Category: Healthcare

Coronavirus Impact: How a Crisis Is Changing the U.S. Image

The coronavirus is changing how we live our daily lives. Taking a look at how the global pandemic has affected various aspects of life in the United States reveals the unique nature of this crisis.

Workers in the tourism industry are worrying about their livelihoods as governments across the world close borders, prohibit large gatherings and implement strict quarantines on entire regions and countries.

We spoke with several travel and hospitality workers. Each had their own story, but echoed similar concerns about the uncertainty about their future. In looking at an unprecedented worldwide coronavirus outbreak, they turned to the past: how their tourism industry had survived devastating hurricanes and destructive civil wars. They will survive this, too, they said.

A selection of their remarks is below. These interviews, conducted by telephone and email, have been edited and condensed for clarity.

TRANSPORTATION

Carlos Tamarit, 62, has worked as a driver for EmpireCLS Worldwide Chauffeured Services in New Jersey for more than five years. He was laid off on Sunday.

With your family’s health concerns, are you worried about being exposed to the coronavirus?

As drivers we’re putting ourselves at risk. If coronavirus is coming from other countries, it’s coming from the airports, and who’s going to the airports? We do. Everyone who gets into the car is potentially a carrier. But in our position it’s either work and eat, or don’t work and don’t eat.

TOUR GUIDES

Jacob Knapp, 39, a tour guide working for Bespoke Lifestyle Management and living in Rio Grande, Puerto Rico, has been out of work since Monday. On Sunday, the territory issued one of the most restrictive lockdowns in the United States.

You’ve not been able to give a tour since Sunday. How does it feel to be out of work?

I have a lot of worries. I have two boys — 2 and 4 years old, and one is diabetic and I have to be sure there’s always money for insulin — so I always have to provide. I just can’t not provide.

Something I learned with Hurricane Maria is you have to have a Plan B in life, and it has to be a complete opposite of your Plan A. After the disaster, the whole infrastructure was down and the only people who worked were those who worked with their hands — so I got certified as an electrician. I’m worried right now but, down the line, I have many doors open.

AIRLINES

A Chicago-based flight attendant for United Airlines, Maria Alpogianis, 51, has worked in the field for 25 years.

What is the physical and psychological toll?

I don’t feel I have a sense of job security. I really don’t. I’m flying with several very junior flight attendants who are terrified of losing their jobs and their insurance. I’ve been flying for 25 years and I, too, am afraid that I’m going to be furloughed.

When I leave somewhere I become concerned about not being able to get home because of the border closures. When we land we cringe because we don’t know what’s changed during the time we’ve been in flight.

How the World’s Richest Country Ran Out of a 75-Cent Face Mask

A very American story about capitalism consuming our national preparedness and resiliency.

Why is the United States running out of face masks for medical workers? How does the world’s wealthiest country find itself in such a tragic and avoidable mess? And how long will it take to get enough protective gear, if that’s even possible now?

I’ve spent the last few days digging into these questions, because the shortages of protective gear, particularly face masks, has struck me as one of the more disturbing absurdities in America’s response to this pandemic.

Yes, it would have been nice to have had early, widespread testing for the coronavirus, the strategy South Korea used to contain its outbreak. It would be amazing if we can avoid running out of ventilators and hospital space, the catastrophe that has befallen parts of Italy. But neither matters much — in fact, no significant intervention is possible — if health care workers cannot even come into contact with coronavirus patients without getting sick themselves.

That’s where cheap, disposable face masks, eye protection, gloves and gowns come in. That we failed to procure enough safety gear for medical workers — not to mention for sick people and for the public, as some health experts might have recommended if masks were not in such low supply — seems astoundingly negligent.

What a small, shameful way for a strong nation to falter: For want of a 75-cent face mask, the kingdom was lost.

I am sorry to say that digging into the mask shortage does little to assuage one’s sense of outrage. The answer to why we’re running out of protective gear involves a very American set of capitalist pathologies — the rise and inevitable lure of low-cost overseas manufacturing, and a strategic failure, at the national level and in the health care industry, to consider seriously the cascading vulnerabilities that flowed from the incentives to reduce costs.

Perhaps the only way to address the shortfall now is to recognize that the market is broken, and to have the government step in to immediately spur global and domestic production. President Trump, bizarrely, has so far resisted ordering companies to produce more supplies and equipment. In the case of masks, manufacturers say they are moving mountains to ramp up production, and some large companies are donating millions of masks from their own reserves.

But given the vast global need for masks — in the United States alone, fighting the coronavirus will consume 3.5 billion face masks, according to an estimate by the Department of Health and Human Services — corporate generosity will fall short. People in the mask business say it will take a few months, at a minimum, to significantly expand production.

“We are at full capacity today, and increased production by building another factory or extending further will take anywhere between three to four months,” said Guillaume Laverdure, the chief operating officer of Medicom, a Canadian company that makes masks and other protective equipment in factories around the world.

And though some nontraditional manufacturers like T-shirt factories and other apparel makers have announced plans to rush-produce masks, it’s unclear that they will be able to meet required safety standards or shift over production in time to answer demand.

Few in the protective equipment industry are surprised by the shortages, because they’ve been predicted for years. In 2005, the George W. Bush administration called for the coordination of domestic production and stockpiling of protective gear in preparation for pandemic influenza. In 2006, Congress approved funds to add protective gear to a national strategic stockpile — among other things, the stockpile collected 52 million surgical face masks and 104 million N95 respirator masks.

But about 100 million masks in the stockpile were deployed in 2009 in the fight against the H1N1 flu pandemic, and the government never bothered to replace them. This month, Alex Azar, secretary of health and human services, testified that there are only about 40 million masks in the stockpile — around 1 percent of the projected national need.

As the coronavirus began to spread in China early this year, a global shortage of protective equipment began to look inevitable. But by then it was too late for the American government to do much about the problem. Two decades ago, most hospital protective gear was made domestically. But like much of the rest of the apparel and consumer products business, face mask manufacturing has since shifted nearly entirely overseas. “China is a producer of 80 percent of masks worldwide,” Laverdure said.

Hospitals began to run out of masks for the same reason that supermarkets ran out of toilet paper — because their “just-in-time” supply chains, which call for holding as little inventory as possible to meet demand, are built to optimize efficiency, not resiliency.

“You’re talking about a commodity item,” said Michael J. Alkire, president of Premier, a company that purchases medical supplies for hospitals and health systems. In the supply chain, he said, “by definition, there’s not going to be a lot of redundancy, because everyone wants the low cost.”

In January, the brittle supply chain began to crack under pressure. To deal with its own outbreak, China began to restrict exports of protective equipment. Then other countries did as well — Taiwan, Germany, France and India took steps to stop exports of medical equipment. That left American hospitals to seek more and more masks from fewer and fewer producers.

Trump Pledged to End H.I.V. But His Policies Veer the Other Way.

WASHINGTON — In his State of the Union address, President Trump announced a bold plan to end the scourge of H.I.V. by 2030, a promise that seemed to fly in the face of two years of policies and proposals that go in the opposite direction and could undermine progress against the virus that causes AIDS.

In November, the Trump administration proposed a rule change that would make it more difficult for Medicare beneficiaries to get the medicines that treat H.I.V. infection and prevent the virus from spreading.

Mr. Trump has repeatedly urged Congress to repeal the expansion of Medicaid under the Affordable Care Act, even though Medicaid is the largest source of coverage for people with H.I.V. And he has promoted the sale of short-term health plans that skirt the Affordable Care Act, even though such plans usually exclude people with H.I.V.

To end the spread of the virus, federal health officials say they must reduce the stigma attached to gay men and transgender people who are at high risk so they will seek testing and treatment. But for two years the administration has tried to roll back legal protections for people in those groups.

Those opposing moves by the administration have AIDS activists baffled.

“The president’s announcement comes as a surprise, albeit a welcome surprise,” said Jennifer C. Pizer, the law and policy director at Lambda Legal, a gay rights group. “It represents an about-face on H.I.V. policy.”

The administration describes the plan to end the spread of H.I.V. as one of the most important public health initiatives in history. But the record shows a rather large gap between the administration’s words and deeds.

Since Medicare’s outpatient drug benefit began in 2006, the government has required prescription drug plans to cover “all or substantially all drugs” in six therapeutic classes, including antiretroviral medicines to treat H.I.V.

In November, the Trump administration proposed a new policy to cut costs for Medicare by reducing the number of drugs that must be made available to people with H.I.V.

The proposal would allow certain exceptions to the requirement for Medicare drug plans to cover all drugs in the six “protected classes.”

Insurers could require Medicare beneficiaries to get advance approval, or “prior authorization,” for H.I.V. drugs and could require them to try less expensive medications before using more costly ones, a practice known as step therapy.

People with H.I.V. and doctors have condemned the proposals.

Bruce Packett, the executive director of the American Academy of H.I.V. Medicine, representing doctors who care for H.I.V. patients, said the administration’s proposals “could be catastrophic” for Medicare patients with the virus, as well as for the president’s campaign to end the epidemic.

“At least 25 percent of all people living with H.I.V. who are in care in the United States rely on Medicare as their insurer,” Mr. Packett said.

Those patients are 65 or older or have disabilities and often have other chronic diseases or conditions, so doctors need access to the “full arsenal” of medicines to treat H.I.V., Mr. Packett said.

Many of the Medicare patients with H.I.V. are taking medicines for their other conditions, so doctors have to worry about drug interactions, Mr. Packett said. In addition, he said, some have drug-resistant strains of H.I.V., and different patients often respond to the same drug in different ways.

“It’s important that providers have access to all the available options” among drugs to treat H.I.V., he said.

Requirements for prior authorization and similar restrictions can delay the start of treatment. Studies show that a rapid start to therapy, within a week or even a day of diagnosis, produces better results for patients and reduces the likelihood that they will infect others while waiting for treatment.

READ MORE: https://www.nytimes.com/2019/02/12/us/politics/trump-hiv-plan.html


Crystal Meth Is North Korea’s Trendiest Lunar New Year’s Gift

HONG KONG — Like many across East Asia, North Koreans have been exchanging presents this month to celebrate the Lunar New Year. But rather than tea, sweets or clothing, some in this impoverished, isolated country are giving the gift of crystal meth.

The gifting and use of methamphetamine, a powerful stimulant that has been blamed in health and addiction crises around the world, is said to be a well-established custom in North Korea. Users are said to inject or snort the drug as casually as they might smoke a cigarette, with little awareness of its addictive qualities or destructive effects.

“Meth, until recently, has been largely seen inside North Korea as a kind of very powerful energy drug — something like Red Bull, amplified,” said Andrei Lankov, an expert on the North at Kookmin University in Seoul, South Korea, who directs the news site NK News. That misconception, he said, highlighted a “significant underestimation” within the country of the general risks of drug abuse.

Methamphetamine was introduced to the Korean Peninsula during the Japanese colonial period, in the early 20th century, and defectors have reported that the North Korean military provided methamphetamine to its soldiers in the years after World War II. Since the 1970s, many North Korean diplomats have been arrested abroad for drug smuggling.

In the 1990s, the North’s cash-poor government began manufacturing meth for export, about two decades after it began sponsoring local opium cultivation and the production of opiates, according to a 2014 study by Sheena Chestnut Greitens, a University of Missouri political scientist. Finished meth was typically sent across the northern border into China, or handed off at sea to criminal organizations like Chinese triads or the Japanese yakuza.

But around the mid-2000s, meth production that was “clearly sponsored and controlled” by the government began to decline, the study said. That left a surplus of people with the skills to manufacture meth, many of whom created small-scale meth labs and began selling to the local market.

Amid a chronic lack of health care supplies and medical treatments in North Korea, many people take opiates and amphetamine-type stimulants as perceived medicinal alternatives, Ms. Greitens, the political scientist, said in an email. “Methamphetamine is highly addictive, so it’s easy for casual users to develop more dependence and addiction over relatively short amounts of time,” she said.

The drug’s popularity in North Korea as a Lunar New Year gift was first reported last week by Radio Free Asia, a United States government-funded news outlet. Radio Free Asia quoted several anonymous sources as saying that the custom was especially popular among the country’s young people.

The Radio Free Asia report could not be independently verified, and the North Korean government has long denied that its citizens use or produce methamphetamine. “The illegal use, trafficking and production of drugs which reduce human being into mental cripples do not exist in the D.P.R.K.,” the North’s state-run news agency said in 2013, referring to the initials of the country’s formal name, the Democratic People’s Republic of Korea.

READ MORE: https://www.nytimes.com/2019/02/12/world/asia/north-korea-crystal-meth-methamphetamine-drugs-.html

The Reasonable Way to View Marijuana’s Risks

Cannabis has downsides, but speculation and fear should be replaced with the best evidence available.

Are we underestimating the harms of legalizing marijuana?

Those who hold this view have been in the news recently, saying that research shows we are moving too far too fast without understanding the damage.

America is in the midst of a sea change in policies on pot, and we should all be a bit nervous about unintended consequences.

Vigilance is required. But it should be reasoned and thoughtful. To tackle recent claims, we should use the best methods and evidence as a starting point.

Crime has gone up in Colorado and Washington since those states legalized marijuana. It’s reasonable to wonder about the connection, but it’s also reasonable to be skeptical about causation.

The best method to investigate this may be synthetic controls. Researchers can use a weighted combination of similar groups (states that are like Colorado and Washington in a number of ways) to create a model of how those states might have been expected to perform with respect to crime without any changes in marijuana laws. Benjamin Hansen, a professor of economics at the University of Oregon, used this methodology to create a comparison group that most closely resembled the homicide trends and levels from 2000-12.

“I picked those years because they were after the tremendous crime drop in the early ’90s and most predictive of crime today,” he said. “I ended in 2012 because that’s when Colorado and Washington voted to legalize marijuana.”

This model showed that we might have predicted more of an increasein Colorado or Washington just based on trends seen in comparable states, even without legalization. When he compared the two states with the synthetic control, Colorado and Washington actually had lower rates after legalization than you’d expect given trends.

This is not evidence that legalization lowers crime rates. But it does suggest that we shouldn’t conclude that it increases them. A number of other studies agree.

A potential misperception involves automobile crashes. Drunken drivers are measurably impaired when their blood alcohol level is above a certain level. We can prove this in randomized controlled trials.

READ MORE: https://www.nytimes.com/2019/01/14/upshot/the-reasonable-way-to-view-marijuanas-risks.html

How to Take Charge of Your Medical Care

Screen Shot 2018-11-13 at 4.34.13 AMWalking into a doctor’s office or hospital can be intimidating. But when you go armed with the right tools and frame of mind, you can walk out of that appointment or hospital stay feeling more confident and satisfied. Learn how to ask your questions, either for yourself or a loved one, figure out your various medical options and determine the best course of action. Just having that knowledge in your pocket can help you feel better.

When You’re Healthy

It can be hard to think about dealing with a medical emergency when you are well, but the things you do now can really pay off later.

Screen Shot 2018-11-13 at 4.39.05 AM

Get Your Paperwork in Order

As much as we don’t want to think about the end of our own lives, it’s a good idea to get a head start while you’re still relatively young and in good health. Don’t just assume your partner or family can read your mind about whether or not you’d want to be put on a feeding tube or be resuscitated if something went wrong. Yes, that means having an advance care directive on hand. This also means appointing a proxy granting him or her power-of-attorney to make your medical decisions if you’re not able to do so.

If you are fortunate enough to have some form of health insurance, always have your current policy information handy and organized in case you need it. In fact, keep it in an easily accessible folder, along with an updated list of all the medications you’re taking — prescribed, over-the-counter and supplements — and a record of your personal and family medical history. Regardless of whether you’re going to see your general practitioner about a viral infection or end up in the E.R. with a broken foot, you’re going to be asked about your medical history, so it’s best to come with as much detail as possible.

Know Your Rights

In the United States, we have various sources setting forth our rights as patients. HIPAA, for example, guarantees on a federal level a patient’s right to get a copy of his medical records, as well as the right to keep them private. There is also the Patient’s Bill of Rights that is part of the Affordable Care Act, though it primarily deals with insurance-specific rights, rather than general health care. Some states, like New York, do have a Patients’ Bill of Rights which grants additional protections, like receiving an itemized bill and explanation of all charges, as well as a right to get emergency care if you need it, meaning that hospitals are not permitted  to turn away a patient requiring emergency care, regardless of where they live and regardless of whether they can pay the bill. In addition, some organizations, like the American Hospital Association, have their own guidelines outlining the rights of patients.

All patients also have the right of informed consent, meaning that if you require any sort of treatment or procedure, your physician should explain what will happen to you in a way you understand, which allows you to make an educated decision. Being familiar with informed consent before needing medical treatment can help you achieve the best outcome possible.

Schedule Regular Appointments

It’s important to stay on top of your health, so schedule regular check-ups to ensure everything is in working order. If you live somewhere with numerous options for medical care, you’ll have the task of finding and then selecting a doctor who best serves your needs. This is true when dealing with your physical as well as a mental health. Once you’re at the appointment, make the most of your time with your doctor, by asking any questions you may have about your body and health, and requesting a full blood test workup.