Over 3.1 million coronavirus cases have now been confirmed in the U.S. and the death toll is over 135,000. By Election Day, that number could be greater than 250,000, according to a new projection. The country set another record for new coronavirus cases this week with more than 60,000 infections announced.  It was the fifth national record set in nine days.  South Carolina, Florida, and Texas continue to be hot-spots in the latest surge. South Carolina averages over 1500 cases per day.  More than 5,000 South Carolinians will die as a result of COVID-19.

Wear a mask!

In Oklahoma, voters passed a measure expanding Medicaid to nearly 200,000 low-income adults after the state’s Republican governor declined to do so. That makes Oklahoma the fifth state to overrule its Republican executive and embrace a key element of the Affordable Care Act.  Most Republicans in Congress now represent states that have accepted the Medicaid expansion.

June saw more than 800,000 new coronavirus cases, bringing the total number of cases in the United States to more than 2.6 million.  The administration’s failure to “adequately prepare for the COVID-19 pandemic” and its “delayed and disorganized response” contributed to the pandemic’s deadly impact in nursing homes, according to a Senate report.  The running tally shows that nationwide more than 60,000 residents and staff have died from coronavirus outbreaks at nursing homes and other long-term care facilities as well.

The senators also accused the administration of not providing timely, complete and accessible COVID-19 case and death data for nursing homes. And the administration did not implement a national testing strategy and was too late in providing guidance on how to conduct new infection control oversight measures at facilities, the report said.

They issued a series of recommendations, which include providing PPE and testing to nursing home workers, ensuring adequate data collection, and giving workers sufficient pay and benefits. The lawmakers also called on the Centers for Medicare & Medicaid Services and Federal Emergency Management Agency to improve emergency management and infection control practices in nursing homes.

Urgent action is needed to address the tragedy that continues to unfold in nursing homes,” authors said.

Despite the pandemic spreading, the Trump administration is still trying to undo ObamaCare. Trump submitted a legal argument last week demanding the Supreme Court to throw out the law.  And Fourth of July gatherings have the potential to make a bad situation worse.

McKnight’s allowed CMS to defend themselves against nursing home industry attacks.  They included the following:

In March 2019, CMS updated training in infection prevention for nursing homes.

In November 2019, CMS reminded nursing homes of the infection prevention requirements, and disseminated an infection control self-assessment tool.

Then, on February 6, 2020 in preparation for COVID-19 spread in the U.S., CMS reissued long-standing infection control guidance. Following our Feb. 6, 2020, guidance, we called for screening of staff and visitors, followed soon thereafter by a complete restriction of nonessential visitors and staff. All of this guidance, created in coordination with the CDC and based on the latest information, helped approximately 80% of nursing homes prevent the spread of COVID-19.

CMS also provided nursing homes with infection control training for frontline staff.

The infection control practices CMS reemphasized for nursing homes were not new; they have been part of CMS’s regulatory expectations for years. In fact, two years ago, CMS urgently alerted the nursing home industry that they “have to do better on infection control,” a message that was carried in this very periodical. Infection control — including basic violations like a lack of handwashing — was the number one violation.

Since the beginning of the COVID-19 pandemic, CMS has kept up a steady drumbeat of guidance and recommendations to nursing homes and other kinds of healthcare providers based on CDC and CMS COVID-19 investigations and surveys.

At the same time, we also know that when nursing homes have a history of infection control violations, they are at higher risk of the spread of infectious diseases like COVID-19. Therefore, we’ve decided to hold nursing homes more accountable for the kinds of infection control violations that can help infectious diseases like COVID-19 spread. Given that these requirements are longstanding, there is simply no excuse for continued noncompliance. 

More than any other institution in America, nursing homes have come to symbolize the deadly destruction of the coronavirus crisis. More than 55,000 residents and employees of nursing homes and long-term care facilities have died, representing more than 40 percent of the total death toll in the United States.  They are taking on coronavirus-stricken patients to bolster their bottom lines.

The New York Times recently reported on the nursing home industry kicking out old and disabled residents including veterans, and sending them to homeless shelters, assisted living facilities, and rundown motels according to 22 watchdogs in 16 states, as well as dozens of elder-care lawyers, social workers and former nursing home executives. The New York Times contacted more than 80 state-funded nursing-home ombudsmen in 46 states for a tally of involuntary discharges during the pandemic at facilities they monitor. Twenty six ombudsmen, from 18 states, provided figures to The Times: a total of more than 6,400 discharges, many to homeless shelters.

The corporate bean counters have figured out how they can profit from COVID-19.  Nursing home employees even informed journalists that staff are being told to clear out less-profitable residents to make room for a new class of customers who would generate more revenue: patients with Covid-19.  Covid-19 patients can bring in at least $600 more a day in Medicare dollars than people with relatively mild health issues, according to nursing home executives and state officials.

Most of the evictions, known as involuntary discharges, violate federal rules that require nursing homes to place residents in safe locations and to provide them with at least 30 days’ notice before forcing them to leave. Fifteen state-funded ombudsmen said in interviews that some homes appear to be taking advantage of that void to evict vulnerable residents.

Nursing homes have long had a financial incentive to evict Medicaid patients in favor of those who pay through private insurance or Medicare, which reimburses nursing homes at a much higher rate than Medicaid. More than 10,000 residents and their families complained to watchdogs about being discharged in 2018, the most recent year for which data are available.

Nursing homes are allowed to evict residents only if they aren’t able to pay for their care, are endangering others in the facility or have sufficiently recovered. Under federal law, before discharging patients, nursing homes are required to give formal notice to the resident and to the ombudsman’s office. They must also find a safe alternative location for the resident to go, whether that is an assisted living facility, an apartment or, in rare circumstances, a homeless shelter.

Anne Schuchat, director of the Centers for Disease Control (the CDC) said that the virus is spreading too fast and too far for the United States to bring it under control. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, testified he was “very concerned.” “We’re going in the wrong direction if you look at the curves of the new cases,” he said, “so we really have got to do something about that and we need to do it quickly.”  Faci warns we may see 100,000 new cases per day.

The country is now seeing more than 50,000 new infections a day while the European Union is seeing fewer than 6,000. The South Carolina Department of Health and Environmental Control reported that there has been a 413.6% increase in newly reported coronavirus cases in South Carolinian’s aged 21-30 since April 4. DHEC reports a 966.1% increase for aged 11-20.

South Carolina has had record setting days for over a week now.  Official Covid-19 death counts in the United States underestimate the fatalities linked to the pandemic, according to a new study published in the journal JAMA Internal Medicine which found that the number of “excess deaths” that have occurred so far during the pandemic, between March and May, is 28% higher than the nation’s official number of deaths attributed to Covid-19.

“The gap between reported COVID-19 deaths and excess deaths can be influenced by several factors, including the intensity of testing; guidelines on the recording of deaths that are suspected to be related to COVID-19 but do not have a laboratory confirmation; and the location of death,” the researchers wrote in the study.

Meanwhile Nero tweets about Confederate Monuments as the country burns: “This is a battle to save the Heritage, History, and Greatness of our Country,” Trump tweeted. A senior campaign official told the Washington Post, “It’s a great political issue for the president.”

Kaiser Health News had an article about Summit Hills, an assisted living facility in my hometown of Spartanburg, S.C.  The article explains the difficulty of preventing and containing the coronavirus when some people believe it is a hoax.  Since the start of the pandemic, the public has been barraged by conflicting messages in part because some politicians and scientists deliver conflicting advice. That is particularly true in the United States, where the coronavirus has somehow morphed into a right-wing political issue — and Americans increasingly reject information that doesn’t match their leanings.  Rumors, misinformation and outright falsehoods — some intentionally propagated — have flourished in the vacuum of leadership.

The article uses Administrator Regina Fargis who operates Summit Hills.  She took obvious precautions: no visitors, hand sanitizer everywhere and regular reminders for residents about the importance of social distancing. Summit Hills remained COVID-free until mid-June. Three residents and four employees have now tested positive and are being quarantined.

By mid-May, two residents had become convinced that the COVID-19 death count — which has surpassed 130,000 people in the U.S. — was a hoax manufactured by the media and Democrats. Some people may be dying, they said, but it wasn’t actually that severe. They didn’t think her precautions were necessary.

I don’t know how to respond, to tell you the truth,” Fargis said. “If someone has that kind of mindset, what kind of conversation do you have” to convince them of the pandemic’s severity and the need for strict precautions?

The misinformation includes the “Plandemic” video, Facebook posts claiming 5G cell networks cause the virus and articles suggesting it can be cured with garlic or using a combination of hot water with baking soda and lemon.

Research shows people who support Trump and rely on Fox News are more likely to believe the virus has been exaggerated. Republicans are more likely than Democrats to think that COVID-19 was never a threat and that the worst is over. That contributed to the push for early reopening in some states that had not met the requirements recommended by the Centers for Disease Control and Prevention for doing so. And Republicans are less likely than Democrats to don protective masks, which are believed to reduce the spread of the virus. (President Donald Trump famously has refused to wear a mask in public.) Now daily case counts are spiking.

In fact, political figures like Trump have held outsize influence in shaping public understanding. “The news feed abhors a vacuum,” said Jeff Hancock, a professor of communication at Stanford University who has studied the implications of COVID misinformation.  Misinformation spread by political figures and celebrities made up only 20% of the sample but accounted for 69% of engagement.

At Summit Hills, the politicization of COVID-19 has “without a doubt” made it harder for Fargis, its executive director, to convince her residents — many of whom would typically look to the federal government for credible information — of the pandemic’s severity.

When South Carolina began opening up, Fargis decided to see if the numbers of new COVID-19 cases declined significantly before lifting precautions. Now, with the virus in her facility, she has no intention of letting up social distancing rules and other prevention strategies.

And since May, at least one of her residents has since come around to understanding the pandemic’s severity. But another, she said, still emails her arguing that the virus has been overblown or that social distancing does not work and suggesting that unproven medicines — like hydroxychloroquine or beta-glucans — can treat or prevent the illness.

We’d all be far better off if we kept those nonsensical remarks out of the news,” she said. “The more misinformation we have, the more likely we are going to have lives at stake.”

With the White House narrative at odds with facts and data, health experts including Dr. Deborah Birx and Dr. Anthony Fauci have been silenced. Dr. Jonathan Reiner, a professor of medicine at George Washington University, told CNN it’s because “they tell the truth. And the truth is that the pandemic is still very, very active in the United States and that we’re not getting back to normal and there are difficult things that the public has to do,” Reiner said.
Fauci recently warned in an episode of the US Department of Health and Human Services’ podcast “Learning Curve” about an “anti-science bias” contributing to case spikes in the country.
One of the problems we face in the United States is that unfortunately, there is a combination of an anti-science bias that people are — for reasons that sometimes are, you know, inconceivable and not understandable — they just don’t believe science and they don’t believe authority.”  I wonder who he is talking about?
“So when they see someone up in the White House, which has an air of authority to it, who’s talking about science, that there are some people who just don’t believe that — and that’s unfortunate because, you know, science is truth.”
“We’ve never finished the first wave,” Hotez, dean of the National School of Tropical Medicine, said of spikes in new cases in South Carolina, Florida, Texas and Arizona. “We didn’t complete that social distancing period that we needed to do.”
Models showed states needed to extend stay-at-home orders through May, according to Hotez.
“Things opened up prematurely,” he said.