Showing: 1 - 8 of 8 RESULTS

California regulators launch review of long, deadly delays in L.A. County specialty care

Los Angeles, CA, August 24, 2019 - Majid Vatandoust, a 49-year old heating and air conditioning technician from Canoga Park, who went to LAC clinic Mid-Valley for a check-up in early 2014. He had unintentionally lost about 20 pounds and routine tests found he was anemic and had blood in his stool, all early indicators of potentially deadly colon cancer. His doctor put in a request via eConsult for a colonoscopy but was denied, his medical records show. The gastroenterologist who turned down the request without ever seeing Vatandoust said the test used to detect blood in Vatandoust's stool was "not valid for patients under 50 years old." Thousands of patients in L.A. County's public hospital system who endure long, sometimes deadly delays to see medical specialists, a Times investigation has found. Doctors, nurses and patients describe chronic waits that leave the sick with intolerable pain, worsening illnesses and a growing sense of hopelessness. According to a Times data analysis of more than 860,000 requests for specialty care at the L.A. County Department of Health Services, a sprawling safety-net system that serves more than 2 million, primarily the region's poorest and most vulnerable residents. (Robert Gauthier / Los Angeles Times)
Majid Vatandoust died of colon cancer at age 52, three years after a request for a colonoscopy was denied by a specialist working for L.A. County despite tests that showed clear indicators of the disease. (Robert Gauthier / Los Angeles Times)

As current and former doctors in Los Angeles County’s public hospital system condemn delays in providing specialist care, California regulators have launched a review of the long, sometimes deadly waits faced by patients who need treatment from one of the nation’s largest public health systems.

The actions come in the wake of a Times investigation that found patients of the Los Angeles County Department of Health Services face agonizing delays to see specialists after referrals from primary care providers, leaving many with intolerable pain, worsening illnesses and a growing sense of hopelessness. The Times report included several patients who died of the conditions they waited to have treated.

The California Department of Health Care Services will review whether any managed care plan that offers Medi-Cal — the government-subsidized program that covers low-income Californians and most county patients — violated its contract with the state to provide adequate access to care, an agency spokeswoman said.

“Any untimely death is a tragedy, and our hearts go out to the families suffering the loss of a loved one. The wait times outlined by The Times are unacceptable,” Michelle Baass, undersecretary of the California Health and Human Services Agency, said in a statement. “Timely access to care is a fundamental patient right.”

The review is the second underway by the state. The California Department of Managed Health Care began an investigation of the county’s wait times this year in response to questions from The Times about delays in specialist appointments.

Baass is overseeing both inquiries after her boss, state Health Secretary Dr. Mark Ghaly, recused himself. Ghaly is married to the director of the Los Angeles County safety-net hospital system, Dr. Christina Ghaly.

The average wait to see a specialist in the L.A. County system was 89 days, according to a Times data analysis of more than 860,000 requests for specialty care at the county’s Department of Health Services, which serves more than 2 million people, primarily the region’s poorest and most vulnerable residents.

Even patients waiting to see doctors whose prompt care can mean the difference between life and death — neurologists, kidney specialists, cardiologists — endured delays that stretched on for months, according to the data, which consisted of nonemergency requests from primary care providers to specialists from 2016 through 2019.

Several doctors who now work for the county or recently left called for reform, including better communication between primary care providers and specialists as well as a dramatic increase in hiring of specialists.

Dr. Michael Hochman, a primary care physician and associate professor of clinical medicine at USC’s Keck School of Medicine, who has practiced at safety-net health systems on both coasts, said Los Angeles County’s is “the least effective system that I’ve worked at in my 14

Why coronavirus has been less deadly in Africa



a girl looking at the camera


© Getty Images


Many African countries have been praised for waging an effective campaign to combat the spread of coronavirus despite their reputation for having fragile state heath systems.

The continent, which has a population of more than one billion, has had about 1.5 million cases, according to data compiled by the John Hopkins University.

Africa has recorded about 37,000 deaths, compared with roughly 580,000 in the Americas, 230,000 in Europe, and 205,000 in Asia.

These figures are far lower than those in Europe, Asia or the Americas, with reported cases continuing to decline.

“The case-fatality ratio (CFR) for Covid-19 in Africa is lower than the global CFR, suggesting the outcomes have been less severe among African populations,” noted a recent continental study by Partnership for Evidence-based Response to Covid-19 (PERC), which brings together a number of private and public organisations.

Low testing rates continue to undermine the continental response however, there is no indication that a large number of Covid-19 deaths have been missed, said Dr John Nkengasong, the head of Africa Centres for Disease Control and Prevention (Africa CDC).

So what are some of the reasons for Africa’s relatively low death rate?

1: Quick action



a group of people in a room: Most places of worship in African countries have re-opened after the easing of restrictions


© Getty Images
Most places of worship in African countries have re-opened after the easing of restrictions

The first case on the continent was confirmed in Egypt on 14 February. There were fears that the new virus could quickly overwhelm largely fragile health systems on the continent.

So, right from the beginning, most African governments took drastic measures to try and slow the spread of the virus.

Public health measures – including avoiding handshakes, frequent hand-washing, social distancing and wearing of face masks – were swiftly introduced.



chart


© BBC


Some countries – like Lesotho – acted even before a single case was reported.

It declared an emergency and closed schools on 18 March, and went into a three-week lockdown about 10 days later in unison with many other southern Africa states.

But only days after the lockdown was lifted – in early May – did Lesotho find its first confirmed cases. In a population of more than 2 million, it has so far recorded about 1,700 cases and 40 deaths.

2: Public support

In a survey conducted in 18 countries in August by PERC, public support for safety measures was high – 85% of respondents said they wore masks in the previous week.

“With strict public health and social measures implemented, African Union member states were able to contain the virus between March and May,” the report said.

It added that “minor loosening [of restrictions] in June and July coincided with an increase in the reported cases across the continent”.

Since then, there has been a notable drop in the number of confirmed cases and deaths in about half of the continent, possibly linked to the end of the southern hemisphere winter (see below).



chart, bar chart: Adherence to Covid-19 measures. Survey in 18 African countries. Self-reported adherence to coronavirus measures in Africa. The report draws on findings from a telephone poll of more than 24,000 adults in 18 AU Member States (conducted between 4 and 17 August, 2020) as well as social, economic, epidemiological, population movement, media and security data. It draws on findings from a telephone poll of more than 24,000 adults between 4 -17 August 2020.


© Provided by BBC News
Adherence to Covid-19 measures. Survey in 18 African countries. Self-reported adherence to coronavirus measures

Five reasons why Covid-19 has been less deadly than elsewhere

People wearing face masks as a precautionary measure against the coronavirus (Covid-19) come to Entoto Kidane Mehret Church as Ethiopian Orthodox Christians celebrate Filseta Day after the end of fasting for 15 days without consuming animal products in commemoration of Assumption of Mary in Addis Ababa, Ethiopia on August 22, 2020
People wearing face masks as a precautionary measure against the coronavirus (Covid-19) come to Entoto Kidane Mehret Church as Ethiopian Orthodox Christians celebrate Filseta Day after the end of fasting for 15 days without consuming animal products in commemoration of Assumption of Mary in Addis Ababa, Ethiopia on August 22, 2020

Many African countries have been praised for waging an effective campaign to combat the spread of coronavirus despite their reputation for having fragile state heath systems.

The continent, which has a population of more than one billion, has had about 1.5 million cases, according to data compiled by the John Hopkins University.

Africa has recorded about 37,000 deaths, compared with roughly 580,000 in the Americas, 230,000 in Europe, and 205,000 in Asia.

These figures are far lower than those in Europe, Asia or the Americas, with reported cases continuing to decline.

“The case-fatality ratio (CFR) for Covid-19 in Africa is lower than the global CFR, suggesting the outcomes have been less severe among African populations,” noted a recent continental study by Partnership for Evidence-based Response to Covid-19 (PERC), which brings together a number of private and public organisations.

Low testing rates continue to undermine the continental response however, there is no indication that a large number of Covid-19 deaths have been missed, said Dr John Nkengasong, the head of Africa Centres for Disease Control and Prevention (Africa CDC).

So what are some of the reasons for Africa’s relatively low death rate?

1: Quick action

Most places of worship in African countries have re-opened after the easing of restrictions
Most places of worship in African countries have re-opened after the easing of restrictions

The first case on the continent was confirmed in Egypt on 14 February. There were fears that the new virus could quickly overwhelm largely fragile health systems on the continent.

So, right from the beginning, most African governments took drastic measures to try and slow the spread of the virus.

Public health measures – including avoiding handshakes, frequent hand-washing, social distancing and wearing of face masks – were swiftly introduced.

Chart showing cases by continent. Updated 3 Oct.
Chart showing cases by continent. Updated 3 Oct.

Some countries – like Lesotho – acted even before a single case was reported.

It declared an emergency and closed schools on 18 March, and went into a three-week lockdown about 10 days later in unison with many other southern Africa states.

But only days after the lockdown was lifted – in early May – did Lesotho find its first confirmed cases. In a population of more than 2 million, it has so far recorded about 1,700 cases and 40 deaths.

2: Public support

In a survey conducted in 18 countries in August by PERC, public support for safety measures was high – 85% of respondents said they wore masks in the previous week.

“With strict public health and social measures implemented, African Union member states were able to contain the virus between March and May,” the report said.

It added that “minor loosening [of restrictions] in June and July coincided with an increase in the reported cases across the continent”.

Facebook, Twitter Block Post Claiming COVID Is Less Deadly Than Flu

Social media giants Facebook and Twitter have blocked a post from President Donald Trump on Tuesday falsely claiming COVID-19 is less deadly than the flu. Facebook has removed the post, while Twitter has added a message saying it broke the rules on “spreading misleading and potentially harmful information related to COVID-19.” 

“We remove incorrect information about the severity of COVID-19,” a Facebook spokesperson told Reuters.

Trump, who is currently recovering from the virus, posted the controversial tweet early in the day.

“Flu season is coming up! Many people every year, sometimes over 100,000, and despite the Vaccine, die from the Flu. Are we going to close down our Country? No, we have learned to live with it, just like we are learning to live with Covid, in most populations far less lethal!!!” Trump tweeted.

According to estimates from the Centers for Disease Control, 22,000 deaths were linked to the flu during the 2019 to 2020 influenza season.

Trump admitted to Washington Post journalist Bob Woodward in February that he had been intentionally downplaying COVID-19 on purpose. The recordings of the conversation were released in September and used as source material for Woodward’s latest book, “Rage.”

In the interview with Woodward, Trump said COVID-19 is “more deadly than even your strenuous flus” but admitted to downplaying the virus in order to not cause a panic. 

Trump is currently at the White House, after spending several days at Walter Reed Military Hospital to receive treatment for the virus. First lady Melania Trump, Press Secretary Kayleigh McEnany, Trump campaign manager Bill Stepien, Republican National Committee Chairwoman Ronna McDaniel, former New Jersey Gov. Chris Christie and three Republican senators are the latest political figures to contract COVID-19.

Coronavirus cases continue to rise across the United States. As of Tuesday at 6 p.m. ET, there are nearly 7.5 million COVID-19 cases in the U.S., with the domestic death toll over 210,000, according to Johns Hopkins University.

Source Article

Trump’s coronavirus infection is the result of his deadly, foolish recklessness

President Trump and First Lady Melania Trump arrive at the White House on Sept. 11. <span class="copyright">(Associated Press)</span>
President Trump and First Lady Melania Trump arrive at the White House on Sept. 11. (Associated Press)

Americans awaken this morning to the grave news that President Trump and First Lady Melania Trump have tested positive for the dreadful coronavirus that has killed more than 207,000 people in the U.S. and brought the U.S. economy to its knees.

The news came the way that so much of the news from the White House does: in a tweet early Friday from the president himself. Trump wrote that he and the first lady had tested positive for the coronavirus (he noticeably did not call it the “China virus”) and declared: “We will begin our quarantine and recovery process immediately. We will get through this TOGETHER!”

No matter how you feel about Trump’s performance as president — and we feel pretty strongly that it has been a disaster — this is another crisis for a nation reeling from a year that almost seems apocalyptic: Trump’s impeachment, COVID-19, a popular outcry over racial injustice, the deaths of John Lewis and Ruth Bader Ginsburg, catastrophic wildfires. And now this: A reckless president whose irresponsibility has endangered not only himself and his family but the stability of the country by throwing the executive branch into chaos. Another crisis, this one fully of Trump’s own making.

The president may not be showing COVID-19 symptoms yet. His physician later said Trump was feeling well and would continue his presidential duties. But the fact is that Trump is at particular risk of severe illness and death by virtue of his age: He is 74, and also obese. We hope he doesn’t find out how much worse COVID-19 is than flu, but it’s a real possibility for which we must be prepared.

Furthermore, how many others in the White House have been infected? We have now learned that one of Trump’s closest aides, Hope Hicks, experienced symptoms and tested positive for the coronavirus Wednesday. Astonishingly, Trump went ahead with an indoor fundraiser at his New Jersey golf club. Considering the lack of regard Trump and his aides have shown for the simple infection-control measures of social distancing and face masks, there’s no telling how many other people working in critical White House roles may have been infected.

In a way, this outcome was inevitable. From the start, Trump has downplayed the severity of the coronavirus, dismissing it as no more than the flu even when he knew full well that it was a serious threat. While other nations were launching serious and sustained testing and tracing responses to keep the spread of the virus in check, Trump dithered.

Worse still, the president politicized the pandemic, contradicting and sidelining his own health officials when they said things he didn’t want to hear. He undermined the federal agencies charged with fighting infectious diseases, including the Food and Drug Administration and the Centers for Disease Control and Prevention, and urged governors to lift restrictions and reopen schools before state and local

Acute Kidney Injury in COVID-19 Varies, But It Is Deadly

Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

The incidence of acute kidney injury (AKI) among patients hospitalized for COVID-19 in China was significantly lower than for similar patients in the United States, a new retrospective study from Wuhan indicates.

However, mortality among patients who do develop AKI following COVID-19 infection — especially if they require dialysis — is much higher in both regions than it is for patients who do not sustain kidney damage, this and other studies consistently show.

In an editorial accompanying the Wuhan study, published in the Clinical Journal of the American Society of Nephrology, Edward Siew, MD, Vanderbilt University Medical Center, and Bethany Birkelo, DO, Veterans Affairs, Nashville, Tennessee, say the Chinese researchers should “be commended” for their contribution to the literature. “The extraction and analysis of data under challenging conditions with several clinical and logistical unknowns are laudable,” they write.

Yet, they add, “Although the findings add important data to the existing knowledge on COVID-19–associated AKI, important knowledge gaps remain.”

“Among these are the need to better understand the factors underpinning individual differences in the risk for AKI. The incidence of AKI in this study was one fifth of that observed in more recent studies of hospitalized patients from Western countries,” they comment.

Do Age, Presence of Comorbidities Explain the Differences?

Digging down, it would appear that age and the presence of comorbidities explain a large part of the variance in AKI incidence rates.

In the group of 1392 COVID-19–infected patients admitted to a tertiary teaching hospital in Wuhan between January 18 and February 28, 2020, only 7% developed AKI during their hospital stay. That said, 72% of patients who developed AKI died in hospital. 

In contrast, among hospitalized patients who did not develop AKI, the mortality rate was only 14%, note Yichun Cheng, MD, of Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China, and colleagues in their article published online September 22 in the Clinical Journal of the American Society of Nephrology.

“Acute kidney injury is a common, serious complication in critically ill patients that is associated with increased mortality, longer hospital stay, and higher medical costs,” the Chinese investigators point out.

Meanwhile, US researchers have updated a prior analysis in which the incidence of AKI was 36.6% among approximately 5500 patients admitted to 13 New York hospitals between March 1 and April 5, 2020, as reported by Medscape Medical News.

At the time of publication, 40% of these patients were still in hospital, “so we didn’t know what happened to them,” second author of the new paper, Jamie Hirsch, MD, told Medscape Medical News.

The incidence of AKI of 39.9% in the larger cohort of 9657 hospitalized patients is similar to the earlier figure. The updated analysis was published online September 19 by Jia H. Ng, MD, MSCE, of the Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York City, and colleagues in the American Journal of Kidney Diseases

Mounting Ransomware Attacks Morph Into a Deadly Concern

Hackers are increasingly targeting health-care institutions and threatening people’s well-being as their software attacks get more sophisticated and brazen.

Ransomware attacks, in which hackers cripple a software system until they receive a bounty, have surged this year, along with financial demands, security experts say. The attacks have been around for decades but have flourished as society has become more dependent on technology. Other factors include the rise of the cryptocurrency bitcoin, more advanced hacking techniques and, some say, the widespread adoption of cyber insurance.

“The trend has been going up for a while, but in 2020 it has just been skyrocketing,” said Dmitri Alperovitch, the chairman of Silverado Policy Accelerator, a nonprofit think tank focused on cybersecurity.

Hackers have expanded their targets to include health-care companies. This week, one of the nation’s largest hospital chains,

Universal Health Services Inc.,

diverted ambulances from some facilities after a crippling ransomware attack. It said the outage didn’t harm patients, but systems used for medical records, laboratories and pharmacies were offline at about 250 of the company’s U.S. facilities.

The attack occurred Sunday morning, and the Universal Health’s network remained offline Wednesday, though priority systems such as email and clinical operations systems were being restored gradually across the country, the company said.

In a separate incident in Germany, prosecutors have launched an investigation after a woman died earlier this month when her ambulance was diverted from University Hospital Düsseldorf in the country’s North Rhine-Westphalia state.

A ransomware attack hit the hospital on Sept. 10, shutting down computer systems and forcing it to reroute ambulances away from its emergency room for 13 days. IT systems there are still recovering, hospital spokesman Tobias Pott said Tuesday.

Attacks on medical facilities are worrying because delays in patient care have been directly linked to patient harm, said Joshua Corman, a senior adviser at the Department of Homeland Security’s Cybersecurity and Infrastructure Security Agency. “We’ve had a growing concern that this degraded and delayed patient care would lead to a demonstrable loss of life.”

Mr. Corman said he had hoped hackers would leave hospitals alone as they were swamped by the coronavirus pandemic, but that hasn’t happened. “We’d assumed that they would be smart enough not to attack, but I think [hackers’] assumption was that [victims] would definitely pay.”

Cybersecurity company

FireEye Inc.

says ransom demands for large organizations can range between $10 million and $30 million, and hackers are increasingly following up their ransom demands with threats to publish stolen data online, hoping to extract more money. Many companies make the payments.


“Victims are paying millions of dollars in ransom, and it’s continuing to perpetuate this criminal activity.”


— Dmitri Alperovitch, chairman of cybersecurity think thank Silverado Policy Accelerator

But some don’t. Last week, hackers released Social Security numbers and other private information after administrators at a Las Vegas public-school district refused to pay an extortion demand, The Wall Street Journal reported Monday.

This month alone, FireEye has tracked 100 ransomware incidents world-wide, more than twice

Deadly delays in L.A. County’s public hospital system

A tip from a doctor led Times reporters to investigate specialty appointment waits in Los Angeles County's public hospital system. <span class="copyright">(Robert Gauthier / Los Angeles Times)</span>
A tip from a doctor led Times reporters to investigate specialty appointment waits in Los Angeles County’s public hospital system. (Robert Gauthier / Los Angeles Times)

It started with a phone call in the fall of 2018 from a doctor working for the Los Angeles County Department of Health Services.

Patients by the thousands were suffering unnecessarily because of extremely long waits to see specialists, the doctor said. Some were dying before they could get an appointment.

The tip launched an investigation that spanned nearly two years and focused on the county’s sprawling safety-net healthcare system that serves more than 2 million, primarily the region’s poorest and most vulnerable residents.

We interviewed dozens of current and former county healthcare providers, patients and outside medical experts. We also analyzed L.A. County data from hundreds of thousands of specialist referrals and obtained thousands of pages of medical records.

How we verified long waits

The stories we heard were always the same: Wait times were dangerously long.

But the patients and their families were most often relying on memory. Doctors and nurses can’t talk about cases for fear of retaliation from their bosses and concerns about violating strict medical privacy laws. We needed medical records to verify the accounts.

By law, medical records are private. So requests have to be signed by patients or, if the patient has died, by the person who signed the death certificate. We spent months driving across Southern California knocking on doors and collecting signatures.

More months passed as families waited to receive the records. When the documents finally arrived, county health officials had almost always withheld important parts of the medical files.

Conspicuously absent were records from eConsult, an internal email-like system that primary care doctors and nurses use to discuss cases and arrange face-to-face appointments with specialists. We helped the family members push back and demand everything they were entitled to.

It was only after county officials learned The Times was working with the families that they turned over records from the referral system — with an apology for the delay.

After asking for permission from the families, we shared the documents the county finally produced with medical experts inside and outside the county system. Long waits were obvious in every case.

Half a dozen of the patients died after waiting at least three months to see a doctor in a critical specialty — cardiology, oncology, gastroenterology and nephrology. It wasn’t always clear how much the long waits contributed to the patient’s death, but in every case, the experts said, the patient should have been treated much sooner.

Though the individual stories were heartbreaking, they were also anecdotal. We needed to find out whether they were unusual or represented a common experience for L.A. County patients.

How we calculated overall wait times

We knew that it was possible to measure wait times for routine specialist appointments provided by the Department of Health Services. In 2017, two county health services executives published a study with