Refuge in the Storm? ACA’s Role as Safety Net Is Tested by COVID Recession

The Affordable Care Act, facing its first test during a deep recession, is providing a refuge for some — but by no means all — people who have lost health coverage as the economy has been battered by the coronavirus pandemic.

New studies, from both federal and private research groups, generally indicate that when the country marked precipitous job losses from March to May — with more than 25 million people forced out of work — the loss of health insurance was less dramatic.

That’s partly because large numbers of mostly low-income workers who lost employment during the crisis were in jobs that already did not provide health insurance. It helped that many employers chose to leave furloughed and temporarily laid-off workers on the company insurance plan.

And others who lost health benefits along with their job immediately sought alternatives, such as coverage through a spouse’s or parent’s job, Medicaid or plans offered on the state-based ACA marketplaces.

From June to September, however, things weren’t as rosy. Even as the unemployment rate declined from 14.7% in April to 8.4% in August, many temporary job losses became permanent, some people who found a new job didn’t get one that came with health insurance, and others just couldn’t afford coverage.

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The upshot, studies indicate, is that even with the new options and expanded safety net created by the ACA, by the end of summer a record number of people were poised to become newly uninsured.

What’s more, those losses could deepen in the months ahead, and into 2021, if the economy doesn’t improve and Congress offers no further assistance, health policy experts and insurers say.

“It’s a very fluid situation,” said Sara Collins, vice president for health care coverage and access at the Commonwealth Fund, a New York-based health research group. “The ACA provides an important cushion, but we don’t know how much of one yet, since this is first real test of the law as a safety net in a serious recession.”

Collins also noted that accurately tracking health insurance coverage and shifts is difficult in the best of times; amid an economic meltdown, it becomes even more precarious.

Coverage Was Already on the Decline

Some 20 million people gained coverage between 2010 and 2016 under the ACA’s expansion of Medicaid and its insurance marketplaces for people without employer-based coverage. A gradually booming economy after the 2008-2009 recession also helped. The percentage of the population without health insurance declined from about 15% in 2010 to 8.8% in 2016.

But then, even as the economy continued to grow after 2016, coverage began to decline when the Trump administration and some Republican-led states took steps that undermined the law’s main aim: to expand coverage.

In 2018, 1.9 million people joined the ranks of the uninsured, and the Census Bureau reported earlier this month that an additional 1 million Americans lost coverage in 2019.

The accelerating decline is helping fuel anxiety over the fate of the ACA in the wake of the death of Supreme Court Justice Ruth Bader Ginsburg. The high court is scheduled to hear a case in November brought by Republican state officials, and supported by the Trump administration, that seeks to nullify the entire law.

In July, researchers at the Urban Institute, a Washington, D.C., think tank, forecast that around 10 million workers and their dependents would lose employer coverage in 2020. But they estimated that two-thirds of them will have found new coverage by year’s end — leaving about 3.3 million uninsured.

A more recent Urban Institute report, released Sept. 18, and using 2020 data from the Census Bureau, calculated that of the roughly 3 million people under age 65 who had lost job-based insurance between May and July, 1.4 million found coverage elsewhere — most through Medicaid — and 1.9 million became newly uninsured. Notably, 2.2 million of those who lost their coverage were between 18 and 39 years old; 1.6 million were Hispanic.

Another recent study, using different methods, reported higher numbers for the same period. The analysis released by the Economic Policy Institute last month determined that between April and July 6.2 million people lost employer coverage. The authors didn’t calculate how many found alternative coverage via Medicaid or the ACA, however.

Other findings support the notion that the health insurance loss trend shifted by mid summer. KFF, for example, published an analysis Sept. 11 showing that most companies that offered coverage to begin with chose to continue insuring furloughed and temporarily laid-off workers between March and the end of June. But as the virus continued to batter the economy, employers moved to permanently shed those jobs. (KHN is an editorially independent program of KFF.)

“The issue now is that the temporary layoffs have greatly decreased and permanent job losses, including jobs that came with health coverage, are increasing,” said Cynthia Cox, a KFF vice president and director for the Program on the ACA.

Many low-income workers who lose their jobs and don’t have coverage through a spouse or parent turn to Medicaid, the federal-state health program for low-income people. The Centers for Medicare & Medicaid Services reported last week that enrollment in Medicaid and the Children’s Health Insurance Program grew by 4 million between February and June, a nearly 6% increase since the beginning of the coronavirus crisis.

The Impact of the Marketplaces

Gains and losses of coverage in the ACA marketplace are not yet clear, experts say. The Trump administration issued a report in June indicating that 487,000 people had, between January and June, enrolled in an ACA plan via the federal website, healthcare.gov. But that report failed to say how many people dropped an ACA plan in that period — for example, because they could no longer afford the premiums.

A study by Avalere, a health research and consulting firm in Washington, D.C., has estimated that enrollment in the ACA marketplaces since March could have swelled by around 1 million. That includes new enrollees in the 13 ACA marketplaces that states, plus the District of Columbia, operate. Many of those states held a “special enrollment period” when the pandemic hit. Healthcare.gov, run by the Trump administration, did not offer a special enrollment period.

About 11 million were enrolled in an ACA plan in February. Open enrollment for coverage that would start on Jan. 1, 2021, begins Nov. 1.

Jessica Banthin, a senior health policy researcher at the Urban Institute and until 2019 deputy director for health at the Congressional Budget Office, said it’s anyone’s guess how many people who lost their job-based coverage this year will choose this option. She said numerous factors will influence people’s health insurance decisions this fall, and into 2021.

Chief among them is gauging whether they might soon get a new job, or get back an old job, that offers insurance. That may hold some people back from enrolling in an ACA plan this fall, Banthin said. Plus, buying insurance may be too expensive, especially for families more concerned with paying for housing, food and child care while going without a paycheck.

“Health insurance may not be their immediate concern,” Banthin said. “Many people’s lives have been disrupted as never before. There’s a lot of trauma out there.”

Collins of the Commonwealth Fund said that, even before the pandemic, a growing proportion of families were vulnerable to loss of coverage and care.

In a survey of more than 4,000 adults early this year, Collins and colleagues found a “persistent vulnerability among working-age adults in their ability to afford coverage and health care that could worsen if the economic downturn continues.”

In large part, that’s because 1 in 5 respondents who had coverage were “underinsured.” Underinsurance reflects the extent to which coverage leaves people at risk of high out-of-pocket costs — a situation exacerbated by widespread job loss.

“Now is absolutely not be the time for the ACA to be further undermined, let alone killed outright,” said Stan Dorn, director of the National Center for Coverage Innovation at Families USA.

Lifetime Experiences Help Older Adults Build Resilience to Pandemic Trauma

Older adults are especially vulnerable physically during the coronavirus pandemic. But they’re also notably resilient psychologically, calling upon a lifetime of experience and perspective to help them through difficult times.

New research calls attention to this little-remarked-upon resilience as well as significant challenges for older adults as the pandemic stretches on. It shows that many seniors have changed behaviors — reaching out to family and friends, pursuing hobbies, exercising, participating in faith communities — as they strive to stay safe from the coronavirus.

“There are some older adults who are doing quite well during the pandemic and have actually expanded their social networks and activities,” said Brian Carpenter, a professor of psychological and brain sciences at Washington University in St. Louis. “But you don’t hear about them because the pandemic narrative reinforces stereotypes of older adults as frail, disabled and dependent.”

Whether those coping strategies will prove effective as the pandemic lingers, however, is an open question.

“In other circumstances — hurricanes, fires, earthquakes, terrorist attacks — older adults have been shown to have a lot of resilience to trauma,” said Sarah Lowe, an assistant professor at Yale University School of Public Health who studies the mental health effects of traumatic events.

“But COVID-19 is distinctive from other disasters because of its constellation of stressors, geographic spread and protracted duration,” she continued. “And older adults are now cut off from many of the social and psychological resources that enable resilience because of their heightened risk.”

The most salient risk is of severe illness and death: 80% of COVID-19 deaths have occurred in people 65 and older.

Here are notable findings from a new wave of research documenting the early experiences of older adults during the pandemic:

Changing behaviors. Older adults have listened to public health authorities and taken steps to minimize the risk of being infected with COVID-19, according to a new study in The Gerontologist.

Results come from a survey of 1,272 adults age 64 and older administered online between May 4 and May 17. More than 80% of the respondents lived in New Jersey, an early pandemic hot spot. Blacks and Hispanics — as well as seniors with lower incomes and in poor health — were underrepresented.

These seniors reported spending less face-to-face time with family and friends (95%), limiting trips to the grocery store (94%), canceling plans to attend a celebration (88%), saying no to out-of-town trips (88%), not going to funerals (72%), going to public places less often (72%) and canceling doctors’ appointments (69%).

Safeguarding well-being. In another new study published in The Gerontologist, Brenda Whitehead, an associate professor of psychology at the University of Michigan-Dearborn, addresses how older adults have adjusted to altered routines and physical distancing.

Her data comes from an online survey of 825 adults age 60 and older on March 22 and 23 — another sample weighted toward whites and people with higher incomes.

Instead of inquiring about “coping” — a term that can carry negative connotations — Whitehead asked about sources of joy and comfort during the pandemic. Most commonly reported were connecting with family and friends (31.6%), interacting on digital platforms (video chats, emails, social media, texts — 22%), engaging in hobbies (19%), being with pets (19%), spending time with spouses or partners (15%) and relying on faith (11.5%).

“In terms of how these findings relate to where we are now, I would argue these sources of joy and comfort, these coping resources, are even more important” as stress related to the pandemic persists, Whitehead said.

Maintaining meaningful connections with older adults remains crucial, she said. “Don’t assume that people are OK,” she advised families and friends. “Check in with them. Ask how they’re doing.”

Coping with stress. What are the most significant sources of stress that older adults are experiencing? In Whitehead’s survey, older adults most often mentioned dealing with mandated restrictions and the resulting confinement (13%), concern for others’ health and well-being (12%), feelings of loneliness and social isolation (12%), and uncertainty about the future of the pandemic and its impact (9%).

Keep in mind, older adults expressed these attitudes at the start of the pandemic. Answers might differ now. And the longer stress endures, the more likely it is to adversely affect both physical and mental health.

Managing distress. The COVID-19 Coping Study, a research effort by a team at the University of Michigan’s Institute for Social Research, offers an early look at the pandemic’s psychological impact.

Results come from an online survey of 6,938 adults age 55 and older in April and May. Researchers are following up with 4,211 respondents monthly to track changes in older adults’ responses to the pandemic over a year.

Among the key findings published to date: 64% of older adults said they were extremely or moderately worried about the pandemic. Thirty-two percent reported symptoms of depression, while 29% reported serious anxiety.

Notably, these types of distress were about twice as common among 55- to 64-year-olds as among those 75 and older. This is consistent with research showing that people become better able to regulate their emotions and manage stress as they advance through later life.

On the positive side, older adults are responding by getting exercise, going outside, altering routines, practicing self-care, and adjusting attitudes via meditation and mindfulness, among other practices, the study found.

“It’s important to focus on the things we can control and recognize that we do still have agency to change things,” said Lindsay Kobayashi, a co-author of the study and assistant professor of epidemiology at the University of Michigan School of Public Health.

Addressing loneliness. The growing burden of social isolation and loneliness in the older population is dramatically evident in new results from the University of Michigan’s National Poll on Healthy Aging, with 2,074 respondents from 50 to 80 years old. (It found that, in June, twice as many older adults (56%) felt isolated from other people as in October 2018 (27%).

Although most reported using social media (70%) and video chats (57%) to stay connected with family and friends during the pandemic, they indicated this didn’t alleviate feelings of isolation.

“What I take from this is it’s important to find ways for older adults to interact face to face with other people in safe ways,” said Dr. Preeti Malani, chief health officer at the University of Michigan. “Back in March, April and May, Zoom family time was great. But you can’t live in that virtual universe forever.”

“A lot of well-intentioned families are staying away from their parents because they don’t want to expose them to risk,” Malani continued. “But we’re at a point where risks can be mitigated, with careful planning. Masks help a lot. Social distancing is essential. Getting tested can be useful.”

Malani practices what she preaches: Each weekend, she and her husband take their children to see her elderly in-laws or parents. Both couples live less than an hour away.

“We do it carefully — outdoors, physically distant, no hugs,” Malani said. “But I make a point to visit with them because the harms of isolation are just too high.”


This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Distrusting Trump, States Plan to Vet COVID Vaccines Themselves. Bad Idea, Say Experts.

As trust in the Food and Drug Administration wavers, several states have vowed to conduct independent reviews of any COVID-19 vaccine the federal agency authorizes.

But top health experts say such vetting may be misguided, even if it reflects a well-founded lack of confidence in the Trump administration — especially now that the FDA has held firm by releasing rules that make a risky preelection vaccine release highly unlikely.

At least six states and the District of Columbia have indicated they intend to review the scientific data for any vaccine approved to fight COVID-19, with some citing concern over political interference by President Donald Trump and his appointees. Officials in New York and California said they are convening expert panels expressly for that purpose.

“Frankly, I’m not going to trust the federal government’s opinion and I wouldn’t recommend [vaccines] to New Yorkers based on the federal government’s opinion,” New York Gov. Andrew Cuomo said last month.

“We want to make sure — despite the urge and interest in having a useful vaccine — that we do it with the utmost safety of Californians in mind,” Dr. Mark Ghaly, California’s health and human services secretary, said at a recent news conference.

The District of Columbia, Colorado, Michigan, Oregon and West Virginia also have said they’ll review vaccine data independently.

But scientists who study vaccine policy said such plans could backfire, confusing the public, eroding confidence in any eventual vaccine and undermining the best strategy to end the pandemic, which has sickened nearly 7.5 million Americans and killed more than 210,000.

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“Do you really want a situation where Texas, Alabama and Arkansas are making drastically different vaccine policies than New York, California and Massachusetts?” asked Dr. Saad Omer, an epidemiologist who leads the Yale Institute for Global Health.

Separate state vaccine reviews would be unprecedented and disruptive, and a robust regulatory process already exists, said Michael Osterholm, an epidemiologist and director of the Center for Infectious Disease Research and Policy at the University of Minnesota.

“States should stay out of the vaccine review business,” Osterholm said. “I think the Food and Drug Administration is doing their job right now. Unless there’s something that changes that, I do believe that they will be able to go ahead.”

The administration has given reasons for states to worry. Trump has repeatedly signaled a desire for approval of a vaccine by the Nov. 3 election, arousing fears that he will steamroll the normal regulatory process.

The president wields “considerable power” over the FDA because it’s part of the executive branch of government, said Lawrence Gostin, faculty director of the O’Neill Institute for National and Global Health Law. The president nominates the FDA commissioner and can replace him at any time.

Trump has already contradicted the advice of his own scientific advisers in order to promote unproven therapies to fight COVID-19. The FDA approved two treatments — hydroxychloroquine and convalescent plasma — without strong evidence of safety and efficacy after Trump pushed for the therapies to be widely available.

Late Monday, The New York Times reported that top White House officials planned to block FDA guidelines that would bolster requirements for emergency authorization of a COVID vaccine — because the new guidelines would almost certainly delay approval until after the election.

The White House’s actions undermine the agency, said Dr. Paul Offit, an infectious disease expert at Children’s Hospital of Philadelphia and a member of the FDA advisory committee on vaccines.

“Trump has perverted the FDA,” Offit said. “He has scared people into thinking that normal systems aren’t in place there anymore.”

But the FDA seems to be maintaining plans that would make it virtually impossible for a vaccine to be approved by Election Day.

Dr. Peter Marks, who heads the FDA division responsible for vaccine approval, has repeatedly said career scientists at the agency are working to ensure that political pressure isn’t a factor in any decision.

FDA reviewers are determined to “keep our hands over our ears to the noise that’s coming in from all sides and keep our eyes on the prize,” Marks said Monday in a JAMA webinar.

On Tuesday, the FDA pushed back against White House interference by publishing stricter guidance for vaccine developers on its website. The document instructs vaccine companies to follow patients for two months after their last shot in order to give researchers more time to detect serious side effects and ensure the vaccine works.

For now, supporters of the normal regulatory process are pinning their hopes on two advisory groups of respected scientists who will evaluate vaccines for safety and efficacy and send their recommendations to federal agencies.

The FDA’s advisory group, known as VRBPAC, will review data submitted by the pharmaceutical companies and the agency for any vaccine. The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices, or ACIP, will weigh in on its use. Their recommendations aren’t binding, but the federal government has rarely contravened them.

Before jumping to independent reviews, states should allow ACIP and VRBPAC to do their jobs, said Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. That’s the best defense against any political pressure, he said, and individual states likely wouldn’t have access to the data — or, perhaps, the expertise — to conduct their own reviews.

ACIP Chairman Dr. José Romero, who also is the chief medical officer for the Arkansas Department of Health, said the group has been meeting regularly since spring to discuss COVID vaccines and they’ve been able to proceed “in an unfettered fashion.”

“I have not felt pressured by the CDC, other government agencies or pharmaceutical companies to arrive at any particular recommendation,” he said.

Other safeguards are in place as well. Trump cannot simply override the FDA’s authority to approve drugs and vaccines, which comes from Congress.

“The president can influence the FDA, but it must be consistent with the FDA’s statutory mandate,” Gostin said. “The White House may not, for example, direct the agency to ignore science or use a lower scientific standard.”

Congress could sue the FDA for failing to follow its own standards, and a judge could issue a temporary restraining order blocking release of a COVID vaccine, Gostin said. Courts would require the FDA commissioner or health and human services secretary to have “valid, evidence-based reasons” for any decision.

“The commissioner or secretary may not act arbitrarily or according to political preferences alone,” Gostin said.

Individual states could not overrule the FDA’s authorization or approval of a vaccine, but they could wield their power in other ways. States distribute vaccines through contracts with the CDC, noted Dr. Kelly Moore, associate director of immunization education for the Immunization Action Coalition. They could say, “‘We will not place any orders until we’re sure,’” she said.

States probably could not prevent private companies, such as pharmacy chains, from distributing vaccines that are shipped directly to them. Pharmacies would likely sue any states that try to prevent them from distributing vaccines, Gostin said.

Although federal and state agencies play a crucial role in ensuring patient safety, they’re not the only entities looking out for patient interests, said Dr. Joshua Sharfstein, a former FDA deputy commissioner who is now a vice dean at the Johns Hopkins Bloomberg School of Public Health. Doctors and other medical providers won’t recommend a vaccine they don’t trust, he said.

“We have an entire health care system standing between politics and the patients,” Sharfstein said. “I think doctors are going to be very concerned if a vaccine is rushed.”

Even pharmaceutical companies that stand to profit from vaccines have a huge stake in protecting the integrity of the approval process. Nine rival vaccine makers took the unusual step last month of pledging not to release a COVID vaccine until it has been thoroughly tested for safety.

The bigger consideration, however, is how state-by-state vetting would affect consumer trust in a COVID vaccine — or any vaccine in the future, Plescia said. A recent KFF poll found 54% of Americans would not submit to a COVID vaccine authorized before Election Day.

“Are people going to mistrust the entire process?” he said. “We will get through COVID one way or another, but if we undermine confidence in public health, that would be a disaster.”

Fighting for Patient Protections While Attacking ACA — Hard to Have It Both Ways

Throughout the 2020 election cycle, candidates’ positions on health care have been particularly important for voters with underlying and often expensive medical needs — in short, those with preexisting conditions.

It’s no surprise, then, that protections for people who have chronic health problems like diabetes and cancer have become a focal point for candidates nationwide — among them, Matt Rosendale, the Republican contender for Montana’s only U.S. House seat.

On Sept. 22, Rosendale’s campaign hit airwaves and online streaming services with an ad featuring a Whitefish resident named Sandee, whose son was diagnosed with a life-threatening disease. Sandee told the story of how Rosendale came to her family’s aid, concluding that “Matt fights for everyone with a preexisting condition.”

As is often the case with health care policy, however, the truth is far from simple. Rosendale and many other Republican congressional candidates face the challenge of convincing voters they support these safeguards even as they oppose the Affordable Care Act, which codifies those safeguards.

Polls show broad public support for keeping the ACA’s preexisting condition protections.

We decided to investigate.

Rosendale is up against Democrat Kathleen Williams for the congressional seat now occupied by Republican Rep. Greg Gianforte, who has entered the state’s gubernatorial race. The open seat has been controlled by the GOP for the past 12 terms, but this year’s race is expected to be close. Williams, who also ran for the seat in 2018, has made health care her top campaign issue.

We contacted the Rosendale campaign to find out the basis for his ad’s claim. Campaign spokesperson Shelby DeMars listed a range of health policies backed by the candidate that would help people with preexisting conditions directly or indirectly by holding down health care costs. She specifically pointed to Rosendale’s work on the state’s reinsurance program as Montana’s state auditor and insurance commissioner, a post he was elected to in 2016.

“Matt Rosendale is a champion for those with pre-existing conditions and he has the record to prove it,” DeMars said via email. “It is because of the Reinsurance program he implemented that Montanans with pre-existing conditions can access the affordable healthcare coverage they need.”

Examining Reinsurance

In a nutshell, Montana’s reinsurance program is designed to help insurers cover costly medical claims with a mix of federal pass-through dollars and funding generated by a premium tax on all major medical policies in the state. Gov. Steve Bullock announced the formation of a bipartisan group tasked with developing reinsurance program legislation in fall 2018, and the state’s legislature approved the plan in 2019, allowing Rosendale to apply for and receive the necessary waiver under the Affordable Care Act.

Subsequent news accounts indicated the idea worked. In-state insurers credited the program with lowering premiums by 8% to 14% for 2020. As Montana Health Co-op CEO Richard Miltenberger told MTN News shortly after the 2019 legislative session, “It allows the insurance companies to have rate stabilization for those really big claims, the ones that are the earthquakes in health insurance.” He went on to say that this stability “brings the cost down for the consumer.” More to the point, the American Medical Association has also stated that reinsurance not only serves to subsidize high-cost patients but “protects patients with pre-existing conditions.”

But there’s a rub.

The reinsurance program that Rosendale touts wouldn’t exist without a state innovation waiver created by the ACA, which Rosendale says he’ll work to repeal. That effort will doubtless continue to fuel pitched battles in Congress, and how the U.S. Supreme Court may rule on a pending ACA challenge remains a point of speculation. One thing is clear, though: If the entire ACA is thrown out, the reinsurance program goes with it, along with Montana’s Medicaid expansion and the ban on insurers from excluding people with health problems from affordable coverage.

When asked about the resulting elimination of the reinsurance program, DeMars reiterated that Rosendale’s work as auditor has created a system that will ensure protections for preexisting conditions “regardless of what happens to the ACA.” She did not elaborate or explain what protections would remain if the ACA were repealed.

The Short-Term Plan Component

In defending his stance on preexisting conditions, Rosendale continues to be haunted by another health care policy specter from his political past. During his unsuccessful challenge against Democratic U.S. Sen. Jon Tester in 2018, Rosendale faced criticism for promoting short-term, limited-duration health insurance plans. Unlike plans offered on the individual marketplace, these short-term plans are exempt from the ACA’s ban on excluding people with preexisting conditions. And, under a 2018 regulatory change pushed by the Trump administration, the length of these short-term plans has been extended from three months to 12, with the potential to renew for up to three years.

As state auditor, Rosendale included those plans in his March 2020 roundup of year-round options for immediate coverage. They often exclude coverage for a variety of higher-cost benefits. In Montana, for example, a review by KFF found that of four short-term plans available in Billings in 2018, none offered coverage for maternity care, mental health, substance abuse or prescription drug services. (KHN is an editorially independent program of KFF.)

Historically, short-term plans were designed to help individuals fill gaps in health coverage. According to Dania Palanker, an assistant research professor at Georgetown University’s Center on Health Insurance Reforms, the role short-term plans play on today’s health insurance landscape is to attract younger, healthier individuals seeking low-cost options to cover catastrophic events. That splits insurers into two pools — those who are less likely to incur medical expenses, and those who are more likely to incur them. Costs on the individual market go up as a result, leaving people with preexisting conditions no other option than to pay higher premiums. Short-term plans are, Palanker said, “actively hurting people with preexisting conditions.”

“Promoting short-term plans and stumping on supporting protections for preexisting conditions are mutually exclusive,” she continued.

Asked whether the cost-lowering effect of a reinsurance program would be enough to offset the effects of short-term plans, Palanker said the only way such an offset would be enough is if the program encompassed short-term plans. She hasn’t seen that happen anywhere.

Our Ruling

A campaign ad says Rosendale “fights for everyone with a preexisting condition.” While it is true that health insurance premiums have dropped during Rosendale’s tenure as state auditor, the choice to establish Montana’s reinsurance program ultimately fell to decision-makers in the state’s legislature and the governor’s office. Since his ad’s claim simply states that he “fights” for people with preexisting conditions, his testimony in support of that program and role in securing the state waiver do seem to fit the bill.

In the long-term, however, Rosendale’s positions begin to run counter to the claim. His support for short-term, limited-duration plans poses a considerable threat to keeping health insurance affordable for all, and absent a solid plan from Congress to ensure that state reinsurance programs survive, his stated goal of repealing the ACA would actually serve to unravel the very protection he’s built his case on.

We rate this statement as Mostly False.


This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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This story can be republished for free (details).

Hard Lives Made Harder by COVID: Homeless Endure a ‘Slow-Moving Train Wreck’

CALEXICO, Calif. — The message wasn’t lost on Daniel Gonzalez.

Early in the pandemic, one of the first things Imperial County did to ward off the virus was close the public bathrooms and, later, public cooling centers. In this sprawling Southern California desert, where summer brings blistering triple-digit heat, that lack of access could amount to a death sentence for people without shelter.

People like Gonzalez, homeless the past two years, were simply not a priority.

Months into the coronavirus shutdown, Gonzalez, 47, felt lonely. Calexico’s quiet downtown had emptied out. July highs were topping 110, and it was uncomfortable wearing a mask in the swelter. But not having a place to rinse off or wash up, that was just a hazard.

Standing outside a closed restroom in Calexico’s Border Friendship Park, looking out over the complex of metal bars and security equipment that marks the U.S.-Mexico border, he waited for dinner. Every night at 7:30 p.m., volunteers assembled at the park to serve a hot meal to anyone in need. A few weeks before, pressured by the organizers, the county started dropping off hand-washing stations right before the meal, only to whisk them away as soon as it was served.

Gonzalez lined up. At least it was something.

This was supposed to be the year that California finally did something about its epidemic of homelessness. On February 19, Gov. Gavin Newsom stood before lawmakers in the state Capitol, and delivered an unprecedented State of the State address devoted entirely to the homelessness crisis. California is home to one-quarter of the nation’s homeless population, a grim distinction painfully visible not only on city sidewalks, but also along the state’s freeways and farm levees, in its urban parks and suburban strip malls.

Past administrations had mostly ignored the problem, Newsom said, but he’d be different. “It’s a disgrace that the richest state in the richest nation — succeeding across so many sectors — is falling so far behind to properly house, heal and humanely treat so many of its own people,” he told the crowd.

But even as Newsom spoke, a different epidemic was advancing silently across the state. Exactly one month later, he would order a far-reaching statewide shutdown, asking every person in California not working in an essential industry to shelter at home in an effort to stave off COVID-19.

It was a complicated ask for the more than 150,000 Californians without a home.

For two weeks in March, Newsom’s top homelessness adviser, Jason Elliott, gathered with academics, service providers and county representatives at the emergency operations center just outside Sacramento to confront the menace that COVID-19 presented for tens of thousands of people living outside, often without access to clean water or basic hygiene. They pored over data showing how California’s homeless population had gotten larger, older and sicker in recent years. More than 40% of homeless Californians are age 65 or older or have underlying health conditions such as heart disease, according to the state’s internal estimates — factors that put them at greater risk of infection and death from COVID-19.

“When you take the attack rate and apply it to more than 100,000 unsheltered people,” Elliott said, “you very quickly find out that tens of thousands of homeless people are potentially susceptible to dying of coronavirus.”

They would need to act quickly. The crowded shelters, in short supply and usually considered safe ground for homeless people, suddenly posed a risk of transmission and would have to be thinned out. Instead, the very conditions lambasted as California’s shameful legacy of neglect — people subsisting in makeshift shanties and battered tents in parks and alleys and freeway underpasses — emerged as a safer alternative. The federal Centers for Disease Control and Prevention advised that people sleeping outside should be left alone; the encampments that pre-pandemic were routinely dismantled would be largely left in place, state officials decided.

But California still would need somewhere to house people considered most at risk: those who are older and have chronic health conditions. His plan wasn’t ready for prime time, but Newsom had been quietly pursuing an ambitious idea to buy up hotel and motel rooms to get people off the streets and into housing with supportive services. Now, with the declaration of a state and national emergency, it looked as if the Federal Emergency Management Agency might help pay to rent them temporarily. Newsom set a goal of 15,000 rooms.

In the months since, the state’s efforts to shelter homeless residents amid COVID-19 have played out in starkly contrasting storylines, bent and molded by local politics and resources. The state and federal governments have pledged millions for Project Roomkey, the state’s signature public health effort to move the most vulnerable into housing, with local counties expected to foot a quarter of the bill, as well as arrange meals, security and support services. For now, the counties taking part are fronting all the funding and say they have no idea when they’ll be reimbursed.

Still, most counties are participating and have procured nearly 16,500 rooms, according to state data, housing 22,300 people at various times since March. And homeless services providers, particularly in the state’s urban centers, say the unprecedented promise of funds has allowed them to work small miracles, linking desperate people to social services, health care and sometimes jobs.

But if the hotel rooms have been lifesaving for those lucky enough to get inside, providers across the state also were forceful in noting they are reaching just a sliver of those in need. In some cases, hotel owners have been unwilling to participate in Project Roomkey, while elsewhere city and county leaders have been hesitant or flat-out opposed.

In the meantime, the prolonged closure of shelters, churches and charities — along with the restaurants and retailers that offer access to electricity, water and food — has made life far more brutal for the tens of thousands of homeless people who weren’t selected for a room. In many counties, the life hacks and cobbled-together supports that homeless people rely on for survival have disintegrated. The squalid encampments have only gotten larger, fueled by COVID-spurred prison and jail releases and an unprecedented economic shutdown that community leaders say has landed scores more people on the streets.

If the state’s goal was to ward off a deadly COVID-19 outbreak among the homeless, it can claim success. Quick work to thin out the shelters has so far prevented widespread homeless deaths from the virus, authorities say.

But suffering comes in other forms. And interviews with dozens of homeless people, activists and local officials in 12 counties reveal a new magnitude of hardship and indignity for California’s homeless — and no easy answers ahead. What follows are a few of their stories.

Imperial County

“I’m one of the ones that it would probably kill me quick if I got that virus. I’m just staying away from everyone.” — Carl Wilkinson, 60, El Centro

Carl Wilkinson had been living for several weeks on a stretch of dirt beside a plowed field in sight of the lone indoor mall in El Centro. Wilkinson has chronic obstructive pulmonary disease and probably qualifies for a COVID hotel room through Project Roomkey. But he lost his ID a while back, so he hasn’t even tried applying.

Wilkinson has no idea how he’ll get an ID; money is tighter than usual because the recycling centers, where he takes the cans and bottles he collects, have closed. He’s become so desperate that he has resorted to panhandling, though that hasn’t gone well either, since so many people are staying inside. “It’s all-around tougher,” he said.

In May, the only men’s shelter in Imperial County closed temporarily after seven of the 20 men staying there caught the coronavirus. Though the shelter spaced beds farther apart and hung plastic dividers, men say they are afraid to return. The Salvation Army, which typically offers meals and a place to shower, has closed several times as staffers have fallen ill.

Instead, Wilkinson has been bathing in the dingy waters of the irrigation ditch next to his tent.

He knew about the federal guidelines saying people are safer from the virus if they can stay in one place. That had given him and two neighbors some hope there would be at least one silver lining to the pandemic: not getting rousted by cops. But the sheriff had shown up the day before saying they had to pack up. He wasn’t sure where they’d go. “They move us around like cattle in a pasture when it’s grazed,” Wilkinson said.

Imperial County, which hugs the border with Mexico, is a desert valley transformed into an agricultural hub nearly a century ago by water diverted from the Colorado River. The county of 181,000 people has an official homeless count of 1,527, including several hundred people who live off the grid in a remote area known as Slab City. Imperial has the highest death rate from COVID-19 of any county in California.

The largest city in the county is El Centro, home to one of the county’s two hospitals, and, until its church leaders were arrested last year, a ministry the FBI accused of luring homeless people into forced labor. Though the homeless population has steadily grown in the past few years, the county has little in the way of services for the homeless.

Sgt. James Thompson of the El Centro Police Department and Anna Garcia, a code enforcement officer, serve as the lone homeless outreach team for the city but are limited in what they can do. “A lot of people are confused about my role,” Thompson said. “We have not gotten into the homeless business; it’s an effort to curb the quality-of-life issues.” The pair know many of the people who are homeless in El Centro by name. They know who gets in trouble with the law, who has an issue with drug use and who has a mental illness.

Before COVID-19, Thompson had a daily routine. Get in at 8, hit the streets to talk to people who are homeless. He’d move them, make sure they weren’t getting into trouble, offer help when he could. Then in June, a colleague on the force got into a physical altercation with a homeless man, contracted COVID-19 and died. Thompson’s chief has been a lot more cautious with his officers in the weeks since.

Before their work was curbed, Thompson and Garcia helped several people fill out paperwork for a hotel room. None got in. “They met the criteria, they did do what they were supposed to do. But for whatever reason, there was no funding when it was time for them to be placed,” Garcia said. She feels it fits a pattern of services going to those who are easiest to help, whether it’s families or people who just can’t make rent. People who chronically live on the streets are not the easiest to help.

In August, months into the pandemic, county officials had 36 hotel rooms to work with, and had placed 274 homeless people in rooms or trailers at some point. Among them were 27 people who had COVID-19, although there were almost certainly more since the county isn’t routinely testing homeless groups.

And the El Centro officers say they worry there’s been a spike in other types of deaths. Three people died of overdoses over three days in the same dusty parking lot this summer, said Thompson. One was a young woman who’d experienced years of family abuse. They had been working to get her off the streets. He’d thought she was doing better.

Twenty minutes south, Maribel Padilla has organized the nightly feeding program in Border Friendship Park since 2015. She’s seen how the closing of fast-food restaurants and local businesses have made it harder for the people she helps. When the county closed the public bathrooms early in the pandemic, the folks her Brown Bag Coalition feeds no longer had a place to wash their hands.

It took a protracted battle and her loud mouth to change that, Padilla said. County officials told her they were concerned the virus would spread through hand-washing stations, a concern that makes Padilla spew profanities.

“They’ve been out there and exposed to so much shit,” Padilla said. Thousands go back-and-forth between Mexico and the U.S. each day; farmworkers cram into crowded buses to get to work; elderly and homeless residents travel together via public transportation.

“It’s going everywhere,” she fumed “and you’re worried about the soap dispenser?”

Alameda County

“Due to the number of deaths especially in the African American community, I have reasonable concern of the likelihood of harm and injury, possibly death.” — Andre Alberty, 53, Oakland, in a grievance filed with the California Department of Corrections and Rehabilitation

Andre Alberty was born and raised in Oakland, like his parents. Except for the years he spent in prison, it has always been home. When he returned to the neighborhood after an early release from San Quentin, a maximum-security prison in one of the wealthiest counties in the country, he was blown away by the number of RVs, tents and live-in cars lining the streets. It was a striking testament to housing costs that had soared out of reach. “There needs to be more affordable housing for people,” he said. “I never saw it like this.”

Alberty’s most recent prison stint was for burglary. He contracted COVID-19 in San Quentin after the California Department of Corrections and Rehabilitation moved dozens of inmates to the Bay Area prison from the California Institute for Men in Chino while it was in the midst of a major coronavirus outbreak. “What makes you think it’s not going to come in here when it went around the world in four months?” he remembers thinking. “You don’t think it’s going to jump a hallway?”

When Alberty, 53, and his cellmate developed symptoms, they knew that telling the guards would get them thrown into solitary, a place usually used as punishment that has been turned into a de facto medical isolation wing. And so, for several weeks in June and July, he was alone in “the hole,” with nothing but his thoughts and a virus to keep him company. By the end of September, COVID-19 had killed 28 inmates at San Quentin and infected 2,241 others, as well as 290 staff members.

It was demoralizing, to be infected and confined in solitary as a result. “Psychologically, that affects you,” Alberty said. “You feel like you ain’t nobody. Then how do you expect us to come out here and try to make ourselves somebody?”

That’s where his mind was in mid-July when his sentence was cut short, part of a massive early-release program Newsom ordered as COVID-19 carved a deadly swath through the state’s 35 prisons. Since then, Alberty has alternated between staying on a sick friend’s couch and in a friend’s RV, part of a large community of locals camping along Mandela Parkway in the heart of West Oakland because they’ve been priced out.

Prison releases are just one of the ways the homeless population has grown since the pandemic began. Californians have experienced unprecedented job loss, with the unemployment rate at 13%. A moratorium on evictions has helped millions stay in their homes, but the protections are loosely enforced and many tenants aren’t aware of their rights. Others were kicked out of the homes of family and friends who weren’t eager to have someone sleeping on the couch or floor in the middle of a pandemic.

“This is a slow-moving train wreck on a scale that we have never seen,” said Dr. Anthony Iton, senior vice president for healthy communities at the California Endowment.

To Alberty’s south, in East Oakland, Megan Ruskofsky-Zuccato, 25, was living under an overhead rail line in an old RV with her partner and a friend. Though she’d been homeless on and off, they had a place when the pandemic hit — until April, when, without explanation, the landlord asked them to move out. “I wish I would have known that Gov. Gavin Newsom put that [eviction moratorium] in effect, because then I would have never left,” she said.

Her partner got the RV as a trade for unpaid work as a welder at the start of the pandemic. She finds the whole situation humiliating. “When you live out here, people just look at you like you’re a bad person,” she said.

Jennifer Friedenbach is executive director of the Coalition on Homelessness in San Francisco, which advocates for housing and social justice in the city. On a daily basis, she sees both the opportunity — and nightmare — of the pandemic response. She is thrilled nearly 3,000 people in San Francisco had a hotel to sleep in at some point during the pandemic. And that San Francisco has put out more portable hand-washing stations and bathrooms.

The problem is, there’s not nearly enough to go around. Not enough rooms, not enough sanitation, not enough enforcement of tenant protections, not enough places to charge a phone. The number of tenants calling an anti-eviction hotline has doubled to 200 a week since 2019, and Friedenbach thinks more should have been done for rental assistance. Vehicles are often a first stop for people when they lose their homes, she said, and she’s seeing a lot more people sleeping in cars.

And while homeless people aren’t dying from COVID-19 in the numbers once feared, they are dying nonetheless. Deaths among the homeless tripled in San Francisco in the early months of the pandemic. In Los Angeles County, homeless deaths were up 27% over 2019.

Friedenbach worries that’s about to get worse. “Everything is coming to a screeching halt; the placement in hotels is halted,” she said. “Things are going to start getting really bad again in terms of a lot of people being out on the streets.”

Fresno County

“It’s hard times and we are suffering. My voices are getting stronger and stronger.” — Juan Gallardo, 53, Selma

Luciana Lopez sat in the back seat of a van rumbling across rutted roads in the rural outskirts southeast of Fresno. Her eyes scanned the dusty expanse of orchards and vineyards looking for the telltale hollows. Her attention was tuned to a bitter reality in this breadbasket-feeding-a-nation: the dozens of people living underground in the farm fields, subsisting in burrows hand-dug into the ground and irrigation levees — where they can hide from the sun, immigration authorities, violence, judgment.

Just days before, after local landowners complained, law enforcement had descended on this encampment, known casually as “The Hole,” and rousted an estimated 60 people from their dirt caves, many of them seniors. Outreach workers said maybe two landed in a shelter. The rest, a mix of addicts, itinerant farmhands and those with a run of bad luck, had dispersed to god-knows-where.

For Lopez, who works as an outreach worker for a homeless services provider that contracts with Fresno County, it was yet another COVID setback. Whatever trust had been built, whatever efforts underway to connect these men and women with ID cards, food stamps, disability payments, medical services — the chances of follow-through had largely evaporated.

Nearly five months into the pandemic, finding housing for Fresno County’s homeless seemed an insurmountable challenge. A January count pegged the homeless population of Fresno and Madera counties at more than 3,600, a 45% rise from 2019. Even in non-COVID times, this region of mega-farms and meatpacking plants had relatively little to offer in terms of government-sponsored shelters and supportive housing outside the city of Fresno. Instead, social workers looked to the relatively cheap housing stock as a solution, using federal and state funds to rent apartments for their clients.

But COVID has changed the real estate arithmetic. Local providers say large numbers of middle-income residents have lost jobs in the state’s months-long shutdown and are relocating to less expensive rentals. The units once available for $600 or $800 a month — and affordable for someone living on government assistance — are disappearing amid pitched demand.

Hotel and motel operators in Fresno County have not enthusiastically embraced Project Roomkey. Under the program, the county is sparingly using just one hotel to house homeless people infected with COVID-19. Drawing on other state and federal funds, the county managed to rent out two additional hotels, open to anyone who is homeless and vulnerable, in Selma and the nearby town of Sanger. As of late September, all 82 rooms were filled, with waiting lists stretching dozens long. Vacancies at four other converted sites, with about 350 beds, are quickly filled.

“It’s heartbreaking, we go through the breakdowns with them, we go through all the frustrations to get them ready for housing, just for the freaking system to spit them out and say there’s nothing for you,” Lopez said.

Her crew had resorted to basics, driving the farm roads southeast of the city to distribute water, snacks and masks to people living in ragtag encampments amid bountiful acres of fruit and nuts. They did so not knowing who might be carrying the virus, because there has been so little testing.

Juan Gallardo, 53, was on one of Lopez’s stops on a muggy morning in mid-July. Homeless most of his life, Gallardo had set up camp under suspended tarps on a dirt field just below the Golden State Highway near Selma. When the stores and churches shut down, he was cut off from the critical supports he’d developed for a life on the streets: odd jobs; gathering cans and bottles for recycling. There was nowhere close by to charge a phone or buy groceries, no access to clean water. He had taken to bathing in a nearby drainage canal, though it triggered rashes. For drinking water, he’d haul back a couple of pails for boiling.

“It’s hard to get food on your table right now, you have to hustle even more,” Gallardo said, as he rinsed clothes in a bucket. “It’s hard being in the crisis; you never know who can have [the virus]. But I try not to think about it, because the more you think about it, you start getting worried and then you stop doing what you’re supposed to be doing.”

Gallardo, who has untreated bipolar disorder and arthritis in both his knees, said he had lost access to medication and it was getting harder to cope. “My voices are getting stronger,” he said.

About a mile away, in downtown Selma, Delfina Vazquez said the pandemic has exposed a whole new level of desperation in her county. Vazquez heads Selma Community Outreach Ministries, a charity run out of a converted storefront that launched a daily food pantry at the start of the pandemic. As other local charities shuttered, she said, “We knew people would still need to eat. We looked to the Lord, who said, ‘Open your doors.’”

What started as a hot midday meal expanded into a food delivery service to families in a circle of farm towns, from Selma to Reedley to Parlier and Orange Cove. Vazquez said her ministry, funded primarily by donations and government contracts, is now providing 10,000 meals a month, mostly to homeless people and farmworker families struggling amid the shutdown. “People are becoming homeless because of COVID,” she said. “It’s absolutely growing.”

Through her ministry, Vazquez also oversees a Super 8 in Selma and Townhouse Motel in Sanger that have been converted to COVID shelters for the homeless. All 30 rooms at the Super 8 are full, she said, providing housing for 14 families, including 30 children. The waitlist stands at 60.

Like many advocates working with the homeless amid COVID-19, she worries about what will happen when the state and federal emergency funding wind down at year’s end. If the newly converted hotels close down, she said, “that’s 81 families out on the street.” And where would they go? The real estate offices “don’t want to flat-out say we don’t want to rent” to homeless people, she said, so instead have started demanding that applicants earn three times the rent to qualify.

Vazquez is already working on a Phase Two: talking with local officials about raising money to buy land in Selma where they could build a community of tiny homes. “Realistically, no one wants to rent to someone evicted,” she said. “There’s no second chance here. That’s where we’re at right now.”

Los Angeles

“He was really afraid of finding out what his true identity was, but we assured him he’s staying here no matter what. We’re not kicking him out.” — Dr. Coley King, speaking about Charles Poindexter, 71, Santa Monica

For people who did get indoors during the pandemic, the rooms have, in many cases, been life-changing.

Dr. Coley King, a physician with the Venice Family Clinic and director of homeless services, practices “street medicine,” bringing health care directly to people on the street. His patients have complex histories, and it’s rare that he gets clear signs their health is improving. But during the pandemic, it’s happened several times after patients have received housing. One patient with uncontrolled diabetes started having normal blood sugar readings. One of his “super users,” who makes regular visits to the emergency room, hadn’t been to a hospital in months. And multiple clients with addiction issues were getting sober.

Then there was, perhaps, the most dramatic case, involving the tall, sturdy man he’d seen on the streets of Santa Monica over the years. The man had previously confided in King that he wasn’t sure who he was, and the doctor noted signs of memory loss. In June, the street medicine team found him a space in a Santa Monica hotel. It took just a few days to find a diagnosis for his cognitive issues: untreated syphilis and a traumatic brain injury from a bus accident.

They also found his name: Charles Poindexter.

“He’s telling me, ‘I don’t know if I did something wrong out there, and I don’t know if I want to know who I am,’” King said. “It turned out good because he’s not wanted by the law anywhere, and we’re all good.”

These stories can be found across the state. In Fresno, Cammie Bethel, 37, could bring her six children back to live with her after getting into transitional housing. Cornelio Mendoza, 52, who in December became homeless for the first time, was able to get sober after getting a city-sanctioned tent in Santa Rosa. “Being here, I’m grateful,” he said.

Seeing the transformation that can happen when someone has a safe place to sleep makes it all the more tragic how limited resources are, advocates say.

Across the state, counties have marshaled thousands of rooms and safe camping sites for hundreds of tents. The state gave counties more than 1,300 trailers to isolate people infected with or exposed to COVID-19. Still, lack of interest from hotel owners and opposition from neighbors have blunted the program’s reach. That’s true also in Los Angeles, which set its own goal of renting 15,000 rooms and fell far short.

In L.A., rooms are not evenly distributed across the sprawling county. Less-affluent areas like South Los Angeles, a historically Black neighborhood that’s now predominantly Latino and experiencing high rates of COVID-19, have few hotels available. Whiter, wealthier cities like Santa Monica, meanwhile, have bolstered the county supply by renting hotels with their own budgets.

In Bakersfield, neighbors and a hospital pushed back on two different plans to rent motel rooms. Kern County, where Bakersfield is located, has not made available any new hotel rooms to the homeless during the pandemic.

And officials in liberal cities — including on Newsom’s home turf of San Francisco — say the governor must do more to persuade business owners and financiers to participate in housing the homeless.

“I’m surprised and honestly a bit disappointed that the state hasn’t been more forceful and proactive to secure the adequate number of hotel rooms,” said San Francisco Supervisor Matt Haney, whose district includes the Tenderloin, a neighborhood where hundreds of people sleep on sidewalks and in alleys. “I would like to see more leadership from the governor on some larger negotiated statewide solution with hotels and unions.”

The hotel rooms weren’t meant for everyone unsheltered, said Kim Johnson, director of the California Department of Social Services. For those who didn’t have mental and physical health conditions that put them at extreme risk, “the right environment wasn’t necessarily a hotel room,” she said.

Newsom said he is staying the course on his vow to make this the year California finally starts tackling its epidemic of homelessness. In some ways, the pandemic gave him a leg up — he would have been hard-pressed to find even temporary housing for the 22,300 people moved into hotels and motels in recent months.

But it’s also a short-term response to a long-term public health crisis. To battle homelessness, the state needs more housing.

Counties across the state say they are already winding down Project Roomkey. The state has launched a new program called “Project Homekey,” which will allocate an estimated $800 million in federal and state emergency funding to cities and counties to purchase hotels and motels, vacant apartment buildings and other structures, then convert them into supportive housing. So far the state has approved $450 million worth of projects in 34 jurisdictions, stretching from El Centro to Ukiah. If successful, they’d open more than 3,300 housing units — a valiant effort but a fraction of what experts say is needed.

Newsom has acknowledged the extraordinary task ahead but said solving homelessness in the age of COVID-19 remains his priority.

“We need a permanent response,” Newsom said at a recent news conference. “I can assure you, we are just winding up.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

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Neurological Symptoms of Coronavirus Occur in 80% of Hospitalized Patients, According to a Study

While respiratory issues such as asthma, pneumonia, etc. are well-known symptoms of the covid 19, a new study published in the journal Annals of Clinical and Translational Neurology has found that 4 out of 5 of hospitalized patients experience some kind of neurological manifestation. The researchers carried out the study in 509 patients admitted to a Chicago hospital network and found out that 419 of these patients showed neurological symptoms of coronavirus at some point during their time at the hospital.

The authors wrote in their study that the most frequently occurring neurological symptoms of coronavirus were headaches (experienced by 37.7% patients), dizziness (experienced by 30% of patients), anosmia (loss of smell) (experienced by 11.4% of patients), myalgias, encephalopathy (experienced by 32% of patients), and dysgeusia (impaired sense of taste) (experienced by 16% of patients). Some of the uncommon symptoms were movement disorders, motor, and sensory deficits, seizures, strokes, and ataxia. The average stay in the hospital for these patients was also three times longer than usual and the risk of death was seven times higher.

Also read: Europe is Facing Pandemic Fatigue, According to WHO

The study included data from coronavirus patients admitted across an academic medical center and nine hospitals within the Northwestern Medicine Healthcare system in Chicago between March and April. Moreover, a quarter of those patients required mechanical ventilation. The researchers found that around 42% of the patients, before going to the hospital, had neurological manifestations when they first started experiencing symptoms. Then when they were sick enough to be admitted to the hospital, nearly 63% of them showed neurological symptoms of coronavirus, according to the data.

The researchers also discovered that younger patients were found to be more likely to be impacted by the neurological symptoms of coronavirus than older patients. They wrote that the fact that any neurological manifestations as a whole were more likely to occur in younger people is surprising, and could be explained by greater clinical emphasis on the risk of respiratory failure than other symptoms in older patients, however in contrast encephalopathy was more frequent in older people. Less than 6% of patients in the study were evaluated by neurologists or neurosurgeons, so more research is needed to find out if similar findings would occur in other hospital systems.

Even after these patients left the hospital, many of their symptoms remained. Only around 32% of them were able to complete simple tasks like paying bills or cooking, according to the chief of neuro-infectious disease and global neurology at Northwestern Medicine and senior author of the study Dr. Igor Koralnik.

The study did not specify how the coronavirus can cause encephalopathy, however, Dr. Koralnik believes that encephalopathy is sometimes brought on by other diseases including those that cause changes in blood circulation and inflammation, particularly in older patients. Moreover, a majority of the health experts believe that the covid19 doesn’t attack the brain cells directly but these neurological symptoms are a byproduct of inflammation and immune system responses.

This isn’t the first study of its kind, as a study in April of 214 coronavirus patients discovered that more than one-third of the patients experienced some sort of neurological complications. The virus is capable of causing neurological complications like brain inflammation, nerve damage, delirium, and stroke.

 

The post Neurological Symptoms of Coronavirus Occur in 80% of Hospitalized Patients, According to a Study appeared first on Spark Health MD.

Neurological Symptoms of Coronavirus Occur in 80% of Hospitalized Patients, a Study finds

While respiratory issues such as asthma, pneumonia, etc. are well-known symptoms of the covid 19, a new study published in the journal Annals of Clinical and Translational Neurology has found that 4 out of 5 of hospitalized patients face some kind of neurological manifestation. The researchers carried out the study in 509 patients hospitalized in a hospital network in Chicago and found out that 419 of those patients showed neurological symptoms of coronavirus at some point in the course of their time at the hospital.

The authors wrote in their study that the most frequently occurring neurological symptoms of coronavirus were headaches (experienced by 37.7% patients), dizziness (experienced by 30% of patients), anosmia (experienced by 11.4% of patients), myalgias, encephalopathy (experienced by 32% of patients), and dysgeusia (impaired sense of taste) (experienced by 16% of patients). Some of the uncommon symptoms were motor, and sensory deficits, seizures, movement disorders, strokes, and ataxia. The average stay in the hospital for these patients was also three times longer than usual and the risk of death was seven times higher.

Also Read: Entire Europe is Facing Coronavirus Pandemic Fatigue, WHO Reports

The study incorporated data from coronavirus patients admitted across an academic medical center and nine hospitals within Chicago’s Northwestern Medicine Healthcare system between the months of March and April. Moreover, around 26% of those patients needed mechanical ventilation. The researchers found that around 42% of the patients, before going to the hospital, had some sort of neurological manifestations when the symptoms first started to emerge. Then when they needed to be admitted to the hospital, nearly 63% of them showed neurological symptoms of coronavirus, according to the data.

Researchers also discovered that younger patients tended to be more vulnerable to the neurological symptoms of coronavirus, however, encephalopathy was more recurring in older people. The researchers believe that the cause of these neurological symptoms being discovered in young people might be because doctors focused more on younger patients as the younger patients are less likely to suffer a respiratory failure or the fact that it is more likely that young people seek medical care for the symptoms.

Even after these patients left the hospital, many of their symptoms remained. Only around 32% of them were able to complete simple tasks like paying bills or cooking, according to the chief of neuro-infectious disease and global neurology at Northwestern Medicine and senior author of the study Dr. Igor Koralnik.

The study did not specify how the coronavirus can cause encephalopathy, however, Dr. Koralnik believes that encephalopathy is sometimes brought on by other diseases including those that cause changes in blood circulation and inflammation, particularly in older patients. Moreover, a majority of the health experts believe that the covid19 doesn’t attack the brain cells directly but these neurological symptoms are a byproduct of inflammation and immune system responses.

This isn’t the first study of its kind, as a study in April of 214 coronavirus patients discovered that more than one-third of the patients experienced some sort of neurological complications. The virus is capable of causing neurological complications like brain inflammation, nerve damage, delirium, and stroke.

 

The post Neurological Symptoms of Coronavirus Occur in 80% of Hospitalized Patients, a Study finds appeared first on Spark Health MD.

Europe is Facing Pandemic Fatigue, According to WHO

Europeans are facing rising levels of pandemic fatigue as they are feeling less motivated for following restrictions after living with uncertainty and disruption for months, says WHO. According to WHO this fatigue varies depending on the country but it is now estimated to have crossed 60% in some cases. Hans Kluge, the regional director of WHO for Europe, said that the huge sacrifices made by the people had come at an extraordinary cost which has exhausted all the people regardless of where they live or what they do.

Hans Kluge said that after such hardships it is natural for the people to feel demotivated and apathetic and to experience this pandemic fatigue. He further added that based on aggregated survey data from countries across Europe, the fatigue is increasing among the surveyed.

Also Read: Actual Coronavirus Cases Worldwide Maybe 20 Times More than the Reported Cases, According to WHO

European Nations have registered more than 6 million coronavirus cases and close to 240,000 deaths since the start of the pandemic eight months ago, according to the data from WHO. After months of lockdown, the restrictions were gradually relaxed over the summer. However, Europe is now facing the second wave of the virus and instead of reinforcing lockdowns, the governments are emphasizing on recommending social distancing measures, good personal hygiene, and efforts to restrict social activity. However, due to the pandemic fatigue general public in Europe is refusing to adhere to the rules and is constantly arranging public protests against the restrictive measures.

The strategies to get people back on track and reduce the pandemic fatigue as proposed by Hans Kluge include understanding people by taking account of their opinion regularly and also acknowledging their hardships, involving communities in decisions and discussions as part of the solution, and allowing people to live their lives but limit the risk by using innovative ways to meet the needs of society. He also emphasizes virtual celebrations during religious events or floating cinemas that could be used to help people successfully adapt to the new normal.

Across Europe Britain remains the worst-hit country with more than 500,000 confirmed cases of the virus. Neighboring country Ireland, due to the recent surge in cases, is considering a nationwide lockdown. The national public health emergency team has recommended that the highest levels of coronavirus restrictions should be imposed again in the entire country as they were imposed during March.

Moreover, due to this second wave of the virus, Paris was forced to shutter its iconic cafes this week, which according to the police chief of Paris were braking measures because the pandemic is moving too fast. France reported around 17000 new coronavirus cases in a day on Saturday which is the highest number since the widespread testing began in the country. More than half of these new cases have been found in the extreme poverty region in Paris, particularly in migrants, said the French aid group Doctors without Borders (MSF) on Tuesday. The positivity rate in food distribution centers and emergency shelters stood at 55% compared with 12% across Paris currently.

Spain has also decided to impose partial lockdowns in the cities of Leon and Palencia after the people of Madrid and some nearby towns were not allowed to leave city limits for reasons other than medical or legal appointments, schools, or work. Regional authorities in Madrid criticized the restrictions, however, health care experts believe it’s for the best.

The post Europe is Facing Pandemic Fatigue, According to WHO appeared first on Spark Health MD.

Bones from an Iron Age massacre paint a violent picture of prehistoric Europe

Attacked from behind and at times dismembered, the fallen residents of an ancient Iberian village add to evidence that prehistoric Europe was a violent place.

Violence in ancient Europe isn’t unheard of, with some unearthed massacres attributed to power struggles after the fall of the Roman Empire around 1,500 years ago (SN: 4/25/18). But a new analysis of bones from 13 victims suggests that a violent massacre occurred at a site in what’s now Spain centuries before the Romans arrived, researchers report October 1 in Antiquity.

Finding “partially burnt skeletons and scattered human bones with unhealed injuries caused by sharp weapons demonstrated that this was an extremely violent event,” says archaeologist Javier Ordoño Daubagna of Arkikus, an archaeological research company in Vitoria-Gasteiz, Spain.

Ordoño Daubagna and colleagues examined nine adults, two adolescents, a young child and one infant who died sometime between 365 and 195 B.C., in the ancient village of La Hoya. One of the adults was decapitated in a single blow, the team found. And one of the adolescents, a female, had her arm cut off. The researchers found the arm bones nearly three meters away from the girl’s skeleton, with five copper-alloy bracelets still attached.

Cracks and flaking of the outer layers of some of the bones suggest that the victims were abandoned after they died, rather than buried, the report shows. Other people may have been trapped inside burning buildings — bone shrinkage and discoloration suggest that the remains were in a fire that reached 350° to 650° Celsius. The fact that the bones were only partially burned suggest that they were not scorched during cremation, a common ritual at the time, the researchers say.

“The nature of the injuries, the presence of women and young children as victims and the context of where the human remains were found on the site all indicated that this was not a battle between anything like matched forces,” says coauthor Rick Schulting, an archaeologist at the University of Oxford. “This was not a battle between noble warriors.”

The study supports the idea that Iron Age societies on the Iberian Peninsula were fully capable of resorting to brutal violence as a means of settling disputes, the researchers argue. “We can conclude that the aim of the attackers was the total destruction of La Hoya, perhaps by a rival center for political and economic dominance in the area,” Ordoño Daubagna says.

In-depth accounts of similar attacks during the pre-Roman Iron Age are rare, but this sort of violence may have been more common than scientists have realized. During that time, “power was gained by violence and control over resources,” explains Ludvig Papmehl-Dufay, an archaeologist at Linnaeus University in Kalmar, Sweden, who wasn’t involved in the study. If people think of the past as something peaceful and idealized, he says, “that needs to be revised.”

11 Gripping Books About Alcoholism and Recovery

Addiction Recovery Bulletin

Time to read? Time to read –  

Oct. 2, 2020 – I recently came to terms with my own problematic relationship with alcohol, and my one solace has been in books. I’ve dug into memoir after memoir, tiptoed into the hard science books, and enjoyed the fiction from afar. The following are a smattering of the books about alcoholism I’ve found meaningful. 

Trigger warnings: addiction and alcoholism, amid other mental illnesses. 

The first book on this list was the one to really set my mind toward easing off the alcohol. Did you know that getting blackout drunk on the regular is not normal? I didn’t. I’d always been drinking toward blackout, assuming that was the same goal everyone had on a night out. I thought the point of drinking was to lose hours of your life to darkness. Reading about someone else’s experiences shocked me, yet I told myself I’m not like them. I don’t need to drink every day. I just don’t want to feel. I know it’s bad—so that means I’m different, right?

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