A large nationwide study has found important differences in the two major ways in which children have become seriously ill from the coronavirus, findings that may help doctors and parents better recognize the conditions and understand more about the children at risk for each one.
The study, published on Wednesday in the journal JAMA, analyzed 1,116 cases of young people who were treated at 66 hospitals in 31 states. Slightly more than half the patients had acute Covid-19, the predominantly lung-related illness that afflicts most adults who get sick from the virus, while 539 patients had the inflammatory syndrome that has erupted in some children weeks after they have had a typically mild initial infection.
The researchers found some similarities, but also significant differences in the symptoms and characteristics of the patients, who ranged from infants to 20-year-olds and were hospitalized last year between March 15 and October 31.
Young people with the syndrome, called Multisystem Inflammatory Syndrome in Children or MIS-C, were more likely to be between 6 and 12 years of age, while more than 80 percent of the patients with acute Covid-19 were either younger than 6 or older than 12.
More than two-thirds of patients with either condition were Black or Hispanic, which experts say most likely reflects socioeconomic and other factors that have disproportionately exposed some communities to the virus.
Its still shocking that the overwhelming majority of the patients are nonwhite and that is true for MIS-C and for acute Covid, said Dr. Jean A. Ballweg, medical director of pediatric heart transplant and advanced heart failure at Childrens Hospital & Medical Center in Omaha, who was not involved in the study. Theres clearly racial disparity there.
For reasons that are unclear, while Hispanic young people seemed equally likely to be at risk for both conditions, Black children appeared to be at greater risk for developing the inflammatory syndrome than the acute illness, said Dr. Adrienne Randolph, the senior author of the study and a pediatric critical care specialist at Boston Childrens Hospital.
One potential clue mentioned by the authors is that with Kawasaki disease, a rare childhood inflammatory syndrome that has similarities with some aspects of MIS-C, Black children appear to have greater frequency of heart abnormalities and are less responsive to one of the standard treatments: intravenous immunoglobulin.
The researchers found that young people with the inflammatory syndrome were significantly more likely to have had no underlying medical conditions than those with acute Covid. Still, more than a third of patients with acute Covid had no previous medical condition. Its not like previously healthy kids are completely scot-free here, Dr. Randolph said.
The study evaluated obesity separately from other underlying health conditions and only in patients who were age 2 or older, finding that a somewhat higher percentage of the young people with acute Covid had obesity.
Feb. 25, 2021, 7:19 p.m. ET
Dr. Srinivas Murthy, an associate professor of pediatrics at the University of British Columbia, who was not involved in the study, said he was not convinced that the findings established that healthy children were at higher risk for MIS-C. It could be mostly a numbers game, with the proportion of kids infected and the proportion of healthy kids out there, rather than saying that theres something immune in healthy kids that puts them at a disproportionately higher risk, he said.
Overall, he said, the studys documentation of the differences between the two conditions was useful, especially because it reflected a reasonably representative set of hospitals across the U.S.
Young people with the inflammatory syndrome were more likely to need to be treated in intensive care units. Their symptoms were much more likely to include gastrointestinal problems and inflammation and to involve the skin and mucous membranes. They were also much more likely to have heart-related issues, although many of the acute Covid patients did not receive detailed cardiac assessments, the study noted.
Roughly the same large proportion of patients with each condition more than half needed respiratory support, with slightly less than a third of those needing mechanical ventilation. Roughly the same small number of patients in each group died: 10 with MIS-C and eight with acute Covid-19.
The data does not reflect a recent surge in cases of the inflammatory syndrome that followed a rise in overall Covid-19 infections across the country during the winter holiday season. Some hospitals have reported that there have been a greater number of seriously ill MIS-C patients in the current wave compared with previous waves.
I am going to be fascinated to see comparison from Nov. 1 forward versus this group because I think we all felt that the kids with MIS-C have been even more sick recently, Dr. Ballweg said.
An optimistic sign from the study was that most of the severe cardiac problems in young people with the inflammatory syndrome improved to normal condition within 30 days. Still, Dr. Randolph said any residual effects were still unknown, which is why one of her co-authors, Dr. Jane Newburger, associate chief for academic affairs in Boston Childrens Hospitals cardiology department, is leading a nationwide study to follow children with the inflammatory syndrome for up to five years.
We cant say 100 percent for sure that everythings going to be normal long-term, Dr. Randolph said.
Journal Staff| The Providence Journal
Feb. 27: Marc Thibault, the 48-year-old vice principal of student life at Saint Raphael Academy in Pawtucket, is admitted to The Miriam Hospital five days after returning from a school-organized trip to Italy.
March 1: The Department of Health announces the first two confirmed cases of coronavirus in Rhode Island. Both are connected to the Saint Raphael trip to Italy.
March 9: Although only four Rhode Islanders have tested positive in total, Gov. Gina Raimondo declares a state of emergency, authorizing the National Guard to assist in the state's response.
March 11: Hours after the World Health Organization declares coronavirus a global pandemic, the University of Rhode Island suspends in-person classes.
March 12: Providence Mayor Jorge Elorza declares a state of emergency, canceling all city events and revoking entertainment licenses.
March 13: Raimondo moves up the April vacation week, after students at Cranston High School West and Springbrook Elementary School in Westerly test positive for the virus. Visits to nursing homes are halted.Twin River casinos close. Newport cancels St. Patrick's Day parade.
March 16: Public Masses in the Diocese of Providence are canceled until further notice.
March 17: Raimondo shuts down in-person dining, bans crowds of 25 or more. Elorza closes Providence Place mall. Health officials say "community spread" of virus occurring in Rhode Island, though only 32 cases have been confirmed.
March 20: National Guard activated to deliver food and assist in testing.
March 22: Raimondo orders all public recreation and entertainment venues to close, as well as close-contact businesses such as gyms, barbershops and tattoo parlors.
March 23: Public schools in Rhode Island transition to distance learning.
March 24: Raimondo orders travelers arriving at T.F. Green Airport to quarantine for 14 days. Colleges and universities begin canceling commencement exercises.
March 25: State health officials learn of the first positive case in a nursing home, Oak Hill Center, inPawtucket.
March 26:Raimondo says that while the spread of COVID-19 in the United States has accelerated, the speed of our response has also been incredibly fast. ... We are ahead of this virus in Rhode Island.
March 27: A day after the governor orders residents of New York to quarantine after entering Rhode Island, state police and National Guard troops begin stopping cars with New York plates at the Connecticut border.
March 28: Rhode Island reports its first two coronavirus deaths. (The state now says the first death occurred on March 19.) Raimondo issues stay-at-home order, closes "nonessential" retail, bans gatherings of five or more. The governor tells those who are flouting her orders to "knock it off."
March 30: Bernard A. Bernie Lanzi, the mayor of Golden Crest, dies at the North Providence nursing home. By April 6 nine other residents had died there, more than 50 had tested positive.
April 3: Raimondo closes state beaches and parks, announces that field hospitals will be set up in the Rhode Island Convention Center, at a former Citizens Bank building in Cranston and in a former Lowe's hardware store in North Kingstown.
April 6: CVS begins offering free, rapid coronavirus testing outside the closed Twin River Casino. The rapid testing is not, however, available at nursing homes.
April 7: More than 100,000 Rhode Islanders have filed claims for unemployment since the start of the pandemic.
April 18: Raimondo orders employees at "customer-facing" businesses to wear masks. "Ill be the first to admit, it feels strange, she says. This is not normal... but its the right thing to do.
April 24: With cases and deaths surging, Raimondo announces that nursing-home workers will be eligible to receive hazard pay, and that National Guard "strike teams" will help with testing there.
April 25: The peak of the first wave. Known infections average 370 a day over a seven-day period, with 12% of tests coming back positive. About 100 protesters demonstrate outside the State House against Raimondo's restrictions.
April 27: Raimondo announces a multi-phase plan for reopening the Rhode Island economy, starting in early May.
April 29: Raimondo cancels large, signature summer events in Rhode Island, including the Newport Folk Festival, Newport Jazz Festival and Washington County Fair.
May 5: Raimondo requires Rhode Islanders to wear face coverings in all public places. State authorities say they are investigating hundreds, if not thousands, of complaints of unemployment fraud. David Butziger and David Staveley, former owners of the closed Remington House restaurant in Warwick, become the first two people charged with defrauding the Paycheck Protection Program.
May 9: Rhode Island's stay-at-home order is lifted, and state enters Phase One of its reopening. Nonessential retailers and state parks reopen with restrictions. Hospitals allowed to resume nonessential procedures.
May 18: Restaurants allowed to reopen for outdoor dining.
May 19: State unveils "CRUSH COVID" contact-tracing app. Raimondo says she would like to see 90% of the state's population sign up.
May 25: Memorial Day. Two state beaches, East Matunuck and Scarborough, reopen with limited parking and no restrooms.
May 30: Houses of worship allowed to reopen at 25% capacity.
June 1: Rhode Island enters Phase Two of reopening plan. Gyms and salons can reopen with limited capacity, all state beaches reopen, child-care facilities reopen, offices allowed to bring a third of work force back on site. Indoor dining resumes with 50% capacity limit.
June 8: Twin River casinos reopen, by invitation only.
June 29: Raimondo announces that quarantine rules will apply to people entering the Rhode Islandfrom states where more than 5% of coronavirus tests are positive.
June 30: Rhode Island enters Phase Three of reopening plan, which allows for larger gatherings and a reopening of indoor recreation facilities. While most of the country is seeing surging coronavirus caseloads, the seven-day new-case average in Rhode Island falls to 40, its lowest point since March. It has not been that low since.
July 11: Rhode Island surpasses 1,000 coronavirus deaths. The majority are associated with nursinghomes.
July 28: Visits can resume at Rhode Island's hard-hit nursing homes.
July 29: With virus cases on the rise again, Raimondo lowers the social-gathering limit from 25 to 15, and says she will not move Rhode Island into Phase Four reopening in early August as she had planned.
Aug. 4: New York, New Jersey, Connecticut and Massachusetts all add Rhode Island to their list of states facing travel restrictions. While Rhode Island is eventually removed from three of those states' lists, Massachusetts continues to restrict travelers from Rhode Island due to the state's case rate.
Sept. 5: Rhode Island's midsummer uptick in cases appears to have abated. For fifth straight day, fewer than 1% of coronavirus tests in the state are positive. The seven-day new-case average falls to lowest point in nearly seven weeks.
Sept. 14: Most public schools reopen for in-person learning, for the first time since mid-March.
Sept. 18: Providence College says 120 students have tested positive for COVID over three days. College shifts to remote learning.
Sept. 30: Rhode Island sees most new cases in a single day since May. Raimondo says young adults are driving the increase in cases.
Oct. 15: With cases continuing to rise, Raimondo orders businesses to close break rooms for 30 days.
Oct. 21: 470 Rhode Islanders test positive for the virus, shattering the previous high set in April.
Nov. 5: Raimondo announces a series of new business restrictions and a "stay-at-home advisory" from late evening through 5 a.m. essentially a voluntary curfew.
Nov. 11: More than 1,000 Rhode Islanders test positive for the virus in a single day, for the first time.
Nov. 19: Raimondo announces a two-week "pause," which will take effect after Thanksgiving, in an effort to slow surging cases. The pause involves increased restrictions on businesses but allows most to remain open. Social gatherings involving more than one household are prohibited. It will ultimately be a three-week pause.
Nov. 30: Field hospitals in Providence and Cranston, which were never used in the spring, begin receiving patients for the first time.
Dec. 6: Rhode Island leads country in new coronavirus cases, per capita, over the previous seven days. It will maintain this sad distinction for 10 straight days.
Dec. 7: The peak of the second wave. Known infections average 1,329a day over a seven-day period, with 10.4% of tests coming back positive.
Dec. 12: State announces that Health Director Dr. Nicole Alexander-Scotthas tested positive for coronavirus. Raimondo, who is a close contact, entersquarantine.
Dec. 13: In the deadliest single day of the pandemic in the state, 30 COVID-positive Rhode Islanders die.
Dec. 14: The firstPfizer-BioNTech coronavirus vaccines are administered in Rhode Island, to high-risk hospital workers. Rhode Island Hospital emergency physicianDr. Christian Arbelaez receives the first shot.
Dec. 30: The state begins an effort to vaccinate members of the general public in Central Falls, the community hardest-hit by the virus.
Jan. 5: Rhode Island surpasses 2,000 coronavirus-related deaths.
Jan. 7: Raimondo is nominated by President-elect Joe Biden to be U.S. commerce secretary. She abruptly stops answering questions from the media about the state's coronavirus response, and turns the regular vaccine briefings over to Alexander-Scott.
Feb. 15: With Rhode Island near the bottom of the country in the percentage of residents who have received a vaccine shot, and in the percentage of allocated vaccine doses used, Lt. Gov. Dan McKee says he is "not satisfied" with the vaccine rollout.
Feb. 18:Rhode Island opens two mass-vaccination sites, at the Dunkin' Donuts Center and on Sockanosset Cross Road in Cranston. (Opening thesites had been planned before McKee criticized the vaccine rollout). Within a few days, the state begins to climb toward the middle of the pack in percentage of population vaccinated and percentage of shots administered.
Feb. 22: With the number of hospitalized coronavirus patients just a third of the peak from December, the state announces plans to shut the field hospitals in Providence and Cranston.
Vivek Murthy, President Bidens nominee to be surgeon general, testified during his confirmation hearing on Tuesday morning that one of the biggest challenges during the pandemic has been learning about the virus while responding to it and communicating clearly changes in the approach to fighting the pandemic to the public. He told lawmakers that if confirmed, he would first and foremost work with the [Centers for Disease Control and Prevention], with the [National Institutes of Health] and other scientific entities in government to make sure we are clear on what the science says and communicate that clearly to the public.Also, public education starts with listening to understand the publics needs and concerns, not just speaking, he said.
Dr. Rachel Leland Levine, nominee for Health and Human Services Department assistant secretary for health, also testified during the Senate Health, Education, Labor and Pensions Committee hearing.
She said she has a unique perspective having been Pennsylvania secretary of health during the pandemic, in addition to being president of the Association of State and Territorial Health Officials. I know first hand the importance of the collaboration and coordination between federal public health officials, state public health officials and local public health officials, she testified. Levine would be the highest-ranking transgender federal government official, if confirmed. Here are some of the other recent headlines you might have missed.
An analysis by the Food and Drug Administration, posted on Wednesday, says that Johnson & Johnsons coronavirus vaccine fits the requirements for emergency use authorization. The agencys advisory committee will meet on Friday to consider the findings.
The Biden administration brought on Lauren Silvis, former FDA chief-of-staff, to be a consultant on the COVID response team, BioCentury reported. The appointment brings regulatory expertise and a link to one of the few Trump administration officials who is widely respected across the political spectrum, said the report. Silvis served as chief of staff for former FDA Commissioner Scott Gottlieb from May 2017 to June 2019, and as deputy director for policy of FDAs Center for Devices and Radiological Health from 2015 to 2017.
Dr. Stephen Hahn, former FDA commissioner, joined the board of directors of Blackfynn, which develops treatments for Parkinson's and neurodegeneration. This makes him among the first high-ranking Trump health officials to land a private-sector role since Bidens inauguration, Politico noted on Wednesday.
The White House said on Wednesday that the Health and Human Services and Defense departments will deliver millions of masks to federally qualified community health centers nationwide. These approximately 1,300 health centers will be eligible to receive high-quality masks for free. Two-thirds of the people served by community health centers are living in poverty, 60% are racial and/or ethnic minorities, and nearly 1.4 million are un-housed, said a fact-sheet from the White House. Anyone in the community will be eligible to pick up masks from their local community health center.
Also, Defense and USDA are working to distribute masks to many of the nations 300 food banks, which reach a vast network of 60,000 food pantries, soup kitchens, and other food distribution points where masks will be distributed to individuals and families, the White House said.
Using money from the COVID-19 package enacted in December, the Federal Emergency Management Agency is planning a $2 billion program to help families pay for coronavirus funerals, but it's being delayed over concerns that it is susceptible to fraud, Politico reported on Thursday. While the agency has run similar programs over the years for other emergencies and major disasters, this is poised to be the largest the agency has ever mounted, said the report. FEMA is scrambling to find safeguards that would prevent fraudsters from forging death certificates in an attempt to collect thousands of dollars for funerals that either never happened or were for people who died from another cause.
The Government Accountability Office summarized on Wednesday its 44 recommendations in its reports on the federal governments response to the pandemic between June 2020 and January 2021. Of the 44 recommendations we have made to date, 16 fall into one of the following public health areas: COVID-19 testing, vaccines and therapeutics, medical supply chain, COVID-19 health disparities, and COVID-19 health data, said the watchdog. Most of the recommendations have not been implemented. We maintain that doing so would improve the governments response.
The Agriculture Department outlined on Wednesday how its implementing President Bidens national strategy to combat the pandemic. In addition to various programs, it has 354 personnel deployed to help with vaccine efforts nationwide.
The New Yorker published a profile on the secret life of White House staff on Wednesday, which dives into how Trump officials functioned during the pandemic. Timothy Harleth, White House chief usher installed by President Trump then fired by the Bidens, told me that the residence staff took COVID-19 precautions more seriously than others at the Trump White House, said the report. By his count seven or eight residence staff workers contracted the virus. Once they recovered, those workers were asked to fill in for others, because of their presumed immunity...According to [a career White House employee] Jason, the lifers were given conflicting advice: stay home; later, come in.
Help us understand the situation better. Are you a federal employee, contractor or military member with information, concerns, etc. about how your agency is handling the coronavirus? Email us at newstips@govexec.com.
CLEVELAND, Ohio - Four Ohio counties were downgraded from Level 3 red alert for concern of coronavirus spread on Thursday, marking the first improvement in weeks for the Ohio Department of Healths alert warning map.
However, Cuyahoga County and every other county in the northeast corner of Ohio remain on red alert this week. Overall, 80 of Ohios 88 counties are on red alert, meaning that according to the health department there remains a public emergency for increased exposure and spread, and that people should exercise a high degree of caution.
Beginning with Dec. 24, the red counties had been the same with the exception of two weeks in mid-January when Hamilton County was listed at the higher concern level of purple.
Downgraded to the lower level of Level 2 orange were Holmes, Mercer, Shelby and Williams counties. They join four Southeast Ohio counties that have been on orange for weeks - Gallia, Hocking, Monroe and Vinton.
A key test in whether counties are downgraded to the lower concern of Level 2 orange alert is the per capita case rate. Once designed as red, counties stay there at least until their rate of new cases drops below 100 per 100,000 over the previous two weeks, excluding incarcerated individuals.
Drawing close are several counties, including Noble (104 cases per 100,000), Ottawa (111), Putnam (112.2), Harrison (113), Ashland 114.1) and Wayne (115.8). The highest rates are in Morgan County (344.6), Athens (313.8) and Jefferson (295.4).
Every county in Greater Cleveland has shown marked improvements in this measure:
* Cuyahoga: 187 cases per 100,000 this week, down from 239 a week ago and 673.4 in mid-January, on Jan. 14.
* Geauga: 223.2, down from 262.6 and 604.4.
* Lake: 213.3, down from 295 and 762.5.
* Lorain: 216.9, down from 308.2 and 774.
* Medina: 185.8, down from 262.6 and 647.6.
* Portage: 234.5, down from 285 and 667.8.
* Summit: 210.9, down 289.1 and 724.8.
Overall, the health department in making alert designations tracks seven measures, including hospitalizations, trips to doctors offices and emergency room visits.
Every Ohio county was flagged again this week for having new case rates in excess of 50 per 100,000 over the last two weeks. And 86 of the 88 counties were flagged for at least 50% of the new cases at some point in the last three weeks being outside congregate living centers.
Cuyahoga, Geauga and Lorain counties were cited for meeting three of the seven thresholds this week; Lake, Medina, Portage and Summit two each.
Heres a closer look at the advisory system Gov. Mike DeWine introduced in early July.
* 1. New cases - Alert triggered when there are 50 new cases per cases 100,000 residents over the last two weeks.
* 2. Increase in new cases - Alert triggered by an increase in cases for five straight days at any point over the last three weeks. This is based on the date of onset of symptoms, not when the cases are reported.
* 3. Non-congregate living cases - Alert triggered when at least 50% of the new cases in one of the last three weeks have occurred in outside congregate living spaces such as nursing homes and prisons.
* 4. Emergency rooms - Alert triggered when there is an increase in visits for COVID-like symptoms or a diagnosis for five straight days at any point in the last three weeks.
* 5. Doctor visits - Alert triggered when there is an increase in out-patient visits resulting in confirmed cases or suspected diagnosis for COVID-19 for five straight days at any point in the last three weeks.
* 6. Hospitalizations - Alert triggered when there is an increase in new COVID-19 patients for five straight days at any point over the last three weeks. This is based on the county or residence, not the location of the hospital.
* 7. Intensive Care Unit occupancy - Alert triggered when ICU occupancy in a region exceeds 80% of total ICU beds and at least 20% of the beds are being used for coronavirus patients for at least three days in the last week.
KYIV, Ukraine (AP) Ukraine has recorded a 50% increase in the number of daily new COVID-19 infections, a day after authorities launched the countrys vaccination campaign. Health Minister Maxim Stepanov said Thursday that 8,147 new infections were found over the past day, up from 5,424 a day earlier. He did not speculate on the cause of the spike, but said the country so far has not detected the presence of the more contagious British virus variant. The surge is alarming for the country whose understaffed medical system is already struggling to treat coronavirus patients, particularly in the hard-hit western regions where cases rose significantly after a two-week lockdown in January.
BATH, N.Y. (WETM) The Steuben County Public Health Department is reporting 15 new cases of COVID-19 with 5,509 confirmed cases since the pandemic began last year.
The county currently has 106 active cases of the virus.
The individuals who recently tested positive are residents of the:
City of Corning (2)
City of Hornell (4)
Town of Bath
Town of Cameron
Town of Caton
Town of Hornby
Town of Prattsburgh
Town of Thurston
Town of Troupsburg
Village of Painted Post (2)
The individuals are isolated and being monitored by the County Health Department. Public Health staff investigated and identified close contacts of the confirmed cases and exposure risks. All those known to have direct contact with the individuals have been notified.
Per CDC and New York State Department of Health guidance, information is collected beginning 48 hours prior to symptom onset or date of test if asymptomatic through the day of the positive test result to identify any potential exposure risks.
The investigations indicate:
Four individuals had contact with previously reported Steuben positives
Two individuals are associated with Upstate Farms Cheese in Campbell
One individual is associated with the Steuben County Jail
In addition, the individuals reported visiting the following locations that could pose an exposure risk within their investigation timeframes:
2/18, 2/19 Tops in Riverside
2/20 Silgan Plastics in Penn Yan
Todays age groups for the positives are as follows:
0 9 years: 1
10 19 years: 1
20 29 years: 2
30 39 years: 3
40 49 years: 1
50 59 years: 4
60 69 years: 3
Over the last year we have seen case spread within workplaces, said Public Health Director, Darlene Smith. To keep spread low and protect coworkers, stay home if feeling unwell and get tested.
All residents should continue to monitor themselves for COVID-19 symptoms of fever, cough, shortness of breath, chills or repeated shaking with chills, muscle pain, headache, sore throat, and new loss of taste or smell and contact their healthcare provider for instructions if feeling ill.
Powered by Watson:
Our COVID Q&A with Watson is an AI-powered chatbot that addresses consumers' questions and concerns about COVID-19. It's built on the IBM Watson Ads Builder platform, which utilizes Watson Natural Language Understanding, and proprietary, natural- language-generation technology. The chatbot utilizes approved content from the CDC and WHO. Incidents information is provided by USAFacts.org.
To populate our Interactive Incidents Map, Watson AI looks for the latest and most up-to- date information. To understand and extract the information necessary to feed the maps, we use Watson Natural Language Understandingfor extracting insights from natural language text and Watson Discovery for extracting insights from PDFs, HTML, tables, images and more.COVID Impact Survey, conducted by NORC at the University of Chicago for the Data Foundation
After 56 years together, COVID-19 forced them apart - OPB
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Alice Maurer, 79, waits 15 minutes after receiving her COVID-19 vaccination at Friendsview Retirement Community in Newberg, Ore., Feb. 5, 2021. Maurer's husband is in the memory care unit at Friendsville and on hospice, and she hopes that since she has been vaccinated, she will be able to visit him soon.
Kristyna Wentz-Graff / OPB
On Valentines Day this year, Alice Mauer brought her husband, Nick, a big bouquet of colorful balloons.
Theyve been married 56 years. Nick Mauer has advanced Alzheimers and is partially blind, so communicating with him is a challenge.
I think he sees enough hell be able to see the movement of bright colors, Alice said. Itll be something to catch his attention.
But she couldnt give him the balloons herself. She couldnt even see him. Instead, she handed them to staff at the Friendsview retirement community, where the couple lives, Alice in an apartment for independent residents on the 5th floor, Nick in hospice care on a closed memory care unit in the same building.
Though they live just floors apart, Alice has been only rarely able to see or touch her husband in the past year because of COVID-19 and long term care visitation restrictions, in what may be the final year of his life.
I just want to be able to hug him and kiss him, she said.
Separation from family and friends is one of the hardest things about the pandemic. For bed-bound nursing home and long term care residents, its a particularly harsh consequence of the rules meant to keep COVID-19 out of the facilities where it has done the most harm.
For couples with a spouse living in long-term care, that separation can be particularly challenging.
Alice and Nick are retired missionaries. Shes 79, and hes 87.
They met when Alice was a college student at George Fox University, just across the street from the retirement community where they now live. Nick had thick hair back then, she says, and Coke-bottle glasses.
It wasnt his looks that drew me to him. It was his spirit, she said. He had a concern, a commitment to God, a seriousness about life that was very appealing to me. That was the first thing that drew me to him.
And a beautiful deep bass voice, she added with a laugh.
"I'm so thankful," says Alice Maurer, 79, after she receives a COVID-19 vaccination from McMinnville paramedic Elle Miller, earlier this month. Maurer lives in an apartment for independent residents on the 5th floor at Friendsview, while her husband Nick lives in hospice care on a closed memory care unit in the same building.
Kristyna Wentz-Graff / OPB
The Mauers moved around a lot together, working as missionaries in the Peruvian Andes, singing hymns in Spanish and the indigenous Amyra language. They moved to Idaho, then back to Oregon. They had three kids.
Alice says they were both strong-willed people. It was a loving marriage, and a challenging one.
We made a commitment when we were first married that this was for life, she said. This is what Gods plan is for life, and that no matter what, we were sticking it out.
When the pandemic first started, Alice says she was completely unable to see Nick. Then, for a while, visitation restrictions at Friendsview were relaxed for people with spouses on hospice. She wore a mask and was able to sit at his bedside.
He doesnt know who I am anymore, but I know who he is, she said. And he knows Im somebody special, I think. He responds in a way that theres got to be some connection.
She would play Nick recordings of their children on her cell phone and sing to him.
Sometimes when I get to singing the old hymns and songs, it would perk in his mind and he would sing along, she said.
But as cases in the community surged this past fall, those visits ended. Indoor visitation at long term care facilities is not allowed in counties the state rates at Extreme Risk for COVID-19 spread, or in facilities that had a resident or staff member test positive for COVID-19 in the past 14 days.
Friendsview has reported a handful of positive cases and exposures, though never a full-blown outbreak.
.Alice was able to visit Nick for about three days around Christmas, but otherwise, she hasnt been able to sit with him for the past five months. She says he is getting loving care at Friendsview, and she understands the need for restrictions on in-person visits.
Michelle Townley, RN, left, talks with Alice Maurer, 79, while Maurer waits 15 minutes after receiving her COVID-19 vaccination. Alice Maurer is hoping to be able to visit her husband Nick after shes fully vaccinated.
Kristyna Wentz-Graff / OPB
It doesnt mean you like them, but weve been thankful that theyre working so hard to keep us safe, she said.
And a reunion may happen soon. In mid-February, Nick received his second dose of the COVID-19 vaccine. Alice got her first a few days before at a clinic held for Friendsview residents. It was amazing, she said, to be surrounded by friends and neighbors.
I kept saying, Oh, hi, she said. It was like a family reunion, that feeling of joy.
Alice is hoping to be able to visit Nick after shes fully vaccinated.
The state and CDC have yet to announce new guidance around visitation policies in long-term care facilities where residents have been vaccinated.
Yamhill County, where Alice and Nick live, is still considered at extreme risk for COVID-19, according to the states system. But the number of cases there is falling, and that could change soon, making it possible for Alice to see Nick again consistently.
Shes thought about the hymn she wants to sing to him: Leaning on the Everlasting Arm. Shes going to sing it in the Amayra language, like they used to when they were young missionaries living in Peru. Thats the way Nick remembers it best, and sometimes, he can sing it along with her.
I just cant help but feel that if I can give him a big hug and kiss, and hold his hand and sing I just cant wait, she said.
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A federal program was supposed to bring COVID-19 vaccination right to the door of seniors living in long-term care: like nursing homes, assisted living, and memory care. But confusion over how to enroll left thousands of the highest priority Oregonians waiting weeks longer than necessary for their shots.
Some Oregonians said a Legacy Health website for scheduling vaccine appointments would not let them complete a reservation Monday morning.
Oregon may have quietly reached a monumental milestone last week in the fight against COVID-19.
Tags:Science & Environment
Thursday, February 25, 2021
A trend is emerging. Commercial health plans are delaying and even denying reimbursement for COVID-19 hospitalizationsespecially high-dollar inpatient stays. Plans are attempting to defer these claims to workers compensation on the health plans assertion that COVID-19 is a work-related illness. Some hospitals defer to health plans, as it relates to these types of claims, because it is plausible that patients could have contracted COVID-19 at work and because workers compensation is typically primary for coordination of benefits purposes. But workers compensation is notoriously complex, and hospitals may not understand the nuances of the program enough to know when it is appropriate to challenge this type of health plan denial. Failing to appeal these denials may impact hospital reimbursement, as well as a hospitals accounts receivable days, known as AR days, depending on the number of COVID hospitalizations and the corresponding amount in open balances. It is definitely a conundrum. The goal of this article is to provide hospitals and its business offices with a better understanding of COVID-19 as an occupational illness to enable hospitals to be better equipped to determine when it is appropriate to challenge health plans that seek to delay or deny reimbursement for COVID hospitalizations.
It is important to have a general understanding of workers compensation coverage. Workers compensation is a state-mandated insurance program that protects employers and employees from financial loss when employees suffer job-related injuries and illnesses. Virtually all employers, even small employers, must maintain workers compensation coverage. If an employee suffers an occupational injury or illness, an employer through its workers compensation carrier may provide missed wage replacement, temporary and permanent disability, death benefits, and supplemental benefits. But one of the basic benefits in all states is medical and hospital benefits. Each state regulates workers compensation coverage differently, which is a critical factor with respect to COVID-19 and whether a health plan may delay or deny payment. In some states, employer premiums for workers compensation policies are experience-rated, meaning that employers that file more claims pay more in premium.
Patient X is a grocery worker who becomes ill and is eventually hospitalized with a COVID-19 diagnosis. Upon discharge, the hospital submits the bill to the health plan. The health plan fails to timely adjudicate the claim. Instead, the health plan contacts the hospital and states that it needs additional information. The health plan believes the patient is covered by workers compensation because the patient probably acquired the virus at work. Should workers compensation cover Patient Xs hospitalization?
Its complicated.
When it comes to COVID-19 as an occupational illness, states have responded differently. On one hand, 17 states and Puerto Rico have extended workers compensation coverage to include COVID-19 as a work-related illness. Within this group of states, there are varying degrees of coverage.[1] The majority of these states have established COVID-19 workers compensability presumptions for various types of workers. In these states, if a designated worker contracts COVID-19, it is generally presumed that the worker acquired the virus during the course of employment thus eligible for workers compensation, including medical and hospital benefits. But employers can dispute this presumption and produce evidence to the contrary, if done so within a certain amount of time under state law. Hospitals are often left out of this decision-making process, which is unfortunate because hospitals may have additional information about where the worker contracted COVID-19.
On the other hand, some states still consider COVID-19 an ordinary disease of life, similar to a cold or the flu, which means the virus is not covered by workers compensation. Still other states have taken no action to clarify whether COVID-19 hospitalizations and treatments should or should not be covered by workers compensation.
Workers compensation laws were difficult to navigate prior to the pandemic, which makes the recent patchwork of legislation and executive orders classifying COVID-19 as an occupational illness even more difficult to understand. As a result, health plans may accidentally or intentionally delay or deny reimbursement.
Take Patient X for example. Grocery workers in California may be entitled to workers compensation.[2] But elsewhere, these same workers are not entitled to benefits. A health plan with members in several states, including California, might seek to delay or deny payment to hospitals elsewhere because the health plan is successful in ultimately denying the same COVID hospitalizations in California. Therefore, it is important for hospitals to review all claims when health plans seek to delay or deny payment for COVID hospitalizations.
It is complicated to determine if a patients stay is covered by workers compensation when faced with a health plan that attempts to delay or deny payment. If faced with this scenario, hospitals should consider the following:
(1) Understand your state workers compensation laws and the coverage available for COVID-19 hospitalizations. Determine if the state where the hospital is located designates COVID-19 as an occupational illness and whether the patients occupation falls within the states definition of a covered worker.
(2) If the patient is not eligible for coverage under workers compensation, then the hospital should appeal the health plans delay in or denial of reimbursement. In addition, the hospital should consider contacting the patients employer to jointly assess whether to dispute any state presumptions that a worker contracted COVIID-19 on the job.
(3) If workers compensation denies all or part of a claim, the hospital should submit the remainder of the bill to the health plan.
(4) As an employer, the hospital should understand whether its own workers compensation policy is experience-rated. If so, the hospital may want to be more diligent about ensuring the hospitals health plan or health plan administrator does not inappropriately delay or deny claims based on workers compensation coverage.
[1] States limit coverage to covered workers, with each state defining occupations that fall within the scope of coverage.
[2]See Cal. Labor Code 3212.88.
Polsinelli PC, Polsinelli LLP in CaliforniaNational Law Review, Volume XI, Number 56
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The newest case count is part of a trend in Alaska of declining infections over the last two months, following a peak in November and early December that strained hospital capacity. Hospitalizations are now less than a quarter of what they were in November and December.
By Thursday, there were 41 people with COVID-19 in hospitals throughout the state, including five on ventilators. Another four patients were believed to have the virus.
The COVID-19 vaccine reached Alaska in mid-December. By Thursday, 149,992 people 21% of Alaskas total population had received at least their first vaccine shot, according to the states vaccine monitoring dashboard. Thats far above the national average of 13.6%.
Among Alaskans 16 and older, 27% had received at least one dose of vaccine. The Pfizer vaccine has been authorized for use for people ages 16 and older, and Modernas has been cleared for use in people 18 and older. At least 95,257 people had received both doses of the vaccine. Alaska has currently vaccinated more residents per capita than any other state, according to a national tracker.
Health care workers and nursing home staff and residents were the first people prioritized to receive the vaccine. Alaskans older than 65 became eligible in early January, and the state further widened eligibility criteria this month to include educators, people 50 and older with a high-risk medical condition, front-line essential workers 50 and older and people living or working in congregate settings like shelters and prisons. On Wednesday, officials said people who help Alaskans 65 and older get a vaccination are now eligible to get a vaccine.
Those eligible to receive the vaccine can visit covidvax.alaska.gov or call 907-646-3322 to sign up and to confirm eligibility. The phone line is staffed 9 a.m.-6:30 p.m. on weekdays and 9 a.m.-4:30 p.m. on weekends.
While most regions of the state have seen declining cases, the Matanuska-Susitna region has recently seen a spike in new infections, and this week surpassed the Yukon-Kuskokwim Delta to record the highest average daily case rate in the state. As of Wednesday, the Mat-Su has seen 34.41 cases per 100,000 over the past 14 days.
Of the 149 cases reported among Alaska residents on Thursday, there were 31 in Anchorage, plus two in Chugiak, two in Eagle River, and three in Girdwood; 11 in Cordova; one in Soldotna; one in Ester; 23 in Fairbanks plus four in North Pole; one in Delta Junction; ten in Palmer; four in Sutton-Alpine; 32 in Wasilla; one in Nome; one in Juneau; seven in Ketchikan; and 10 in Petersburg;
In communities smaller than 1,000 people not named to protect privacy, there was one in the Prince of Wales and Hyder Census Area; two in the Bethel Census Area; and one in Dillingham.
There were also 41 nonresident cases including one in Anchorage, one in Fairbanks, one in the Matanuska-Susitna Borough, one in Juneau, 34 in Unalaska, and three in an unidentified region of the state.
While people might get tested more than once, each case reported by the state health department represents only one person.
The states data doesnt specify whether people testing positive for COVID-19 have symptoms. More than half of the nations infections are transmitted from asymptomatic people, according to CDC estimates.
