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As virus surges anew, Milan hospitals under pressure again

MILAN (AP) — Coronavirus infections are surging anew in the northern Italian region where the pandemic first took hold in Europe, putting pressure again on hospitals and health care workers.

At Milan’s San Paolo hospital, a ward dedicated to coronavirus patients and outfitted with breathing machines reopened this weekend, a sign that the city and the surrounding area is entering a new emergency phase of the pandemic.

For the medical personnel who fought the virus in Italy’s hardest-hit region of Lombardy in the spring, the long-predicted resurgence came too soon.


“On a psychological level, I have to say I still have not recovered,’’ said nurse Cristina Settembrese, referring to last March and April when Lombardy accounted for nearly half of the dead and one-third of the nation’s coronavirus cases.

“In the last five days, I am seeing many people who are hospitalized who need breathing support,” Settembrese said. “I am reliving the nightmare, with the difference that the virus is less lethal.”

Months after Italy eased one of the globe’s toughest lockdowns, the country is now recording well over 5,000 new infections a day — eerily close to the highs of the spring — as the weather cools and a remarkably relaxed summer of travel and socializing fades into memory. Lombardy is again leading the nation in case numbers, an echo of the trauma of March and April when ambulance sirens pierced the silence of stilled cities.

So far, Italy’s death toll remains significantly below the spring heights, hovering recently around 50 per day nationwide, a handful in Lombardy. That compares with over 900 dead nationwide one day in March.

In response to the new surge, Premier Giuseppe Conte’s government twice tightened nationwide restrictions inside a week. Starting Thursday, Italians cannot play casual pickup sports, bars and restaurants face a midnight curfew, and private celebrations in public venues are banned. Masks are mandatory outdoors as of last week.

But there is also growing concern among doctors that Italy squandered the gains it made during its 10-week lockdown and didn’t move quick enough to reimpose restrictions. Concerns persist that the rising stress on hospitals will force scheduled surgeries and screenings to be postponed — creating a parallel health emergency, as happened in the spring.

Italy is not the only European country seeing a resurgence — and, in fact, is faring better than its neighbors this time around. Italy’s cases per 100,000 residents have doubled in the last two weeks to nearly 87 — a rate well below countries like Belgium, the Netherlands, France, Spain and Britain that are seeing between around 300 to around 500 per 100,000. Those countries have also started to impose new restrictions.

This time, Milan is bearing the brunt. With Lombardy recording more than 1,000 cases a day, the regional capital and its surroundings account for as many as half of that total. Bergamo — which was hardest hit last time and has been seared into collective memory by images of army trucks transporting the dead to

Fauci says large Trump rallies are ‘asking for trouble’ as virus surges.

Even as President Trump returned to the campaign trail in Florida and announced plans to begin a full schedule of rallies, the nation’s top infectious disease expert, Dr. Anthony S. Fauci, warned, “We know that that is asking for trouble when you do that” at a time when coronavirus cases are surging in many states.

Dr. Fauci told CNN on Monday, “We’ve seen that when you have situations of congregate settings where there are a lot of people without masks, the data speak for themselves. It happens. And now is even more so a worse time to do that, because when you look at what’s going on in the United States, it’s really very troublesome.”

He noted that many states were now seeing increases in positive tests — “It’s going in the wrong direction right now,” he said — and suggested that Americans should be “doubling down” on precautions rather than casting them aside.

He said that people should continue to wear masks and practice social distancing — and avoid large gatherings — to prevent new outbreaks.

“That’s just a recipe of a real problem if we don’t get things under control before we get into that seasonal challenge,” he said.

Dr. Fauci’s comments came the day after he objected to a Trump campaign television ad that portrayed him as praising the president’s response to the pandemic.

Dr. Fauci reiterated on Monday that the ad had taken his past remarks out of context, and called his inclusion in it “very disappointing.” He said he had been speaking more broadly about the collaborative efforts of the federal government and was “not a political person.” Asked by CNN’s Jake Tapper whether the ad should be taken down, something the Trump campaign says it has no intention of doing, Dr. Fauci said, “I think so.”

In an interview with The Times on Monday, Dr. Fauci said that he had been unsuccessful so far in having the ad removed.

“I wouldn’t know who to contact in the campaign to tell them to pull it down,” he said. “I spoke to someone who I know well in the White House to figure it out for me and tell me how to get it down. I haven’t heard back from them yet.”

Dr. Fauci said that he did not want to be pulled into the fray of the campaign.

“I never in my five decades ever directly or indirectly supported a political candidate and I’m not going to start now,” he said. “I do not want to be involved in it.”

Dr. Fauci made an even more pointed criticism of the Trump campaign in an interview on Monday with The Daily Beast.

“By doing this against my will they are, in effect, harassing me,” he said. But he said he had not thought about quitting — “not in my wildest freakin’ dreams.”

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Calif.’s positivity holds at all-time low as virus surges in some counties

California’s COVID-19 numbers are looking good, but experts warn that we shouldn’t let our guard down as some pockets of the state struggle with outbreaks.

California has reached an all-time high for COVID-19 testing, and the percentage of those tests coming back positive has reached its lowest point since the start of the pandemic.

Across the past two weeks, the state has tested an all-time high average of 122,000 tests a day, and the percentage of those tests coming back positive has held at 2.6% since Tuesday, the lowest point since the start of the pandemic and less than half the positivity rate of when the virus surged across the state in July.

What’s more, the death rate has steadily decreased in California since this summer, reaching a 14-day average of 142 in August and a low of 70 over the weekend.

UCSF’s Dr. George Rutherford said on KCBS this morning the numbers are good news, but warned, “This is not a time to take a victory lap.”


“There are hot spots around the state, including Sonoma County close to the Bay Area, and possibly some more activity in Marin and Solano,” Rutherford added of the local counties that are struggling to control the virus.

Sonoma is the only county in the Bay Area still in the most restrictive purple tier in the state’s reopening structure, meaning the virus is widespread and certain businesses are restricted from reopening.  As of Monday, the county’s adjusted case rate is 10.8 cases per 100,000 residents, and the positivity rate is 5%.

Rutherford also noted Shasta County has experienced the state’s worst outbreak in recent weeks with a positivity rate of 6.9% and 13 cases per 100,000 residents.

These numbers may be surprising in this pocket of Northern California known for vast open spaces and endless forests, but COVID-19 outbreaks across the country have shown that the virus can spiral out of control anywhere. The spike in Shasta County is being driven by spates of cases at an evangelical school and a nursing facility in Redding, the county’s largest city (pop. 91,000).

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New York City Should Have Done More Outreach in Covid-19 Hot Spots Before Surges, Community Leaders Say

This summer New York City’s public-hospital system identified the areas most at risk of a resurgence of Covid-19 and enlisted community-based organizations to help educate residents and test and trace for the virus.

Now, with the new coronavirus resurgent across pockets of the city, some say this summer’s effort was insufficient and focused on the wrong neighborhoods.

Earlier this week, New York Gov. Andrew Cuomo ordered new restrictions on communities around the state where the virus has rebounded. The affected areas have higher positivity rates of Covid-19 than the rest of the state and include communities in nine ZIP Codes in Brooklyn and Queens that the city has been tracking for weeks as hot spots. Large Orthodox Jewish communities reside in most of the hot spots.

Of the nine ZIP Codes targeted by the city, only one was listed as a high priority this summer by the Health + Hospitals system in a request for grant applications from community-based organizations to help test and trace the virus. Five of the nine ZIP Codes were listed as a low priority and three weren’t listed at all.

Health officials said the neighborhoods under scrutiny now weren’t as high a priority in the summer when other areas were experiencing worsening numbers or were improving at a slower rate than the citywide average.

None of the community-based organizations awarded grants under the program were from the Orthodox community. But officials said that many organizations had now been enlisted to help with the response to the surge in Orthodox neighborhoods.

Officials said that one aim of the city’s outreach to community-based organizations was to address structural conditions of racism that exacerbated the effects of the pandemic. City data show that the pandemic disproportionately affected low-income neighborhoods and people of color compared with whites and higher-income neighborhoods.

Christopher Miller, a spokesman for the city’s hospital system, Health + Hospitals, said: “We continue to identify new organizations to partner with as positivity increases in certain neighborhoods.”

A worker from the Mayor’s Office of Immigrant Affairs handing out masks and printed information about Covid-19 testing in July in New York.



Photo:

Mark Lennihan/Associated Press

The city’s health department, which also does education on the virus, said since February it has done extensive outreach in the communities that are now under lockdowns. The outreach includes advertisements in local newspapers in multiple languages, community round tables and talks with leaders, including rabbis. In late August, officials also began distributing masks at synagogues and conducting testing, according to the health department.

City officials said they have also recently increased testing in these communities.

Carlina Rivera, the Democratic chairwoman of New York City Council’s committee on hospitals, said the hospital system hasn’t been forthcoming about the methods it used to prioritize certain areas or about how many contact tracers speak languages such as Yiddish.

“We think Health and Hospitals is doing their best, but that just might not be enough for an organization that is used to emergency treatment inside a hospital,”

The Virus Surges in North Dakota, Filling Hospitals and Testing Attitudes

Around Bismarck, there is a range of responses to the virus; but people are generally left to make their own choices about the potential risks. Some cafes are bursting with maskless patrons and workers. Other businesses have limited their capacities. Around half of the customers in Al’s Barber Shop, near one of the city’s hospitals, wear a mask, Travis Zenker, the owner, said.

All of it should be a personal choice, said Wanda Serr, owner of Little Cottage Cafe, a popular diner where workers do not wear masks.

“If you feel safe, go out and do what you do; if you don’t feel safe, it’s your right to stay home,” she said.

As cases have risen, some officials have tried to press for county-level mask requirements.

“I feel like I’m powerless,” said Renae Moch, public health director for Bismarck-Burleigh Public Health, who said she received insulting and threatening emails and Facebook messages for suggesting that the county set a mandate.

Miles from Bismarck, smaller communities have long turned to city hospitals to handle cases they do not have capacity to manage, but that is shifting.

“In the past two weeks, my ability to send people to Fargo or to Bismarck has been nonexistent,” Dr. Sarah Newton of Linton Hospital, a facility in Emmons County, told her City Council last week.

Emmons County is dealing with the state’s worst level of infections per capita, and Linton Hospital has been completely full. Dr. Newton described spending hours calling around the state for a patient who needed emergency heart surgery. A bed finally opened in Fargo.

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Coronavirus Infection Rate Among Children Surges as Schools Reopen | Health News

The number of children infected with the coronavirus rose dramatically between April and September, according to new research by the American Academy of Pediatrics and the Children’s Hospital Association, and by more than 14% in the last two weeks alone – a surge that coincides with schools reopening across the country.

“These rising numbers concern us greatly, as the children’s cases reflect the increasing virus spread in our communities,” Sally Goza, president of the American Academy of Pediatrics, said in a statement. “While children generally don’t get as sick with the coronavirus as adults, they are not immune and there is much to learn about how easily they can transmit it to others.”

Photos: Daily Life, Disrupted

TOPSHOT - A passenger in an outfit (R) poses for a picture as a security guard wearing a facemask as a preventive measure against the Covid-19 coronavirus stands nearby on a last century-style boat, featuring a theatrical drama set between the 1920s and 1930s in Wuhan, in Chinas central Hubei province on September 27, 2020. (Photo by Hector RETAMAL / AFP) (Photo by HECTOR RETAMAL/AFP via Getty Images)

Drawing on data from state health departments, researchers analyzed trends over five months in reported COVID-19 cases and found that the number of children infected rose from 2.2% of all cumulative reported cases nationwide in April to 10% of all cases in September.

Notably, in the last eight weeks, children represented between 12% and 16% of newly reported cases each week, according to the study. In the two-week span of Sept. 10 to Sept. 24, more than 75,000 new child cases were reported – a 14% increase in child cases over two weeks.

As of Sept. 24, officials reported 624,890 cases of COVID-19 in children, which represents 10.5% of all cases.

The new figures come on the heels of reporting by the New York Times that found top White House officials pressured the Centers for Disease Control and Prevention to play down the risk of sending children back to school and pushed public health experts there to use alternate data showing that the pandemic posed little danger to children.

Hospitalizations and serious infections among children are still rare, despite the surge in cases: As of Sept. 10, children represented 1.7% of total hospitalizations and 0.07% of total deaths. Just 0.01% of child cases resulted in death.

The study found substantial variation in case growth by region: In April, a preponderance of cases were in the Northeast. In June, cases surged in the South and West, followed by mid-July increases in the Midwest.

Researchers underscored that the data is limited because states differ in how they report it, and it is unknown how many children have been infected but not tested. In addition, they said, it’s unclear how much of the increase in cases among children is due to increased testing capacity – though CDC data from public and commercial labs shows the share of all tests administered to children, about 5% to 7%, has remained stable since late April.

“We will continue to closely monitor children’s cases, with hopes of seeing the upward trend turn around,” Goza said. “We encourage parents to call their pediatricians and get their children into the office for well visits and vaccinations, especially now that some schools are reopening and flu season has arrived.”

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Telehealth Patient Satisfaction Surges During Pandemic but Barriers to Access Persist, J.D. Power Finds

Amwell Ranks Highest among Direct-to-Consumer Brands; Cigna Ranks Highest among Health Plans

Telehealth has emerged as one of the bright spots in the “new normal,” giving patients the ability to meet virtually with healthcare providers from the safety and comfort of home. However, the technology is still experiencing growing pains. According to the J.D. Power 2020 U.S. Telehealth Satisfaction Study,SM released today, patient satisfaction with telehealth services has been increasing during the COVID-19 pandemic, but several barriers to access still exist for many patients, including those most at risk.

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J.D. Power 2020 U.S. Telehealth Satisfaction Study (Graphic: Business Wire)

“The COVID-19 pandemic has been a moment of truth for telehealth, and, by most accounts, the technology is rising to the challenge and delivering a high degree of satisfaction among those who use it,” said James Beem, managing director of global healthcare intelligence at J.D. Power. “However, even though the public awareness with Telehealth is higher due to the influence of COVID-19, the barriers for the consumer to engage with the technology has been a consistent theme in our research.”

Following are some key findings of the 2020 study:

  • Great patient experience: The overall customer satisfaction score for telehealth services is 860 (on a 1,000-point scale), which is among the highest of all healthcare, insurance and financial services industry studies conducted by J.D. Power.

  • Barriers to access persist: Though telehealth has been pitched as a solution to improve access to healthcare for everyone, more than half (52%) of telehealth users say they encountered at least one barrier that made it difficult to use telehealth. The most common hurdles are limited services (24%); confusing technology requirements (17%); and lack of awareness of cost (15%). Additionally, 35% of telehealth users indicate they experienced a problem during a visit. Tech audio issues (26%) are the most common problem.

  • At-risk patients have lower levels of satisfaction: Overall satisfaction is 117 points lower among patients with the lowest self-reported health status than among patients who consider themselves to be in excellent health. Similarly, healthier patients are significantly more likely to understand the information provided during the visit, receive clear explanations, feel their visits are highly personalized and obtain a high-quality diagnosis.

  • Safety becomes a top driver of utilization: Among patients who used a telehealth offering this year, 46% say their top reason for choosing telehealth was safety. That compares with just 13% in 2019.

Study Rankings

Amwell ranks highest in telehealth satisfaction among direct-to-consumer brands, with a score of 885. Doctor on Demand (879) ranks second.

Cigna ranks highest among payers of health plan-provided telehealth services with a score of 874. Kaiser Foundation Health Plan (867) ranks second and UnitedHealthcare (865) ranks third.

The J.D. Power U.S. Telehealth Satisfaction Study, now in its second year, measures consumer satisfaction with their telehealth service experience based on four factors (in order of importance): customer service (42%); consultation (28%); enrollment (19%); and billing and