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Health Care

'It's Heartbreaking': Worcester Nursing Home Residents Moved To Make Way For COVID-19 Patients

CommonHealth (WBUR) - Sun, 03/29/2020 - 4:22pm

The Beaumont Rehabilitation and Skilled Nursing Center in Worcester is the first of what will be multiple skilled nursing facilities converted for ongoing coronavirus care.

Categories: Health Care

Boston Adds 240 More Beds To House City's Homeless Population During Outbreak

CommonHealth (WBUR) - Sun, 03/29/2020 - 1:09pm

He also announced that Boston would be adding hundreds more beds to house those who are homeless, allowing them a place to isolate and recuperate if they fall ill.

Categories: Health Care

Brigham And Women's Doctor On What Restrictions On Visitors Means For Patients

CommonHealth (WBUR) - Sun, 03/29/2020 - 10:36am

To fight the spread of the coronavirus hospitals are changing policies and many patients are now mostly alone. In a lot of situations, no visitors are allowed.

Categories: Health Care

One Medical Student On Graduating Early To Help Respond To The Coronavirus

CommonHealth (WBUR) - Sun, 03/29/2020 - 10:34am

Many medical students in Massachusetts are graduating early so they can help respond to the coronavirus outbreak.

Categories: Health Care

‘Red Dawn Breaking Bad’: Officials Warned About Safety Gear Shortfall Early On, Emails Show

Kaiser Health News - Sat, 03/28/2020 - 10:00pm

A high-ranking federal official in late February warned that the United States needed to plan for not having enough personal protective equipment for medical workers as they began to battle the novel coronavirus, according to internal emails obtained by Kaiser Health News.

The messages provide a sharp contrast to President Donald Trump’s statements at the time that the threat the coronavirus posed to the American public remained “very low.” In fact, concerns were already mounting, the emails show, that medical workers and first responders would not have enough masks, gloves, face shields and other supplies, known as PPE, to protect themselves against infection when treating COVID-19 patients.

The emails, part of a lengthy chain titled “Red Dawn Breaking Bad,” includes senior officials across the Department of Veterans Affairs, the State Department, the Department of Homeland Security and the Department of Health and Human Services, as well as outside academics and some state health officials. KHN obtained the correspondence through a public records request in King County, Washington, where officials struggled as the virus set upon a nursing home in the Seattle area, eventually killing 37 people. It was the scene of the first major outbreak in the nation.

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“We should plan assuming we won’t have enough PPE — so need to change the battlefield and how we envision or even define the front lines,” Dr. Carter Mecher, a physician and senior medical adviser at the Department of Veterans Affairs, wrote on Feb. 25. It would be weeks before front-line health workers would take to social media with the hashtag #GetMePPE and before health systems would appeal to the public to donate protective gear.

In the email, Mecher said confirmed-positive patients should be categorized under two groups with different care models for each: those with mild symptoms should be encouraged to stay home under self-isolation, while more serious patients should go to hospital emergency rooms.

“The demand is rising and there is no guarantee that we can continue with the supply since the supply-chain has been disrupted,” Eva Lee, director of the Center for Operations Research in Medicine and HealthCare at Georgia Tech and a former health scientist at the Atlanta VA Medical Center, wrote that same day citing shortages of personal protective equipment and medical supplies. “I do not know if we have enough resources to protect all frontline providers.”

Related Stories All KHN Coronavirus Stories

Reached on Saturday, Lee said she isn’t sure who saw the message trail but “what I want is that we take action because at the end of the day we need to save patients and health care workers.”

Mecher, also reached Saturday, said the emails were an “an informal group of us who have known each other for years exchanging information.” He said concerns aired at the time on medical protective gear were top of mind for most people in health care. More than 35 people were on the email chain, many of them high-ranking government officials.

The same day Mecher and others raised the concern in the messages, Trump made remarks to a business roundtable group in New Delhi, India.

“We think we’re in very good shape in the United States,” he said, noting that the U.S. closed the borders to some areas. “Let’s just say we’re fortunate so far.  And we think it’s going to remain that way.”

The White House declined to comment. In a statement, VA press secretary Christina Mandreucci said, “All VA facilities are equipped with essential items and supplies to handle additional coronavirus cases, and the department is continually monitoring the status of those items to ensure a robust supply chain.”

Doctors and other front-line medical workers in the weeks since have escalated concerns about shortages of medical gear, voicing alarm about the need to protect themselves, their families and patients against COVID-19, which as of Saturday evening had sickened more than 121,000 in the United States and killed at least 2,000.

As Mecher and others sent emails about growing PPE concerns, HHS Secretary Alex Azar testified to lawmakers that the U.S. had 30 million N95 respirator masks stockpiled but needed 300 million to combat the outbreak. Some senior U.S. government officials were also warning the public to not buy masks for themselves to conserve the supply for health care providers.

U.S. Surgeon General Jerome Adams tweeted on Feb. 29: “Seriously people – STOP BUYING MASKS!  They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!”

Still, on Feb. 27, the FDA in a statement said that officials were not aware of widespread shortages of equipment.

“We are aware of reports from CDC and other U.S. partners of increased ordering of a range of human medical products through distributors as some healthcare facilities in the U.S. are preparing for potential needs if the outbreak becomes severe,” the agency said.

Simultaneously, Trump downplayed the risk of the novel coronavirus to the American public even though the Centers for Disease Control and Prevention was warning it was only a matter of time before it would spread across the country. On Feb. 29, the CDC also updated its strategies for health workers to optimize supplies of N95 masks.

An HHS spokesperson said Saturday the department has been in “an all-out effort to mobilize America’s capacity” for personal protective equipment and other supplies, including allowing the use of industrial N95 respirators in health care settings and awarding contracts to several private manufacturers to buy roughly 600 million masks over the next 18 months.

“Health care supply chains are private-sector-driven,” the spokesperson said. “The federal role is to support that work, coordinate information across the industry and with state or local agencies if needed during emergencies, and drive manufacturing demand as best we can.”

The emails from King County officials and others in Washington state also show growing concern about the exposure of health care workers to the virus, as well as a view into local officials’ attempts to get help from the CDC.

In one instance, local medical leaders were alarmed that paramedics and other emergency personnel were possibly exposed after encountering confirmed-positive patients at the Life Care Center of Kirkland, the Seattle-area nursing home where roughly three dozen people have died because of the virus.

“We are having a very serious challenge related to hospital exposures and impact on the health care system,” Dr. Jeff Duchin, the public health officer for Seattle and King County, wrote in a different email to CDC officials March 1. Duchin pleaded for a field team to test exposed health care workers and additional support.

Duchin’s email came hours after a physician at UW Medicine wrote about being “very concerned” about exposed workers at multiple hospitals and their attempts to isolate infected workers.

“I suspect that we will not be able to follow current CDC [recommendations] for exposed HCWs [health care workers] either,” wrote Dr. John Lynch, medical director of employee health for Harborview Medical Center and associate professor of Medicine and Allergy and Infectious Diseases at the University of Washington. “As you migh [sic] imagine, I am very concerned about the hospitals at this point.”

Those concerns have been underscored with an unusual weekend statement from Dr. Patrice Harris, president of the American Medical Association, which represents doctors, calling on Saturday for more coordination of needed medical supplies.

“At this critical moment, a unified effort is urgently needed to identify gaps in the supply of and lack of access to PPE necessary to fight COVID-19,” the statement says. “Physicians stand ready to provide urgent medical care on the front lines in a pandemic crisis. But their need for protective gear is equally urgent and necessary.”

Categories: Health Care

The Nation’s 5,000 Outpatient Surgery Centers Could Help With The COVID-19 Overflow

Kaiser Health News - Fri, 03/27/2020 - 11:03pm

As the number of COVID-19 cases continues to rise, a group of anesthesiologists wants to convert America’s surgery centers into critical care units for infected patients.

Many of the country’s more than 5,000 outpatient surgery centers have closed or sharply cut back on the number of elective procedures they perform, to comply with requests from government agencies and professional societies. But those surgery centers have space and staff, as well as anesthesia machines that could be repurposed into ventilators — all of which could be especially crucial in hard-hit areas like New York.

“Half of the surgery centers in New York are not doing anything,” said Adam Schlifke, an anesthesiologist and clinical assistant professor at Stanford University in California, who is leading the push for the centers to help. “All these anesthesiologists and nurses who are sitting on the sidelines, they want to help. They don’t know how to help. There’s nowhere for them to help. What if they could work in the surgery centers?”

Opening such outpatient centers nationwide to coronavirus patients would nearly double the number of facilities nationwide, up from the country’s fewer than 6,200 hospitals. But turning day facilities into places for 24/7 care worries some anesthesiologists. There are questions about staffing, regulations and payment. They also fear that using surgery centers as critical care units would do more harm than good if the centers aren’t properly equipped to handle severe cases of COVID-19.

“Even if we lifted the regulatory restrictions, surgery centers are licensed to do a certain thing,” said Dr. Steven Dalbec, a private practice anesthesiologist in Columbia, Missouri, who once ran a surgery center in Arizona. “If we could say, ‘OK, we’re going to lift all those restrictions and let you take care of critically ill patients,’ it’s not something that could happen overnight.”

Still, that’s exactly why Schlifke argues that it’s important to start now, especially in parts of the country with fewer cases. His group has created a blueprint that outlines the steps needed for surgery centers to convert.

In the coming days, Schlifke said, he and the approximately 75 members of the CovidVent coalition of anesthesiologists he’s helping organize will call for a federal executive order to enable the conversion of surgery centers and hospital operating rooms into COVID-19 care sites to help save lives.

The order is needed, he said, because he recognizes that providers want to get paid. The idea is so new, he said, there’s no reimbursement plan in place for surgery centers that agree to treat COVID-19 patients.

What’s most troubling, Schlifke said, is the number of anesthesiologists who cannot help with the pandemic because their center is either closed or they are busy with elective surgeries that aren’t necessary. It’s a frustrating dilemma.

“They want to work,” Schlifke said.

The CovidVent group also wants to make sure surgery centers follow Centers for Medicare & Medicaid Services recommendations that call for them to end nonessential elective surgeries to keep front-line medical providers safe amid shortages of protective supplies such as masks. Many of those surgery centers are in states like New York, California and Washington where hospitals can’t keep up with the demand.

“An important question for hospitals and health systems that continue to perform elective and nonessential surgeries is, ‘Why?’” said Dr. Greg Martin, president-elect of the Society of Critical Care Medicine, which represents intensive care doctors. “How do they justify the risk to the otherwise healthy individuals, justify the risk to the health care provider workforce who may be imminently needed elsewhere, and justify the unnecessary consumption of health care resources such as masks, gloves and gowns?”

But William Prentice, CEO of the Ambulatory Surgery Center Association, an industry group, argued that some surgeries remain necessary. “We’re pushing things off that can be pushed off,” he said.

Meanwhile, in Washington, D.C., Vice President Mike Pence has already come out in support of the use of anesthesiology equipment as ventilators.

Anesthesia machines used in the operating room can be repurposed as mechanical ventilators, Martin said. “But they function differently and do not have all the same settings as ICU ventilators, so employing them in COVID-19 care requires education or oversight from those who are expert in using them.”

Dalbec also supports converting anesthesia machines into ventilators. He now works at Boone Hospital Center in Columbia, Missouri, which he said is prepared to do that if needed. As of Friday, he said, the 230-bed hospital hasn’t treated a confirmed COVID-19 patient.

But creating new intensive care units is challenging, according to both Dalbec and Martin.

Dalbec, who ran a surgery center in Tucson, Arizona, for 10 years, worries a lot of surgery centers don’t have the training, skills or supplies to care for critically ill patients.

“Time is of the essence,” Dalbec said. “And so that would make the care for these patients considerably challenging.”

An ICU has sophisticated equipment, such as bedside machines to monitor a patient’s heart rate and mechanical ventilators to help them breathe, Martin said. Ventilators need to be hooked up to oxygen and gas lines, which supply patients with the appropriate mix of air.

Only a few areas of the hospital have the equipment and gas hookups to provide ventilator care to critically ill patients, Martin said. These include the operating room, emergency department and units used for post-anesthesia care. To convert an ordinary hospital unit to an ICU, Martin said, “You would literally need to tear down the wall and run the piping in.”

Hospitals are already looking to use operating rooms for intensive care, Martin said.

“Using OR space, equipment and staff to care for sick COVID-19 patients is the right thing to do,” Martin said. “This is one approach that most health systems are already considering and using.”

Many outpatient operating rooms at surgery centers already have the required gas and oxygen hookups, Martin said. “Some will have fully configured operating rooms with ventilators,” he said. “It would be one way to expand ICU-level patient care space.”

But they are unlikely to stock all the medications used in an ICU.

Another challenge, he said, would be that staff from most surgery centers may be pulled into hospitals — anesthesiologists, nurses and nurse anesthetists — and surgery centers would not have all the pharmacists, respiratory therapists and other staff.

Intensive care units are staffed by specially trained doctors, nurses and respiratory therapists, who set up ventilators and closely monitor patients’ breathing, Martin said. “The hardest thing to change is the staffing,” he said. “We only have a certain number of doctors, nurses and respiratory therapists.”

CovidVent is working with several telemedicine groups that could help treat patients in areas where the staff lacks the expertise, Schlifke said.

Outpatient surgery centers would need to receive a waiver from federal regulators to keep patients overnight or perform medical care they don’t currently perform, Prentice said.

Prentice said he’s optimistic that the Centers for Medicare & Medicaid Services will make an announcement about such waivers in coming days.

“Once we get that flexibility, we can find the best way to help,” Prentice said. “Decisions about how to best to use ambulatory surgery centers need to be made in conjunction with hospitals at the local level.”

Categories: Health Care

With Empty Beds And An Expandable ICU, Mass. General 'Looks Down The Barrel' Of Outbreak

CommonHealth (WBUR) - Fri, 03/27/2020 - 6:24pm

The chief of Massachusetts General Hospital says its 150 ICU beds can be expanded to 400 beds if needed for coronavirus patients, and meanwhile the hospital is unusually empty.

Categories: Health Care

Listen: How Hospitals Are Preparing For Surge In COVID-19 Patients

Kaiser Health News - Fri, 03/27/2020 - 4:30pm

California Healthline senior correspondent Anna Maria Barry-Jester appeared on KALW’s “Your Call” on Friday to discuss how hospitals are preparing for a surge in COVID-19 patients.

Dr. Mark Ghaly, the state’s secretary of Health and Human Services, said on Wednesday that COVID-19 cases in California continued to double every three to four days ― a pace on par with New York, where some hospitals are already overwhelmed by coronavirus patients.

As of Friday afternoon, the number of coronavirus cases in California topped 4,000 and at least 85 people had died.

Hospitals have been shifting patients with less urgent medical needs to other facilities to free up beds and working to boost supplies of personal protective equipment for medical staff, but still face shortages of both.

Categories: Health Care

UMass Tries Innovative Method To Clean N95 Masks: UV Light

CommonHealth (WBUR) - Fri, 03/27/2020 - 3:30pm

Once they are decontaminated, a hospital epidemiologist said, the masks can be re-used several times.

Categories: Health Care

House Passes Historic $2.2T Stimulus Legislation

Kaiser Health News - Fri, 03/27/2020 - 2:41pm
The U.S. House passed the unprecedented financial rescue measure by voice vote to accommodate those lawmakers who couldn't make it back to Washington. The bill represents the largest stimulus package in modern American history.
Categories: Health Care

Boston To Open First-Responders Only COVID-19 Testing Site At Suffolk Downs

CommonHealth (WBUR) - Fri, 03/27/2020 - 2:34pm

A dedicated testing facility for Boston's coronavirus first responders will open at Suffolk Downs in East Boston this weekend, Boston Mayor Marty Walsh announced at a press conference Friday.

Categories: Health Care

Centros de salud comunitarios enfrentan al coronavirus, bajo presión financiera

Kaiser Health News - Fri, 03/27/2020 - 2:27pm
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La administración Trump acaba de anunciar $100 millones en fondos suplementarios para centros de salud comunitarios, para apoyar la respuesta a la pandemia de coronavirus.

“Los centros de salud están desempeñando un papel fundamental”, dijo James Macrae, administrador asociado de la Oficina de Atención Primaria de Salud del gobierno federal.

Forma parte del grupo de Facebook de Kaiser Health News en español “KHN-Hablemos de Salud”.

KHN-Hablemos de Salud

Alrededor de 29 millones de personas en el país dependen de estos centros, que ofrecen atención médica a pacientes de bajos ingresos y sin seguro. Millones de latinos reciben atención en estas clínicas.

A medida que los hospitales reciben más pacientes con COVID-19, los centros están revisando la forma en que atienden a los pacientes y han puesto en marcha nuevos protocolos para el manejo de enfermedades infecciosas.

Los fondos extra del gobierno se repartirán entre 1,381 centros de salud comunitarios (muchos de los cuales operan múltiples clínicas), principalmente para respaldar más pruebas para COVID-19, telemedicina y adquisición de equipos de protección personal.

“No está cerca de lo que se necesita, pero estamos agradecidos”, dijo Bob Marsalli, CEO de la Washington Association for Community Health, un grupo que representa a los centros de salud comunitarios en el estado de Washington.

Marsalli dijo que los centros en el estado están bajo una creciente presión financiera a medida que recrudece la batalla contra el coronavirus, al tiempo que pierden algunas fuentes clave de financiación.

“[Nuestras clínicas] están reasignando su fuerza laboral de manera inteligente, pero frenética, para mantenerse al día con la demanda”, dijo Marsalli.

Nuevas reglas de juego

En circunstancias normales, HealthPoint, un centro de salud comunitario en Auburn, Washington, alentaría a los pacientes a ir a la clínica para todas sus necesidades médicas, tanto para surtir una receta como para aprender sobre nutrición.

“Por lo general, nuestro lobby está colmado”, dijo la doctora Esther Johnston. “Es un espacio abierto y todos están juntos”.

Pero en estos días solo hay unos pocos pacientes con máscaras quirúrgicas esperando que los atiendan. Y Johnston les dice a los pacientes que no vayan a menos que realmente necesiten atención médica.

“Es un poco frustrante y desmoralizante, pero es la realidad de la situación”, dijo.

HealthPoint dirige más de una docena de clínicas en todo el oeste de Washington. Ahora, en la entrada de sus centros, el personal hace preguntas a los pacientes para identificar los síntomas de COVID-19 y controlar los mantiene a distancia uno del otro una vez dentro.

Johnston dijo que la clínica no se abrió para albergar una afluencia de pacientes con enfermedades infecciosas. Tienen un limitado número de cuartos, y cada uno debe cerrarse y limpiarse después que entra un paciente sospechoso de tener COVID-19.

“Simplemente no tenemos suficiente espacio para poder hacer eso de forma rutinaria”, dijo.

Al igual que muchos centros de salud comunitarios, el modelo de HealthPoint es atender a más personas para que no vayan a las salas de emergencia. Pero ahora la organización está tomando nuevas precauciones para prevenir la propagación del coronavirus y mantener al personal seguro. (Will Stone for KHN)

Johnston se preocupa por lo que vendrá a medida que aumenten los casos de COVID-19 en su área.

“Nos enorgullecemos de ser un espacio de atención primaria”, dijo Johnston. “No tenemos suficientes máscaras N95, ni, para ser sinceros, estábamos preparados para una situación en la que todos debían estar bien equipados”.

La doctora Judy Featherstone, directora médica de HealthPoint, dijo que ahora la mayoría de las citas se hacen por teléfono. Su personal está atendiendo llamadas de personas preocupadas por los síntomas, así como de nuevos pacientes que quieren tener un médico en caso que contraigan el coronavirus.

“Es un poco como tomar 20 años de trabajo y rediseñarlo en una semana”, dijo Featherstone. “Creo que estamos anticipando posibles problemas de la fuerza laboral”.

Al igual que muchas clínicas en Washington, HealthPoint ha establecido sitios de pruebas al aire libre, pero el suministro de kits y equipos de protección personal, limita el número de pacientes que pueden hacérselas.

Crece la tensión financiera

A medida que van menos pacientes para recibir atención, autoridades se preocupan por el futuro financiero de los centros. Las clínicas han cambiado a citas telefónicas, pero el programa de Medicaid de Washington tardó varias semanas en ajustar la forma en que paga esas visitas. Mientras tanto, los centros de salud comunitarios están eliminando las visitas dentales de rutina, un flujo de financiación clave.

“Toma esos tres factores… y ya has comenzado a perder ingresos antes de prepararte para nuevas formas de brindar atención”, dijo Michael Erikson, CEO de Neighborcare Health, que atiende a más de 70,000 residentes de Washington, más de la mitad de ellos bajo Medicaid. “Estamos en camino de perder $3 millones al mes”.

La Washington Association for Community Health proyecta que el recorte en la atención dental podría llevar a un déficit de $250 millones para el sistema de centros de salud comunitarios del estado durante los próximos nueve meses.

Rol vital en el sistema de salud

Las clínicas comunitarias juegan un papel importante en el servicio a pacientes que de otro modo terminarían en una sala de emergencias. Erikson dijo que su organización está tratando de aliviar la presión sobre el sistema hospitalario al ver pacientes con problemas de atención médica urgentes no relacionados con COVID-19.

“Por ejemplo, a un paciente para el cuidado de heridas que tiene diabetes subyacente no quieres exponerlo a un posible entorno con COVID-19”, dijo Erikson.

Algunos líderes de clínicas comunitarias también se preocupan por perder personal debido a una infección real o sospechada por coronavirus.

“Es muy crítico que las clínicas permanezcan con todo el personal, de modo que solo aquellos que están gravemente enfermos vayan al hospital”, dijo Sheila Berschauer, directora ejecutiva de Moses Lake Community Health Center, un proveedor de atención médica rural en Washington que atiende a un tercio de la población de su condado, de aproximadamente 100,000 residentes.

Si incluso cinco a 10 trabajadores de salud se enferman, dijo Berschauer, eso podría afectar su organización y, como resultado, posiblemente abrumar al hospital local.

Berschauer agregó que algunos pacientes aún no se dan cuenta de la gravedad de la pandemia y se enojan cuando se los deriva al sitio de prueba al aire libre en lugar de a la clínica.

Un trabajador de alud en un centro en las afueras de Seattle dijo que varios pacientes han tergiversado sus riesgos de COVID-19 para pasar el examen.

“Recibimos una paciente que logró pasar todos los controles y llegó ante un médico para recién entonces revelarnos que su pareja está expuesta a COVID y que se siente enferma”, dijo un empleado (le preocupa perder su trabajo por hablar, por lo que NPR y KHN no están usando su nombre).

Los trabajadores de salud que vieron al paciente no usaron equipo protector porque esos suministros limitados están reservados para pacientes con riesgo conocido de COVID-19.

“Ahora todos los proveedores y el personal de esa instalación deben comenzar a autocontrolarse para detectar signos de infección”, dijo el empleado. “Si se infectan, entonces toda la clínica cierra. Es un problema muy grande”.

Esta historia es parte de una asociación entre NPR y Kaiser Health News

Categories: Health Care

Para luchar contra el coronavirus, médicos y enfermeras retirados vuelven a trabajar

Kaiser Health News - Fri, 03/27/2020 - 2:15pm
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Laura Benson se retiró de la enfermería en 2018, pero hace pocos días volvió a presentarse a trabajar en New Rochelle, Nueva York, donde se registró uno de los primeros grupos de casos de COVID-19.

“Las enfermeras somos entregadas”, dijo. “Si no hay suficiente gente, simplemente te presentas”.

Forma parte del grupo de Facebook de Kaiser Health News en español “KHN-Hablemos de Salud”.

KHN-Hablemos de Salud

Con más de 40,000 casos confirmados, Nueva York es ahora el epicentro del brote de coronavirus en el país: casi la mitad de los más de 92,900 casos en todo el país hasta el viernes 27 de marzo al mediodía.

Anticipándose a una grave escasez de personal médico para tratar el flujo de pacientes enfermos, el gobernador Andrew Cuomo y otros funcionarios hicieron un llamado para que médicos, enfermeras y otros profesionales de salud retirados desempolvaran sus guardapolvos y regresaran al trabajo.

Para el jueves 26, habían respondido 52,000 personas.

Funcionarios de otros estados, incluidos California, Colorado e Illinois, han hecho pedidos similares para que los profesionales de salud retirados den un paso adelante.

En el condado de Westchester, en Nueva York -que incluye New Rochelle y otras ciudades al norte de la ciudad de Nueva York- su ejecutivo, George Latimer, dijo que cerca de 90 enfermeras retiradas y un puñado de médicos respondieron después que publicara un mensaje en la página de Facebook del condado en busca de ayuda.

No hay un plan definitivo para desplegar con los voluntarios médicos, explicó Latimer. Pueden ser necesarios para atender a pacientes por fuera del coronavirus, o para ayudar al personal del Westchester County Center, que ahora funciona como un hospital temporal.

Laura Benson(Courtesy of Laura Benson)

Benson, de 60 años, trabaja para el Departamento de Salud del condado. Enfermera practicante con especialidad en oncología, pasó 20 años en el Albert Einstein Cancer Center en el Bronx. Se retiró de un trabajo en una compañía de dispositivos médicos, donde trabajó con pacientes con tumores cerebrales. También enseña a estudiantes de enfermería en un colegio comunitario.

En su primer día como voluntaria jubilada, Benson llamó por teléfono a pacientes que habían sido examinados recientemente para detectar el nuevo coronavirus para explicarles las pautas que deberían seguir para protegerse a sí mismos y a los demás.

Si hay una necesidad, dijo, está “absolutamente” dispuesta a trabajar directamente con pacientes que tengan COVID-19.

“Pienso en la persona en esa cama de hospital”, dijo. “Me gustaría que alguien la cuide”.

Benson no está particularmente preocupada por el virus, ya que trabajó durante la crisis del sida y trató a los pacientes incluso antes que la gente entendiera qué era esa enfermedad. “Sigues las pautas y te proteges”, explicó.

El mejor papel para muchos profesionales médicos retirados puede ser ayudar detrás de escena, dijeron expertos, liberando a colegas más jóvenes para que puedan centrarse en la atención directa del paciente.

Una razón para esto: la edad.

“Mi única preocupación es que muchas de estas personas retiradas estén en grupos de alto riesgo” con mayor probabilidad de verse gravemente afectados por COVID-19, dijo el doctor Arthur Fougner, presidente de la Sociedad Médica del Estado de Nueva York.

Otra preocupación es si los jubilados están actualizados con sus conocimientos médicos.

“Si han estado sin trabajar por más de dos o tres años, debes preocuparte que estén al día”, dijo el doctor Janis Orlowski, director de atención médica de la Asociación de Colegios Médicos Americanos.

Además, las licencias estatales de los proveedores de atención médica pueden haber caducado si han estado retirados por unos años. Renovarlas puede llevar mucho tiempo.

Aun así, “si alguien todavía tiene su licencia y está dispuesto a regresar, deberíamos recibirlo”, dijo Orlowski.

Michele Pedicone es una de esas profesionales. La terapeuta de atención respiratoria dejó su trabajo en Seattle el año pasado para dirigir el área de educación clínica en el departamento de educación de terapia respiratoria de la Universidad Médica SUNY Upstate en Syracuse, Nueva York.

Con sus clases ahora en su mayoría en línea y las prácticas de los estudiantes, suspendidas, tiene tiempo para volver a la atención clínica. Pedicone contactó a dos hospitales cercanos para ver si podían usar sus servicios y espera trabajar tres o cuatro días a la semana.

“Sinceramente, no sé lo que me están pagando; el dinero no es un problema “, dijo Pedicone, de 54 años.” Es lo correcto”.

Los terapeutas respiratorios, los médicos de cuidados críticos y las enfermeras capacitadas en la operación de ventiladores que ayudan a los pacientes hospitalizados a respirar se encuentran entre los especialistas que se espera que comiencen a escasear a medida que la pandemia de coronavirus empeora en Nueva York y en otros lugares, según un análisis de la Sociedad de Medicina de Cuidados Críticos.

La expansión de la oferta de trabajadores de cuidados intensivos será clave para manejar la pandemia de coronavirus, dijo Ashish Jha, director del Instituto de Salud Global de Harvard, en una sesión informativa la semana del 23 sobre asuntos de la fuerza laboral de atención médica patrocinados por el Commonwealth Fund.

Una opción que los encargados de formular políticas han discutido es que los estados podrían permitir, por ejemplo, que los profesionales médicos que se retiraron en los últimos cinco años con licencias vigentes obtengan una licencia automática de tres o seis meses sin tener que hacer muchos trámites, dijo Jha.

Mientras tanto, los sistemas de atención médica están desarrollando sus propias estrategias.

Northwell Health posee y opera 19 hospitales en la ciudad de Nueva York, el condado de Westchester y Long Island. La semana del 23, el sistema de salud ha tenido más de 700 pacientes con COVID-19, en comparación con solo 40 pacientes la semana anterior, según Terry Lynam, vicepresidente senior del sistema de salud.

Northwell ha estado planeando cómo fortalecer al personal desde enero, contó Judy Howard, vicepresidenta de adquisición que supervisa la contratación de personal. Desarrollaron una lista de 200 enfermeras jubiladas a las que se ha contactado para evaluar su interés en regresar al trabajo remunerado de alguna manera. Hasta ahora, 28 han firmado, dijo Howard.

En este momento, están pidiendo a las enfermeras jubiladas que trabajen en el centro de llamadas del sistema de salud y compartan las responsabilidades para capacitar a las nuevas enfermeras. Algunas trabajan en atención directa al paciente. Otra posibilidad es que colaboren en las instalaciones que Northwell ha establecido para cuidar a los hijos de los miembros del personal durante la pandemia de coronavirus.

“Si alguien realmente quiere trabajar cuatro horas a la semana o le gustaría trabajar 10 horas a la semana, trabajaremos con ellos para satisfacer sus necesidades”, dijo Howard.

Categories: Health Care

Resurge la telemedicina, por miedo al coronavirus y cambios en los pagos

Kaiser Health News - Fri, 03/27/2020 - 2:04pm
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Lukas Kopacki, quien regresó a casa después que el campus de su universidad cerrara por la pandemia de coronavirus, se había estado sintiendo mal durante días, con dolores de cabeza y garganta, y dificultad para respirar. Pero le preocupaba que ir al consultorio médico pudiera enfermarlo más.

“No tenía ganas de entrar en ese agujero negro de bacterias y virus”, dijo Kopacki, de 19 años, de Ringwood, Nueva Jersey.

Forma parte del grupo de Facebook de Kaiser Health News en español “KHN-Hablemos de Salud”.

KHN-Hablemos de Salud

Entonces, la semana del 16 de marzo, el estudiante de la Universidad de Vermont decidió llamar a Teladoc, una compañía que conecta a pacientes con médicos por teléfono en todo el país. El médico le diagnosticó una infección sinusal y le envió una receta para un antibiótico a su farmacia local.

Con su cobertura de salud de Aetna, que a principios de marzo renunció temporalmente a su copago de $45 por atención virtual, Kopacki pagó de su bolsillo $1.44, que cubrió los costos del medicamento.

“Fue fácil y rápido”, dijo.

Recibir atención médica por teléfono o videoconferencia ha existido durante varias décadas, pero el brote de coronavirus ha llevado a un aumento en el uso de la telemedicina como nunca antes se había visto, según los sistemas de salud y los grupos de proveedores en todo el país.

Millones de estadounidenses buscan atención conectándose electrónicamente con un médico, muchos por primera vez. Los sistemas de salud, las aseguradoras y los grupos de médicos dijeron que esta práctica permite a las personas practicar el distanciamiento social a la vez que reduce la propagación de la enfermedad, y protege a los trabajadores de salud.

Las empresas privadas de tecnología como Teladoc, Doctor On Demand y Amwell, y los grandes sistemas de atención médica, pueden proporcionar un médico directamente a alguien que se contacte con ellos.

Otros pacientes pueden pedir una cita de telemedicina con su médico habitual, que puede utilizar aplicaciones informáticas a través de celulares y computadoras. Todos los tipos de atención primaria y especializada, y los servicios de salud mental se pueden proporcionar a través de la telemedicina.

Muchos hospitales han agregado recientemente servicios de telemedicina para evitar que los pacientes preocupados por el coronavirus colmen sus salas de emergencia.

También estimulados por el objetivo de mantener a los pacientes alejados de las instalaciones médicas abarrotadas, las aseguradoras, del gobierno y privadas han aumentado el pago de las visitas de telemedicina para que estén a la par de las citas en persona.

Antes del brote, las aseguradoras pagaban menos de la mitad de esa cantidad, lo que disuadía a muchos médicos de ofrecer este servicio.

La semana del 16, Medicare habilitó a todos los afiliados usar la telemedicina, una opción que anteriormente solo estaba disponible para personas que viven en áreas remotas, y para chequeos específicos y breves. El gobierno federal también dijo que los médicos podrían ofrecer servicio fuera de sus estados durante la pandemia para tratar a los pacientes de Medicare virtualmente, incluso si no tienen licencia en el estado del paciente.

California, Florida y otros estados también han renunciado a sus requisitos de que un médico tenga licencia en el estado para brindar atención.

La Clínica Cleveland está en camino de registrar más de 60,000 visitas de telemedicina en marzo, según sus autoridades. Antes de marzo, ese sistema de salud, que tiene hospitales en Ohio y Florida, promediaba unas 3,400 visitas virtuales al mes.

Su sistema Express Care Online atiende a pacientes de todo el país las 24 horas del día. Alrededor del 75% de las llamadas ahora provienen de personas preocupadas de haber contraído COVID-19, dijo el doctor Matthew Faiman, director médico del servicio. Al igual que muchos otros sistemas de salud, la atención de urgencia virtual de Cleveland Clinic está renunciando a los copagos de los pacientes durante la pandemia.

“Estamos viendo un aumento significativo en la demanda de pacientes que buscan atención, tanto las personas preocupadas por el virus como los pacientes que están enfermos y que necesitan saber cómo manejar sus síntomas”, explicó Faiman.

La clínica ha contratado más médicos para telesalud desde que se cancelaron las cirugías electivas y menos pacientes van al consultorio.

“La telemedicina ha estado en los bordes del sistema por un tiempo”, dijo el doctor Manish Naik, director de tecnología de información médica de la Clínica Regional de Austin, en Texas. “Y, cuando todo esto termine, muchos médicos y pacientes querrán que la opción de telemedicina permanezca”.

Por supuesto, tales visitas tienen limitaciones, como cuando los médicos necesitan auscultar los pulmones o el corazón de un paciente u ordenar una radiografía para verificar si hay neumonía. Pero Naik dijo que la telemedicina también brinda a los médicos una visión más completa de los pacientes a través de “observación en el hogar” e interacciones que muestran “cosas que nunca antes pudimos ver”.

Antes de marzo, NYU Langone Health en Nueva York tenía alrededor de 50 visitas virtuales por día a través de su plataforma de telemedicina de atención de urgencia. Durante la semana del 23 de marzo, el sistema hospitalario ha promediado alrededor de 900 por día.

Para el 80% de las visitas de telemedicina, la tos es la principal preocupación, seguida por la fiebre, dijo el doctor Paul Testa, jefe de información médica. NYU Langone tiene 170 médicos que atienden a pacientes a través de la telemedicina, en comparación con 35 antes, dijo.

“No estamos recomendando pruebas para todos, pero estamos aconsejando el cuidado personal, la hidratación y el autoaislamiento”, agregó Testa. “El objetivo es crear una opción para estos pacientes en lugar que se apresuren a una urgencia o a una sala de emergencias”.

Si un paciente tiene problemas para respirar, un proveedor de telemedicina de la NYU le indicará que llame a una ambulancia si es necesario o que vaya a la sala de emergencias.

Teladoc tiene un promedio de 15,000 visitas de pacientes por día en los Estados Unidos, 50% más que en febrero. Los tiempos de espera han aumentado de minutos a horas en algunos casos, dijo un vocero.

En la Clínica Regional de Austin, que cuenta con 340 médicos en 28 consultorios, casi la mitad de las visitas de pacientes ahora son virtuales en comparación con una fracción antes del brote.

“Con la situación de COVID-19, tenemos pacientes que están nerviosos por venir, y no queremos pacientes con síntomas que expongan a otros”, dijo Naik.

La administración Trump estuvo actuando para ampliar las opciones de telemedicina incluso antes de la pandemia. En 2019, le permitió a Medicare pagar por primera vez a los médicos un promedio de $14 por una llamada telefónica de cinco minutos para comunicarse con sus pacientes.

Ken Prussner, de 74 años, de Herndon, Virginia, usó la computadora de su casa el lunes 23 para conectarse con su médico de toda la vida.

Prussner tenía una enfermedad gastrointestinal y un poco de fiebre, y su familia quería asegurarse que no tuviera COVID-19. Habló con su médico como si estuviera en el consultorio. Prussner tenía una infección típica del intestino delgado que desaparecería por sí sola en tres o cinco días.

“Fue bastante sencillo”, dijo Prussner, oficial retirado del Servicio Exterior de los Estados Unidos.

Categories: Health Care

Must-Reads Of The Week From Brianna Labuskes

Kaiser Health News - Fri, 03/27/2020 - 2:00pm
The Friday Breeze

Newsletter editor Brianna Labuskes, who reads everything on health care to compile our daily Morning Briefing, offers the best and most provocative stories for the weekend.

Hello! We have once again reached Friday, and I’ll do my best to give you a snapshot of the biggest health news from the week. But, first, I must dispel some bad advice that I’ve seen: Everyone wants to see your pet on those video conferences! Don’t hide them away in this time of need! Show us the doggos, the cats, and the … whatever this is. (A porcupine, I think?) Also make sure you’re following DogsOfKFF on Twitter for some of the best content on that social media platform.

All right, onto the news.

As predicted, the United States has surpassed China in the number of confirmed coronavirus cases, with nearly 93,000 to China’s nearly 82,000, as of 1 p.m. ET Friday. According to Johns Hopkins’ tracker, we also have surpassed 1,300 recorded deaths. (Worldwide, we’re at more than 566,000 and over 25,000 deaths.) Meanwhile, all that data comes with an asterisk in that most experts believe there are far more cases going unrecorded either because of testing flaws or overwhelmed state health departments that can’t keep up. Either way, not exactly something we want to be first in.

Meanwhile, the House came back to Washington to approve the $2.2 trillion stimulus package the Senate managed to send through this week (more on that in a second), despite concerns over lawmakers’ safety. There had been (dim but existent) hope earlier in the week that the House might be able to pass the legislation by unanimous consent. But that seemed too easy to be true, and it was. Concerns that a voice vote would be derailed by objections from a libertarian Kentucky lawmaker went unrealized, and the House passed the legislation Friday afternoon. The bill now goes to President Donald Trump, who is expected to sign it.

So what exactly is in that legislation?

— Direct payments of $1,200 to millions of Americans, including those earning up to $75,000, and an additional $500 per child

— $100 billion for grants to hospitals, public and nonprofit health organizations and Medicare and Medicaid suppliers, including a 20% bump in Medicare payments for treating patients with the virus

— $221 billion in a variety of tax benefits for businesses, including allowing businesses to defer payroll taxes, which finance Medicare and Social Security, for the rest of the year

— More than $25 billion in new money for food assistance programs, like SNAP

— Expanded jobless aid, providing an additional 13 weeks and a four-month enhancement of benefits, and extending the payments for the first time to freelancers and gig workers

— $377 billion in federally guaranteed loans to small businesses and the establishment of a $500 billion government lending program for distressed companies

— Millions in aid for states to begin offering early voting or voting by mail

— A rule that blocks foreclosures and evictions during the crisis on properties where the federal government backs the mortgage

— The suspension of federal student loan payments for six months and waives the interest

Predictably, some sectors (like cruise ships) were unhappy with being left out, but for once some people were pleased — for example, the hospital industry, which got the $100 billion it asked for.

For those of you, like me, who love a good tick-tock, here are a few inside looks at how Senate leaders and White House advisers struck a quick, expansive deal in a Washington that typically seems incapable of compromise.

The New York Times: As Coronavirus Spread, Largest Stimulus in History United a Polarized Senate

Politico: Inside the 10 Days to Rescue the Economy

The Washington Post: The Dealmaker’s Dealmaker: Mnuchin Steps In as Trump’s Negotiator, but President’s Doubts Linger With Economy in Crisis

The urgency of the legislation was underscored by an astronomical jump in jobless claims this week. Nearly 3.3. million Americans applied for benefits, up from 200,000 during pre-outbreak days. The “widespread carnage,” as one economist put it, is expected to get worse. While the stimulus package is expected to help mitigate some of the devastation, many have said it should be looked at as just the beginning.

It seemed strangely appropriate this week that the health law turned 10 amid a pandemic — the legislation’s journey to here has been anything but smooth, why should this anniversary be? But one ripple effect of the pandemic and economic fallout might actually be a boost to the health law, which is likely to serve as a crucial safety net for many Americans who possibly lost their employer-sponsored coverage in the past few weeks. States have already started reopening their marketplaces, and the federal government is being urged to follow suit.

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Trump chafed this week at the drastic measures states are putting in place to try to curb the outbreak, raising eyebrows when he said he’d like to see church pews full by Easter. Public health experts have warned that lifting the social-distancing measures would result in a surge of cases that slam an already stretched-thin hospital system. But for Trump, who has tied his reputation to the well-being of the stock market, the economic toll seems too much. (The rhetoric also started a truly bizarre push from conservatives for older Americans to sacrifice themselves for the good of the country.)

The president’s most recent proposal to kick-start parts of the country is identifying places by risk level and applying strategies to match. But experts, like Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, warn that even “cool spots” that aren’t seeing many cases might be in for a surge coming down the pike.

Meanwhile, Gov. Andrew Cuomo has said that New York’s experience presages America’s future. But some say that’s not necessarily accurate. Leading specialists say that while it is likely that devastation similar to New York’s will emerge in other places, there’s hope that in lower-density areas, where there are fewer factors like mass transit to exacerbate the spread, the outcome might be different.

Realistically, though, Americans will need to eventually think about returning to normalcy. Are there exit strategies from this complete lockdown that would work effectively? Here’s the problem: All the experts say success relies on extreme, aggressive and widespread testing to isolate the sick before they can give it to anyone. This has not exactly been America’s strong suit in recent weeks.

There are two storylines that have taken hold to demonstrate how much this pandemic will strain the hospital system, the first being the lack of ventilators available. States and hospitals have been pleading with the federal government to invoke war powers to jump-start the manufacturing process on the equipment. This comes as doctors are being forced to split ventilators between patients (a risky practice), planning to make the tough ethical decisions to ration care, creating policies to not resuscitate, searching for alternative treatments despite the dangers they might pose, and being warned that morgues are reaching capacity.

But Trump, who had been set to announce a partnership with GM to produce up to 80,000 ventilators, balked this week at the $1 billion price tag that came with it. “I don’t believe you need 40,000 or 30,000 ventilators,” he said, in a reference to New York, where Gov. Andrew Cuomo has appealed for federal help in obtaining them. “You go into major hospitals sometimes, and they’ll have two ventilators. And now all of a sudden they’re saying, ‘Can we order 30,000 ventilators?’”

The second notable thread throughout the country is a lack of personal protective equipment for health care workers on the front lines of the epidemic. There might be a long medical tradition of accepting elevated risk in the middle of a crisis, but many health care workers are frustrated that they’re being put in that position. Some are resorting to using hand-sewn masks, which do little to protect them and trash bags for surgical gowns. But others are drawing a line in the sand.

Meanwhile, something that might get missed with everyone’s attention directed at the coasts: Atlanta’s mayor is warning that its hospitals are at capacity.

Gilead, whose antiviral drug is getting a lot of buzz, was granted orphan drug status for the treatment because there are fewer than 200,000 cases of COVID-19 in the States right now. The designation would have granted Gilead lucrative perks, like the ability to keep generic competitors from the marketplace. But the news was meant with rage-filled incredulity from, uh, pretty much everyone, and so the company rescinded the request. As one expert said: “I think it’s embarrassing to take something that’s potentially the most widespread disease in the history of the pharmaceutical industry and claim it’s a rare disease.”

Meanwhile, an antimalarial drug is getting tons of attention after Trump touted it as a possible game changer. But a new, more carefully constructed study that finds it did little to help patients in China shows why people shouldn’t be looking for a quick, miracle cure. Researchers say this doesn’t disprove that the drug works but is a good check on expectations, especially when people are trying to self-medicate with the drug — resulting in shortages for those who need it for other illnesses and fatal consequences for others.

On the good-news front (there is some!), Moderna said there could be a vaccine ready for the fall for health care workers under emergency use authorization, ahead of the wider release that’s not expected to come for about a year.

And another treatment that some scientists are hopeful about is the practice of injecting recovered patients’ blood into new patients. The strategy is at least a century old but has scattershot results. “It’s not exactly a shot in the dark, but it’s not tried and true,” says one scientist. Still, in this era, people are willing to try what they can.

And here are some other interesting stories to get you through the weekend.

Federal Response:

Politico: Trump Team Failed to Follow NSC’s Pandemic Playbook

Politico: Those Who Intentionally Spread Coronavirus Could Be Charged As Terrorists

The New York Times: As Coronavirus Surveillance Escalates, Personal Privacy Plummets

2020 Elections:

The New York Times: Joe Biden, Struggling for Visibility, Faults Trump’s Response to Coronavirus

The New York Times: Is All of 2020 Postponed?

From The States:

Stateline: One Governor’s Actions Highlight the Strengths — and Shortcomings — of State-Led Interventions

The New York Times: Governors Tell Outsiders From ‘Hot Zone’ to Stay Away as Virus Divides States

NBC News: Entire Senior Home in New Jersey, 94 People, Presumed to Have Coronavirus

Science And Innovation:

The New York Times: The Virus Can Be Stopped, But Only With Harsh Steps, Experts Say

The New York Times: Warmer Weather May Slow, But Not Halt Coronavirus

The Washington Post: What Research on Coronavirus Structure Can Tell Us About How to Kill It

The Washington Post: The Science of Why Coronavirus Is So Hard to Stop

Reuters: Smokers Likely to Be More at Risk From Coronavirus: EU Agency

Public Health:

ProPublica: Domestic Violence and Child Abuse Will Rise During Quarantines. So Will Neglect of At-Risk People, Social Workers Say.

NBC News: Anti-Abortion Groups Seek Halt to Abortions During Coronavirus Pandemic

Politico: New York’s Health Care Workforce Braces for Influx of Retirees, Inexperienced Staffers

That’s it from me! Have a safe and healthy weekend!

Categories: Health Care

Boston Doctor's Up-Close View Of COVID-19: It Can Get Bad Fast, Last Long, And Hit The Young

CommonHealth (WBUR) - Fri, 03/27/2020 - 11:03am

A doctor in the thick of the coronavirus battle, the director of the Beth Israel Deaconess Medical Center unit who is treating some of the sickest patients, shares her on-the-ground hospital view.

Categories: Health Care

Emptied Clinics And Hospitals Prepare For New Purpose In COVID-19 Pandemic

CommonHealth (WBUR) - Fri, 03/27/2020 - 10:49am

Beds at speciality health care facilities may soon be filled with patients without COVID-19 that have come over from other hospitals. That clears space from larger facilities that are better equipped to care for patients that are in critical condition due to the coronavirus.

Categories: Health Care

Coronavirus Has Upended Our World. It’s OK To Grieve.

Kaiser Health News - Fri, 03/27/2020 - 9:45am

On weekday evenings, sisters Lesley Laine and Lisa Ingle stage online happy hours from the Southern California home they share. It’s something they’ve been enjoying with local and faraway friends during this period of social distancing and self-isolation. And on a recent evening, I shared a toast with them.

We laughed and had fun during our half-hour FaceTime meetup. But unlike our pre-pandemic visits, we now worried out loud about a lot of things — like our millennial-aged kids: their health and jobs. And what about the fragile elders, the economy? Will life ever return to ‘normal’?

“It feels like a free fall,” said Francis Weller, a Santa Rosa, California, psychotherapist. “What we once held as solid is no longer something we can rely upon.”

The coronavirus pandemic sweeping the globe has not only left many anxious about life-and-death issues, but it also has left people struggling with a host of less obvious, existential losses as they heed stay-home warnings and wonder how bad all this will get.

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To weather these uncertain times, it’s important to acknowledge and grieve lost routines, social connections, family structures and our sense of security — and then create new ways to move forward — said interfaith chaplain and trauma counselor Terri Daniel.

“We need to recognize that mixed in with all the feelings we’re having of anger, disappointment, perhaps rage, blame and powerlessness is grief,” said Daniel, who works with the dying and bereaved.

Left unrecognized and unattended, grief can negatively affect “every aspect of our being — physically, cognitively, emotionally, spiritually,” said Sonya Lott, a Philadelphia psychologist specializing in grief counseling.

Yet with our national focus on the daily turn of events as the new coronavirus spreads and with the chaos it has brought, these underlying or secondary losses may escape us. People who are physically well may not feel entitled to their emotional upset over the disruption of normal life. Yet, Lott argued, it’s important to honor our own losses even if those losses seem small compared with others.

“We can’t heal what we don’t have an awareness of,” said Lott.

Recognize Our Losses

Whether we’ve named them or not, these are some of the communitywide losses many of us are grieving. Consider how you feel when you think of these.

Social connections. Perhaps the most impactful of the immediate losses as we hunker down at home is the separation from close friends and family. “Children aren’t able to play together. There’s no in-person social engagement, no hugging, no touching — which is disruptive to our emotional well-being,” said Daniel.

Separation from our colleagues and office mates also creates a significant loss. Said Lott: “Our work environment is like a second family. Even if we don’t love all the people we work with, we still depend on each other.”

Habits and habitat. With the world outside our homes no longer safe to inhabit the way we once did, Daniel said, we’ve lost our “habits and habitats.” We can no longer engage in our usual routines and rituals. And no matter how mundane they may have seemed — whether grabbing a morning coffee at the local cafe, driving to work or picking up the kids from school — routines help define your sense of self in the world. Losing them, Daniel said, “shocks your system.”

Assumptions and security. We go to sleep assuming that we’ll wake up the next morning, “that the sun will be there and your friends will all be alive and you’ll be healthy,” Weller said. But the spread of the coronavirus has shaken nearly every assumption we once counted on. “And so we’re losing our sense of safety in the world and our assumptions about ourselves,” he said.

Trust in our systems. When government leaders, government agencies, medical systems, religious bodies, the stock market and corporations fail to meet public expectations, citizens can feel betrayed and emotionally unmoored. “We are all grieving this loss,” Daniel said.

Sympathy for others’ losses. Even if you’re not directly affected by a particular loss, you may feel the grief of others, including that of displaced workers, of health care workers on the front lines, of people barred from visiting older relatives in nursing homes, of those who have already lost friends and family to the virus, and of those who will.

4 Ways To Honor Your Grief

Once you identify the losses you’re feeling, look for ways to honor the grief surrounding you, grief experts urge.

Bear witness and communicate. Sharing our stories is an essential step, Daniel said. “If you can’t talk about what’s happened to you and you can’t share it, you can’t really start working on it,” Daniel said. “So communicate with your friends and family about your experience.”

It can be as simple as picking up the phone and calling a friend or family member, said Weller. He suggests simply asking for and offering a space in which to share your feelings without either of you offering advice or trying to fix anything for the other.

“Grief is not a problem to be solved,” he said. “It’s a presence in the psyche awaiting, witnessing.”

For those with robust social networks, Daniel suggests gathering a group of friends virtually to share these losses together. Using apps like Zoom, Skype, FaceTime or Facebook Live, virtual meetups are easy to set up daily or weekly.

Write, create, express. Whether you’re an extrovert or introvert, keeping a written or recorded journal of these days offers another way to express, to identify and to acknowledge loss and grief.

And then there’s art therapy, which can be especially helpful for children unable to express themselves well with words, and also for teens and even many adults. “Make a sculpture, draw a picture or create a ceremonial object,” said Daniel, who often incorporates shamanic ceremonies into grief workshops she conducts.

Another exercise she often uses in grief workshops is a simple one in which participants use their breath to blow their sadness, fear and anger into a rock they then throw away.

“What this does is takes all that intense, painful energy out of your body and into an inanimate object that they symbolically throw far away from themselves,” Daniel said.

Meditate. Regular meditation or just taking time to slow down and take several deep, calming breaths throughout the day also works to lower stress — and is available to everyone, Lott said. For beginners who want guidance, she suggests downloading a meditation app onto your smartphone or computer.

Be open to joy. And finally, Lott urges, make sure to let joy and gratitude into your life during these challenging times. Whether it’s a virtual happy hour, teatime or dance party, reach out to others, she said.

“If we can find gratitude in the creative ways that we connect with each other and help somebody,” she said, “then we can hold our grief better and move through it with less difficulty and more grace.”

This story was produced in partnership with NPR and Kaiser Health News.

Stephanie O’Neill is the recipient of a journalism fellowship at the Natural Hazards Center at the University of Colorado-Boulder, supported by Direct Relief.

Categories: Health Care

Longer Looks: Public Housing, Small Pox Experts, Climate Change In The Time Of Coronavirus, And More

Kaiser Health News - Fri, 03/27/2020 - 9:06am
Each week, KHN finds interesting reads from around the Web.
Categories: Health Care


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