Articles Posted in Clinical guidelines

disinfectkellysikkema-300x201Because Covid-19 is caused by a novel coronavirus, the world has much to learn about it and its effects. For the voting and taxpaying public, a critical line of inquiry in the days ahead may be this: Why does this disease also seem to cause such an outbreak of shiftiness among our leaders?

Let’s start at the already beleaguered federal Centers for Disease Control and Prevention, once considered among the globe’s best agencies in handling infectious diseases.

Sure, the medical science changes by the day about Covid-19. But why did the agency set itself up for deserved criticism by changing, “without formal announcement or explanation,” its guidance about the infectiousness of “contaminated” surfaces and how the coronavirus spreads? That had been an issue of key concern for experts, who had cautioned the public for weeks now about hygiene and care in coming in contact with such areas. Instead, CDC officials tweaked the language on the agency web site, diminishing the risks. Maybe, they thought, well, that should do it.

chartGAOnursinghomeinfection-300x300Is the coronavirus’s staggering toll on patients in nursing homes something to be written off as a force of nature for which humans bear little fault? Or are there lessons to be learned about shortcomings that could help preserve lives the next time?

News media reports keep unearthing institutional misery and a blindness to the suffering of the aged, chronically ill, and seriously injured. Bad luck, shrug facility owners and operators, seemingly joined in by regulators and some politicians. Couldn’t be helped. Did the best we could.

In fact, investigations — by journalists and watchdogs — have shown the toll taken by nursing homes’ sloppy disregard for infection control, press for profits, and unacceptable paralysis as situations headed south.

covidseeyasoon-225x300Do I, or don’t I? Do we, or don’t we?

As the stringent public health measures designed to bend the curve with the Covid-19 pandemic begin to lift or ease — including in Maryland and Virginia — hundreds of millions of Americans will make difficult individual decisions about their lives and livelihoods.

Fears are high that going back too soon may result in a deadly second wave of infections and deaths. Dr. Anthony Fauci, a preeminent expert on epidemics and a leader at the National Institutes of Health, warned senators of serious consequences from a premature restarting of activities.

covidmdnatguard-300x174Federal and state officials almost seem as if they are competing with each other to race to new lows in their wrong-headed failure to protect elderly, sick, and injured Americans who require institutional care and whose health and lives are being savaged by the novel coronavirus.

An estimated 1.5 million Americans live in long-term institutions, including nursing homes, assisted living centers, skilled nursing facilities, memory care hospitals and the like. Covid-19 has taken a terrible toll on these frail, chronically ill, or seriously injured and debilitated people with more than 27,000 residents and staff dying from the novel coronavirus — roughly a third of all the disease fatalities nationwide. A third of the coronavirus deaths in the District of Columbia have been in skilled nursing facilities, while 40% of the Covid-19 deaths in California, the nation’s largest state, have been in nursing homes.

In the latest baffling response, President Trump and Vice President Mike Pence both suddenly have  “recommended” that states get nursing homes and other similar facilities to step up the testing of residents and staff.  They did not make this common-sense step mandatory, nor did they offer any word on how the federal government could help achieve this. As the Associated Press reported:

covidkids2-charlesdeluvio-300x200Federal officials have launched what may be an aptly named, important, and reassuring study for kids, parents, families, and communities — the large-scale “Heros” investigation on Covid-19 and youngsters.

As the National Institutes of Health explains the “Human Epidemiology and Response to SARS-CoV-2” work:

“[It will] help determine the rate of novel coronavirus infection in children and their family members in the United States [and] will help determine what percentage of children infected with SARS-CoV-2, the virus that causes Covid-19, develop symptoms of the disease. In addition, the HEROS study will examine whether rates of SARS-CoV-2 infection differ between children who have asthma or other allergic conditions and children who do not.”

sagepoint-300x176With nursing home operators bleating up a storm of weak defenses and denials, soaring Covid-19 infections and deaths have laid siege to far too many long-term care facilities in Maryland, Virginia, and the District of Columbia. The consequences have been dire.

In Maryland, the Baltimore Sun reported:

“Nearly three-fifths of Marylanders killed by the coronavirus are residents of long-term care facilities, according to [a recent state] update of nursing home data …The Maryland Department of Health reported that 793 of the state’s 1,338 victims, almost 60%, were residents of nursing homes, rehabilitation facilities and similar long-term care facilities. An additional 11 deaths were staff members of those facilities, with more than one of every five of Maryland’s confirmed infections being a resident or staff member of congregate living facilities.”

magazines-199x300For those who may have more time on their hands due to the pandemic and who may be seeking deeper digs into Covid-19, excellent long-form coverage is abounding.

Consider, for example, taking time for the New Yorker article by  Siddhartha Mukherjee, a cancer doctor, biologist, and best-selling nonfiction author who delves into the question of “What the coronavirus crisis reveals about American medicine.”

His premise includes in its painful illumination a quote from Warren Buffet, the Oracle of Omaha, whose quip assumes a different poignancy when applied to the post-pandemic state of medicine:  “When the tide goes out, you discover who has been swimming naked.”

gileadremdesivir-300x169Optimism and realism should not be oppositional characteristics when looking hard at the slowly evolving measures to deal with the Covid-19 pandemic.

Experts always have said many ways will be needed to battle the novel coronavirus and much attention has focused on a few: effective treatments, a vaccination, as well as testing, testing, testing.

There are reasons to be skeptical and hopeful about what is going on in each area:

calguard-225x300When hundreds of thousands of Americans are getting infected with Covid-19 and tens of thousands of die from it, regulatory incrementalism in protecting some of the most vulnerable is simply unacceptable: The latest halting measures by the Centers for Medicare and Medicaid Services do a disservice to the elderly, injured, and sick residents nationwide in nursing homes, long-term care centers, and skilled nursing facilities.

Seema Verma, the agency’s director, has told these institutions that they now must inform residents and their loved ones about Covid-19 infections and deaths in the care facilities, whether the affected individuals are staff members or others housed in the centers.

She only started, however, to respond to coast-to-coast wails about the official silence that has enshrouded the novel coronavirus’ toll on institutional care, with facilities condemned in increasing fashion by critics as infection petri dishes, or as one politician deemed them, “death pits.”

cvirussurrenderWith the fight against the Covid-19 pandemic now framed as one of the planet’s major battles, it may be worth considering  the historical record on the timing of turning points in matters of war.

The American Revolutionary War, historians note, hit a crucial point at Saratoga — 14 months after the conflict became official with rebels’ declaration of independence. A key moment of the Civil War occurred at Gettysburg — two years and a few months after an attack at Fort Sumter tore the nation apart. In World War I, the tides did not seem to shift until the clash at Marne —  four years after an assassin’s bullet had plunged the world into war. And in World War II, it is a matter of some controversy, but many experts cite the brutal Battle of Stalingrad as a turning point — roughly 3.5 years after Germany launched a global calamity with its invasion of Poland.

The novel coronavirus, in roughly three months, has killed more than 50,000 Americans, with experts conceding that toll is likely an undercount.

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