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Health Care

‘Our Sentences Have Turned Into Death Sentences’: A Look Inside A Louisiana Prison Offers Snapshot Of National Issue

Kaiser Health News - 34 min 33 sec ago
Advocates across the country are worried that if the coronavirus outbreak spreads to the prisons, it could be a catastrophe for those inside, who are often kept in close quarters with sub-par health and hygiene services. The Wall Street Journal interviews inmates and their families at one Louisiana prison who say that the invisible enemy is well entrenched inside the gates.
Categories: Health Care

Mass. Beginning To See Virus Surge, With Nearly 14,000 Positive Tests

CommonHealth (WBUR) - 1 hour 9 min ago

WBUR's Deborah Becker joined Morning Edition host Bob Oakes to report the latest.

Categories: Health Care

A Vaccine Is The One True Global Exit Strategy From This Pandemic, But Timeline Is Frustratingly Long

Kaiser Health News - 1 hour 35 min ago
Scientists, political leaders and businessmen are trying to adopt ways to cut months off the vaccine development timeline. That includes wasting billions on preparing to develop vaccines that might not work. In the meantime, drugmakers race to find an effective treatment option.
Categories: Health Care

Baker: COVID-19 Testing Sites To Open In Lowell, West Springfield

CommonHealth (WBUR) - 1 hour 40 min ago

A testing site in Lowell opening Tuesday in partnership with CVS Health is the first rapid, drive-through testing site open to the public.  

Categories: Health Care

Health Law Could Act As Safety Net For Millions, But Marketing Has Been So Severely Cut They Might Not Know It

Kaiser Health News - 2 hours 18 min ago
Advocates are calling for the Trump administration to ramp up spending on outreach to make sure Americans who have been laid off during the crisis know there's an option out there for them. The administration instead seems to be focused on a plan to tap hospital stimulus funds to pay people’s bills if they get coronavirus and need treatment
Categories: Health Care

HHS Watchdog Report Finds Hospitals Are Seriously Grappling With Equipment And Protective Gear Shortages

Kaiser Health News - 2 hours 20 min ago
In the first nationwide assessment for how hospitals are handling the pandemic, the facilities told HHS' Office of Inspector General that they're increasingly "turning to new, sometimes un-vetted, and non-traditional sources of supplies and medical equipment." The report finds that health systems need more help with tests, supplies and equipment; workforce flexibility; bed capacity; financial assistance; and centralized communication and information, including more and better data about the virus. President Donald Trump waved off the findings.
Categories: Health Care

Industry Roundup: A Medicare Advantage Pay Bump; Hospitals’ Partnerships With Local Agencies; Social Safety Nets And Health

Kaiser Health News - 2 hours 31 min ago
CMS has finalized a bump for Medicare Advantage plans that's a good deal higher than the agency's initial proposal that met with fierce industry opposition. Meanwhile, researchers look at a variety of factors when it comes to spending and safety nets.
Categories: Health Care

How COVID-19 Affects U.S. Kids: CDC Data Confirms That Children Are Less Likely To Fall Seriously Ill

Kaiser Health News - 2 hours 34 min ago
Less than 2 percent of the confirmed U.S. coronavirus infections are pediatric cases, according to a new CDC report. Three kids under 18 so far have died though, and there is some evidence that babies may be at more risk, though data is incomplete. News reports focus on the health impact to pregnant women, as well.
Categories: Health Care

Government To Buy 167M Masks From 3M For Front-Line Workers Following Contentious Negotiations

Kaiser Health News - 2 hours 43 min ago
The federal government's decision to use the Defense Production Act was key to shifting the trajectory of negotiations between the two sides, Trump administration officials say. Health care workers are issuing desperate calls for more masks. In one Detroit hospital system alone, 700 employees have tested positive for the virus. Meanwhile, the military steps up its efforts to produce masks, as well. And despite experts' guidance, President Donald Trump has yet to don a mask in public.
Categories: Health Care

From The States: Is D.C. The Next Hot Spot?; Idaho Balks At Big Government Directives; Pandemic Shaming Takes Off In Small Towns

Kaiser Health News - 2 hours 46 min ago
Media outlets looks at news from D.C., Virginia, Maryland, Idaho, California, Oklahoma, Ohio, Massachusetts, Georgia, Louisiana, Texas and Nevada.
Categories: Health Care

Physical And Mental Complications Can Linger For Patients Who Recover From Coronavirus

Kaiser Health News - 2 hours 51 min ago
While a life-saving tool, ventilators can cause long-term physical and emotional side effects. And physicians say they can’t offer recovered patients who aren’t retested any guarantees about whether they can still transmit the virus. Meanwhile, experts warn of a mental health crisis brewing. More public health news related to the outbreak report on a drop in heart attacks and strokes, fears of dying alone, loneliness, how the virus attacks the body, an anticipated surge in foster care placements, uncertainty for cancer patients, and more.
Categories: Health Care

Virus Outbreak Seems To Hit Black Americans At Alarming Rate But Lack Of Data Obstructs Full Picture

Kaiser Health News - 2 hours 52 min ago
Data on race and the impact of COVID-19 is too limited so far to draw conclusions, experts say. But disparate rates of sickness and death is emerging in many African-American and Latino communities. “We cannot have a colorblind policy,” Stephen Thomas, director of the University of Maryland’s Center for Health Equity tells Politico. “With a colorblind policy — ‘Hey, we're all in this together’ — we'll be left with an explosion of Covid-19 concentrated in racial and ethnic minority communities.”
Categories: Health Care

Baker Administration Unveils Massachusetts COVID-19 Relief Fund

CommonHealth (WBUR) - 3 hours 14 min ago

First Lady of Massachusetts Lauren Baker is spearheading this initiative, and she joined WBUR's Morning Edition to explain.

Categories: Health Care

First Edition: April 7, 2020

Kaiser Health News - 3 hours 24 min ago
Today's early morning highlights from the major news organizations.
Categories: Health Care

Nursing Homes Have Thousands Of Ventilators That Hospitals Desperately Need

Kaiser Health News - 4 hours 46 min ago

As the number of COVID-19 patients climbs and health officials hunt for ventilators to treat them, nursing homes across the United States have a cache ― about 8,200 of the lifesaving machines, according to data from the Centers for Medicare & Medicaid Services.

Most of the machines are in use, often by people who’ve suffered a brain injury or stroke. Some of those residents are in a vegetative state and have remained on a ventilator for years.

State officials are working to consolidate ventilators where they are most urgently needed. But so far, the supply in nursing homes has not drawn the same attention.

Or course, commandeering those units would set up a monumental ethical dilemma: Do you remove life support for a long-term nursing care patient in order to give a COVID-19 patient a better chance of survival?

The highest number of machines, about 2,300, is in California, where the state has created designated nursing home units for people on life support, officially called subacute units but known pejoratively by some doctors as “vent farms.” New York has the second most, 1,822, according to state officials.

Already, one nursing home on Long Island has lent a nearby hospital 11 ventilators that were not being used, leaving just five for its residents.

“The hospital came to us last week and asked, ‘Do you have any ventilators?’” the nursing home assistant administrator said on the condition of anonymity because he was not authorized to speak to the news media.

“We left ourselves with the bare minimum,” he said. In all, three hospitals reached out to the nursing home for ventilators ― it had to say no to the other two.

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New York Gov. Andrew Cuomo has announced an executive order that ventilators not in use by hospitals be redeployed to ICUs. And he’s calling in the New York National Guard to facilitate the order. “We know where every ventilator is,” Cuomo said Sunday.

Nursing home ventilators are not included in his order, but they are included in the state’s tally of the machines.

Dr. Michael Kalafer, a pulmonologist and the medical director at two San Diego subacute units, said he can’t imagine taking one of his patients off a ventilator because it’s needed for someone else.

“I severely doubt we’ll take [a hypothetical] Mrs. Smith off a ventilator because she’s 80 and has been on it for a few years and has not gotten better,” Kalafer said.

But these are precisely the decisions bioethicists are being asked to weigh in on as the country confronts the crush of COVID-19 patients overwhelming the health care system.

And in some cases, states have already decided to give people who are severely brain-injured a lower priority when it comes to access to ventilators. Disability advocates oppose such guidelines and filed complaints with the Department of Health and Human Services last month, according to ProPublica. And although states and health associations can draw up recommendations, they are not legally binding.

“From an ethical point of view, for people who are not conscious, if it’s a matter of removing people from a [ventilator] who are not going to recover, I think it’s a hard decision, but one that in an emergency has to be made,” said Ronald Bayer, a professor of sociomedical sciences at the Mailman School of Public Health at Columbia University.

Bayer has been a member of the World Health Organization and in 2011 served on an ethics subcommittee that advised the Centers for Disease Control and Prevention on the allocation of ventilators in the event of a severe pandemic.

He and several other ethicists said these decisions should not be made at the bedside but by triage committees or people in supervisory roles. And the guidelines ought to be uniform and transparent. That’s why the CDC, the state of New York and medical associations like the American College of Chest Physicians have drafted ethical recommendations for deciding how to ration lifesaving equipment like ventilators in the event of a pandemic.

The California Department of Public Health in 2008 released guidelines to follow during a health care surge: They don’t specifically address ventilator allocation, but rather resources in general. Doctors should consider the likelihood of survival and change in the quality of life as opposed to the ability to pay or the perception of a person’s worth when there are not enough medical resources to treat everyone in need.

When the New York State Task Force on Life and the Law updated its ventilator allocation guidelines in 2015, it considered the question of withdrawing ventilators from nursing home residents, or chronic ventilator patients, to save the lives of those who grow critically ill during a pandemic.

“Are we comfortable sacrificing this group in exchange for saving more lives?” asked Stuart Sherman, the executive director of the task force at the time.

That question drew much debate, but the group ultimately decided that “chronic” vent patients should not be included in the pool when considering how to allocate ventilators during a pandemic. The task force does recommend prioritizing ventilator therapy based on who is likely to survive using a SOFA ― Sequential Organ Failure Assessment ― score.

Cuomo, whose daily televised news conferences have made “ventilators” a household word, is not making decisions based on those guidelines. The task force report is not a binding policy document, according to a spokesperson from the governor’s office.

In the U.S., there are about 62,000 “full-featured ventilators,” the kind needed to treat the most severe cases of COVID-19. An additional 10,000 to 20,000 ventilators are in the government’s National Strategic Stockpile, and 98,000 basic models, the kind often in nursing homes, exist that could be used in a crisis.

In the simplest terms, ventilators push oxygen into the lungs. The machines in ICUs are more powerful and have better monitoring systems than those in a nursing home.

Kalafer’s patients need ventilators to do the work for respiratory muscles. He said they could be used in a pinch during the pandemic. But the real issue is finding enough staff trained to operate and monitor the machines.

Meanwhile, a group of bioethicists, physicians and public health experts are recommending that in a shortage, health care workers could disconnect people from ventilators who have little or no chance of recovery to put them in service of those who do.

The recommendation is the first of six listed in an article published in the New England Journal of Medicine last month.

It did not consider the people who’ve been on vents long term.

“Honestly, before you emailed me, I thought about those patients but never thought about the actual number and how important that might be,” said Dr. James Phillips, one of the paper’s authors and chief of disaster and operational medicine at George Washington University Hospital.

“For patients who have devastating neurological injury and are deemed to never recover and who require ventilation for the rest of their lives, I think it’s an ethical conversation to have with those families to determine if it’s a more appropriate use of resources,” Phillips said.

One ventilator can save multiple lives. The average time a person sick with COVID-19 who needed a ventilator was 11 days, according to an NEJM article that looked at critically ill patients in the Seattle region. Using that number, eight people could potentially be saved over three months.

It is an especially complex moral dilemma when considering the withdrawal of treatment from someone who has lived several years on a ventilator, said Govind Persad, an assistant professor at the University of Denver Sturm College of Law and one of the authors of the NEJM paper.

Persad offered a hypothetical scenario.

“A 78-year-old grandmother has been on ventilator support for 5 years in a subacute facility and is expected to remain on it for the foreseeable future. Covid-19 has reached a senior apartment complex nearby, and doctors are looking everywhere for more ventilators,” Persad wrote.

“They think one more ventilator would give them a chance of saving another 78-year-old grandmother in the senior apartments who is growing worse with viral pneumonia, and, once she is off the ventilator, to save some of her neighbors, who are not yet sick but who they expect to be sick in a few weeks.”

Who gets the ventilator?

Persad suggested it should go to the grandmother in the senior apartments because she is likely to need less time on the ventilator, enabling the ventilator to be used to save her neighbors later.

As he put it: “We save her in order to save more lives, not because of quality-of-life judgments.”

The real-life decision is more problematic and heart-wrenching.

Nancy Curcio’s daughter Maria, who was born with a disabling form of cerebral palsy, was on a ventilator as an adult in San Diego for about three months in 2004. She was eventually weaned off the machine but lived the remainder of her life in a nursing home with a breathing and feeding tube, unable to walk or talk. She died in 2017 at age 57.

“I would be very upset if a doctor said I have to take her ventilator away for someone to live,” Curcio said. “But I can understand in triage this is what a doctor has to do. Would I like it? No. I would want to run away with the ventilator.”

Categories: Health Care

Cancer Patients Face Treatment Delays And Uncertainty As Coronavirus Cripples Hospitals

Kaiser Health News - 4 hours 46 min ago

The federal government has encouraged health centers to delay nonessential surgeries while weighing the severity of patients’ conditions and the availability of personal protective equipment, beds and staffing at hospitals.

People with cancer are among those at high risk of complications if infected with the new coronavirus. It’s estimated 1.8 million people will be diagnosed with cancer in the U.S. this year. More than 600,000 people are receiving chemotherapy.

That means millions of Americans may be navigating unforeseen challenges to getting care.

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Christine Rayburn in Olympia, Washington, was diagnosed with breast cancer in mid-February. The new coronavirus was in the news, but the 48-year-old did not imagine the outbreak would affect her. Her doctor said Rayburn needed to start treatment immediately. The cancer had already spread to her lymph nodes.

“The cancer tumor seemed to have attached itself to a nerve,” said Rayburn, who was a schoolteacher for many years. “I feel pain from it on a regular basis.”

After getting her diagnosis and the treatment plan from her medical team, Rayburn was focused on getting surgery as fast as possible.

Meanwhile, the coronavirus outbreak was getting worse, and Seattle, just an hour north of where Rayburn lives, had become a national focal point.

Rayburn’s husband, David Forsberg, began to get a little nervous about whether his wife’s procedure would go forward as planned.

“It did cross my mind,” he said. “But I did not want to bother with that possibility on top of everything else.”

Two days before Rayburn’s lumpectomy to remove the tumor, Forsberg said, the surgeon phoned, “pretty livid” with bad news. “She said, ‘Look, they’ve canceled it indefinitely,'” Forsberg remembered.

The procedure had been scheduled at Providence St. Peter Hospital in Olympia, a facility run by Providence Health & Services. Across Washington, hospitals were calling off elective surgeries, in order to conserve the limited supply of personal protective equipment, or PPE, and to prevent patients and staffers from unnecessary exposure to the new coronavirus.

“It just felt like one of those really bad movies, and I was being sacrificed,” Rayburn said.

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“It was like we just got cut off from the experts we were relying on,” her husband said.

The hospital said it would review the decision in a few weeks. But Rayburn’s surgeon said that was too long to wait, and they needed to move to Plan B, which was to begin chemotherapy.

Originally, chemotherapy was supposed to happen after Rayburn’s tumor surgery. And rearranging the treatment plan wasn’t ideal because chemotherapy isn’t shown to significantly shrink tumors in Rayburn’s type of breast cancer.

Still, chemotherapy could help stop the cancer from spreading further. But as the couple figured out the new treatment plan, they ran into more obstacles.

“She needed an echocardiogram, except they had canceled all echocardiograms,” said Forsberg.

They spent days on the phone trying to get all the pieces in place so she could start chemotherapy. Rayburn also started writing to her local lawmakers about her predicament.

Hospitals Prioritize Urgent Cases

In mid-March, Washington Gov. Jay Inslee banned most elective procedures, but he did carve out exceptions for certain urgent, life-threatening situations.

“It actually said that it [the ban] excluded removing cancerous tumors,” Rayburn said.

Providence hospitals use algorithms and a team of physicians to figure out which surgeries can be delayed, said Elaine Couture, chief executive of Providence Health in the Washington-Montana region.

“There are no perfect decisions at all in any of this,” said Couture. “None.”

Couture would not talk about specific patients but said she assumes other cases were more urgent than Rayburn’s.

“Were there other patients that even had more aggressive types of cancer that were [surgically] completed?” Couture said. “As sick as you are, there can be other people that are needing something even sooner than you do.”

Couture said hospitals are burning through supplies of masks, gowns and gloves and need to make tough calls about elective procedures.

“I don’t like that, either, and it’s not the way that we want our health care system to work,” Couture said.

Across the Providence hospital system, personal protective equipment is being used much faster than it can be replenished, she said.

No Single Standard

At the American Cancer Society, Deputy Chief Medical Officer Dr. Len Lichtenfeld is hearing from patients across the country who are having their chemotherapy delayed or surgery canceled.

“There was someone who had a brain tumor who was told they would not be able to have surgery, which was, basically, and appears to be a death sentence for that patient,” said Lichtenfeld.

This is uncharted territory for cancer care, he said. Hospitals are making these “decisions on the fly” in response to how the pandemic looks in a particular community. “There is no single national standard that can be applied. I am afraid this is going to become much more common in the coming weeks.”

The cancer society recommends that people postpone their routine cancer screenings — for now.

The American College of Surgeons has published guidance on how to triage surgical care for cancer patients. But Lichtenfeld said every decision ultimately depends on the availability of resources at the hospital and the pressures of COVID-19. In Washington state, which has been hit hard, hospitals are shifting surgical space and beds away from other kinds of treatment.

“We need to forecast two to three weeks down the line when there are more patients that are ill,” said Dr. Steven Pergam, medical director of infection prevention at the Seattle Cancer Care Alliance. “We need to make sure there’s adequate bed capacity.”

Pergam said the care alliance is adjusting treatment plans and, at times, avoiding procedures that would keep cancer patients in the hospital for a prolonged period.

“It really depends on the cancer and the aggressive nature of it,” he said. “We have looked at giving chemotherapy in the outpatient department and changing the particular regimens people get to make them less toxic.”

But Pergam said they expect to keep doing urgent surgeries for cancer patients, even as the pandemic grows worse.

Christine Rayburn in Olympia was steeling herself for the months of chemotherapy to come: staying inside her home and even avoiding contact with her adult daughters, to avoid any possible exposure to the coronavirus.

Then, two weeks ago, the surgeon called again. She had persuaded the hospital to allow the surgery after all, 10 days later than initially planned.

Rayburn and her husband wonder what would have happened if they hadn’t spoken up or pushed to get her lumpectomy back on the hospital’s surgical schedule. Forsberg said it’s possible they could have ended up without the care Rayburn needed.

“If we didn’t say anything, in my mind that may be where we would be at,” he said. “But in our minds, that was not an option.”

This story is part of a partnership between NPR and Kaiser Health News.

Categories: Health Care

Inside Meals On Wheels’ Struggle To Keep Older Americans Fed During A Pandemic

Kaiser Health News - 4 hours 47 min ago

In the best of times, Meals on Wheels faces the herculean task of delivering 200 million meals annually to 2.4 million hungry and isolated older Americans.

But this is the time of the dreaded novel coronavirus.

With the pandemic bearing down, I wanted to get inside Meals on Wheels to see how it would gear up its services. After all, 79% of its existing clients are 75 or older. There would be more demand now that many more seniors — including those who probably never imagined they’d be stuck inside — are advised it is safest to remain housebound.

What I saw was that this agency, a mainstay in the lives of so many, was swamped. Its ideas of what was possible diminished by the hour, and it has had to improvise, sometimes successfully, to complete its mission.

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When I reached out to its press office on March 12, I was optimistic I’d be able to see its local operation, meet its director and volunteers, and maybe even talk to a client or two. While the West Coast was already hunkering down, life was still fairly normal on the East Coast and near its national headquarters in Arlington, Virginia. It would be ideal, of course, to go on a delivery. That was probably too much to ask.

By the next afternoon, a publicist from the headquarters told me, “In an effort to minimize risk, they’re no longer allowing visitors or inviting them into facilities.”

But this, she said, could “illustrate how cautious they’re being and how quickly the situation is escalating.”

That’s OK, I thought.

Not an hour later, another email from a local program director in nearby Alexandria, Virginia: “Things are very dynamic. As a precaution, we are no longer having visitors go along on deliveries.”

He invited me to a meal pickup spot to talk with volunteers, so long as there was “no shaking hands, of course.”

Maybe we could even get a look at meal prep. On the next Monday, four days later, we’d go with a photographer to Jeffery’s Catering, a full-service catering company tucked away in one of Alexandria’s industrial sections.

The novel coronavirus marched on.

About five minutes after I pulled up that Monday, I got a text saying all in-person meetings were canceled. Instead of seeing the director, I drove home to interview him by phone. And I could talk to a volunteer by phone, too. But not a client.

What I couldn’t see, but what I learned, was that Meals on Wheels was desperately — though creatively — struggling to honor its mission. This is also an organization that depends on older volunteers, roughly two-thirds of whom are 65 and up. What if they prefer to stay home for their safety? Or worse, what if they had been struck by this nasty virus, which is particularly deadly for older folks?

The need was overwhelming. Most volunteers were taking shelter. All social norms were upended, with people social distancing and working from home.

By the next Thursday, Vinsen Faris, CEO of Meals on Wheels in San Antonio, was worried. The chapter serves 3,600 meals daily and had lost dozens of corporate volunteers as companies shut down.

With fewer volunteers, staff members would make home deliveries. Faris suspected they’d need to move on to shelf-stable food, like canned fruit and beans and boxed pasta.

He was haunted by the idea that they might not be able to deliver at all.

“I’m up at night wondering: How do we continue to be their lifeline?” Faris said.

Bracing for the worst, the San Antonio group has been providing five extra meals for clients to keep in their refrigerators. It will also distribute emergency meal boxes with four days’ worth of food that can be easily opened and requires little preparation.

In Raleigh, North Carolina, executive director Alan Winstead said that its group would soon scrap fresh, hot meals. They would do more with less: delivering frozen and shelf-stable food. He’d lost 75% of his volunteers.

“I have been with Meals on Wheels for seven years, and this experience — and the need to adapt — is unprecedented,” said Ellie Hollander, CEO of Meals on Wheels America.

But adapt it must. “We will need to provide even more meals than we previously had to,” she said, because requests nationally for new aid are mounting.

Meals on Wheels is informing folks calling for help right now that it can’t take on new applicants until after April 15.

Meal delivery is more complicated, too. Volunteers must wash hands or use sanitizer between stops. They will have their temperature taken, too.

They will place the bag of food on the doorknob, knock on the door and then step back at least 6 feet. Some clients who can’t walk — or who are blind — can’t navigate the trip to the front door. Others aren’t able to bend down to pick up the food. They must wait for the client to come to the door and retrieve the food before leaving.

Rule No. 1: no contact.

The food is critical. But Meals on Wheels offers something just as precious: human connection. Its volunteers offer a conversation. They check in on folks. They might be the first to know that someone’s struggles are getting the best of them. Staff will now reach out by phone to check in.

As Winstead, in Raleigh, puts it: “The social connection is equally important.”

The group’s need for financial assistance is dire. Its COVID-19 Response Fund has raised more than $5 million. Another silver lining: The government has committed $250 million in supplemental funding to feed the needy as part of the Families First Coronavirus Response Act.

With a boost from that, it will hire more drivers and reach out to ride-hailing companies to assist with delivery, said Hollander, the national CEO.

The real possibility of halting all home delivery has Winstead focused on getting as much food as possible to his clients in Raleigh.

“This is a food crisis. This is a community crisis. This crisis challenges every operating procedure we’ve ever had,” he said. “I’m scared.”

Categories: Health Care

Dispatch From A Country Doctor: Seeing Patients Differently In The Time Of Coronavirus

Kaiser Health News - 4 hours 47 min ago

Patients would often stop by River Bend Family Medicine just to gab with staff at the front desk or bring baked goods to Dr. Matt Hahn.

“I’m a simple country doctor,” said Hahn, who has practiced in Hancock, Maryland, for 20 years ― the past decade at his River Bend office. “Our waiting room is like a social network in and of itself.” Hahn is also a candidate for West Virginia’s 2nd Congressional District though he has backed away from campaigning because of the coronavirus threat.

His waiting room is now closed for the same reason. But Hahn’s practice in this small town — pinned hard up against the borders with West Virginia and Pennsylvania, about 100 miles northwest of Washington, D.C. ― is not.

Patients who need an in-office appointment call when they get to the parking lot and wait there instead. A staff member escorts them in, opening all the doors, telling patients not to touch anything. Those who are ill use one specific entrance, which leads them upstairs where they are met by staff who follow strict infection-control measures. The rest, such as those coming in with a wound or a diabetes checkup, are treated downstairs.

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Still, Hahn now sees most of his patients in telehealth appointments, linked to their computers or smartphones. He can do a lot over video and phone, he said. Some things present more of a challenge, though. With rashes, for example, “people are angling their bodies to show a body part to their camera,” said Hahn. “We’ve had some fun with that.”

Humor remains important during this coronavirus crisis. But, jokes aside, Hahn isn’t taking any of it lightly. As of April 6, 37 coronavirus cases were confirmed in Washington County, which encompasses Hancock, and the governor of Maryland on March 30 issued a statewide stay-at-home order.

On March 17, the Trump administration used emergency powers to expand Medicare payments for telemedicine so that more doctors, hospitals and clinics could be paid for such services. While the expansion applies only to Medicare, Hahn said other insurers moved quickly to do the same. Previously, telemedicine coverage was generally limited to people in remote or underserved areas. Even though it’s at least 30 minutes from the nearest hospital, Hancock is not considered remote.

“It’s something we really wanted to do — we didn’t want to shut our doors,” said Hahn, who trained at George Washington University School of Medicine, in Washington, D.C.

Across the country, practices large and small, like River Bend, are enlisting the help of such technological innovations. In addition to the changes to Medicare reimbursement rules, the administration has loosened privacy enforcement for medical providers making “good faith” efforts to use non-public video services: Facebook Messenger is OK, for example, but Facebook Live is not.

Still, online visits are not perfect.

For one thing, internet service can be spotty, Hahn and nurse practitioner Lora Cole said. Another concern: The new rules required the use of both audio and video in consults with patients. But on March 30, the Centers for Medicare & Medicaid Services took an additional step of further loosening telehealth restrictions to allow providers to conduct the telehealth exams for beneficiaries who have audio phones only.

Another concern is that some patients are not that familiar with computers or smartphones, making telehealth consults more challenging, according to Hahn. And a number of them don’t have access to the internet.

For those who do, the staff tries to help them download apps, go to websites, adjust their cameras or turn on the audio.

“The first few days were frustrating. We spent much of the day trying to get people to paste an address into the right line and put in a nine-digit code,” said Hahn.

Part of the problem was they were trying to use a wide variety of different websites or apps. Once they narrowed the choices, the process got easier. Hahn settled on using Google Duo on his phone, while Cole and the other nurses use the web service GoToMeeting in their virtual exam room.

“We give them the code. They click join. It’s a couple of steps that are very quick and easy,” said Cole.

Those who struggle aren’t having problems with the programs themselves, she said, but with maneuvering their smartphone or computer. She and the nurses in the office walk them through it when they can.

“We take a big deep breath,” said Cole. “With some of our patients, we have actually asked them to find someone ― a family member — who can help them.”

The visits themselves work out just fine, even if they are missing a certain, well, human element, both say.

“It has been very hard on my heart,” said Cole, who said her patients know she loves elephants, often bring her presents to add to her collection of pictures, figurines and other tchotchkes. “I miss my patients. I miss being able to see them and give them a hug.”

Clinically, it has limitations, as well.

“I can’t see the entire body. I can’t do a physical exam,” said Hahn. “But, this is a wonderful thing to have right now. Until we have some break in this situation, we want to keep people home. This gives us the opportunity to take care of patients and keep patients safe and staff safe. Under these circumstances, I am not complaining.”

Someday, Hahn and Cole hope things return to normal, whenever that will be.

And what will things look like at River Bend when it’s all over? Will they still rely heavily on video visits? It hasn’t come up yet.

“We just don’t have time to think or even discuss what the future may hold,” said Cole. “We’re just totally focused on what we have to do that day. Personally, I want it to go back. I want to see my patients again.”

Categories: Health Care

Surge In Coronavirus Cases In Boston's Homeless Population 'More Dramatic Than We Anticipated'

CommonHealth (WBUR) - Mon, 04/06/2020 - 9:06pm

The spread of the coronavirus is leading to a growing sense of urgency among clinicians and homeless service providers -- and increasing anxiety for people who are homeless.

Categories: Health Care

The Latest On The Coronavirus In Massachusetts

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Philanthropists in Massachusetts are stepping up to provide relief to those feeling the economic effects of the coronavirus pandemic.

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