Mulvaney: “We still have a testing problem in this country”

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USA Today allowed Trump’s toady and former chief of staff criticize the country’s coronavirus testing. Trump has frequently boasted about the United States’ testing capabilities compared to other countries. He has wrongly and repeatedly attributed a rise in coronavirus cases to expanded testing, even though the surges in cases in hard-hit states exceed the increases in testing and hospitals are facing growing strains.

Mulvaney, who was previously a Republican congressman representing South Carolina, wrote that rather than focusing on giving Americans another round of stimulus checks, future legislation from Congress should aim to address the public health crisis. The reason people aren’t traveling and going on vacations is not necessarily because they lack the funds to do so, Mulvaney wrote, but because they are afraid of the health consequences.

“I know it isn’t popular to talk about in some Republican circles, but we still have a testing problem in this country,” Mick Mulvaney, who is currently the U.S.’ special envoy to Northern Ireland, wrote in an op-ed for CNBC.

Mulvaney described his family’s efforts to get tested for the coronavirus, noting that they had to wait up to a week to receive his son’s results, while being told his daughter didn’t meet the criteria for receiving a test, even though she was planning on visiting her grandparents.

“That is simply inexcusable at this point in the pandemic,” Mulvaney said.

Asked about Mulvaney’s stance that testing was still an issue, White House press secretary Kayleigh McEnany said at a news briefing that the U.S. is “doing a pretty good job” on testing. She is delusional.

Delay in Reporting Deaths

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Last month, 50,000 new coronavirus cases per day seemed like an alarming milestone. We are now averaging 70,000 per day according to data tracked by The Washington Post.  South Carolina, Nebraska, Utah and Oregon each broke their previous single-day records, pushing the total number of infections detected nationwide past 3.6 million.

Gov. Brian Kemp of Georgia actually filed a frivolous lawsuit to block the mayor of Atlanta from requiring masks inside city limits. As Republicans lawmakers mock face-covering mandates, and fights over school reopening plans intensified throughout the country, the U.S. had 77,300 new confirmed cases yesterday and the death toll has surpassed 140,000.  The South Carolina Department of Health and Environmental Control announced almost 2,000 new confirmed cases and at least 69 newly-reported deaths pushing South Carolina over the thousand confirmed deaths caused by COVID-19.

This chart shows COVID-19 deaths in South Carolina by the date the person actually died.

The COVID-19 prevention strategies of social distancing, face coverings and handwashing will curb the spread of the coronavirus, the head of the Centers for Disease Control and Prevention said.

“If we all did that for four, six, eight, 10, 12 weeks, the COVID outbreak in the United States would really be brought to its knees,” Robert Redfield, M.D., CDC director told McKnight’s Thursday. Unfortunately, Republican politicians refuse to allow safe practices.

Previously public data has already disappeared from the Centers for Disease Control and Prevention’s website after the Trump administration suspiciously shifted control of the information to the Department of Health and Human Services. The CDC regularly published data on availability of hospital beds and intensive care units across the country. But Ryan Panchadsaram, who helps run a data-tracking site called Covid Exit Strategy, said that when he tried to collect the data from the CDC this week, it had suddenly disappeared.

“Poor staffing…was the gasoline to COVID-19’s match.” 

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Consumer advocates and industry experts call for the federal government to address inadequate staffing at nursing homes and long-term care facilities in wake of the coronavirus pandemic and its fatal toll on residents and workers. The pandemic’s toll on nursing homes is a “deadly consequence” of inadequate staffing levels and lax infection control practices, according to Toby Edelman, senior policy attorney for the Center for Medicare Advocacy. She added that CMS must establish and enforce stronger oversight measures.

“The coronavirus pandemic has made all too visible the lethal consequences of poor care and no oversight. We can and must learn from what has gone wrong, and do better in the future,” Edelman said.

“The issues that COVID-19 exploited are not highly technical or complex. They are basic issues of training and adequate staffing,” testified Nicole Howell, executive director for Ombudsman Services of Contra Costa and Solano Counties. “Poor staffing in long-term care facilities was the gasoline to COVID-19’s match.” 

Howell also explained that “within the long-term care industry, direct care workers on average earn only $1 to $2 more per hour over state minimum wage, forcing these dedicated people to work 60 to 80 hours per week at multiple locations.”

“Meaning you can have a caregiver that works at one facility where there are active COVID-19 infections who are forced to work at a second location and may transmit the virus to residents,” she added.

David Grabowski, Ph.D., Harvard professor and healthcare policy expert, also stressed the need for providing more resources, such as better wages and more personal protective equipment, to address staffing shortages.

“Staff are frightened given the lack of COVID testing and PPE, and for good reason,” he said. “New federal COVID data suggests that over 500 staff nationally have died from COVID — making nursing home caregiver the most dangerous job right now in America, with a higher death rate than logging workers and commercial fisherman.”

He also emphasized the need for regular testing in nursing facilities and called on the federal government to develop a consistent testing and PPE policies nationwide, and provide resources for facilities to meet those standards.

“Until we get rapid and accurate testing for all staff and residents, we won’t be able to contain COVID. Rather than pushing the logistics and costs of testing and PPE to states and nursing homes, the federal government needs to take ownership of this issue,” Grabowski said.

“If we had testing and PPE in place, we would be able to move safely towards opening nursing homes again to family members,” he added.

Safe Staffing in Rhode Island

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Nursing home lobbyists are trying to trick Rhode Island legislators and citizens that requiring safe staffing at nursing homes will cause the world to collapse and everyone will go bankrupt.  Ridiculous.  Plenty of nursing homes provide staffing higher than what Rhode Island is suggesting as a minimum standard.

The proposed legislation would raise the state’s minimum staffing requirements. The minimum staffing legislation, sponsored by Rep. Scott Slater, requires nursing homes to provide 4.1 hours of direct care daily to each resident. Numerous article have made it clear that 4.1 is the minimum safe staffing for nursing home residents. It would also increase staff pay to a living wage at $15 per hour.

Scott Fraser, president of the Rhode Island Health Care Association, complained without evidence that the minimum safe staffing bill is “unrealistic” and would put many of the state’s nursing homes out of business. “There is no way homes can comply with the provisions of this bill and stay in business. It really is that simple.”

Right now, Rhode Island nursing homes provide an average of 3.6 hours of direct care to each resident, according to the U.S. Centers for Medicare and Medicaid Services. Attorney General Peter Neronha is among those who support the legislation, arguing that Rhode Island “is one of only a handful of states not to have a nursing home staffing standard.”

“Consequently, our state ranks near the bottom of the national average for hours of care provided to nursing home residents,” Neronha testified. “Many falls, infections and other injuries can be prevented by ensuring that health care workers are spending the time we know nursing home residents need to be safe and well cared for.”

CMS Covering for Industry Failures

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The L.A. Times reported on a story that perfectly exemplifies why safe oversight of nursing homes is necessary for good quality of care. Elder-care advocates said the lack of enforcement shows that state regulators abdicated their primary responsibility to police nursing homes at a critical moment. The article discusses how Magnolia Rehabilitation and Nursing Center received a report with “No deficiencies” the day before poor infection controls, short-staffing, and inadequate supplies caused a significant COVID outbreak.

The day after the “inspection”, April 8, a fleet of ambulances lined up outside Magnolia to evacuate all 83 residents after the staff refused to show up for work, terrified of the deadly infection already spreading within the facility. Similar scenarios played out across the country this past Spring, survey records show. Time and again, inspectors sent to assess nursing homes’ ability to prevent or contain the virus found no deficiencies at facilities in the midst of deadly outbreaks or about to suffer one.

At Hollywood Premier Healthcare in Los Angeles, inspectors found the facility to be in compliance on March 30. Three days later, the home had 68 confirmed cases, county records show.

State officials conducted five surveys this spring at Kingston Healthcare Center in Bakersfield, which is on a federal shortlist of the worst nursing homes in the country. Each time, the surveyors found the home in compliance with infection control protocols, even as the virus would eventually spread to 158 residents and staff, killing 21.

California Department of Public Health inspectors carried out more than 1,700 “COVID Focused Surveys” at skilled nursing facilities since late March and had issued just 14 infection control citations as a result of those visits.

The refusal or failure of the inspections to identify problems is just the latest indication of how the industry and regulators were unprepared for the coronavirus and failed to act quickly to slow its spread. Nursing homes lacked basic supplies when COVID-19 began sweeping through the facilities.

CMS said more than 5,700 COVID Focused Surveys were completed nationwide. They described the program as “part of the Trump Administration’s historic transparency efforts to ensure residents, families and the general public have information about COVID-19 in nursing homes.” But the Center for Medicare Advocacy, a nonprofit nonpartisan group noted that only 163 of the surveys — less than 3% — had cited any problems with infection control.

With tens of thousands of nursing home residents and staff already dead from the virus, “it is simply not plausible that facilities have no problems in their infection prevention and control practices,” said Toby Edelman, the center’s senior policy attorney.

CDC v. Trump

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The number of new cases reported in Florida alone over the past week outstrips the total count in most European nations.  You know, the ones with “socialized” medicine.  But it is not just Florida, Arizona, Texas, and South Carolina. States including Oklahoma, Alabama, and Nevada are reporting record numbers of new coronavirus cases, hospitalizations and deaths, according to data tracked by The Washington Post.

We are now averaging more than 60,000 new confirmed cases per day nationwide pushing the total count since the pandemic began past 3.5 million.  Because cloth face coverings can also allow states to more safely ease stay-at-home orders and business closings, Robert Redfield, director of the Centers for Disease Control and Prevention told a JAMA Live webcast Tuesday, “If we could get everybody to wear a mask right now, I really think in the next four, six, eight weeks, we could bring this epidemic under control.”

“Like herd immunity with vaccines, the more individuals wear cloth face coverings in public places where they may be close together, the more the entire community is protected,” Redfield wrote in the Journal of the American Medical Association. President Trump wore a mask in public for the first time last weekend, nearly three months after the CDC issued guidance recommending the use of face coverings when social distancing isn’t possible.

Meanwhile, the Trump administration has ordered hospitals to bypass the Centers for Disease Control and Prevention and send all Covid-19 patient information to Washington. The move has alarmed health experts who fear the data will be politicized or withheld from the public.

History Repeating Itself

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The Atlantic had a great article explaining how America is back to making the same mistakes we made in March when we ignored science and the warnings of experts on how to stop the spread of coronavirus. Nursing homes were ill-equipped, both literally and figuratively, to deal with the pandemic, and federal and state governments took a hands-off approach until it was too late. The lack of government leadership and coordination has led to poor and delayed data collection on deaths and infections in nursing homes. CMS did not even require facilities to report coronavirus infections and deaths that occurred prior to May 8, even though the first nursing-home outbreak began in February.

The article mentions Melvin Hector, a geriatrician in Tucson, Arizona, who went into Sapphire of Tucson Nursing and Rehabilitation and found his patient in her room, wearing a surgical mask. She had been tested for COVID-19, but the results had not yet come back. When Hector asked for a mask for himself, he says a nurse responded, “We don’t have any.”

“I say to her, ‘You’re going into the room; the other staff are going in the room. She just went out to the hospital for a respiratory disease. And we don’t have any masks in the building?’” Hector recalled in a recent interview.

“They’re on order,” Hector remembered the nurse replying.

Sapphire ended their working relationship after Hector reported the situation to the Arizona Department of Health Services. Sapphire claimed that it had never suffered shortages of personal protective equipment, or PPE. In response to Sapphire’s statement, Hector said, “They lie.”

To Hector, the episode was a microcosm of the reasons why the United States has suffered so many COVID-19 deaths among nursing-home staff and residents. “Arizona is just one manifestation of a nationwide policy, an administrative policy to ignore this pandemic until it couldn’t be ignored,” Hector told me.

More COVID-19 deaths in nursing homes are likely, and they will have been preventable. American nursing homes are chronically short-staffed and, even prior to the pandemic, were doing a poor job of controlling infections. A Government Accountability Office report published in May found that more than 80 percent of nursing homes were cited for infection-prevention deficiencies from 2013 to 2017. About half of those homes had “persistent problems and were cited across multiple years.”

Adding to the challenge is that it’s not clear whose problem the nursing-home shortcomings are. Considering CMS is tasked with nursing-home safety, if the agency doesn’t “have enough resources, they should be going to Congress and demanding those resources,” Andy Slavitt, the former acting administrator of CMS under President Barack Obama, told me.

In response to a request for comment, CMS said that although the agency does oversee facilities, nursing homes are themselves responsible for the health of residents and should work with state governments to procure PPE. Authorities kept these facilities strapped for masks, tests, and other desperately needed equipment. The tragedy of even more nursing-home deaths will be worsened by the fact that they could have been stopped. Nursing-home covid-19 deaths may seem inevitable but according to interviews with dozens of nursing-home experts, it didn’t have to be this way. For example, some nursing homes in this country and other places have remained coronavirus-free.

Many nursing homes have likewise succeeded at keeping out the coronavirus. The Maryland Baptist Aged Home, a facility in Baltimore, avoided having any coronavirus cases. Its director, Derrick DeWitt, told me that in February, when the U.S. had just 15 known cases, he paused family visits and community meals, sent vendors and delivery drivers to a separate entrance, and brought in extra cleaning crews. The staff was trained on social distancing, screened regularly for their temperature and symptoms, and asked about their social activities. DeWitt, following the guidance of Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, and New York Governor Andrew Cuomo, said he ordered extra masks early, before they began to run out.

The federal government and nursing home industry could have learned from their previous failures on nursing homes. As COVID-19 ravaged care facilities along the East Coast all spring, officials in southern states, where infections are currently spiking, had months to prepare but they wasted that precious time seeking bailouts and immunity instead.

Essential Visitors?

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We have so many clients complaining abut not being able to see their loved ones in local nursing homes.  Hopefully, that will change soon. Consumer advocates and other experts are pushing long-term care facilities to reconsider their restrictive visitation policies which prevents families from knowing what is going on inside the facility.

“Keeping the doors shut is harmful to the health of residents. Good policy demands more nuanced thinking about how some visitors contribute to their safety,” health care policy expert and Harvard professor David Grabowski, Ph.D., University of Pennsylvania physician Jason Karlawish, MD, and law professor Allison Koffman, argued in an op-ed published in the Washington Post on Monday.

However, most nursing homes cannot meet The Centers for Medicare & Medicaid Services released guidelines that called on nursing homes to meet testing and infection control standards before allowing visitors. Facilities could stagger visits, limiting where they can be  and require them to submit to testing, temperature checks and wearing masks.

“The harm of keeping essential care partners out can itself be a great threat to well-being, as many families have learned,” they wrote. “The risks of visits can be minimized in these controlled situations, as we know more now about the spread of COVID-19. And family and friends will likely be the most vigilant of anyone in protecting their loved ones from exposure.”

Multisystem Inflammatory Syndrome in Children (MIS-C)

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My hometown of Spartanburg County has reported hundreds of new cases of COVID-19 this past wee, bringing the total to over 3,000. Statewide, DHEC announced the total number of confirmed cases approaching 60,000 with over a thousand confirmed deaths.

Meanwhile, DHEC announced the state’s first confirmed cases of Multisystem Inflammatory Syndrome in Children (MIS-C) caused by COVID-19. MIS-C is a rare health condition which occurs in some children and teenagers who have contracted COVID-19 or been in contact with someone infected with the virus. Symptoms of MIS-C include fever, abdominal pain, vomiting, diarrhea, neck pain, rash, bloodshot eyes, and feeling tired. Emergency warning signs of MIS-C include trouble breathing, chest pain or pressure that does not go away, confusion, inability to wake or stay awake, bluish lips or face, and severe abdominal pain.

“We continue to see more and more young people, especially those under 20, contracting and spreading COVID-19, and we know MIS-C is a threat to our youngest South Carolinians,” State Epidemiologist Dr. Linda Bell said in a statement.

“MIS-C is a serious health complication linked to COVID-19 and is all the more reason why we must stop the spread of this virus. Anyone and everyone is susceptible to COVID-19 as well as additional health risks associated with it, which is why all of us must stop the virus by wearing a mask and stay six feet away from others. These simple actions are how we protect ourselves and others, including our children.”