals lucky enough to afford it and a rickety social insurance system for people fortunate enough to have a full-time job.
At their best, both systems respond to the needs of individuals rather than the needs of the public as a whole. In America, the word "public" – as in public health, public education or public welfare – means a sum total of individual needs, not the common good.
Contrast this with America's financial system. The Federal Reserve concerns itself with the health of financial markets as a whole. Late last week the Fed made $1.5 trillion available to banks at the slightest hint of difficulties making trades. No one batted an eye.
When it comes to the health of the nation as a whole, money like this isn't available. And there are no institutions analogous to the Fed with responsibility for overseeing and managing the public's health – able to whip out a giant checkbook at a moment's notice to prevent human, rather than financial, devastation.
Even if a test for the Covid-19 virus had been developed and approved in time, no institutions are in place to administer it to tens of millions of Americans free of charge. Local and state health departments are already barebones, having lost nearly a quarter of their workforce since 2008, according to the National Association of County and City Health Officials.
Healthcare in America is delivered mainly by private for-profit corporations which, unlike financial institutions, are not required to maintain reserve capacity. As a result, the nation's supply of ventilators isn't nearly large enough to care for projected numbers of critically ill coronavirus victims unable to breathe for themselves. Its 45,000 intensive care unit beds fall woefully short of the 2.9 million that are likely to be needed.
The Fed can close banks to quarantine financial crises but the US can't close workplaces because the nation's social insurance system depends on people going to work.
Almost 30% of American workers have no paid sick leave from their employers, including 70% of low-income workers earning less than $10.49 an hour. Vast numbers of self-employed workers cannot afford sick leave. Friday's deal between House Democrats and the White House won't have much effect because it exempts large employers and offers waivers to smaller ones.
Most jobless Americans don't qualify for unemployment insurance because they haven't worked long enough in a steady job, and the ad-hoc deal doesn't alter this. Meanwhile, more than 30 million Americans have no health insurance. Eligibility for Medicaid, food stamps and other public assistance is now linked to having or actively looking for work.
It's hard to close public schools because most working parents cannot afford childcare. Many poor children rely on school lunches for their only square meal a day. In Los Angeles, about 80% of students qualify for free or reduced lunches and just under 20,000 are homeless at some point during the school year.
There is no public health system in the US, in short, because the richest nation in the world has no capacity to protect the public as a whole, apart from national defense. Ad-hoc remedies such as House Democrats and the White House fashioned on Friday are better than nothing, but they don't come close to filling this void.
Apr 08, 2020 | www.moonofalabama.org
b , Apr 6 2020 18:59 utc | 15@Noirette
Here as long thread of U.S. hospitals firing people because their usual business no longer makes money:U.S. healthcare system is so overwhelmed by COVID-19 that hospitals are laying off staff.
Yes, you read that right. Due to coronavirus lockdown and fears, no one's going except in absolute emergencies. Hospitals are getting slammed--by lack of business.
Apr 08, 2020 | consortiumnews.com
Andrew Thomas , April 7, 2020 at 10:32
No, we can't blame Trump for the entire privatized US healthcare system. However, he owns part of this, as recently published information clearly shows. Having said that, his shamelessness has, along with the Fed, and Congress, and the Supreme Court, and state governments all over the country, have also clarified the state of play very well indeed. This is a shithole kleptocracy merged with a kakistocracy. Voting has lost all of its meaning. The only thing left to us is an active boycott in November, assuming the farce isn't called off by a presidential decree. The ruling of the Supreme Court on the Wisconsin election on Monday would seem to make the Court's approval of such a thing unlikely. However, it's not exactly the same question, and the Federalists are nothing if not both inventive and supine when it comes to the exercise of corporate-backed executive power. My guess is that it won't happen, if only because Trump will be crushing the Dems in the polls.
AnneR , April 7, 2020 at 07:32
Indeed, Mr Cook, indeed.
The US (its ruling, plutocratic elites and their fellow traveling political hench-folks) has never wanted to expend taxpayer (i.e. the hoi polloi's taxes, the rich-ultra rich not paying any or very little of their "earnings" to the IRS) monies (however much cheaper, in reality, such a medical system would have been and be) on a single payer, free-at-point-of-service medical care system for all of its citizens. Such a system is "communist," "socialist." The fact that the remainder of the western world has some such construct without apparently being communist or even truly socialist escapes the US ruling elite consciousness. Deliberately.
Indeed, the attitude among many of those elite 20%ers would seem to be along the lines of an Arizonan politico who expressed this worldview on Obamacare (hardly single payer, not free at point of service or anything close to, nor does it cover every American – the poorest are beyond its scope): in answer to some question about the ACA, this politico (doubtless with medical coverage paid for by taxpayers) said that some people could afford Mercs, others Fords, some could only afford umpteenth-hand vehicles and then there were those who couldn't afford any vehicle. Access to medical care falls along the same lines – and that's the way things naturally are.
She was a Reprat – but Mr Biden thinks along the same lines, it would seem.
Yes, the US populace – the hoi polloi, vox populi, the bewildered herd, us – want M4A and as a single payer non-profiteering system. Or most do. But the profiteering companies – pharma, hospitals, clinics, med insurance companies, doctors, medical staffing (for Emergency Depts etc.,) companies – do NOT want anything to do with such a system. And they are among the election funders of those DC politicos (many themselves among the rich) who balk at the very notion of M4A. The medical and the political system here is corrupt. Not only does Power corrupt, but profiteering also corrupts and does so as absolutely as absolute power.
And this system, this political, medical system isn't likely to change without some drastic overhaul – and is that likely?
Other changes – increasing surveillance e.g. – may well take place. But profit before life? One only has to consider the eagerness with which the US Congress – both sides of the Janus party – signed onto the Strumpet's obscenely enormous MIC funding last year, continuing the Profit before People (at home and in the countries devastated by us) construct that is DC.
Apr 07, 2020 | nypost.com
New York has lost a staggering 20,000 hospital beds over the last two decades to budget cuts and insurance overhauls, complicating local and state efforts to battle the coronavirus, according to records and experts.
The Empire State had 73,931 licensed hospital beds in 2000 before years of cuts and closures shrank the number to just 53,000 in 2020, according to records obtained by the New York State Nurses Association from the state Health Department and stats provided by officials.
Gov. Andrew Cuomo said Tuesday the health officials believe they will need anywhere from 55,000 to 110,000 hospital beds to treat the expected wave of coronavirus victims.
"New York has closed too many beds. They went too far," said Judy Wessler, former head of the NY Commission on the Public's Health System, about the 28 percent drop in beds.
Those cutbacks mean the state is in a significantly deeper deficit as it searches for ways to expand its capacity to treat COVID-19 victims.
"This is going to crash the health care system," Cuomo warned, as he again reiterated his request to President Trump that the Army Corps of Engineers be dispatched to help New York state build emergency hospital capacity.
Apr 05, 2020 | www.rt.com
French caregivers battling Covid-19 are appallingly underequipped and overloaded with fresh cases, a local nurse said, explaining a recent action which saw medics posing naked to show their vulnerability to the deadly contagion. The unorthodox demonstration kicked off earlier this week, with dozens of nurses undressing in a silent protest against the government "sending us naked to face this pandemic," as Melina Dufraigne-Laflechelle, one of the nurses behind the flashmob, put it on RT France.
Using the hashtag #apoilcontrelecovid (naked against the Covid), the silent protest featured medics of all ages posing with small signs concealing their private parts.
"As you all know, to be able to treat patients with dignity and not take risks for ourselves and our patients, we need a set of equipment which we don't have," said Dufraigne-Laflechelle.
Old-fashioned masks are the only protective gear local medical staff have received from the government, she claimed.
Apr 01, 2020 | www.moonofalabama.org
Peter AU1 , Apr 1 2020 12:27 utc | 215Yandex translation.
"the Day after the day lengthens the list of doctors who died on the field for Covid-19. And the total up to 51.
Are 6.414 health care workers infected."
Apr 01, 2020 | weekly.chinacdc.cn
The early days of the outbreak have been reminiscent of SARS and MERS, and indeed, the discovery that the causative agent was a closely-related, never-before-described coronavirus predicted potential for nosocomial transmission and so-called "super-spreader" events ( 8 ). Unfortunately, 2019-nCoV did indeed infect health workers in China via nosocomial transmission. Here we offer a first description of the 1,716 confirmed cases among health workers.
Overall, they also display a likely mixed outbreak pattern -- perhaps the data are characterized by a point source curve beginning in late December 2019, which was eclipsed by a higher magnitude continuous source curve beginning on January 20, 2020. To date, there is no evidence of a super-spreader event occurring in any of the Chinese health facilities serving COVID-19 patients. However, we do not know whether this is due to the nature of the virus itself or whether these events have been successfully prevented.
Mar 31, 2020 | www.zerohedge.com
US Health care systems have warned emergency room doctors and nurses that if they speak out about working conditions inside a hospital, they will be fired, reported Bloomberg .
Ming Lin, an emergency room physician in Washington state, lost his job last week after he spoke to a local media outlet about the lack of protective gear for staff at Puget Sound area hospitals.
Hospital staff at the NYU Langone Health system were recently warned that if they spoke to the media without authorization, they would be terminated.
"Hospitals are muzzling nurses and other health-care workers in an attempt to preserve their image," said Ruth Schubert, a spokeswoman for the Washington State Nurses Association. "It is outrageous."
With confirmed virus cases over 163,000 and 3,170 deaths , hospital systems across the country are seeing a massive influx of patients that is straining the system.
Doctors and nurses "must have the ability to tell the public what is really going on inside the facilities where they are caring for Covid-19 patients," Schubert said.
As we noted in January, a hospital doctor in Wuhan, China, the epicenter of COVID-19, tried to inform the world about a fast-spreading disease. However, he was quickly silenced by the Chinese government, and since, more than 800,000 people around the globe have been infected, with 39,000 deaths.
One reason that nurses and doctors must be informative about evolving conditions inside hospitals is that public donations of medical equipment or gear could help out a local facility.
"It is good and appropriate for health-care workers to be able to express their own fears and concerns, especially when expressing that might get them better protection," said Glenn Cohen, faculty director of Harvard Law School's bioethics center. Hospitals are likely trying to limit reputational damage because "when health-care workers say they are not being protected, the public gets very upset at the hospital system."
NYU Langone Health employees received notification last week that if they spoke with media, they would be "subject to disciplinary action, including termination."
New York's Montefiore Health System requires doctors and nurses to get permission from superiors before speaking to the media.
"Associates are not authorized to interact with reporters or speak on behalf of the institution in any capacity, without pre-approval," according to the policy, which was seen by Bloomberg News.
Lauri Mazurkiewicz, a Chicago nurse at Northwestern Memorial Hospital, was fired after she told the hospital staff to wear more protective equipment:
"A lot of hospitals are lying to their workers and saying that simple masks are sufficient and nurses are getting sick and they are dying," Mazurkiewicz said.
Doctors and nurses have also tweeted their frustrations with hospital systems – this has also led to some systems tightening the noose on what employees can and cannot say on social media:
My babies are too young to read this now. And they'd barely recognize me in my gear. But if they lose me to COVID I want them to know Mommy tried really hard to do her job. #GetMePPE #NYC pic.twitter.com/OMew5G7mjK-- Cornelia Griggs (@CorneliaLG) March 29, 2020
Nisha Mehta, a radiologist from Charlotte, North Carolina, runs several Facebook groups for physicians. She says members in her groups have reached out to her and want their stories told about working conditions:
"I'm hearing widespread stories from physicians across the country and they are all saying: 'We have these stories that we think are important to get out, but we are being told by our hospital systems that we are not allowed to speak to the press, and if we do so there will be extreme consequences," Mehta said.
America's hospital system could be cracking , like what happened in China and Italy. If everything were fine, doctors and nurses wouldn't be flooding media outlets and social media platforms, warning the public about hospital conditions and or about how deadly the virus is.
Mar 30, 2020 | www.moonofalabama.org
Circe , Mar 29 2020 20:03 utc | 46So there are a lot of wacky theories out there. Here's mine and warning: I'm pissed at what I'm witnessing.
1. The way health industry workers including maintenance support personnel are carrying the load on the front lines of this pandemic is UNSUSTAINABLE and inhumane both for staff and patients. This story must be EXPOSED in every global hot spot.
2. This pandemic is a WAR, so let's attack it and behave like we are in the midst of a World War.
3. All gloved hands must be on deck for this. Healthcare workers should not be burdened and risking everything in the manner that we are starting to become aware of now in the West. Why should they be subjected to such stress and burden and all the risk while millions of ABLE-BODIED PEOPLE languish at home collecting a check for doing nothing. Where is the government on balancing this chaotic, unjust situation?
4. There are many, many service jobs associated with healthcare and needs brought out by this pandemic that don't involve close contact. The need is great.
5. Governments think the military can help in this crisis? Use it! Better to use them for healing than killing.
6. Need more help? Then recruit college and university students without underlying health conditions between the ages of 17 to 35. Hell, recruit from all healthy, able people under 50 collecting UI.
7. No one should be languishing at home collecting free money while everyone working in the healthcare service industry, and senior residences suffer 24/7 with crazy shifts getting sick!
I know what I'm bitching about. Both my parents were afflicted with cancer a few years apart. I practically lived my life in the hospital and witnessed need wherever I turned in normal times and helped in whatever way I could through the entire ordeal. There is an aging population crisis happening around us and everyone's acting like this is la-la land and who cares!
8. This pandemic is emphasizing deficiencies everywhere in the system, especially moral deficiencies.
9. This pandemic is war, and many are needed on deck to end it! If able bodies want a free ride, to collect a check and languish while others suffer...damn it...draft them or cut off the funds!
10. It's time to go above and beyond the clapping, already! Everyone should be shouldering the need wherever they can.
It's time to organize and share in the work and responsibility involved.
Mar 30, 2020 | www.moonofalabama.org
dltravers , Mar 29 2020 20:20 utc | 48Molecular test labs do not grow on trees nor are they conductive to mass large scale testing...
Why It Takes So Long To Get Most COVID-19 Test Results
Mar 27, 2020 | www.moonofalabama.org
Likklemore , Mar 26 2020 18:54 utc | 2there are shortages of masks and gloves for the frontline so joe and jane may not be allowed. Governments are partnering with manufacturing companies. How bad is it?
In the Inbox: As a result of these posts on social media -
Hospitals Muzzle Doctors and Nurses on PPE, COVID-19 Cases"Physicians are being warned not to speak or post publicly about their COVID-19 experiences, including PPE shortages, case specifics, and the percentage of full hospital beds,[.]
and who shall live and who shall die...
Hospitals across U.S. consider universal do-not-resuscitate orders for coronavirus patientsHospitals on the front lines of the pandemic are engaged in a heated private debate over a calculation few have encountered in their lifetimes - how to weigh the "save at all costs" approach to resuscitating a dying patient against the real danger of exposing doctors and nurses to the contagion of coronavirus.
The conversations are driven by the realization that the risk to staff amid dwindling stores of protective equipment - such as masks, gowns and gloves - may be too great to justify the conventional response when a patient "codes," and their heart or breathing stops.
Northwestern Memorial Hospital in Chicago has been discussing a universal do-not-resuscitate policy for infected patients, regardless of the wishes of the patient or their family members - a wrenching decision to prioritize the lives of the many over the one.[.]
Canada and U.S. were in discussions?
U.S. considers putting troops at Canadian border.
Really? How does one divide the library?
Canada says unnecessary
Mar 27, 2020 | www.moonofalabama.org
VietnamVet , Mar 27 2020 3:03 utc | 121Exactly, a containment strategy with universal testing and quarantine of the infected (ill and asymptomatic) at home or safe facilities is required keep western society from collapsing from this and future waves of the novel coronavirus until a treatment or vaccine is developed.
The problem in the USA is that this will require the reconstruction of the government and a national public health system to run the monitoring and quarantine system. Instead, the corrupt oligarchy will use government money to rescue themselves rather than saving the lives of Americans.
Mar 27, 2020 | www.moonofalabama.org
john brewster , Mar 26 2020 22:56 utc | 77The neoliberal wrecking of our hospital system has been widely cited as a cause of the crisis. Among other things, hospitals reduced the number of beds, sold ventilators, and ran down supplies of masks and protective clothing in order to increase profitability.
On the way to this crisis, the private hospital industry gave the American public the actions and the rhetoric of the Milo Minderbinder character from Catch-22:What's good for M & M Enterprises will be good for the country.
Milo stripped out and sold all kinds of life-saving kit: morphine vials, parachutes, CO2 inflator cartridges for life vests. Milo epitomizes the neoliberal short-term, bottom-line, zero-redundancy world view that has looted America and corrupted its democracy over the last 40 years.
Just like the hapless flightcrew in Catch-22, Americans are discovering the true meaning behind the private hospitals' claim that what was good for their corporations was good for the "crew" as they survey the looted and privatized corpse of their healthcare system.
What was satire 50 years ago, is reality today. We had a preview of this when Rumsfeld ran the DoD.Was Donald Rumsfeld channeling Milo (and laughing up his sleeve) when he said:
It is clearly cost-effective to have contractors for a variety of things that military people need not do, and that, for whatever reason, other civilians, government people, cannot be deployed to do...
But I personally am of the view that there are a lot of things that can be done on a short-time basis by contractors that advantage the United States and advantage other countries who also hire contractors. And that any idea that we shouldn't have them, I think, would be unwise.
- D. Rumsfeld, Rumsfeld's Speech on the Future of Iraq (2005)
Exactly when did America become a bunch of out-takes from Catch-22?
Mar 26, 2020 | www.unz.com
Pandour , says: Website Show Comment March 25, 2020 at 4:04 pm GMT@UncommonGround ,,,As of March 19th there were 93 Corona deaths in Bergamo and counting. As of March 19th five Italian doctors and 13 medics have lost their lives with 2,629 health workers infected, or 8,3 per cent.
Mar 25, 2020 | www.moonofalabama.org
Jen , Mar 25 2020 0:27 utc | 117Arby @ 114:
I was reading an article in a specialist medical newspaper at the doctor's surgery this morning while waiting to pick up my blood test results. The article was written by a doctor who was part of an Australian medical delegation visiting China recently. Among other things the doctor mentioned was that government services personnel had been redeployed into other areas away from their usual ranges of expertise. He saw a woman giving instructions to medical personnel on how to wear medical gowns. He assumed she herself was a doctor; she turned out to be a receptionist.
Mar 24, 2020 | www.unz.com
John Johnson , says: Show Comment March 24, 2020 at 3:47 am GMT@AaronInMVD Yes, being sick sucks. Just would many of these people who are sick and suffering have gone to the hospital if it wasn't for the damned panic.
In Italy the hospitals are completely overwhelmed and it has nothing to do with panic.
They are doing military triaging and medical workers are about to collapse. They have more hospital beds per capita than the US so we definitely don't want to end up like them.
In the US there are probably people showing up at hospitals for tests but that is the fault of the government (including Democrats) for not getting enough tests ready. Even today there aren't enough tests and it is unlikely they will meet demand within weeks if not months.
Democrats are blaming Trump but they were the ones calling travel bans racist and they didn't have anything to say about tests when it was starting to spread two months ago. They were focused on the primary and getting rid of Bernie.
Mar 24, 2020 | www.moonofalabama.org
Peter AU1 , Mar 24 2020 2:13 utc | 140Talking to my daughter this morning. Husband and wife returns from overseas. No testing an quarantine for people coming . They go home do whatever, husband feels a bit crook, tests positive for coronavirus. Hospitalized, on a ventilated and will soon die. She is at a private hospital and this is at the public hospital. no medical staff working with this patient wore protective gear.
I had thought we where following China closely on dealing with this but man was I wrong. Total fuckwits collecting seashells on the seashore as the tsunami approaches.
Sent my daughter links to the pdf handbook put out by the Chinese doctors who worked on the frontlines. Covers PPE and much else. She is now passing it around to the other nurses.
Doctors in Australia had started using chloroquine if they could not obtain other antivirals. Apparently the government has now stopped them from doing this.
Mar 24, 2020 | www.moonofalabama.org
Vig , Mar 24 2020 6:52 utc | 180Pundita's here is a case story of two female 29 year old Chinese health workers, one survives, one dies.
Mar 23, 2020 | independent.co.uk
Coronavirus: NHS doctors feel like 'lambs to slaughter' without protective kit, warns senior medic. 'We must really stress to the prime minister that we need to protect the front line here'
Doctors battling the coronavirus outbreak feel like "lambs to the slaughter" without adequate protection equipment, a senior medic has said.
Dr Rinesh Parmar, chair of the Doctors' Association, said frontline NHS staff were being treated as "cannon fodder" as he launched a desperate appeal to Boris Johnson for more resources to keep medics safe.
Dr Parmar, a consultant anaesthetist who is working on a Covid-19 intensive care ward, said it was the "calm before the storm" and NHS staff were braced for a surge in cases.
His warning came as nearly 4,000 NHS workers appealed to the prime minister to "protect the lives of the life-savers" and resolve the "unacceptable" shortage of protective equipment.
Dr Parmar told the BBC's Andrew Marr Show: "We have had doctors tell us they feel like lambs to the slaughter, that they feel like cannon fodder. GPs tell us that they feel absolutely abandoned.
... ... ...
In an open letter to The Sunday Times, some 3,963 doctors said staff were "putting their lives on the line every day" by treating coronavirus patients without appropriate protection.
The letter said: "Frontline doctors have been telling us for weeks that they do not feel safe at work.
"Intensive care doctors and anaesthetists have told us they have been carrying out the highest-risk procedure, putting a patient on a ventilator, with masks that expired in 2015."
Mar 23, 2020 | www.moonofalabama.org
Mina , Mar 22 2020 17:05 utc | 31Chronology of the death of a French doctor today. Came back from a trip to Madagascar a month ago in good shape. Was working at Compiegnes, which because a cluster in mid-February when it received a taxi driver who was positive and treated him without special precautions. Got sick and was quarantined 3 weeks ago, i.e. early March, two weeks after exposition.
Died today. That is to say that most of the dead we see now might have been affected since mid-Feb.
Jan 26, 2020 | cnnphilippines.com
In Wuhan, ground zero for the virus, four healthcare workers -- including doctors -- have told CNN of the difficulties facing medical crews on the ground. They have asked to remain anonymous to avoid repercussions.
Through telephone conversations with CNN and posts on Chinese social media, they told of low hospital resources. In private groups online, those identified as hospital staff are coordinating with members of the public to import protective equipment as they treat an increasing number of infected patients.
"In terms of resources, the whole of Wuhan is lacking," one Wuhan-based healthcare worker told CNN by phone. This person said they were looking for more protective clothing, protective goggles and masks.
"It's really like we're going into battle stripped to the waist," one healthcare worker added, using a Chinese idiom that equates to "going into battle without armor".
One hospital staff member claims healthcare workers have resorted to wearing diapers to work so as to avoid having to remove their HAZMAT suits, which they say are in short supply. A doctor on her Chinese social media Weibo page described similar accounts at another Wuhan hospital.
"My family members are definitely worried about me, but I still have to work," another doctor told. But she said that she is hopeful they will ultimately get the gear they need. "Our bosses, our hospital suppliers will definitely find a way to get these stocks to us," she added.
It's not clear if these accounts are anecdotal or whether there are widespread shortages across Wuhan.
Chinese state media has also shared posts from multiple Wuhan hospitals in which they ask for public donations of medical supplies. They report that one hospital staff member said the current supplies "are only able to sustain three or four days".
The Wuhan Health Commission has requisitioned over 10,000 beds from 24 hospitals to be used in the treatment of confirmed and suspected cases.
On Friday, Wuhan officials acknowledged that local hospitals were struggling to accommodate people seeking medical attention and said measures were being put into place to alleviate the situation.
State media also reported that the city aims to build a 25,000 square meter (269,100 square foot) new facility within a week, increasing hospital capacity by 1,000 beds, and that several medical centers in Hubei province are asking for medical gear donations.
Mar 22, 2020 | www.moonofalabama.org
Mina , Mar 22 2020 12:57 utc | 154Another reason for the curves in chaotic Fr/It/Sp is a point underlined by Campbell on 19/3 about
the fact the soccer team Manchester United has opened up its hotel free of charge for medical
staff, so that they can return from work to a neutral place rather than to their families and spread
the bug further. Such measures have been applied in Asia and they should have been on the mind of
the EU gov, but apparently they were too busy thinking about their luxury holidays or their shares
in the stocks.
Mar 22, 2020 | www.zerohedge.comHuge jumps in COVID-19 deaths and cases have been reported in the UK, Germany, Spain, Italy, and France this weekend. Hospital systems in many of these countries are running out of supplies, staff, hospital beds, and ICU-level treatments.
The shortage of protective gear for medical staff at many European hospitals has forced some to tape trash bags to their bodies as makeshift biohazard suits.Nurses in England Wearing Trash Bags to Protect from COVID-19
Bloomberg interviewed Samantha Gonzalez,52, who works at the Txagorritxu hospital in Vitoria-Gasteiz, Alava, Spain. She warned: "This is not the first world anymore -- it's a war" amid surging virus cases in the country.
Across Europe on Saturday, deaths accorded to the fast-spreading virus soared, with Italy reporting a record 793 deaths on Friday, and Spain reporting another 300 cases, bringing their totals to 4,825 and 1,326.
The UK also reported another string of deaths, as millions await a lockdown order on London , while hospitals and intensive care units in Italy and Spain are struggling to cope, despite some Madrid hotels being temporarily converted and of the Fair of Madrid, the capital's main exhibition space.
One of the leading hospitals in Bergamo, northern Italy, the current epicenter of the virus outbreak in Europe, has run out of hospital beds, and ICU-level treatment, as an influx in patients, has overwhelmed the facility . The sick are being transferred to offsite locations, equipped with oxygen machines.
From Italy to Spain to other regions in Europe, hospital systems are at full capacity, canceling non-urgent surgeries, and appointments to handle the influx of virus patients. In a couple of weeks, countrywide shutdowns like what's happening in Italy could be the norm across many European countries.
Giovanni Rezza, head of the infectious diseases department at Rome's Superior Health Institute, said, "Italy wasn't completely prepared for the coronavirus:"
"It's only in some two weeks that Italy will find out whether the government's nationwide lockdown and social distancing rules have had an impact," said Rezza.
"The lockdown is only delaying the spread of the epidemic, we expect that there will be new outbreaks in future. But in the meantime we have to equip hospitals with more intensive care beds, even in Lombardy which is one of the best-equipped regions in Europe."
The biggest challenge for European hospital systems is having enough protective gear for medical staff.
In Spain, 3,500 Spanish doctors have contracted the virus, which is 12% of the total number of cases detected. With the lack of gear, doctors and nurses are more susceptible to contracting the virus, which could cause medical staff shortages that would undoubtedly lead to high mortality rates.COVID-19 Map
"Just in the nephrology department, three out of 13 colleagues have fallen ill, one of them seriously," said Giuseppe Remuzzi, a former head of the department of medicine at the Papa Giovanni XXIII hospital in Bergamo, Italy, who has joined efforts to contain the pandemic. "This is a scary, terrible situation."
Medical staff have been instructed to swap out old protective gear every four hours, which includes changing face masks, splash guard googles, and biohazard suits. Since supplies are limited, doctors and nurses are making their own bio hazmat suits with taping garbage bags on their body.
"This thing blew up on us," said Pelayo Pedrero, the head of labor risk prevention at doctors' union AMYTS in Madrid, Spain. "No one was ready for this. They didn't buy the supplies, they didn't prepare the hospitals to receive and treat all these patients. Not just in Madrid or Spain, but all over Europe."
To sum up, the evolution of the virus crisis is that medical gear shortages could lead to labor shortages at hospitals across Europe because medical staff aren't adequately protected against the virus. Europe has become the new China. And in the weeks ahead, parts of the US could transform into Italy .
Mar 22, 2020 | www.moonofalabama.org
JC , Mar 21 2020 22:04 utc | 41ben | Mar 21 2020 20:49 utc | 19
Best watch CGTN....
Live: Medics leave Wuhan after supporting the coronavirus-hit city
Last night watched CGTN TV with Huawei Honor smartphone.
"....team from SW China's Sichuan Province leaves Wuhan today...brings you this bittersweet goodbye."
- Worked 8-12hrs shift.... 100 plus medical workers, 57 days ago leaving spouse, children and parents behinds
- Initially none or limited N95 masks - wore double for protection..
- In capitalist USA.... Fxxk the company or country, Strike, protests...
- 16 makeshift hospitals disbanded but two 16,000 beds still in operations.
Mar 17, 2020 | www.moonofalabama.org
DFC , Mar 17 2020 20:59 utc | 35What is happening now in Italy explained by one of the doctors fighting the pandemic in Bergamo, this was on 9 March, today the situation in Bergamo and all Italy is much worse with this "normal flu" (sarc):
Dr Daniele Macchini's post, translated by Dr Silvia Stringhini
"After much thought about whether and what to write about what is happening to us, I felt that silence was not responsible.
"I will therefore try to convey to people far from our reality what we are living in Bergamo in these days of Covid-19 pandemic. I understand the need not to create panic, but when the message of the dangerousness of what is happening does not reach people I shudder.
"I myself watched with some amazement the reorganization of the entire hospital in the past week, when our current enemy was still in the shadows: the wards slowly 'emptied', elective activities were interrupted, intensive care were freed up to create as many beds as possible.
"All this rapid transformation brought an atmosphere of silence and surreal emptiness to the corridors of the hospital that we did not yet understand, waiting for a war that was yet to begin and that many (including me) were not so sure would ever come with such ferocity.
"I still remember my night call a week ago when I was waiting for the results of a swab. When I think about it, my anxiety over one possible case seems almost ridiculous and unjustified, now that I've seen what's happening. Well, the situation now is dramatic to say the least.
"The war has literally exploded and battles are uninterrupted day and night. But now that need for beds has arrived in all its drama. One after the other the departments that had been emptied fill up at an impressive pace.
"The boards with the names of the patients, of different colours depending on the operating unit, are now all red and instead of surgery you see the diagnosis, which is always the damned same: bilateral interstitial pneumonia.
"Now, explain to me which flu virus causes such a rapid drama. [post continues comparing Covid19 to flu, link here]. And while there are still people who boast of not being afraid by ignoring directions, protesting because their normal routine is 'temporarily' put in crisis, the epidemiological disaster is taking place. And there are no more surgeons, urologists, orthopedists, we are only doctors who suddenly become part of a single team to face this tsunami that has overwhelmed us.
"Cases are multiplying, we arrive at a rate of 15-20 admissions per day all for the same reason. The results of the swabs now come one after the other: positive, positive, positive. Suddenly the E.R. is collapsing.
"Reasons for the access always the same: fever and breathing difficulties, fever and cough, respiratory failure. Radiology reports always the same: bilateral interstitial pneumonia, bilateral interstitial pneumonia, bilateral interstitial pneumonia. All to be hospitalized.
"Someone already to be intubated and go to intensive care. For others it's too late... Every ventilator becomes like gold: those in operating theatres that have now suspended their non-urgent activity become intensive care places that did not exist before.
"The staff is exhausted. I saw the tiredness on faces that didn't know what it was despite the already exhausting workloads they had. I saw a solidarity of all of us, who never failed to go to our internist colleagues to ask, 'What can I do for you now?'
"Doctors who move beds and transfer patients, who administer therapies instead of nurses. Nurses with tears in their eyes because we can't save everyone, and the vital parameters of several patients at the same time reveal an already marked destiny.
"There are no more shifts, no more hours. Social life is suspended for us. We no longer see our families for fear of infecting them. Some of us have already become infected despite the protocols.
"Some of our colleagues who are infected also have infected relatives and some of their relatives are already struggling between life and death. So be patient, you can't go to the theatre, museums or the gym. Try to have pity on the myriad of old people you could exterminate.
"We just try to make ourselves useful. You should do the same: we influence the life and death of a few dozen people. You with yours, many more. Please share this message. We must spread the word to prevent what is happening here from happening all over Italy.
"I finish by saying that I really don't understand this war on panic. The only reason I see is mask shortages, but there's no mask on sale anymore. We don't have a lot of studies, but is it panic really worse than neglect and carelessness during an epidemic of this sort?"
And now let the people make "normal life" and acquire "herd immunity", BoJo and a good part of the western governments (if not all) are criminals
Google matched content
[May 24, 2020] Private Equity Is Ruining Health Care, Covid Is Making It Worse: Investors have been buying up doctor s offices, cutting costs, and, critics say, putting pressure on physicians by Heather Perlberg Published on May 20, 2020 | www.bloomberg.com
[Apr 28, 2020] Coronavirus Fact-Check #4: "Why are so many healthcare workers dying?" Published on Apr 28, 2020 | off-guardian.org
[Apr 13, 2020] American health care, as we call it today, and for all its high-tech miracles, has evolved into one of the most atrocious rackets the world has ever seen. By racket, I mean an enterprise organized explicitly to make money dishonestly by James Howard Kunstler Published on Apr 13, 2020 | www.zerohedge.com
[Apr 13, 2020] The Whistle-giver: the story of Ai Fen, the director of the emergency department of Wuhan Central Hospital Published on Apr 13, 2020 | scienceintegritydigest.com
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