Why this Covid-19 surge is worse than the others

The West Texas city of El Paso, which is seeing facilities hard-pressed to handle the fast-rising number of coronavirus cases, is preparing to open its civic center for additional beds and add a fourth mobile morgue.

a person in a blue blanket: HOUSTON, TX - OCTOBER 31: A medical staff member grabs a hand of a patient to reposition the bed in the COVID-19 intensive care unit (ICU) at the United Memorial Medical Center (UMMC) on October 31, 2020 in Houston, Texas. According to reports, Texas has reached over 916,000 cases, including over 18,000 deaths. (Photo by Go Nakamura/Getty Images)

© Go Nakamura/Getty Images
HOUSTON, TX – OCTOBER 31: A medical staff member grabs a hand of a patient to reposition the bed in the COVID-19 intensive care unit (ICU) at the United Memorial Medical Center (UMMC) on October 31, 2020 in Houston, Texas. According to reports, Texas has reached over 916,000 cases, including over 18,000 deaths. (Photo by Go Nakamura/Getty Images)

University Medical Center of El Paso’s spokesman Ryan Mielke told CNN their hospital has 222 patients with Covid-19.

“We set a record yesterday and beat it today,” Mielke said. “It is just a new peak every day.”

About 978 patients with the virus are hospitalized in El Paso — a city of 680,000 residents — and 273 of those are in intensive care, according to the city’s coronavirus dashboard.

The city is about to use its civic center for Covid-19 patients and will have 50 beds, Mielke said.

The hospital has already expanded its Covid-19 capacity by partnering with El Paso Children’s Hospital, which has dedicated a floor to non-Covid-19 overflow patients, and it has a mobile isolation tent outside the hospital accepting patients.

A fourth mobile morgue is on its way to the hard-hit city, which has reported 605 deaths.

Asked about the surging cases and the link to the need for a fourth mobile morgue, Mielke said, “Simple math will tell you a certain percentage of those will have negative outcomes.”

‘We are breaking records all over the place’

No one wants another shutdown. But Americans who don’t wear masks and ignore social distancing are fueling that possibility, doctors say.

“We are breaking records all over the place here. The rate of acceleration of this virus is just increasing,” emergency medicine physician Dr. Leana Wen said.

“We’re already seeing our hospitals at breaking point in some parts of the country. And that means it doesn’t just affect patients with coronavirus. It also means that elective surgeries are being put off for things like hip replacements, for cancer surgery or heart surgery in some cases,” she said.

“When we get to breaking point here, we might have no other choice but to implement these measures that no one wants, like shutdowns. And that’s why we all have to take action right now with targeted measures, like wearing masks, like restricting indoor gatherings — things we can do now to prevent that really horrible outcome because cases are raging out of control across the US.”

Nationwide, the pandemic has gone from bad to worse.

The US just set a record for the highest seven-day average of daily new cases: 81,336 as of Sunday. That’s the first time the number has ever topped 80,000, according to data from Johns Hopkins University.

And once again, increases in new cases are far exceeding new

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At a top hospital, Catholic restrictions on women’s healthcare are growing worse

Back in 2014, then-California Atty. Gen. Kamala Harris imposed a strict condition on the affiliation between Hoag Memorial Hospital and St. Joseph Health System, a Catholic hospital group: For the most part, Hoag was to be exempt from Catholic church restrictions on women’s healthcare services.

a group of people standing next to a sign: Demonstrators protest the decision to end abortion services at Hoag Memorial Hospital in Newport Beach in 2013. (Allen J. Schaben / Los Angeles Times)

© (Allen J. Schaben / Los Angeles Times)
Demonstrators protest the decision to end abortion services at Hoag Memorial Hospital in Newport Beach in 2013. (Allen J. Schaben / Los Angeles Times)

Doctors at Newport Beach-based Hoag say that condition has been flagrantly breached by Providence Health, the successor to St. Joseph — and the violations are proliferating.

Since 2015 and up to the present day, a managed health plan controlled by Providence has been refusing to pay for contraceptives prescribed by Hoag OB/GYNs for their patients.

We would like to be tops in women’s healthcare, but how can we be if there are certain things we will never be able to provide, based on our association with Providence?

Jeffrey Illeck, an OB/GYN at Hoag Memorial Hospital

The health maintenance organization, Heritage Healthcare, has cited the Ethical and Religious Directives for Catholic Health Care Services as grounds for refusing payment, even though the 2014 agreement under which Harris approved the affiliation explicitly states that Hoag would not be bound by the so-called ERDs then or “in the future.”

Frustration among Hoag OB/GYNs has been rising.

Several members of Hoag’s professional staff filed a confidential complaint with Atty. Gen. Xavier Becerra’s office on Oct. 9.

The complaint asserts that “Providence has increasingly disallowed women’s health services when they involve any form of contraceptive care,” even when IUDs are prescribed for reasons other than birth control, such as heavy menstrual bleeding.

Providence also has refused to cover deliveries when they’re combined with sterilization procedures such as salpingectomies (the removal of one or both fallopian tubes), even though combining those procedures is the standard of care to avoid requiring a patient to undergo two rounds of anesthesia and recovery rather than one.

The complaint says that physicians’ staffs are spending many hours a day pursuing reimbursement claims for Heritage enrollees.

“We have seen IUD reimbursements, for example, pending for as long as two years, requiring multiple appeals and grievances on behalf of patients,” the complaint states. Billing staff “have never spent so much time trying to get reimbursements for IUDs. … In many cases, payment is never received.”

The Hoag doctors say that Providence established “an anonymous hotline for people to complain if they believed Hoag was committing so-called immoral procedures involving women’s reproductive health.” The hotline was connected to the Orange County bishop’s office, they say, adding: “We were never told of its existence.”

In sum, “Providence has established a history of broken trust in its relationship with us, with absolutely no end in sight,” says the complaint, which is not a public document but which I’ve reviewed.

Providence has refused to comment on any of these assertions.

Becerra has not responded to the complaint, even

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Gottlieb pushes back on Trump’s comments of ’rounding the corner’ on virus: ‘Things are getting worse’

Former Food and Drug Administration (FDA) Commissioner Scott Gottlieb is pushing back on President Trump’s repeated comments that the U.S. is “rounding the corner” on coronavirus.

a man wearing a suit and tie looking at the camera: Gottlieb pushes back on Trump's comments of 'rounding the corner' on virus: 'Things are getting worse'

© Greg Nash
Gottlieb pushes back on Trump’s comments of ’rounding the corner’ on virus: ‘Things are getting worse’

Gottlieb told CBS’s “Face The Nation” o Sunday that “things are getting worse.”

“Things are getting worse around the country,” he said. “I think Thanksgiving is really going to be an inflection point. I think December is probably going to be our toughest month.”

Gottlieb said states are “seeing accelerating spread” and the U.S. is “at the beginning of what looks like exponential growth in a lot of states,” including those in the Midwest, the Great Lakes region, Texas, Illinois, Florida and Wisconsin.

“These are very worrisome trends,” he said. “There are about 23 states right now that are accelerating the spread.”

The former FDA official said 15 states have a positivity rate above 10 percent and all of the states are experiencing “an expanding epidemic right now.”

The New York Times documented a record high for new U.S. cases confirmed in a single-day on Friday, at nearly 100,000.

The newspaper categorizes 41 states and territories as places where new cases are “higher” and “staying high.” Eight states and territories were considered places where new cases are “lower but going up.” Almost 30 states and territories are experiencing increasing death tolls.

Overall, the U.S. ranks as the country with the most cases and deaths, with more than 9.1 million cases and 230,732 deaths, according to data from Johns Hopkins University.

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Women in medicine make about $116,000 less than men, and the pandemic could be making things worse

a person holding a baby: HRAUN/Getty Images

© HRAUN/Getty Images
HRAUN/Getty Images

  • Medical networking site Doximity released its fourth annual Physician Compensation Report on Thursday.
  • In addition to compensation differences across US cities, the report highlights that women make less than men in all medical specialties. 
  • According to the report, the wage gap is largest for otolaryngology — or the specialty related to ears, noses, and throats — where women make 77.9% of men or a gap of 22.1%.
  • Overall, the gender wage gap in 2020 for doctors is 28%, about three percentage points higher than last year’s report.
  • Visit Business Insider’s homepage for more stories.

The coronavirus recession has disproportionately hurt working women, and the pressures of balancing work with parenting and household responsibilities amid the pandemic have also affected female doctors.

Medical networking site Doximity just released its fourth annual Physician Compensation Report, and one of the main findings is that the gender wage gap for doctors has widened this year.

The report describes compensation for physicians in various US cities and in different medical specialties. The figures are based on self-reported compensation surveys from 2019 and 2020 that were completed by around 44,000 US physicians.

One notable finding is the various gender wage gaps among medical specialties. Last year’s report showed a declining gap in pay between male and female physicians. However, this year the overall wage gap was 28%, 2.8 percentage points higher than last year’s figure. Women in medicine made about $116,000 less than men, where women make an average salary of around $299,000 compared to the average salary among male doctors of about $415,000. 

“It’s likely that the widening gender pay gap represents another financial consequence of the pandemic. This is a troubling trend economists have previously reported on in other industry sectors,” the company wrote in the report. 

The latest report shows that the pandemic’s effects on working women extends to healthcare, even though the industry is considered essential during the pandemic.  

“What we are thinking is that women have more responsibilities at home and therefore have had to cut back on their hours,” Dr. Peter Alperin, vice president at Doximity, told Business Insider. He also said that overall there’s been a slowing of increases in compensation this year which has especially affected compensation for women in the medical field.

Overall 865,000 women left the workforce in September alone. That is about four times higher than the number of men who dropped out of the workforce that month. NPR reports that more demand within households may be contributing to this large decline of women in the workplace. 

The following chart highlights the medical specialties with the largest gender wage gaps, according to the Doximity report. Otolaryngology, or treating ear, nose, and throat issues, has the largest gap. Women make 77.9% of men’s average annual salaries or is a wage gap of 22.1%. Women in this medical specialty make around $109,000 less than men.  

The following chart highlights the medical specialties with the smallest wage gaps, based on the report.

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Tuberculosis is a major worldwide threat and the pandemic could make it worse, WHO says

In a new report, WHO provides a global update on the state of TB and the fight against the disease, which is both preventable and curable.

The report paints a dire picture of a disease that remains a public health crisis. Just eight countries — India, Indonesia, China, the Philippines, Pakistan, Nigeria, Bangladesh and South Africa — account for two-thirds of the world’s TB cases. And because many carriers of the disease are not yet ill, it can go untreated until it’s too late.

Tuberculosis incidences are falling, the agency says — between 2015 and 2019, cases were reduced by about 9 percent. But that still falls short of WHO’s targets.

The coronavirus pandemic is expected to make things worse.

Large drops occurred in TB diagnoses between January and June. Due to the economic effects of the pandemic, WHO models predict that cases could annually increase by more than 1 million in the next five years if resources continue to be diverted to covid-19, the disease caused by the coronavirus.

The stark report has positive news however. Funding for TB prevention, diagnosis and treatment has doubled since 2006, and seven high-burden countries reached their death reduction milestone. And people living with HIV are more likely than ever to be given preventive treatment for tuberculosis, which is the leading killer of people with HIV worldwide.

The report is available online or as an interactive app. To download, visit bit.ly/TBreportapp.

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N.J.’s child care nightmare could actually get worse. Here’s why.

Smaller class sizes. Stockpiles of PPE. Expensive ventilation upgrades and exhaustive daily cleaning.

The cost to run a child care center will remain elevated as long as COVID-19 safety precautions remain in place, according to new research. And many child care centers face a painful choice: Hike your prices or shut your doors.

“Many child care providers were already struggling to turn a profit before the pandemic, so it shouldn’t surprise anyone if some are now forced to raise rates, turn children away, or close their doors,” said Karin Garver, early childhood education policy specialist for the National Institute for Early Education Research (NIEER) and the report’s author.

As the pandemic persists, child care centers across the state are falling into financial peril with limited recourse beyond raising prices for families, many of which have already felt the crushing weight of layoffs, furloughs and pay cuts. The NIEER report estimates pandemic health precautions — including lower state caps on class sizes — have increased child care provider costs by up to $69 a week per toddler and $37 a week per preschooler.

The best way to keep child care centers open without soaring prices for parents would be increasing state subsidy rates, said Steve Barnett, a senior co-director at NIEER, which operates at Rutgers University.

Currently, the New Jersey Child Care Subsidy Program pays centers up to $241 a week for infants, $201 a week for toddlers and $167 a week for preschoolers. NIEER’s report suggests per child subsidy rates must rise by up to $40 per week for infants and $63 per week for preschoolers to help child care centers break even.

“It simply will not be possible for most providers to offer the quality care infants and toddlers need to support learning and development without a substantive increase in reimbursement rates to cover higher costs in the pandemic,” Barnett said.

State Sen. Teresa Ruiz, D-Essex, said the state should consider raising those rates now before the child care landscape gets worse.

“If we do not act, closures around the state could cause the child care system to collapse once offices begin to reopen and demand increases as more people return to work,” Ruiz warned.

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Adam Clark may be reached at [email protected]

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Antimicrobial resistance could get worse during the coronavirus pandemic

The COVID-19 pandemic is currently coinciding with the flu season and several states and areas of the world are experiencing upticks in new cases. While hospitals have some experience with COVID to go on, some experts are concerned that how doctors are administering antibiotics during the COVID-19 crisis could potentially make the fight against antimicrobial resistance harder. Data from early in the pandemic suggests that the majority of COVID patients are given antibiotics when potentially less than a tenth of them needed it. That could spell disaster if the trend continues.

What is antimicrobial resistance?

Antimicrobial resistance (AMR) occurs when microbes are no longer affected by antibiotics. Doctors can run out of options if a patient comes in with a bacterial infection that is resistant to all available antibiotics.

Part of the issue with AMR is that we are running out of antibiotics that can work against bacteria and other microbes that have developed resistance. Think about it as evolution on a fast track. At first, the antibiotics may kill all or most of the microbes present in a population. But if a few can tolerate the antibiotic and live on, that can allow it to grow into a resistant population that won’t be affected by the antibiotic in the future.

If that strain of the microbe persists, it could become the dominant form that is passed around and infect people. And when those people land in the hospital, doctors may not be able to effectively treat them and they may die from their infections.

The “superbug” crisis has been building for a long time. Increasing resistance is also in part due to antibiotics being heavily used in certain types of agricultural and livestock raising practices. The Centers for Disease Control and Prevention (CDC) published a report in 2016 that estimated “at least 30 percent of antibiotics prescribed in the United States are unnecessary.” In 2019, the World Health Organization estimated that by 2050 AMR could cause 10 million deaths a year.

Without antibiotics that we can count on, we could go back to dying from infected cuts and surgeries will be much more dangerous. “We take antibiotics for granted,” says Steffanie Strathdee, professor of medicine at the University of California, San Diego, to Changing America. “We really are entering an era where a simple surgery like C-section or hip or knee replacement can end up an infection that’s untreatable.”

AMR could become a more urgent crisis than COVID-19. “I don’t think I’m exaggerating to say it’s the biggest human health threat, bar none. Covid is not anywhere near the potential impact of AMR,” says Paul De Barro, who is the biosecurity research director at Australia’s national science agency, the CSIRO, to The Guardian. “We would go back into the dark ages of health.”





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