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The Boston Marathon Has Been Canceled. What's Next?

CommonHealth (WBUR) - 4 hours 35 min ago

What might the cancellation of the 2020 Boston Marathon tell us about the fate of other crowded events and gatherings this year?

Categories: Health Care

When Testing Positive For The Coronavirus Doesn’t Mean You’re Contagious

CommonHealth (WBUR) - 7 hours 31 min ago

A growing body of researcher suggests that coronavirus patients may only be contagious for five to 11 days after the first onset of symptoms.

Categories: Health Care

As COVID Cuts Deadly Path Through Indiana Prisons, Inmates Say Symptoms Ignored

Kaiser Health News - 8 hours 4 min ago

Scottie Edwards died of COVID-19 just weeks before he would have gotten out of the Westville Correctional Facility in Indiana.

Edwards, 73, began showing symptoms of the disease in early April, according to the accounts of three inmates who lived with him in a dormitory. He was short of breath, had chest pain and could barely talk. He was also dizzy, sweaty and throwing up.

Edwards was serving a 40-year sentence for attempting to kill someone in 2001. He would have been released to home detention on May 1 but died on April 13. The next day, the Indiana Department of Correction sent out a statement that indicated Edwards’ symptoms came on suddenly: “The offender, a male over the age of 70, who did not have indications of illness, reported experiencing chest pains and trouble breathing on Monday.”

Edwards’ fellow inmates dispute the statement and say he had been seeking medical attention at the prison for days before he died.

Since the start of the pandemic, prisoners and their families have contradicted state officials about the conditions inside Indiana prisons. Many inmates report they’ve had no way to protect themselves from close contact with other inmates and staff members. They believe contracting the disease is inevitable. Indeed, 85% of the prisoners tested at Westville have been positive for the virus. Many of them were housed in the same dorm as Edwards.

As of May 22, at least 18 Indiana prisoners had died from confirmed or presumed coronavirus infections, and 650 inmates had tested positive for the virus. And while the state has maintained it isolates men and women with symptoms, inmates say even severely ill prisoners have been left in their dorms until it is too late. Their accounts call into question efforts to contain the virus, along with the care inmates receive once they have it.

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“[Edwards] had been sick for approximately about a week and a half,” said one inmate named Josh. Josh allowed a family member to record a call about Edwards, and he asked to be identified only by his first name because he fears retaliation from prison staff.

His fellow prisoners say Edwards couldn’t even make it to see medical staff on his own — they pushed him in a wheelchair. Each time, he was sent back to his quarters.

“Those bastards said I’m fine, I just need to drink water and rest,” Josh recounted Edwards saying. “I’m clearly not fine — I can’t breathe.” Another prisoner wrote in an electronic message to a reporter that Edwards’ room “smelled like sickness and death.”

On the day he died, Josh said Edwards looked pale before he stumbled on his way to the bathroom. A pair of fellow inmates caught him and helped him sit down. “He sounded like he was winded, like he had just ran a marathon,” Josh wrote via the prison system’s electronic communications software. “He was just saying ‘I can’t breathe, I can’t breathe.'” He said an officer called the prison medical staff, who tended to Edwards in the bathroom for about 45 minutes.

“They finally took him out on oxygen,” Josh said. “Next thing we know, five hours later, he died.”

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The Westville inmates emphasize that Edwards didn’t wait until that Monday to report his symptoms — he had complained to staff for days. “There is a major problem here with this place and it’s outta control,” wrote Josh.

Dr. Kristen Dauss, chief medical officer for the Indiana Department of Correction, declined to explain the different accounts of his death. “We do not talk about specific cases and patient clinical status,” she said.

Across the nation, at least 415 prisoners had died of the infection as of the week of May 20, and more than 29,000 had tested positive, according to the Marshall Project.

The American Civil Liberties Union and other advocacy groups have called for the early release of some prisoners, especially the old and sick. Protesters have demonstrated outside Westville and other Indiana prisons to call attention to the conditions inside. Governors in the nearby states of Ohio and Kentucky have ordered some prisoners released, but Indiana Gov. Eric Holcomb has refused. He said it’s up to local judges to decide, on a case-by-case basis.

In the meantime, Dauss said Indiana prisons are taking steps to control the spread of the coronavirus. “We move quickly and, in fact, immediately to separate those who are sick from those who are not sick,” said Dauss.

But according to accounts from numerous inmates, that kind of quick isolation of sick prisoners hasn’t always happened, at least through much of April.

Three different prisoners described another COVID-19 death in a different Indiana prison, the Plainfield Correctional Facility, on April 19. Lonnell Chaney, they said, had been asking for medical help for days.

“He didn’t even know where he was,” one inmate wrote to a reporter. Medical staff had checked on Chaney, who mumbled in response, but left him in the quarters. A prisoner tried to convince officers that the man’s condition was serious — Chaney couldn’t catch his breath — but the officers brushed it off.

The prisoners say Chaney, who was 61, died in his bed in the crowded dorm. “You must be almost dead to get outside help,” wrote the Plainfield inmate.

Six Plainfield prisoners have died during the coronavirus pandemic. The Department of Correction has not released a statement about any of those men. Of 145 Plainfield prisoners tested for the virus, 119 were positive. Forty-five staffers tested positive, as well. Indiana has reported two deaths of prison staffers, as of May 22.

At the Westville prison, Josh said another man in his dorm complained about similar symptoms, and correctional officers wrote the man up for being disruptive.

“Everybody here is terrified,” Josh said.

As the virus spreads, prisoners’ families are told very little. They say prisons refuse to disclose basic information that would put them at ease, including whether an inmate is alive. In Scottie Edwards’ case and others, families didn’t know their loved ones were sick until after they had died — even though a department policy calls for notification when “death may be imminent.”

Crystal Gillispie talked to her father, Lonnell Chaney, for the last time on April 13. Their call lasted five minutes but felt shorter. He told her to send pictures of his grandchildren. And even though the coronavirus had started to spread in his dorm at the Plainfield Correctional Facility, he was more concerned about his family.

“He was like, ‘Just make sure you’re wearing your gloves and masks,'” Gillispie remembered. “I was like, ‘OK, Daddy. You do the same.’ He was so worried about us, and he ended up catching it.”

The next time she heard news of her father, it was from her aunt, his sister: The prison had called her to say Chaney was dead.

Edwards’ sister, Gloria Sam, said her brother was new to Westville prison, because he’d recently requested a transfer to a facility with a law library. He ended up at Westville just before the pandemic started.

“He said, ‘I am afraid of this virus because we’re here close together, and if it comes out, it’ll spread like wildfire,'” she said. Sam hadn’t heard from Edwards in more than a week when her phone rang on April 14. She remembers that even though her caller ID said it was from the State of Indiana, it didn’t occur to her that it was about her brother.

“They said, ‘Well, we have some bad news.’ I thought they were gonna say he was sick,” she said. They told her he had died.

If possible, Sam said, she would have wanted to say goodbye.

“It’s one of the most hurtful things I’ve experienced in my life,” she said.

This story is part of a partnership that includes Side Effects Public Media, WFYI, NPR and Kaiser Health News.

Categories: Health Care

A Senator From Arizona Emerges As A Pharma Favorite

Kaiser Health News - 8 hours 4 min ago

Sen. Kyrsten Sinema formed a congressional caucus to raise “awareness of the benefits of personalized medicine” in February. Soon after that, employees of pharmaceutical companies donated $35,000 to her campaign committee.

Amgen gave $5,000. So did Genentech and Merck. Sanofi, Pfizer and Eli Lilly all gave $2,500. Each of those companies has invested heavily in personalized medicine, which promises individually tailored drugs that can cost a patient hundreds of thousands of dollars.

Explore The Database Campaign Contributions Tracker

Pharma Cash To Congress

By Elizabeth Lucas and Sydney Lupkin May 22

A Kaiser Health News database tracks campaign donations from drugmakers over the past 10 years.

Sinema is a first-term Democrat from Arizona but has nonetheless emerged as a pharma favorite in Congress as the industry steers through a new political and economic landscape formed by the coronavirus.

She is a leading recipient of pharma campaign cash even though she’s not up for reelection until 2024 and lacks major committee or subcommittee leadership posts. For the 2019-20 election cycle through March, political action committees run by employees of drug companies and their trade groups gave her $98,500 in campaign funds, Kaiser Health News’ Pharma Cash to Congress database shows.

That stands out in a Congress in which a third of the members got no pharma cash for the period and half of those who did got $10,000 or less. The contributions give companies a chance to cultivate Sinema as she restocks from a brutal 2018 election victory that cost nearly $25 million. Altogether, pharma PACs have so far given $9.2 million to congressional campaign chests in this cycle, compared with $9.4 million at this point in the 2017-18 period, a sustained surge as the industry has responded to complaints about soaring prices.

Sinema’s pharma haul was twice that of Sen. Susan Collins of Maine, considered one of the most vulnerable Republicans in November, and approached that of fellow Democrat Steny Hoyer, the powerful House majority leader from Maryland.

It all adds up to a bet by drug companies that the 43-year-old Sinema, first elected to the Senate in 2018, will gain influence in coming years and serve as an industry ally in a party that also includes many lawmakers harshly critical of high drug prices and the companies that sell them.

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“This is a long-term play,” said Steven Billet, a former AT&T lobbyist who teaches PAC management at George Washington University. “She’s more of a moderate than people are giving her credit for. If I’m a pharmaceutical guy, I’m saying, ‘You know what? Maybe this is somebody we can work with down the road.’”

The industry’s pivot to Sinema comes as powerful favorites such as former Sen. Orrin Hatch of Utah and retiring Rep. Greg Walden of Oregon, both Republicans, fade from the scene.

Bisexual, an LGBTQ rights advocate and a former member of the Arizona Green Party, Sinema said in 2006 that she was the most liberal member of the Arizona State Legislature, according to HuffPost. These days, representing traditionally conservative Arizona statewide, she portrays herself as a moderate. She favors better medical coverage by improving the insurance company-friendly Affordable Care Act, for example, not by scrapping it in exchange for “Medicare for All.”

“Sinema is a talented politician who knows where she needs to be politically and will get there,” said Nathan Gonzales, editor of Inside Elections, a nonpartisan newsletter.

Sinema’s spokesperson did not respond to queries from KHN.

First elected to the U.S. House in 2012, she has a history of supporting pharmaceutical and biotech firms, dozens of which have operations in Arizona. Her acceptance of drug industry campaign contributions sets her apart from Democrats such as Sen. Cory Booker of New Jersey who have pledged to reject pharma money, not to mention those who spurn all corporate cash.

“The Republican Party tends to be more receptive to pharma cash,” said Paul Jorgensen, a political science professor at the University of Texas Rio Grande Valley, who analyzes campaign finance. “You’re going to see divisions within the party on pharma on the Democratic side.”

In 2017 Sinema introduced a House bill, strongly supported by the Biotechnology Innovation Organization trade group, that would have eased financial regulation on publicly traded biotech firms with little revenue. The measure has not become law, but two weeks later BIO named Sinema “Legislator of the Year,” calling her a “stalwart advocate” for life sciences jobs.

“We welcome the opportunity to work with any policymaker who understands the value of science, the risks, costs and challenges of developing new medicines, and the need to ensure patients have access to medicines with out-of-pocket costs they can afford,” BIO spokesperson Brian Newell said.

Sinema portrayed her backing of a 2016 measure to accelerate the introduction of scarce generic drugs as a blow against high drug costs. A version became law the next year. But support for the bill by the Pharmaceutical Research and Manufacturers of America, the main brand-drug lobby, prompted some to question its potential to bring down overall drug prices.

Sinema was a strong advocate of the biggest overhaul of over-the-counter drug regulation in almost half a century. The measure became law in March with little public notice as part of the CARES Act to rescue the economy and fight the coronavirus. It gives the Food and Drug Administration new leeway to move against possibly dangerous drugs, sets up industry fees to pay for accelerated reviews and creates incentives to bring new medicines to market.

The changes drew widespread, bipartisan support. The old OTC regulation “wasn’t good for anyone,” said Joshua Sharfstein, who was deputy FDA commissioner in the Obama administration. “It wasn’t good for consumers. It wasn’t good for industry.”

The new system resembles the user-fee financing of regulation for prescription drugs. But making the FDA dependent on drug company money for OTC oversight — subject to periodic negotiation with industry — makes the agency beholden to the companies it oversees, said David Hilzenrath, chief investigative reporter for the Project on Government Oversight, a watchdog nonprofit.

Accelerating review of OTC medicines “may be a double-edged sword,” he said. “It could speed decisions that benefit the public and it could speed decisions that put the public at risk.”

Personalized medicine — also known as precision medicine — promises to use genetic characteristics and other traits to identify which treatments are best for a particular patient.

Sinema co-chairs the Personalized Medicine Caucus along with Republican Sen. Tim Scott of South Carolina and two House members. The lawmakers introduced the group in coordination with a pharma industry group, the Personalized Medicine Coalition.

“Raising awareness of the benefits of personalized medicine helps detect and prevent diseases, while making health care more affordable and accessible for Arizona families” was Sinema’s quote in the press release.

But affordability has not been a hallmark of personalized medicine so far. Like other recent pharma products, genetically targeted medicines and tests can come with extremely high prices while sometimes delivering mediocre benefits, health policy analysts say.

One of the best-known precision medicines is Merck’s Keytruda, used against a variety of cancer tumors with certain genetic profiles. It costs more than $100,000 a year.

“It’s a good drug,” said Vinay Prasad, an associate professor at the University of California-San Francisco who studies health policy and cancer drugs. “But behind it is a marketing machine that is trying to maximize its use.”

In any case, personalized medicine generally “has been a mixed bag,” with prices for cancer drugs that are “universally horrendous,” he said. Industry enthusiasm may be “motivated by the fact that when something is called precision or personalized, the regulatory bar needed to approve it is lower,” he added. “And that is often good for profits.”

Categories: Health Care

Hate Unmasked In America

Kaiser Health News - 8 hours 4 min ago

“You are the most selfish f—ing people on the planet.”

I jerked my head to the left, where I saw a neighbor glaring at us from his driveway while unloading groceries from his trunk.

“Where’s your f—ing mask?” he said. “Unbelievable.”

My jaw dropped. I had just walked three blocks home with my toddler and my dad in our leafy, mostly empty Los Angeles neighborhood because my kid had thrown a tantrum in the car.

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And we had forgotten our masks. Four days earlier, Mayor Eric Garcetti had ordered protective face coverings anytime we left home, not just when we entered essential businesses.

I pointed out my house to the neighbor to explain how close we were, just a few doors down from him. He cut me off.

“I don’t give a f– where you live, and I don’t give a f– what your reason is.”

Then my dad jumped in. “Sorry, sir, we forgot our masks. I’m sorry, sir.”

Still, the man didn’t soften.

“You should be sorry. And you should make her be sorry, too,” he gestured toward me. After a few more agonizing seconds, he dismissed us.

Our neighbor’s mask, by the way? It was off his face, hanging loosely around his neck. All the better to shout at us.

As a health care reporter, I had covered America’s evolution on masks as the coronavirus spread across the globe. Back in January, I wrote an article about why Chinese immigrants insisted on wearing surgical and construction masks in the U.S., even though it went against official health recommendations at the time. In February, I wrote about Asian families in California clashing with schools over whether their children should be allowed to wear masks in class.

At that time, Asian people wearing masks were targets for verbal and physical abuse. Attackers saw masks on Asian faces as signs of disease and invasion; people were punched and kicked, harassed in the supermarket, bullied at school and worse.

Now, of course, masks are the norm. And they’ve become more than just personal protection; they are symbols of courtesy and scientific buy-in. They have, to some extent, also become political signifiers. In a new poll from the Kaiser Family Foundation, 70% of Democrats said they wear a protective mask “every time” they leave their house, versus 37% of Republicans. (Kaiser Health News is an editorially independent program of KFF.)

After our verbal beatdown, my dad and I walked home stone-faced, and then retreated to our separate rooms to nurse our wounds.

I have no idea if the neighbor’s comments had a racist undertone. But it felt like the times in my childhood, first in New Zealand, then in a Bay Area suburb, when I had seen my Philippines-born parents, stunned and silent, get dressed down or humiliated by angry, callous white people. Now it was my 3-year-old daughter’s turn to see me dumbstruck. As I began telling my husband the story, I started crying so hard that I got a headache.

Marigold, 3, wore this mask for five minutes outside and then threw it away. We haven’t been able to find it since. In the background is her grandfather, Jovit Almendrala, trying his own mask out for the first time. (Courtesy of Anna Almendrala)

After my tears came reflection, and an attempt at empathy.

My neighbor was obviously scared. He was older, and potentially more medically vulnerable. His trunk had been packed with overstuffed shopping bags ― probably enough food for weeks, to avoid leaving his house.

He had just come from the grocery store, an enclosed space full of things and people that could potentially infect him. I understand the stress that comes with shopping during the pandemic.

Like many of us, my neighbor could be struggling with how to live in mortal fear of the coronavirus. And for him, at least that morning, that struggle got the better of him.

Later that day, I wrote the neighbor a card introducing ourselves. I apologized for making him feel unsafe and acknowledged that he was right about the masks. But I also said he had unfairly used us as a target for his fear and frustration, and I told him I was shocked and saddened he would treat a neighbor with so much hate. I haven’t heard back from him.

My dad spent the rest of that morning praying that the man didn’t get the coronavirus — lest he blame us and all Asians, forever.

Since that day, no one in my family has left the house without a mask on their face, and I’m anxious to train my daughter to wear one, although she resists it the way she has refused hats and headbands in the past.

We can’t stop noticing that most other exercisers and dog-walkers in our neighborhood ― all white ― fly past us without them. They don’t seem to worry about getting caught on the wrong side of whatever America happens to believe about masks on any given day. But my family can’t risk it.

Categories: Health Care

How Should States, Localities Spend CARES Act’s Coronavirus Relief Fund?

Center on Budget and Policy Priorities - Thu, 05/28/2020 - 4:11pm

The CARES Act includes a $150 billion Coronavirus Relief Fund (CRF) to help states, populous cities and counties, tribal governments, and U.S. territories cover unanticipated costs from the COVID-19 pandemic and its economic effects.

Categories: Benefits, Poverty

KHN’s ‘What The Health?’: Still Seeking A Federal Coronavirus Strategy

Kaiser Health News - Thu, 05/28/2020 - 2:00pm
What The Health? · Still Seeking A Federal Coronavirus Strategy

Can’t see the audio player? Click here to listen on SoundCloud.

Julie Rovner

Kaiser Health News

@jrovner

Read Julie's Stories Anna Edney

Bloomberg

@annaedney

Read Anna's Stories Joanne Kenen

Politico

@JoanneKenen

Read Joanne's Stories Erin Mershon

STAT

@eemershon

Read Erin's Stories

The Trump administration sent its COVID-19 testing strategy plan to Congress, formalizing its policy that most testing responsibilities should remain with individual states. Democrats in Congress complained that the U.S. needs a national strategy, but so far none has emerged.

Meanwhile, President Donald Trump, noticing that his popularity among seniors has been falling since the pandemic began, unveiled a plan to lower the cost of insulin for Medicare beneficiaries. However, while diabetes is a major problem for seniors in general and for Medicare’s budget, only a small minority takes insulin.

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Anna Edney of Bloomberg News and Erin Mershon of STAT News.

Among the takeaways from this week’s podcast:

  • The difficulties caused by the lack of a unified federal response to the pandemic can be seen by looking at other countries. Communities around the world face some of the same problems U.S. cities and states do, such as high numbers of cases in nursing homes and other congregate living facilities, and test shortages. But in other countries, the governments have taken the lead in working through the issues.
  • Recent episodes of crowds gathering as states reopen point to a breakdown in public health messaging. That may be partly attributable to the president’s ambivalence or a result of the recent cutback in press briefings and other direct communication from federal public health officials. But much of it could also be directly related to political divisiveness, which runs rampant.
  • With a Rose Garden ceremony, Trump announced the deal with drugmakers to limit Medicare beneficiaries’ out-of-pocket costs for insulin to $35. That is expected to save those patients on average more than $400 a year. But the announcement is a long way from the promises made by the administration to bring down drug prices for all Americans.
  • Republicans have touted short-term insurance plans as a cheaper alternative to health coverage offered under the Affordable Care Act’s marketplaces. But the COVID-19 pandemic has highlighted shortcomings of those plans, including that many don’t cover prescription medications or experimental treatments.
  • The pandemic has also spotlighted the administration’s intent to get more drug manufacturing — which has become concentrated in India and China — to return to the United States. The government recently announced it is starting a project with a Virginia company to add manufacturing capacity stateside.

Also this week, Rovner interviews KHN’s Phil Galewitz, who reported the latest KHN-NPR “Bill of the Month” installment about a patient with a suspected case of COVID-19 who did what he was told by his health plan and got billed, anyway. If you have an outrageous medical bill you would like to share with us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: ProPublica’s “The Feds Gave a Former White House Official $3 Million to Supply Masks to Navajo Hospitals. Some May Not Work,” by Yeganeh Torbati and Derek Willis

Also, The New York Times’ “My Mother Died of the Coronavirus. It’s Time She Be Counted,” by Elisabeth Rosenthal

Joanne Kenen: The New Yorker’s “The Town That Tested Itself,” by Nathan Heller

Anna Edney: The New York Times’ “Wealthiest Hospitals Got Billions in Bailout for Struggling Health Providers,” by Jesse Drucker, Jessica Silver-Greenberg and Sarah Kliff

Erin Mershon: The Washington Post’s “Coronavirus May Never Go Away, Even With a Vaccine,” by William Wan and Carolyn Y. Johnson

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunesStitcherGoogle PlaySpotify, or Pocket Casts.

Categories: Health Care

State Releases New Data About Coronavirus Deaths And Testing At Mass. Nursing Homes

CommonHealth (WBUR) - Thu, 05/28/2020 - 12:09pm

The Mass. Department of Public Health is finally releasing COVID-19 fatalities for individual nursing homes.

Categories: Health Care

Health Insurers Don’t Need Federal “Risk Corridors”

Center on Budget and Policy Priorities - Thu, 05/28/2020 - 9:59am

The “risk corridor” provisions that were added at the last minute to the House-passed Heroes Act would provide an unnecessary benefit for health insurers and do not merit inclusion in the next COVID-19 relief bill. With no indication that health insurers’ net costs are rising due to the pandemic, even well-designed risk corridors should be a low priority for federal legislation compared to other, far more urgent needs.

Categories: Benefits, Poverty

'I Just Couldn't Let Her Die Alone': Nurse FaceTimes COVID-19 Patient Through Final Hours

CommonHealth (WBUR) - Thu, 05/28/2020 - 9:42am

The Cambridge Hospital patient had no family or close friends and was isolated in a special palliative care ward for COVID-19 patients, but a longtime nurse and a tablet allowed her some final human connection.

Categories: Health Care

Pirates, Privateers, and Civil War Maritime Laws

In Custodia Legis - Thu, 05/28/2020 - 9:20am

This is a guest blog by Anna Price, a legal reference librarian at the Law Library of Congress.

As a remote metadata intern with the Law Library last summer, I spent quite a few hours after work reading through the Piracy Trials collection. One item in particular caught my attention: a letter from Charles P. Daly, Chief Justice of the New York Court of Pleas, titled Are the Southern Privateersmen Pirates? Having never investigated this subject previously, this heartfelt and persuasive letter questioning the government’s designation of Confederate privateersmen during the Civil War as pirates sparked my curiosity and led to a lot of digging. Here’s what I learned:

Privateers” were privately-owned merchant ships that the government, in wartime, permitted to attack the enemy’s trade vessels. To incentivize this dangerous activity, the ship’s crew profited by selling the captured vessel’s bounty through a process dictated by federal statutes. To legitimize their actions, the privateers had to obtain “letters of marque” from the federal government. They also were obligated to participate in a court-administered process, which would determine whether the prizes from their exploits were lawful; if so, the cargo would be sold at auction, with the proceeds going to the privateersmen.

This system was pivotal during the War of 1812. In a letter discussing the British Navy at the start of the war, Thomas Jefferson accurately predicted, “Their fleet will annihilate our public force on the water, but our privateers will eat out the vitals of their commerce.” The practice of privateering was all but eliminated by the 1856 Treaty of Paris, which was signed by 55 nations. The United States, however, did not sign the treaty, meaning that by the time the Civil War broke out, privateering remained an established practice in the United States.

The Confederate States privateer Savannah, letter of marque no. 1, captured off Charleston by the U.S. Brig Perry, Lieut. Parrott. 1861. http://hdl.loc.gov/loc.pnp/cph.3g13450

During the Civil War, Jefferson Davis issued letters of marque to Confederate vessels, under a process similar to the one used by the Union. In response, President Lincoln issued “Proclamation 81 – Declaring a Blockade of Ports in Rebellious States.” This proclamation deemed Confederate-issued letters of marque “pretend” because the United States did not recognize the Confederacy as a legitimate nation, and warned that all persons manning such vessels and attacking Union ships would be tried and sentenced as pirates.

Designating these individuals as pirates, not privateersmen, was a distinction with a huge difference. Laws involving piracy had been in place since the First Congress in 1790 and provided:

That if any citizen shall commit any piracy or robbery aforesaid, or any act of hostility against the United States, or any citizen thereof, upon the high sea, under colour of any commission from any foreign prince, or state, or on pretence of authority from any person, such offender shall, notwithstanding the pretence of any such authority, be deemed, adjudged and taken to be a pirate, felon, and robber, and on being thereof convicted shall suffer death. (Emphasis added)

Put another way, Confederate privateersmen who were captured and criminally charged could be convicted of piracy and sentenced to death.

Some jurists opposed this conclusion, including Chief Justice Daly. Visitors to Law.gov can read his brief analysis, but some sections are worth highlighting. Likening the privateersmen to “rebels upon the ocean,” Chief Justice Daly feared that the Union would be setting a regrettable precedent in differentiating Confederate prisoners captured on the sea from those on the battlefield. “As all who have participated in the rebellion are alike guilty of the same political offence, and as there is in point of fact no difference between them, the question then arises – is every seaman or soldier taken in arms against the Government to be hung as a traitor or pirate? If the matter is to be left to the Courts, conviction and the sentence of death must follow in every instance.”

He also feared that escalating punishments like this would exacerbate wartime tactics and hinder attempts to maintain the Union at the war’s end.

In conclusion, we are not to forget that we are carrying on this war for the restoration of the Union, and that every act of aggression not essential to military success, will be separate more widely the two sections from each other, and increase the difficulty of cementing us again in one nationality….

War, when conducted in accordance with the strictest usages of humanity, is, as all who have shared in the recent battles know, a sufficiently bloody business; and if we are to add to its horrors by hanging up all who fall into our hands as traitors or pirates, we leave the South no alternative but resistance to the last extremity; and should we ultimately triumph, we would have entailed upon us, as the consequences of such a policy, the bitter inheritance of maintaining a Government by force, over a people conquered, but not subdued.

While some Confederate privateersmen were tried as pirates, and a few were found guilty, none were executed. Instead, they were treated as prisoners of war and eventually exchanged for Union troops being held by the South.

If you enjoyed learning some of the legal issues surrounding pirates and privateers, be sure to check out more on Piracy Trials and Are the Southern Privateersmen Pirates? Letter to the Hon. Ira Harris, United States Senator, by Charles P. Daly

As a bonus, here are two other good quotations from the letter:

  • “Pirates are the general enemies of all mankind — hostes humani generis; but privateersmen act under and are subject to the authority of the nation or power by whom they are commissioned. They enter into certain securities that they will respect the rights of neutrals; their vessel is liable to the seizure and condemnation if they act illegally, and they wage war only against the Power with which the authority that commissioned them is at war.” p. 3
  • “It is now, and it will continue to be, carried upon both sides, by a resort to all the means and appliances known to modern warfare; and unless we are to fall back into the barbarism of the middle ages, we must observe in its conduct those humane usages in the treatment and exchange of prisoners, which modern civilization has shown to be equally the dictates of humanity and of policy.” p. 9
Categories: Research & Litigation

Dental Offices Open Up For More Care, But The Threat Of COVID-19 Lingers

CommonHealth (WBUR) - Thu, 05/28/2020 - 5:38am

Dental practices are adapting to the coronavirus, increasing disinfection protocols, using more protective gear and taking more time with each patient -- because the pandemic poses special challenges for dentistry.

Categories: Health Care

Searching For Safety: Where Children Hide When Gunfire Is All Too Common

Kaiser Health News - Thu, 05/28/2020 - 5:00am

Justice Buress, 4, demonstrates how she hides under a table during a drill at Little Explorers Learning Center in St. Louis. Day care director Tess Trice carries out monthly drills to train the children to get on the floor when they hear gunfire.(Carolina Hidalgo/St. Louis Public Radio)

ST. LOUIS — Champale Greene-Anderson keeps the volume up on her television when she watches 5-year-old granddaughter Amor Robinson while the girl’s mom is at work.

This story is part of a partnership that includes St. Louis Public RadioNPR and Kaiser Health News.

This story can be republished for free (details). “So we won’t hear the gunshots,” Greene-Anderson said. “I have little bitty grandbabies, and I don’t want them to be afraid to be here.”

As a preschooler, Amor already knows and fears the sounds that occurred with regularity in their neighborhood before the pandemic — and continue even now as the rest of the world has slowed down.

“I don’t like the pop, pop noises,” Amor explained, swinging the beads in her hair. “I can’t hear my tablet when I watch something.”

And when the television or her hot-pink headphones and matching tablet can’t mask the noise of a shooting? “She usually stops everything,” said her mother, Satin White. “Sometimes she cries, sometimes she covers her ears.”

Her grandmother has even watched Amor hide inside a narrow gap between the couch and recliner.

Five-year-old Amor Robinson demonstrates where she sat in her grandmother’s home in St. Louis when she heard gunfire outside. The narrow gap between the couch and armchair recliner became her hideaway.(Carolina Hidalgo/St. Louis Public Radio)

In communities across the United States this spring, families are dealing with more than just the threat of the coronavirus outside their homes. In the midst of violence that does not stop even during a pandemic, children like Amor continually search for safety, peace and a quiet place. “Safer at Home” slogans don’t guarantee safety for them.

More than two dozen parents and caregivers who spoke with Kaiser Health News attested that the kids hide underneath beds, in basements and dry bathtubs, waiting for gunfire to stop while their parents pray that a bullet never finds them.

In St. Louis, which has the nation’s highest murder rate among cities with at least 100,000 people, the reasons are especially stark. More than 20 children in the St. Louis area were killed by gunfire last year, and this year at least 11 children have died already.

While some of the children’s deaths were caused by accidental shootings inside a home, regular gunfire outside is a hurtful reminder that adults have to find ways to keep children safe. And while parents hope their kids grow into healthy adults, evidence shows that children who grow up around violence or witness it frequently are more likely to have health problems later in life.

Can you imagine as a child, you are sleeping, you know, no care in the world as you sleep and being jarred out of your sleep to get under the bed and hide?

Lekesha Davis, a St. Louis mental health counselor

Although the mental health of children around the world has been taxed these past few months, for some children the stress has been going on far longer. Regularly hearing shootings is one example of what’s called an “adverse childhood experience.” Americans who have adverse childhood experiences that remain unaddressed are more likely to suffer heart disease, cancer, chronic respiratory diseases and stroke, according to a 2019 Centers for Disease Control and Prevention report.

St. Louis mental health counselor Lekesha Davis said children and their parents can become desensitized to the violence around them — where even one’s home doesn’t feel safe. And, research shows, black parents and children in the U.S., especially, often cannot get the mental health treatment they may need because of bias or lack of cultural understanding from providers.

“Can you imagine as a child, you are sleeping, you know, no care in the world as you sleep and being jarred out of your sleep to get under the bed and hide?” Davis asked.

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“We have to look at this, not just, you know, emotionally, but what does that do to our body?” she added. “Our brain is impacted by this fight-or-flight response. That’s supposed to happen in rare instances, but when you’re having them happen every single day, you’re having these chemicals released in the brain on a daily basis. How does that affect you as you get older?”

But future health problems are hard to think about when you’re trying to survive.

At This Day Care, ‘Dora’ Means Drop

The children at Little Explorers Learning Center are getting reacquainted with their daily routine now that the day care facility has reopened for families of essential workers as the COVID pandemic stay-at-home orders loosen. And there’s a lot to remember.

Teachers at the center remind the children of their hand-washing, mealtime and academic routines. They also make sure the kids remember what to do when gunfire erupts nearby.  Assistant director Tawanda Brand runs a gunfire safety drill once a month. First, she tells the children to get ready. Then, she shouts: “Dora the Explorer!”

“Dora” is a code word, Brand explained, signaling the kids to drop to the floor — the safest place — in case gunfire erupts nearby.

A child looks out the window to watch snow falling at the Little Explorers Learning Center on Jan. 29, in St. Louis. In November 2019, a stray bullet came through the window.(Carolina Hidalgo/St. Louis Public Radio)

Little Explorers Learning Center assistant director and teacher Tawanda Brand works with preschool students in St. Louis on Jan. 29. After closing temporarily because of the coronavirus, the center reopened in May for the children of essential workers. All staff members now wear masks.(Carolina Hidalgo/St. Louis Public Radio)

During a drill one morning before the pandemic, most of the children got down. Others walked around, sending Brand on a chase as she tried to corral the group of 3- to 5-year-olds.

The drill may sound playful, but sometimes the danger is real.

The Little Explorers protocol isn’t like the “active shooter” drills that took place in schools around the country on the rare chance someone would come inside to shoot — as at Columbine, Parkland or Sandy Hook. The day care program performs these drills because nearby shootings are an ongoing threat.

Day care director Tess Trice said a bullet pierced the window in November while the children were inside. Then, the very next day, bullets flew again.

“We heard gunshots, we got on the floor,” Trice said. “Eventually, when we got up and looked out the window, we saw a body out there.”

Tess Trice, who owns and runs Little Explorers Learning Center, conducts monthly drills to keep the kids safe amid gunfire, which has come frighteningly close. Trice was photographed on Jan. 29, before the center temporarily closed; it reopened in early May for the children of essential workers, and all staff members now wear masks.(Carolina Hidalgo/St. Louis Public Radio)

Trice called parents that day to see if they wanted to pick up their children early. Nicollette Mayo was one of the parents who received a call from the teachers. She knows the neighborhood faces challenges, but can’t see her 4-year-old daughter, Justice, and infant son, Marquis, going anywhere else.

“I trust them,” Mayo said. “And I know that, God forbid, if there is an incident that I’m going to be contacted immediately. They’re gonna do what they need to do to keep my children safe.”

Trice considered bulletproof glass for the day care center but could not afford it. A local company estimated it would cost $8,000 to $10,000 per window. So she relies on the “Dora” drills and newly installed cameras.

Still, in a city with such an alarming homicide rate, such drills aren’t happening only at the few day care facilities that have reopened. They also happen at home.

‘You Live Better If You Sit On The Floor’

Long before the coronavirus pandemic pushed the world to isolate at home, the Hicks family had their own version of sheltering in place. But it was from gun violence. When they hear gunshots outside their home in East St. Louis, Illinois, everyone hides in the dark.

The goal is to keep the family out of sight, because bearing witness to a shooting could put them at a different kind of risk, mom Kianna Hicks said.

Khanyla Blueford, 12, and her siblings demonstrate a drill they practice in which they drop to the floor quickly at their home in East St. Louis, Illinois. The drill helps them feel prepared for when they hear gunfire, which in past years happened at least twice a week in warm months.(Carolina Hidalgo/St. Louis Public Radio)

So when trouble erupts, they do their best to remain unseen and unheard.

“We turn the TV down,” said 13-year-old Anajah Hicks, the oldest of four. “We turn the lights off, and we hurry up and get down on the ground.”

A few times each month, the family practices what to do when they hear gunshots. Hicks tells the kids to get ready. Then, their grandmother Gloria Hicks claps her hands to simulate the sound of gunfire.

“I need them to know exactly what to do, because in too many instances, where we’ve been sitting around, and gunshots, you know, people start shooting, and they’ll just be up walking around or trying to run,” Kianna Hicks said. “I’ll tell ’em, ‘Naw, that’s not what you do. You hear gunshots, you hear gunshots. No matter where you at, you stop — you get on the ground and you wait until it’s over with and then you move around.’”

And this summer, Hicks wants to make sure the kids are ready. At least twice a week in past years when the weather warmed up, the family got on the floor in response to real gunfire. Violence spikes in summer months, according to the Giffords Law Center to Prevent Gun Violence. And she knows they could be spending more time in the house if football camp for her boys is canceled because of coronavirus fears.

Other families in tough neighborhoods sit on the floor more often, even amid moments of relative quiet. The first time Gloria Hicks saw a family sitting on the floor, she was visiting her godson in Chicago decades ago. It was hot that summer, Hicks recalled, so families kept their apartment doors open to stay cool.

“They were sitting on the floor watching TV and I wondered, Why is it like that?” Hicks recalled. “Then I learned that you live better if you sit on the floor than on the couch, because you don’t know when the bullets gon’ fly.”

‘I Immediately Dropped To The Floor’

Although 16-year-old Mariah knows what to do when bullets fly, she said, she still has a difficult time processing the sound of violence. The honor student was babysitting her little cousins at her St. Louis home last winter when she heard gunshots.

“It couldn’t have been no further than, like, my doorstep,” recalled Mariah, whose mother asked that the teen’s last name not be printed so the discussion of the trauma doesn’t follow her into adulthood. “I immediately dropped to the floor, and then in a split second the second thing that ran through my head is like, ‘Oh, my God, the kids.’”

Mariah and her mom, Eisha Taylor, pose for a portrait at their home in St. Louis on Feb. 1. Mariah was babysitting her little cousins there last winter when she heard nearby gunshots.(Carolina Hidalgo/St. Louis Public Radio)

When Mariah walked into the next room, she saw her two younger cousins on the floor doing exactly what their mother had taught them to do when gunfire erupts.

Get down and don’t move.

“I was so worried,” Mariah recalled. “They’re 6 and 3. Imagine that.”

The three kids walked away physically OK that day. But later that night, Mariah said, she pulled out strands of her hair, a behavior associated with stress.

“Pulling my hair got really bad,” she said. “I had to oil my hair again because when I oil it, it makes it hard to pull out.”

Davis, the mental health counselor who has worked for 20 years with children experiencing trauma, encourages parents to comfort their kids after a traumatic event and for the kids to fully explore and discuss their emotions, even months after the fact.

She said getting on the floor explains only how families are maintaining their physical safety.

“But no one’s addressing the emotional and the mental toll that this takes on individuals,” said Davis, vice president of the Hopewell Center, one of the few mental health agencies for kids in the city of St. Louis.

“We get children that were playing in their backyard and they witnessed someone being shot right in front of them,” Davis said. “These are the daily experiences of our children. And that’s not normal.”

Carolina Hidalgo contributed to this report as a journalist at St. Louis Public Radio.

Categories: Health Care

Some Ivory Towers Are Ideal For A Pandemic. Most Aren’t.

Kaiser Health News - Thu, 05/28/2020 - 5:00am

Saint Mary’s College in Moraga, California, is open for business this fall — but to get there, you really have to want it. Tucked amid verdant hills 23 miles east of San Francisco, accessible by a single road and a single entrance, the small, private Roman Catholic school receives almost no visitors by accident.

This, in the age of a pandemic, is good news indeed for its administrators.

“We can control who comes in or out in a way that larger, urban campuses perhaps can’t do,” said William Mullen, the school’s vice provost for enrollment. “Those campuses are in many cases more permeable.”

As colleges and universities across the country juggle student and staff safety, loss of opportunities and loss of revenue during the COVID-19 pandemic, even seemingly secondary considerations — how many entrances a school has, how close it sits to community foot traffic, how food is served — loom large.

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And while officials are loath to make broad guarantees about safety, they can’t ignore public health advice and thus are immersed in an effort to at least minimize the potential for harm. What that looks like will vary wildly from campus to campus, but in almost every case it will include attempts to limit close contact with others — a difficult job for educational institutions.

The stakes are enormous. Some universities are already projecting financial losses in the tens of millions due to declining enrollment and the uncertainty ahead. But at its core, this is a health problem that remains both simple and vexing: How do you open up a campus without inviting mass infection?

One preliminary answer: Don’t let too many people hang around at the same time.

“I would never use the term ‘make it safe,’” said Dr. Sarah Van Orman, who oversees student health services at the University of Southern California, a private school in the heart of Los Angeles. “I would say we’re going to reduce the risk to the degree possible to have everything in place.”

On many campuses, that means reducing class size (even if it requires adding new sections), making large survey courses online-only, cutting dorm residencies by as much as 50%, limiting or eliminating common-area food service, and perhaps even alternating students’ in-person attendance according to class level (freshman, sophomore, etc.) by quarters or semesters.

That’s in addition to the protocols recommended by the American College Health Association. The ACHA, to which more than 800 institutions belong, has called for a phased reopening of campuses “based on local public health conditions as well as [school] capacity.” Its guidelines include widespread testing, contact tracing, and isolation or quarantine of both ill and exposed individuals.

The Centers for Disease Control and Prevention laid out even more daunting instructions for what a campus should do in the event of a positive test, calling for potential short-term closures of buildings and classrooms that might extend into weeks in the middle of a semester. Among other things, the CDC said, the scenario could include having to move some on-campus residents into short-term alternative housing in the surrounding community.

Van Orman is a past president of the ACHA, but her school has yet to announce a definitive plan for the fall. That puts USC in good company. Although a rolling survey by the Chronicle of Higher Education suggests that nearly 70% of schools are planning for on-campus education, almost every institution directly contacted by Kaiser Health News was actually planning for all contingencies, with fully or partly opened campuses simply being the best-case and most publicly touted scenarios.

Making a campus virus-ready could take all summer, according to officials at several schools. Most of them don’t yet know how many students will return, and about half the schools contacted by KHN said they’ve pushed back the decision deadline for incoming freshmen to June 1, a month later than usual.

Those decisions have huge ramifications for university budgets. Ben Kennedy, whose Kennedy & Co. consults higher education institutions, said most are planning for an enrollment drop of 5% to 10%. “They’ll experience the big financial hit this fall,” Kennedy said.

At Georgetown University in Washington, D.C., a projected $50 million shortfall prompted voluntary furloughs, suspended retirement contributions and construction stops. The Massachusetts Institute of Technology reported $50 million in unexpected costs, while Janet Napolitano, president of the University of California’s 10-campus system, estimated combined losses of $1.2 billion from mid-March through April in announcing salary cuts and some freezes.

At the same time, large-scale restructuring will be required at bigger campuses in response to the pandemic. Converting some multiperson dorm rooms to singles will become the norm at many schools, although not every campus — or community — is prepared to handle a surge of students needing to find other housing as a result. Solutions are still being studied to address those who will be in close quarters in shared dining halls, bathrooms and common rooms. Some schools plan to set aside dorms for students who test positive and need to be isolated or quarantined.

“Students with existing health issues will have priority for single occupancy,” said Debbie Beck, executive director of health services for the University of South Carolina’s 33,000-student Columbia campus. “Testing in the residence halls will be critical.”

Several schools are considering ending their fall semesters before Thanksgiving, which Beck said “would further reduce risks and control the spread of COVID” as students are sent home until January. Stanford University, meanwhile, is pondering a range of possibilities that include permitting only a couple of class years on campus, perhaps alternating by quarters.

A common misperception, several officials said, is that college campuses have been “closed” since the outbreak of the coronavirus. Although student life has been restricted, other parts of many campuses have remained in operation, particularly at research institutions.

“We have research departments and laboratories that really don’t work if you’re not there,” said Dr. Jorge Nieva of USC’s Keck School of Medicine. “It’s difficult to do mouse experiments with cancer if you’re not doing mouse experiments with cancer.”

California’s two massive public university systems embody that dichotomy. California State University Chancellor Timothy White said the 23-campus CSU system, primarily instruction-focused, will mostly conduct remote learning. Napolitano expects the research-heavy University of California campuses to be open “in some kind of hybrid mode,” which many other schools likely will adopt.

“These kids are digital natives,” said Nieva, whose son was a freshman living on campus at USC before students were sent home. “A lot of what they’re experiencing, they’re perhaps better equipped to handle than another generation might be.”

Back in Moraga, Saint Mary’s will reduce dorm capacity, record lectures for online retrieval and institute strict guidelines to prevent the spread of illness — but it plans to continue a 150-plus-year tradition of close, personal education for its 2,500 undergraduates. In its case, being small is the biggest advantage.

“If we already only have 15 or 18 students in a classroom that can hold 30, then it becomes much easier to adapt to the new guidelines and protocols,” said Dr. Margaret Kasimatis, the school’s provost. “That’s a pretty good start.”

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Categories: Health Care

For Seniors, COVID-19 Sets Off A Pandemic Of Despair

Kaiser Health News - Thu, 05/28/2020 - 5:00am
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As states relax coronavirus restrictions, older adults are advised, in most cases, to keep sheltering in place. But for some, the burden of isolation and uncertainty is becoming hard to bear.

This “stay at home awhile longer” advice recognizes that older adults are more likely to become critically ill and die if infected with the virus. At highest risk are seniors with underlying medical conditions such as heart, lung or autoimmune diseases.

Yet after two months at home, many want to go out into the world again. It is discouraging for them to see people of other ages resume activities. They feel excluded. Still, they want to be safe.

“It’s been really lonely,” said Kathleen Koenen, 77, who moved to Atlanta in July after selling her house in South Carolina. She’s living in a 16th-floor apartment while waiting to move into a senior housing community, which has had cases of COVID-19.

“I had thought that would be a new community for me, but everyone there is isolated,” Koenen said. “Wherever we go, we’re isolated in this situation. And the longer it goes on, the harder it becomes.”

(Georgia residents age 65 and older are required to shelter in place through June 12, along with other vulnerable populations.)

Her daughter, Karestan Koenen, is a professor of psychiatric epidemiology at Harvard University’s T.H. Chan School of Public Health. During a Facebook Live event this month, she said her mother had felt in March and April that “everyone was in [this crisis] together.” But now, that sense of communality has disappeared.

Making it worse, some seniors fear that their lives may be seen as expendable in the rush to reopen the country.

“[Older adults] are wondering if their lives are going to end shortly for reasons out of their control,” said Dr. Linda Fried, dean of the Mailman School of Public Health at Columbia University, in a university publication. “They’re wondering if they’ll be able to get the care they need. And most profoundly, they’re wondering if they are going to be cast out of society. If their lives have value.”

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On the positive side, resilience is common in this age group. Virtually all older adults have known adversity and loss; many have a “this too shall pass” attitude. And research confirms that they tend to be adept at regulating their reactions to stressful life events — a useful skill in this pandemic.

“If anything, I’ve seen a very strong will to live and acceptance of whatever one’s fate might be,” said Dr. Marc Agronin, a geriatric psychiatrist and vice president of behavioral health at Miami Jewish Health, a 20-acre campus with independent living, assisted living, nursing home care and other services.

Several times a week, psychologists, nurses and social workers are calling residents on the campus, doing brief mental health checks and referring anyone who needs help for follow-up attention. There’s “a lot of loneliness,” Agronin said, but many seniors are “already habituated to being alone or are doing OK with contact [only] from staff.”

Still, “if this goes on much longer,” he said, “I think we’ll start to see less engagement, more withdrawal, more isolation — a greater toll of disconnection.”

Erin Cassidy-Eagle, a clinical associate professor of psychiatry at Stanford University, shares that concern.

From mid-March to mid-April, all her conversations with older patients revolved around several questions: “How do we keep from getting COVID-19? How am I going to get my needs met? What’s going to happen to me?”

But more recently, Cassidy-Eagle said, “older adults have realized the course of being isolated is going to be much longer for them than for everyone else. And sadness, loneliness and some hopelessness have set in.”

She tells of a woman in her 70s who moved into independent living in a continuing care community because she wanted to build a strong social network. Since March, activities and group dining have been canceled. The community’s director recently announced that restrictions would remain until 2021.

“This woman had a tendency to be depressed, but she was doing OK,” Cassidy-Eagle said. “Now she’s incredibly depressed and she feels trapped.”

Especially vulnerable during this pandemic are older adults who have suffered previous trauma. Dr. Gary Kennedy, director of the division of geriatric psychiatry at Montefiore Medical Center in New York City, has seen this happen to several patients, including a Holocaust survivor in her 90s.

This woman lives with her son, who got COVID-19. Then she did as well. “It’s like going back to the terror of the [concentration] camp,” Kennedy said, “an agonizing emotional flashback.”

Jennifer Olszewski, an expert in gerontology at Drexel University, works in three nursing homes in the Philadelphia area. As is true across most of the country, no visitors are allowed and residents are mostly confined to their rooms.

“I’m seeing a lot of patients with pronounced situational depression,” she said — “decreased appetite, decreased energy, a lack of motivation and overall feelings of sadness.”

“If this goes on for months longer, I think we’ll see more people with functional decline, mental health decline and failure to thrive,” Olszewski said.

Some are simply giving up. Anne Sansevero, a geriatric care manager in New York City, has a 93-year-old client who plunged into despair after her assisted living facility went on lockdown in mid-March. Antidepressant and anti-anxiety medications have not helped.

“She’s telling her family and her health aides ‘life’s not worth living. Please help me end it,’” Sansevero said. “And she’s stopped eating and getting out of bed.”

The woman’s attentive adult children are doing all they can to comfort their mother at a distance and are feeling acute anguish.

What can be done to ease this sort of psychic pain? Kennedy of Montefiore has several suggestions.

“Don’t try to counter the person’s perception and offer false reassurance. Instead, say, yes, this is bad, no doubt about it. It’s understandable to be angry, to be sad. Then provide a sense of companionship. Tell the person, ‘I can’t change this situation but I can be with you. I’ll call tomorrow or in a few days and check in with you again.’”

“Try to explore what made life worth living before the person started feeling this way,” she said. “Remind them of ways they’ve coped with adversity in the past.”

If someone is religiously-inclined, encourage them to reach out to a pastor or a rabbi. “Tell them, I’d like to pray together or read this Bible passage and discuss it,” Kennedy said. “Comforting person-to-person interaction is a very effective form of support.”

Do not count on older adults to own up to feeling depressed. “Some people will acknowledge that, yes, they’ve been feeling sad, but others may describe physical symptoms — fatigue, difficulty sleeping, difficulty concentrating,” said Julie Lutz, a geropsychologist and postdoctoral fellow at the University of Rochester.

If someone has expressed frequent concerns about being a burden to other people or has become notably withdrawn, that’s a worrisome sign, Lutz said.

In nursing homes, ask for a referral to a psychologist or social worker, especially for a loved one who’s recovering from a COVID hospitalization.

“Almost everybody that I’m seeing has some kind of adjustment disorder because their whole worlds have been turned upside down,” said Eleanor Feldman Barbera, an elder care psychologist in New York City. “Talking to a psychologist when they first come in can help put people on a good trajectory.”

The National Alliance on Mental Illness has compiled a COVID-19 information and resource guide, available at https://www.nami.org/covid-19-guide. The American Psychological Association has created a webpage devoted to this topic and recently wrote about finding local mental health resources. The Substance Abuse and Mental Health Services Administration has a 24-hour hotline, 1-800-662-4357. And the national suicide prevention hotline for those in acute distress is 1-800-273-8255.

Categories: Health Care

Antibody Tests Were Hailed As Way To End Lockdowns. Instead, They Cause Confusion.

Kaiser Health News - Thu, 05/28/2020 - 5:00am

Aspen was an early COVID-19 hot spot in Colorado, with a cluster of cases in March linked to tourists visiting for its world-famous skiing. Tests were in short supply, making it difficult to know how the virus was spreading.

So in April, when the Pitkin County Public Health Department announced it had obtained 1,000 COVID-19 antibody tests that it would offer residents at no charge, it seemed like an exciting opportunity to evaluate the efforts underway to stop the spread of the virus.

“This test will allow us to get the epidemiological data that we’ve been looking for,” Aspen Ambulance District director Gabe Muething said during an April 9 community meeting held online.

However, the plan soon fell apart amid questions about the reliability of the test from Aytu BioScience. Other ski towns such as Telluride, Colorado, and Jackson, Wyoming, as well as the less wealthy border community of Laredo, Texas, were also drawn to antibody testing to inform decisions about how to exit lockdown. But they, too, determined the tests weren’t living up to their promise.

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The allure of antibody tests is understandable. Although they can’t find active cases of COVID-19, they can identify people who previously have been infected with the coronavirus that causes the disease, which could give health officials important epidemiological information about how widely it has spread in a community and the extent of asymptomatic cases. In theory, at least, antibodies would be present in such people whether they had a severe case, little more than a dry cough or no complaints at all.

Even more enticing: These tests were billed as a path to restart local economies by identifying people who might be immune to the virus and could therefore safely return to the public sphere.

But, in these and other communities, testing programs initially slated to test hundreds or thousands have been scaled back or put on hold.

“I don’t think these tests are ready for clinical use yet,” said University of California-San Francisco immunologist Dr. Alexander Marson, who has studied their reliability. He and his team vetted 12 different antibody tests and found all but one turned up false positives — implying that someone had antibodies when they didn’t ― with false-positive rates reaching as high as 16%. (The study is preliminary and has not been peer-reviewed yet.)

More than 100 antibody tests are currently available in the U.S., including offerings by commercial labs, academic centers and small entrepreneurial ventures. As serious questions emerged earlier this month about the accuracy of the tests and the usefulness of the results, the U.S. Food and Drug Administration said it will require companies to submit validation data on their products and apply for emergency-use authorizations for their products. (Previously, companies were allowed to sell their tests without review from the FDA, as long as they did their own validation and included a disclaimer.) And the American Medical Association said on May 14 that the tests should not be used to assess an individual’s immunity or when to end physical distancing.

And this week, the Centers for Disease Control and Prevention released new guidelines warning that antibody test results can have high false positive rates and should not be used to make decisions about returning people to work, schools, dorms or other places where people congregate.

Once hailed as a solution, the current crop of tests, which have not been thoroughly vetted by any regulatory agency, now seem more likely to add chaos and uncertainty to a situation already fraught with anxiety. “To give people a false sense of security has a lot of danger right now,” said Dr. Travis Riddell, the health officer for Teton County, which includes Jackson, Wyoming.

Accuracy Questions Raised

The gold standard for confirming an active COVID-19 infection is to take a swab from the nasopharynx and test it for the presence of viral RNA. The antibody tests instead parse the blood for antibodies against the COVID-19 virus. It takes time for an infected person to produce antibodies, so these tests can’t diagnose an ongoing infection, only indicate that a person has encountered the virus.

In Aspen, county officials knew the FDA had not approved the Aytu BioScience test, which the Colorado-based company was importing from China. So they first conducted their own validation tests, said Bill Linn, spokesperson for the Pitkin County Incident Management Team. “We weren’t reassured enough by our own testing to feel like we should move ahead.”

In Laredo, officials had been told by one of the community members helping to arrange the purchase of 20,000 tests from the Chinese company Anhui DeepBlue Medical Technology that they were FDA-approved, but the city’s own validation trials revealed only about a 20% accuracy rate, said Laredo spokesperson Rafael Benavides. Before Laredo could pay for the tests, Benavides said, an arm of U.S. Immigration and Customs Enforcement seized them and launched an investigation.

Neither Anhui DeepBlue Medical Technology, nor Aytu returned requests for comment.

In March, Covaxx, a company led by two part-time Telluride residents, offered to test residents of the town and the surrounding county with an antibody test it had developed. But the project was suspended indefinitely when the company’s testing facility fell behind on processing them.

The county is committed to doing a second round of testing but is evaluating how to proceed, said San Miguel County spokesperson Susan Lilly. “The question is how do you target it to be the most relevant clinically and for the public health team’s decision-making moving forward?”

Officials Back Off, Community Members Step In

On May 4, the FDA updated its antibody test policy to require that manufacturers submit validation data, but it is still allowing the tests to be sold without the normal lengthy vetting and approval process, which includes demonstrating safety and effectiveness.

In some wealthy areas, government officials had been offering free tests from startups with local investors. In Jackson, for example, a venture capitalist with an investment in Covaxx, the test used in Telluride, offered to help the city obtain 1,000 tests. But after reviewing the offer, Teton County declined over concerns about the test’s accuracy. “If a person tests positive, what does that mean? And is that useful information? We just don’t know yet,” Riddell said.

Covaxx spokesperson John Schaefer said in a statement that the test had been validated on more than 900 blood samples and is being reviewed by the FDA.

After Teton County officials decided against community antibody testing, a private nonprofit, Test Teton Now, sprung up to provide free COVID-19 antibody testing using the Covaxx test for roughly 8,000 people, about a third of the county’s residents. As of May 22, they’d raised $396,000 and tested 843 samples. The group has “done a lot” to verify the Covaxx tests, said Test Teton Now president Shaun Andrikopoulos. “I don’t want to call it validation, because we didn’t go through an independent review board, but we have sent our samples out to other labs.”

Organizers of Test Teton Now don’t share others’ concerns about the test’s utility. “We don’t encourage people to make any decisions about what they’re going to do or how they’re going to behave based on the results,” said the nonprofit’s spokesperson, Jennifer Ford.

What good is a test that can’t be used for practical purposes? “We think knowledge is power, and data is the beginning of knowledge,” Ford said. But unreliable data doesn’t give knowledge, it gives an illusion of knowledge.

So many unknowns remain, and false data may be worse than none. Even a very accurate test will produce a large number of false positives when used in a population where few people have been infected. If only 4% of people have actually been infected, a test with 95% accuracy would produce nine positive results for every 100 tests, five of which are false positives.

And that creates a danger that the tests could lead people to incorrectly think that they have antibodies that make them immune, which could have disastrous consequences if they changed their behavior as a result. Consider, for example, a person falsely told she had antibodies going to work at a nursing home, believing she couldn’t catch or spread the virus to anyone.

It’s not even known for sure that having antibodies makes someone immune. Researchers are hopeful that exposure can confer some level of immunity, but how strong that immunity might be and how long it might last remain unknown, said Harvard epidemiologist Marc Lipsitch.

So, having been burned once, Aspen has put antibody testing on hold and is instead focusing on identifying and isolating people who are sick or at risk of becoming so. “It’s actually a step back to where we started,” Linn said.

Given the remaining unknowns about immunity and COVID-19, the best methods for addressing the pandemic in communities may be the most time-tested ones, Linn said. “Put the sick people in places where they can’t get anyone else sick. It’s the bread and butter of epidemiology.”

Categories: Health Care

Homeless Shelter Pine Street Inn Sees Significant Drop In Number Of Positive Coronavirus Tests

CommonHealth (WBUR) - Wed, 05/27/2020 - 6:09pm

A recent round of testing at Pine Street's shelters found just 4% of guests were positive for the coronavirus, compared to a 36% positive rate the month before.

Categories: Health Care

Medicaid Coverage Protections in Families First Act: What They Require and How to Implement Them

Center on Budget and Policy Priorities - Wed, 05/27/2020 - 1:32pm

This paper explains the MOE’s requirements and recommends how states can best implement continuous coverage.

Categories: Benefits, Poverty

The Great Recession Badly Hurt Kids’ Schooling; Today’s Recession Could Do Much Worse

Center on Budget and Policy Priorities - Wed, 05/27/2020 - 9:59am

Whenever our kids return to school, a severely diminished learning experience awaits them unless the federal government learns an important lesson from the past and significantly boosts state aid — and soon.

Categories: Benefits, Poverty

Domestic Violence: Resources in the United States

In Custodia Legis - Wed, 05/27/2020 - 8:29am

This is a guest post by Ann Hemmens, a senior legal reference librarian with the Law Library of Congress.

We recently received a question concerning resources available for victims of domestic violence. During this coronavirus pandemic we are seeing news articles about the increased reporting of domestic violence, also called intimate partner violence. According to the Centers for Disease Control, “[i]ntimate partner violence (IPV) is abuse or aggression that occurs in a close relationship. ‘Intimate partner’ refers to both current and former spouses and dating partners.”

This blog post focuses specifically on resources available, at the national and local level, within the U.S., for individuals seeking assistance regarding domestic violence or intimate partner violence. The National Domestic Violence Hotline provides referrals to agencies in all 50 U.S. states, the District of ColumbiaPuerto Rico, Guam, and the U.S. Virgin Islands. The hotline is staffed 24 hours a day, seven days a week. They can be reached via phone [1-800-799-SAFE (7233) or 1-800-787-3224 (TTY) or (206) 518-9361 (video phone only for deaf callers)] or by texting LOVEIS to 22522 or online through the website. On the website homepage you will find a section titled “Staying Safe During COVID-19.”

Several federal government websites provide comprehensive collections of resources available at the state and national level:

Resources by State on Violence Against Women, from the Office of Women’s Health within the U.S. Department of Health & Human Services
Family Violence Prevention and Services Resource Centers, from the Family and Youth Services Bureau, within the U.S. Department of Health & Human Services
Watch for Warning Signs of Relationship Violence, from My Healthfinder, within the U.S. Department of Health and Human Services
Domestic Violence, from the Office on Violence Against Women, within the U.S. Department of Justice
Intimate Partner Violence, from the Injury Center, within the Centers for Disease Control and Prevention

Many state and local governments (cities, municipalities, and counties) also provide resources. For example, the state of Massachusetts has information on sexual and domestic violence prevention and services. The Baltimore Mayor’s Office of Criminal Justice posts information on domestic violence resources available. The Phoenix Police Department has posted information online on how to get help. The Oregon Judicial Branch has information on domestic violence resources, including crisis help, financial assistance, legal assistance, protective (restraining) orders and more.

To locate federal legislation proposing to address domestic violence during this public health emergency of the COVID-19 pandemic, you can conduct a keyword search, limited to the current 116th Congress, in Congress.gov. You might use search terms such as “domestic violence,” “intimate partner violence,” or “violence against women act.” For guidance on constructing a search, see the Help page.

Libraries in your area, including public, academic, and law libraries, may have posted guides online for local resources and assistance. Here are a few examples:
• Wisconsin State Law Library has posted information on domestic abuse, including services, reporting, laws, and more
• San Diego Law Library has posted a Civil Harassment and Domestic Violence Actions guide
• San Antonio Public Library has posted a COVID-19 guide with a section on domestic violence resources
• Cornell Library has posted a Domestic Violence Awareness Month guide, focused on print and electronic resources

If you have research questions, please submit a request online through our Ask-A-Librarian service.

Categories: Research & Litigation

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