‘It Seems Systematic’: Doctors Cite 115 Cases of Head Injuries From Crowd Control Devices

At least 115 people were injured this summer when police shot them in the head or neck with so-called “less-lethal” projectiles at protests over racial injustice and police brutality, according to a report published Monday.

It’s the most comprehensive tally of such injuries to date, with about twice as many victims as KHN and USA Today cited in a July examination of how police across the U.S. wielded the weapons to control crowds.

But Physicians for Human Rights, the organization that compiled the incidents, believes even its figures are an undercount because its analysis is based on publicly available data and excluded some reports without adequate evidence.

The organization identified Austin, Texas; Portland, Oregon; and Los Angeles as hot spots during the period studied, May 26 to July 27.

Abigail Rodas, who was shot in the jaw with a rubber bullet on May 30, was one of the victims in Los Angeles, according to a lawsuit filed against the city and the police chief on behalf of Black Lives Matter Los Angeles, the Los Angeles Community Action Network and 14 people, including six who were struck with projectiles.

According to the suit, Rodas was leaving a protest when she “was struck in the face by a projectile and momentarily lost consciousness.”

A steel plate was used to repair her jawbone, the lawsuit says. She couldn’t talk for about 10 days and could drink only liquids for a week, it says.

“Nearly three weeks after the injury, she has screws in her gums and rubber bands to immobilize her jaw while the bones rejoin,” the suit says.

The city denied the allegations in a court filing, saying any use of force “was reasonable and necessary for self-defense.”

Protests Shine Light on Use of ‘Less-Lethal’ Weapons

The sheer number of incidents in those two months was shocking, said Dr. Rohini Haar, lead investigator for the analysis and an emergency physician in Oakland, California.

“It seems systematic,” Haar said. “It seems like there needs to be a reckoning with the use of force in protests.”

The projectiles in question are often called “rubber bullets,” but in law enforcement they’re known as “kinetic impact projectiles.”

They include plastic projectiles tipped with hard sponge or foam, “bean bag” rounds that consist of fabric socks containing metal shot, and “Sting-Balls” — grenades that spray hard rubber pellets. The report also cites incidents in which tear gas canisters were fired at people.

Though the weapons are referred to as “less lethal,” Haar said, there should be a shift to language that acknowledges how dangerous they can be. “Weapons are just as lethal as somebody wants them to be,” she said.

A study published in 2017 in the medical journal BMJ Open, which Haar co-authored, found that 3% of people hit by projectiles worldwide died. Fifteen percent of the 1,984 people studied were permanently injured.

In a letter to the editor of the New England Journal of Medicine, a group of Austin doctors said 19 patients were treated for bean bag-related wounds at the downtown hospital closest to the protests over two days in late May.

For its analysis, Physicians for Human Rights searched social media, news accounts, lawsuits and other publicly available sources. They counted incidents on social media only if they were documented by photos or videos, and included news reports without visual evidence only from major newspapers or local affiliates of major outlets.

Physicians for Human Rights identified by name most of the people who were struck.

Among the group’s recommendations are banning weapons that release scattershot or multiple projectiles from a single canister because they can hit people indiscriminately, Haar said. Metal projectiles are particularly dangerous, she said.

She called for more training and adherence to departments’ rules on the use of such weapons.

“One of the findings of our study is police do not even appear to be following their own protocols for how to use these weapons or when,” Haar said.

There are no national standards for police use of less-lethal projectiles and no comprehensive data on their use, USA Today found.

Demonstrators in Los Angeles, Minneapolis, San Jose, Denver and Dallas told USA Today they were shot with less-lethal projectiles even though those departments don’t allow the weapons to be used against nonviolent people. Some witnesses said police aimed at faces or fired at close range.

Police have said they fired the weapons to protect themselves and property in chaotic, dangerous situations.

‘Protesters Feel Like They’re Being Attacked’

Haar, who has been studying these projectiles since 2014, said they have no place in crowd control. “Even before you get to the use of weapons, there needs to be a change in how we engage with protesters in terms of communication,” she said.

For example, police can get the phone number of a protest leader, opening the lines of communication. Police have other options besides firing projectiles, Haar said, such as “arresting the person that is actually violent, not just dispersing the entire crowd, or changing what you decide is an illegal assembly.”

Haar said the use of these projectiles tends to escalate tensions, “where the protesters feel like they’re being attacked.” Those who aren’t struck, she said, “are often incited. It’s not until that full crowd is dispersed that the anger goes away. The volatility has a cumulative impact that can last weeks or months.”

At least seven major U.S. cities and a few states have enacted or proposed limits on the use of less-lethal projectiles.

However, similar efforts have stalled in the face of opposition from police agencies or other critics. And as the summer stretched on, local and federal law enforcement agencies continued to use less-lethal weapons when confronting protesters.

Haar said city councils have reached out to her recently, showing they are “really trying to reckon with what they want in their communities.”

“I see more hope now than I have in all of my years of research,” she said. “I think the attention now is remarkable, and we actually have a really good chance of getting some actual, meaningful change.”

USA Today’s Kevin McCoy contributed to this report.


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.

USE OUR CONTENT

This story can be republished for free (details).

Phosphine gas found in Venus’ atmosphere may be ‘a possible sign of life’

Venus’ clouds appear to contain a smelly, toxic gas that could be produced by bacteria, a new study suggests.

Chemical signs of the gas phosphine have been spotted in observations of the Venusian atmosphere, researchers report September 14 in Nature Astronomy. Examining the atmosphere in millimeter wavelengths of light showed that the planet’s clouds appear to contain up to 20 parts per billion of phosphine — enough that something must be actively producing it, the researchers say. 

If the discovery holds up, and if no other explanations for the gas are found, then the hellish planet next door could be the first to yield signs of extraterrestrial life — though those are very big ifs.

“We’re not saying it’s life,” says astronomer Jane Greaves of Cardiff University in Wales. “We’re saying it’s a possible sign of life.”

Venus has roughly the same mass and size as Earth, so, from far away, the neighboring planet might look like a habitable world (SN: 10/4/19). But up close, Venus is a scorching hellscape with sulfuric acid rain and crushing atmospheric pressures.

Still, Venus might have been more hospitable in the recent past (SN: 8/26/16). And the current harsh conditions haven’t stopped astrobiologists from speculating about niches on Venus where present-day life could hang on, such as the temperate cloud decks.

“Fifty kilometers above the surface of Venus, the conditions are what you would find if you walk out of your door right now,” at least in terms of atmospheric pressure and temperature, says planetary scientist Sanjay Limaye of the University of Wisconsin–Madison, who was not involved in the new study. The chemistry is alien, but “that’s a hospitable environment for life.”

Previous work led by astrochemist Clara Sousa-Silva at MIT suggested that phosphine could be a promising biosignature, a chemical signature of life that can be detected in the atmospheres of other planets using Earth-based or space telescopes.

On Earth, phosphine is associated with microbes or industrial activity — although that doesn’t mean it’s pleasant. “It’s a horrific molecule. It’s terrifying,” Sousa-Silva says. For most Earthly life, phosphine is poisonous because “it interferes with oxygen metabolism in a variety of macabre ways.” For anaerobic life, which does not use oxygen, “phosphine is not so evil,” Sousa-Silva says. Anaerobic microbes living in such places as sewage, swamps and the intestinal tracts of animals from penguins to people are the only known life-forms on Earth that produce the molecule.  

Still, when Greaves and colleagues searched Venus’ skies for signs of phosphine, the researchers didn’t expect to actually find any. Greaves looked at Venus with the James Clerk Maxwell Telescope in Hawaii over five mornings in June 2017, aiming to set a detectability benchmark for future studies seeking the gas in the atmospheres of exoplanets (SN: 5/4/20), but was startled to find the hints of phosphine. “That’s a complete surprise,” Greaves says. When she was analyzing the observations, “I thought ‘Oh, I must have done it wrong.’”

James Clerk Maxwell Telescope
Signs of phosphine first showed up in data taken with the James Clerk Maxwell Telescope in Hawaii.Will Montgomerie/JCMT/EAO

So the team checked again with a more powerful telescope, the Atacama Large Millimeter/submillimeter Array in Chile, in March 2019. But the signature of phosphine — seen as a dip in the spectrum of light at about 1.12 millimeters — was still there. The gas absorbs light in that wavelength. Some other molecules also absorb light near that wavelength, but those either couldn’t explain the whole signal or seemed improbable, Greaves says. “One of those is a plastic,” she says. “I think a floating plastic factory is a less plausible explanation than just saying there’s phosphine.”

Phosphine takes a fair amount of energy to create and is easily destroyed by sunlight or sulfuric acid, which is found in Venus’ atmosphere. So if the gas was produced a long time ago, it shouldn’t still be detectable. “There has to be a source,” Greaves says.

Greaves, Sousa-Silva and colleagues considered every explanation they could think of apart from life: atmospheric chemistry; ground and subsurface chemistry; volcanoes outgassing phosphine from the Venusian interior; meteorites peppering the atmosphere with phosphine from the outside; lightning; solar wind; tectonic plates sliding against each other. Some of those processes could produce trace amounts of phosphine, the team found, but orders of magnitude less than the team detected.

“We’re at the end of our rope,” Sousa-Silva says. She hopes other scientists will come up with other explanations. “I’m curious what kind of exotic geochemistry people will come up with to explain this abiotically.”

The idea of searching for life on Venus “has been regarded as a pretty out-there concept,” says Planetary Science Institute astrobiologist David Grinspoon, who is based in Washington, D.C. Grinspoon has been publishing about the prospects for life on Venus since 1997, but was not involved in the new discovery.

“So now I hear about this, and I’m delighted,” he says. “Not because I want to declare victory and say this is definite evidence of life on Venus. It’s not. But it’s an intriguing signature that could be a sign of life on Venus. And it obligates us to go investigate further.”

Because of the planet’s acidic atmosphere, extreme pressures and lead-melting temperatures, sending spacecraft to Venus is a challenge (SN: 2/13/18). But several space agencies are considering missions that could fly in the next few decades.

In the meantime, Greaves and colleagues want to confirm the new phosphine detection in other wavelengths of light. Observations they had planned for the spring were put on hold by the coronavirus pandemic. And now, Venus is in a part of its orbit where it’s on the other side of the sun.

“Maybe when Venus comes around on the other side of the sun again,” Greaves says, “things will be better for us here on Earth.”

Los NIH, “muy preocupados” por efectos secundarios en ensayo de vacuna para COVID

La Administración de Alimentos y Medicamentos (FDA) está evaluando la posibilidad de seguir a los reguladores británicos y reanudar el ensayo de la vacuna contra el coronavirus que se detuvo cuando un participante sufrió daño en la médula espinal. Incluso cuando los Institutos Nacionales de Salud (NIH) están investigando el caso.

“Los niveles más altos de los NIH están muy preocupados”, dijo el doctor Avindra Nath, director clínico y líder de investigación viral en el Instituto Nacional de Trastornos Neurológicos y Accidentes Cerebrovasculares, una división de los NIH.

“Las esperanzas de todos están en una vacuna, y si tienes una complicación importante, todo podría descarrilarse”, agregó.

Lo que le pasó a este paciente anónimo sigue siendo algo incierto, para frustración de quienes siguen con avidez el progreso de esta vacuna.

AstraZeneca, que está realizando el ensayo global de la vacuna que produjo junto con la Universidad de Oxford, dijo que el voluntario se recuperó de una inflamación severa de la médula espinal y que ya no está en el hospital.

AstraZeneca no ha confirmado que el paciente padeciera mielitis transversa, pero Nath y otro neurólogo dijeron que ese podría haber sido el caso. La mielitis transversa produce un conjunto de síntomas que involucran inflamación a lo largo de la médula espinal. Puede causar dolor, debilidad muscular y parálisis.

La Agencia Reguladora de Medicamentos y Productos Sanitarios, la autoridad británica similar a la FDA, revisó el caso y permitió que el ensayo se reanudara en el Reino Unido.

AstraZeneca “necesita ser más comunicativo con una posible complicación de una vacuna que eventualmente se administrará a millones de personas”, dijo Nath. “Nos gustaría ver cómo podemos ayudar, pero la falta de información lo dificulta”.

Cualquier decisión sobre si continuar un ensayo es compleja porque es difícil evaluar la causa de una lesión poco común que ocurre durante un estudio, y porque los científicos y las autoridades tienen que sopesar el riesgo de efectos secundarios poco comunes frente a una vacuna que podría frenar una pandemia.

“Son muchos los factores que intervienen en estas decisiones”, dijo Nath. “Lo último que quieres hacer es lastimar a las personas sanas”.

Los NIH aún tienen que obtener muestras de tejido o sangre del paciente británico, y su investigación está “en etapa de planificación”, dijo Nath.

Los científicos estadounidenses podrían analizar muestras de otros pacientes vacunados para ver si alguno de los anticuerpos que generaron en respuesta al coronavirus también ataca el tejido cerebral o de la médula espinal.

Estos estudios podrían llevar uno o dos meses, explicó. La FDA se negó a comentar sobre cuánto tiempo tomaría antes de decidir si seguir adelante.

El doctor Jesse Goodman, profesor de la Universidad Georgetown que fue científico jefe y principal regulador de vacunas de la FDA durante la administración Obama, dijo que la agencia revisará los datos y posiblemente consultará con sus pares británicos antes de permitir la reanudación del estudio en los Estados Unidos, que recién comenzaba cuando se reportó el problema.

Otras dos vacunas contra el coronavirus también se encuentran en la última etapa de ensayos en el país.

Si se determina que la lesión en el ensayo británico fue causada por la vacuna, la FDA podría cancelarlo. Si permite que se reanude, los reguladores y científicos seguramente estarán atentos a síntomas similares en otros participantes.

Una voluntaria en una fase anterior del ensayo de AstraZeneca experimentó un efecto secundario similar, pero los investigadores descubrieron que tenía esclerosis multiple, que no estaba relacionada con la vacunación, según el doctor Elliot Frohman, director del Centro de Esclerosis Múltiple y Neuroinmunología de la Universidad de Texas.

Los neurólogos que estudian enfermedades como la mielitis transversa dicen que son raras (ocurren a una tasa de quizás 1 de cada 250.000 personas) y atacan con mayor frecuencia como resultado de la respuesta inmunitaria del cuerpo a un virus. En menor grado, estos episodios también se han relacionado con las vacunas.

La causa precisa de la enfermedad es clave para decidir si reiniciar o no el ensayo. A veces, una condición médica subyacente se “desenmascara” por la respuesta inmune de una persona a la vacuna, como sucedió con la paciente con esclerosis múltiple. En ese caso, el ensayo podría continuar sin temor, porque la enfermedad no está relacionada con la vacuna.

Más preocupante es un fenómeno llamado “mimetismo molecular”. En tales casos, una pequeña porción de la vacuna puede ser similar al tejido del cerebro o la médula espinal, lo que da como resultado un ataque inmunológico en ese tejido en respuesta a un componente de la vacuna.

Si ese fuera el caso, sería probable otra aparición de mielitis transversa si se reanudara el ensayo, dijo el doctor William Schaffner, especialista en enfermedades infecciosas de la Escuela de Medicina de la Universidad de Vanderbilt. Un segundo caso cerraría el ensayo, expresó.

En 1976, un programa masivo de vacunación contra la influenza porcina se detuvo cuando los médicos comenzaron a diagnosticar un trastorno similar, el síndrome de Guillain-Barré, en personas que habían recibido la vacuna. En ese momento nadie sabía qué tan común era, por lo que era difícil saber si los episodios estaban relacionados con la vacuna.

Finalmente, los científicos descubrieron que la vacuna aumentaba el riesgo del trastorno en un caso adicional por cada 100.000 pacientes vacunados. La vacunación típica contra la influenza estacional aumenta el riesgo de contraer GBS en aproximadamente un caso adicional por cada millón de personas.

“Es muy, muy difícil” determinar si un evento raro fue causado por una vacuna, dijo Schaffner. “¿Cómo atribuyes un mayor riesgo de algo que ocurre en una persona en un millón?”.

Antes de permitir que se reinicien los ensayos en los Estados Unidos, la FDA querrá ver por qué la compañía y una junta independiente de monitoreo en el Reino Unido decidieron que era seguro continuar, dijo Goodman. El ensayo de AstraZeneca en los Estados Unidos tiene una placa de seguridad separada.

Los funcionarios de la FDA deberán revisar todos los detalles del caso y pueden solicitar más información sobre el voluntario del estudio afectado antes de decidir si permitir que continúe el ensayo en el país, dijo Goodman. También pueden requerir que AstraZeneca actualice la información de seguridad que proporciona a los participantes del estudio.

Es posible que el problema de salud del voluntario fuera una coincidencia no relacionada con la vacuna, dijo el doctor Amesh Adalja, investigador principal del Johns Hopkins Center for Health Security. Por lo general, los estudios no se detienen por un solo problema de salud, incluso si es grave.

Muchos líderes de salud han expresado su frustración porque AstraZeneca no ha publicado más información sobre el problema de salud que lo llevó a detener su ensayo en el Reino Unido.

AstraZeneca argumentó que dar más información violaría la privacidad del paciente, aunque no aclaró de qué manera.

Pero existe una necesidad excepcional de transparencia en un clima político plagado de vacilaciones sobre las vacunas y desconfianza en el manejo de la respuesta a COVID-19 de la administración Trump, dicen científicos.

“Si bien respeto la necesidad crítica de confidencialidad del paciente, creo que sería realmente útil saber cuál fue su evaluación de estos problemas”, dijo Goodman. “¿Cuál fue el diagnóstico? Si no hubo un diagnóstico claro, ¿qué les llevó a pensar que se podría reiniciar el ensayo? Existe tanto interés y preocupación potencial acerca de una vacuna contra COVID-19 que cuanta más información se pueda proporcionar, más tranquilizador sería”.

La FDA deberá balancear los posibles riesgos de una vacuna experimental con el peligro que representa COVID-19, que ya ha matado a casi 200,000 estadounidenses.

“También hay consecuencias potenciales si detiene un estudio”, dijo Goodman.

Si la de AstraZeneca falla, el gobierno estadounidense está apoyando otras seis vacunas. Los problemas potenciales con la vacuna de AstraZeneca muestran que ésta es una inversión inteligente, dijo Adalja. “Te da un poco más de seguridad”.

Schaffner dijo que los científicos deben recordar que la investigación de vacunas es impredecible.

“Los investigadores de Oxford estuvieron diciendo este verano que iban a llegar primero”. “Pero esta es exactamente la razón por la que el doctor Anthony Fauci y el resto de nosotros hemos estado diciendo: ‘Nunca se sabe lo que sucederá una vez que comienzas los ensayos en humanos a gran escala’”.

Esta historia de KHN se publicó primero en California Healthline, un servicio de la California Health Care Foundation

Esta historia fue producida por Kaiser Health News, un programa editorial independiente de la 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.

USE OUR CONTENT

This story can be republished for free (details).

Potent Drug Supply Drop, Not U.S. Domestic Drug Policies, Likely Behind 2018’s Overdose Death Downturn

Original post: Newswise - Drug and Drug Abuse Potent Drug Supply Drop, Not U.S. Domestic Drug Policies, Likely Behind 2018's Overdose Death Downturn

The slight decline in drug overdose deaths in 2018 coincides with Chinese regulations on the powerful opioid carfentanil, rather than the result of domestic U.S. efforts to curb the opioid epidemic, a University of Pittsburgh Graduate School of Public Health analysis revealed today.

Readers and Tweeters Grapple With COVID Therapies and Forecasts

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

Giving Convalescent Plasma a Shot

Used to effectively treat mumps, measles, and even the so-called Spanish flu in 1918, convalescent plasma may not be a silver bullet, but it still has the potential to play an important role in helping some patients recover from COVID-19 (“5 Things to Know About Convalescent Blood Plasma,” Aug. 27).

To support its recent decision, the Food and Drug Administration used data from previous use cases of convalescent plasma for other respiratory coronaviruses, results of early safety and efficacy trials in animal models, and published studies on the safety and efficacy of convalescent plasma before issuing Emergency Use Authorization (EUA). The agency also pointed to a Mayo Clinic preliminary analysis of 56,000 patients who were given high or low titer units of blood plasma.

[khn_slabs slabs=”241884″ view=”inline”]

The EUA also specifies that donor blood can be released only to hospitals and patients after it is tested with a currently available antibody test that accurately detects the right type of antibodies to neutralize the virus and confirms that the blood contains sufficient levels of these antibodies for treatment purposes. This means that less accurate, less specific tests that are more susceptible to false positives will not be used to identify COVID-19 convalescent plasma — something that should give patients higher confidence that the plasma they receive meets scientific and quality standards.

Dr. Fernando Chaves, a board-certified hematopathologist who serves as Global Head of Medical and Scientific Affairs at Ortho Clinical Diagnostics, Raritan, New Jersey

I’m quoted here saying what everybody already knows: if we want to know if plasma works, we need a trial.

This isn’t academic for me: I want to know if I should be using plasma in my patients with severe COVID-19. This fiasco was preventable. https://t.co/MjS2DXbYUX

— Adam W Gaffney (@awgaffney) August 28, 2020

— Dr. Andrew Gaffney, Boston

Vaccination and Prognostication

Both assertions that seniors will drive 800 miles or come home from an assisted living or skilled nursing facility to live with families are dubious (“What Seniors Can Expect as Their New Normal in a Post-Vaccine World,” Aug. 3). The latter are need-based moves (think dementia, wandering). The former makes sense for those who won’t tolerate the physical strain of long car rides — think Florida to D.C.

— Laurie Orlov, Aging and Health Technology Watch, Port St. Lucie, Florida

I wonder if many of these predictions are more likely to be true among those who have personal experience with COVID-19, either through personal experience with illness or loss of family or friends. https://t.co/uRZnuSfFLf via @khnews

— Rosemary Wright, PhD (@rwrightphd) August 3, 2020

— Rosemary Wright, Wichita, Kansas

I don’t want these precautions to last forever. I want there to be a time where we can all give each other hugs and high fives again. We were built to be together and celebrations bring us so much joy. I want there to be a time when we can all be in fun crowds again. I want to be able to smile out in public again and not have to cover my face. What do you think about all of this?

— Christopher DeCarlo, Oyster Bay, New York

We won’t go back to “the way things were” even after a vaccine for #COVID19 has been invented. This experience has been an opportunity to innovate and do better. Here are some changes you’re likely to see in #healthcare and beyond. https://t.co/l4x50qVxvM

— Tony Slonim MD, DrPH (@RenownCEOTonyMD) August 8, 2020

— Dr. Tony Slonim, Reno, Nevada

Humans as Guinea Pigs for the Sake of Corporate Piggy Banks?

We assume that this vaccine works, but how do we know (“They Pledged to Donate Rights to Their COVID Vaccine, Then Sold Them to Pharma,” Aug. 25)? The public is not some testing animal. I would not take this vaccine, especially since the back-and-forth is over money and not public health. No government should give any money to a business without a deal that protects the public as investors. We are not a source of free money; just as they make no concessions, we also should make no concessions without a deal. And the deal is public health.

There was no vaccine during the 1918-19 influenza, not until 1940. Our immune system needs to be considered as part of a cure. Is that not the theory behind flu shots? So, if we are exposed to the virus and allow our bodies to fight it off, that defense is greater than any vaccine. Those who cannot fight off the infection are the ones who need to be considered for medical attention — and not just some shot hopefully manufactured by a company that does not prioritize money over health.

There are times when profit is important, but since businesses are being subsidized, this is not one of those times. The world economy has been seriously affected, and printing money we do not have is not a sound idea. What good are medicine and doctors and medical research? Seems we should consider those old grandma medications, such as the hot toddy … whiskey and hot coffee and a good night to sweat it out under many covers. That cured my grandfather of influenza long before there was a vaccine.

Medical science doesn’t have all the answers. If soap can kill this coronavirus, then there must be a common household solution to eradicate it that is medically safe for humans. Perhaps technology students would do better to help the world instead of these money-hungry corporations.

— Tom Berger, Suffolk County, New York

Volunteers risk their lives in clinical trials, and the Oxford converted vaccine from public good to profitable commodity? …

They Pledged to Donate Rights to Their COVID Vaccine, Then Sold Them to Pharma https://t.co/vQw94BfxKE via @khnews

— Amar Jesani (@amarjesani) August 31, 2020

— Amar Jesani, Mumbai, India

On COVID Tests and Risk

I have worked in a clean lab for many decades. I know how to behave and how to take advantage of and handle PPE, for the purpose of achieving very low contamination levels. The article “Analysis: When Is a Coronavirus Test Not a Coronavirus Test?” (July 29) presents a false option. It is not about accepting a level of risk, it is about doing everything possible to reduce the risk.

In my labs, I had the ability to require adherence to careful procedures and the option to fire anyone who would not follow approved procedures. I don’t have that option with those who refuse to follow the simple instructions for COVID-19, including the “religious” wearing of a mask, the same way that women cover their heads when entering a Catholic church and Jewish men wear a yarmulke in a temple.

And when the president irresponsibly and criminally refuses to follow and to mandate simple instructions by medical experts, then I am unable to calculate the risk. I don’t think Ms. Rosenthal can calculate the level of risk she suggests we accept.

— Dimitri Papanastassiou, Pasadena, California

I enjoyed your piece, but I regret that you said so little about therapies that may emerge to help us. Vaccines are not the only hope. I think a disservice is being done by indicating that our only options are to live with it or wait for a vaccine.

— John Van Drie, North Andover, Massachusetts

Great article by @ahartreports. I too cringed initially at likening #covid19 to war but couldn’t agree more that we need to treat our #PublicHealthOfficials with respect and be grateful for their sacrifices https://t.co/rr9NT4tNlB via @khnews

— Meghan McGinty, PhD (@Breukelen299) September 1, 2020

— Meghan McGinty, Brooklyn, New York

The Hydroxy Paradox

Wouldn’t it be refreshing, instead of slamming other doctors’ practical experience with hydroxychloroquine at low dosages and supplemented with zinc, etc. at the first sign of the infection, to at least let them make fools of themselves (“Don’t Fall for This Video: Hydroxychloroquine Is Not a COVID-19 Cure,” July 31)? What is the harm?

Aren’t “we all in this together”? Why are we afraid of a difference in opinion? What if it really works using the protocols as stated? Let it play out. Pretty sure no one has died when prescribed “hydroxy” in low dosages by doctors in actual practice, unlike the deaths that occurred when given in massive dosages late in the infection.

Why make fun of doctors who are trying their best to help us all? That seems narrow-minded to me.

— Larry Koch, Agoura Hills, California

Reported this tweet. You are encouraging the use of a medication a. Without a license b. Without citing sources and c. Every double blind study has shown and increase in death.https://t.co/iN7eionH03https://t.co/eSPDwPz9V6

— Tara Tisch🦓🍀🎨🏴‍☠️ (@TaraTisch) August 22, 2020

— Tara Tisch, Peoria, Illinois

I know you disagree with Dr. Stella Immanuel, and that’s OK. The problem I have is that no one has done the clinical trials to prove that hydroxychloroquine doesn’t work. She said she has 350 patients who have had success with her prescriptions; the doctor from Dallas said she uses it with her own little concoction. If, in fact, what they are doing is working, then why don’t people visit these doctors to see if it is true — and, if it is, then try collaborating with them to keep people from dying, for crying out loud.

That is one of the problems here: Everyone is against one another instead of trying to support one another. We are Americans and, as in years past, we have stuck together for the betterment of the country. If we would stop trying to take care of America with money and start taking care of America with information, then America would live and thrive.

I am a first-year respiratory therapy student and spent 20 years in the Marine Corps, and back in the ’80s we took chloroquine, and I have no side effects and neither do the guys I stay in contact with. Keep in mind that the reports of the side effects are not in every patient and if hydroxychloroquine is offered to a patient and the patient is told, “This is going to make you better but there could be side effects later, but if you don’t take this you will get worse and we don’t know if you will die or not,” what do you think they will say? No one wants to die.

C’mon, let’s just be people trying to keep other people alive no matter the cost, no matter who is right or wrong — we can sort that out later.

— Jim Tumlinson, Canyon Lake, Texas

Editor’s note: A recent report from the Centers for Disease Control and Prevention expressed caution and concern that hydroxychloroquine was potentially being misused to treat COVID-19 and affecting supplies of the medication to treat rheumatoid arthritis, lupus and other conditions. “Current data on treatment and pre- or postexposure prophylaxis for COVID-19 indicate that the potential benefits of these drugs do not appear to outweigh their risks,” it said.

Yoga for All

I appreciate your article (“Namaste Noir: Yoga Co-Op Seeks to Diversify Yoga to Heal Racialized Trauma,” July 30) but have a hard time with “people of color” being repeated over and over. Yoga benefits all people, and until we start thinking as one and not labeling everything we will always have racial issues. We need to think all lives matter, not just a specific color. Thank you for your writings.

— Susan Ferguson, Cypress, California

“Namaste Noir” ?????????? good and important article, but really, really poor headline choice @KHNews https://t.co/GefI9Zkoy8

— Eli Imadali (@eliimadaliphoto) August 9, 2020

— Eli Imadali, Denver

#Namaste. Yoga and meditation are helping Ms. Grant deal with COVID-19, the loss of her son and racial stress. Lots of lessons here for all of us. @KHNews #Equality https://t.co/GnxZn4l7QF

— Jimmy Etheredge (@JimmyEtheredge) August 14, 2020

— Jimmy Etheredge, Atlanta

Words That Carry Weight

Thank you for calling attention to the challenges people with obesity face regarding risks of COVID-19 infections and the potential that vaccines may not be effective (“America’s Obesity Epidemic Threatens Effectiveness of Any COVID Vaccine,” Aug. 6). I would like to comment on how you refer to people with obesity. The Obesity Action Coalition, and other organizations focused on obesity, recommend using people-first language. An article about cancer does not refer to cancer people, nor does one on cardiovascular disease label individuals as heart disease people. The terms “obese people” and “morbid obesity” are stigmatizing. It is better to utilize people-first language as Dr. Timothy Garvey did at the end of the article. As a member of the Obesity Medicine Association as well as an obesity medicine specialist and educator, I work diligently with patients to overcome the bias and stigma that society imposes. Please be considerate of the use of language when referring to people with obesity.

— Dr. Nicholas Pennings, Raleigh, North Carolina

It is becoming more & more obvious that we would‘ve “saved” FAR more lives here if we had put all the mask shaming energy into getting people to lose weight. But that would be un-PC.

America’s Obesity Epidemic Threatens Effectiveness of Any COVID Vaccine https://t.co/wfbUz9JSB9

— John Ziegler (@Zigmanfreud) August 10, 2020

— John Ziegler, Los Angeles

As a sociologist researching weight stigma, I am appalled by the article by Sarah Varney suggesting obesity will undermine vaccine effectiveness. The article is full of stereotypes and misinformation. In the first place, it is Big Pharma’s fault vaccines aren’t made for fat people. It is beyond incompetence that any vaccine drugmakers come up with would be less effective for half the population. In the second place, many of the diseases fat folk allegedly have are caused by yoyo dieting and stigma. And there is no proof weight loss would make any vaccines more effective as most fat people are biochemically different than thin ones. This is a tone-deaf, fat-phobic article that serves only corporate interests.

— Sherie Sanders, Springfield, Illinois

Jail Outbreaks

My life and those of others are being put in danger by the San Bernardino County Sheriff’s Department (“COVID Runs Amok in 3 Detroit-Area Jails, Killing At Least 2 Doctors,” July 23). I’m in jail with health issues: asthma, prediabetes, vitamin D deficiency, high blood pressure, and may have a cancerous tumor and peripheral neuropathy. I’ve already been put on quarantine two times, once because a deputy who tested positive for COVID-19 had direct contact with me and the other because they put someone in the cell with me who was symptomatic for COVID-19. When being transported anywhere, they put chains on us that have been on many people and have not been cleaned. Then they chain multiple people together, not even knowing if a person has or is a carrier of the coronavirus. The social distancing was put in effect to protect the lives of people. The sheriff’s department is violating it, putting lives in danger and will continue to do so until they are stopped. To top it off, I am state property and not even supposed to be here. I don’t want to die or see anyone else die for being in jail and catching COVID-19. So can someone please help us all.

— LeAire Moore Sr., Adelanto, California

Lots of people ask me why I stay home most of the time, mask up, wash my hands, socially distance.

Why should I? I’m young. I’m healthy. I work out and eat right.

But, I have a mother.

This is why. ⬇️https://t.co/IlKPXmTu65

— Samuel Cook, III | CPT, CNC, USAW (@samueljcookiii) September 6, 2020

— Samuel Cook III, New Orleans

Correcting the Record on the Navajo Language

The article “Two Navajo Sisters Who Were Inseparable Died of COVID Just Weeks Apart” (Aug. 26) is incorrect. The Navajo language is most certainly “written down” and is taught in schools and universities.

— Randy Truman, Albuquerque

Editor’s note: Thanks for helping us clarify that point. The article has been updated.

Medicaid Expansion in the Age of COVID

The COVID-19 pandemic has shown us that Americans are in desperate need of health insurance, including publicly financed health insurance programs such as Medicaid. The time is now for some policymakers in America to reshape how they think of Medicaid as more than a government handout that makes us worse and not better.

Medicaid is a health insurance program that is jointly funded by the state and federal government. This program provides low-cost insurance to adults with low income, both young and elderly, pregnant women, the disabled and children through the Children’s Health Insurance Program, commonly known as the CHIP program.

The Affordable Care Act provided an opportunity for states to expand coverage to individuals at 138% of the federal poverty level. As an added incentive, the federal government pledged to pay 100% of the costs to expand, a share that would be reduced to 90% by 2020. In recent months, states such as Oklahoma and Missouri through the ballot box have expanded Medicaid. This leaves only 12 states to not expand, but millions more in need of affordable health insurance.

The argument by some policymakers against the Medicaid program is the fear of incentivizing Americans to not work. Contrary to this belief, in 2017, it was reported that more than 63% of Medicaid recipients are already in the workforce while only 7% were not working for various reasons.

Finally, since the beginning of the pandemic, one study estimated that nearly 27 million Americans could lose their employer-sponsored insurance this year. Of those 27 million, nearly 13 million would be eligible for Medicaid.

The American people deserve to have affordable health insurance. Therefore, policymakers have an obligation to expand it and not contract.

— Reginald Parson, Portland, Maine

This is happening right now throughout our system and its utterly disgusting and unacceptable.

Health Care Workers of Color Nearly Twice as Likely as Whites to Get #COVID-19 https://t.co/1VOFQid8mM via @khnews

— Stephen Ferrara, DNP (@StephenNP) August 6, 2020

— Stephen Ferrara, New York City

With No Legal Guardrails for Patients, Ambulances Drive Surprise Medical Billing

School librarian Amanda Brasfield bent over to grab her lunch from a small refrigerator and felt her heart begin to race. Even after lying on her office floor and closing her eyes, her heart kept pounding and fluttering in her chest.

The school nurse checked Brasfield’s pulse, found it too fast to count and called 911 for an ambulance. Soon after the May 2018 incident, Brasfield, now 39, got a $1,206 bill for the 4-mile ambulance ride across the northwestern Ohio city of Findlay — more than $300 a mile. And she was on the hook for $859 of it because the only emergency medical service in the city has no contract with the insurance plan she has through her government job.

More than two years later, what was diagnosed as a relatively minor heart rhythm problem hasn’t caused any more health issues for Brasfield, but the bill caused her some heartburn.

“I felt like it was too much,” she said. “I wasn’t dying.”

Brasfield’s predicament is common in the U.S. health care market, where studies show the majority of ambulance rides leave patients saddled with hundreds of dollars in out-of-network medical bills. Yet ground ambulances have mostly been left out of federal legislation targeting “surprise” medical bills, which happen when out-of-network providers charge more than insurers are willing to pay, leaving patients with the balance.

However, the COVID-19 pandemic has prompted temporary changes that could help some patients. For instance, ambulance services that received federal money from the CARES Act Provider Relief Fund aren’t allowed to charge presumptive or confirmed coronavirus patients the balance remaining on bills after insurance coverage kicks in. Also during the pandemic, the Centers for Medicare & Medicaid Services is letting Medicare pay for ambulance trips to destinations besides hospitals, such as doctors’ offices or urgent care centers equipped to treat recipients’ illnesses or injuries.

But researchers and patient advocates said consumers need more, and lasting, protections.

[khn_slabs slabs=”241884″ view=”inline” /]

 

“You call 911. You need an ambulance. You can’t really shop around for it,” said Christopher Garmon, an assistant professor at the University of Missouri-Kansas City who has studied the issue.

A Health Affairs study, published in April, found 71% of all ambulance rides in 2013-17 for members of one large, national insurance plan involved potential surprise bills. The median out-of-network surprise ground ambulance bill was $450, for a combined impact of $129 million a year.

And a study published last summer in JAMA Internal Medicine found 86% of ambulance rides to ERs — the vast majority by ground ambulances, not helicopters — resulted in out-of-network bills.

Caitlin Donovan, senior director of the National Patient Advocate Foundation in Washington, D.C., said she hears from consumers who get such bills and resolve to call Uber the next time they need to get to the ER. Although experts — and Uber — agree an ambulance is the safest option in an emergency, research out of the University of Kansas found that the Uber ride-sharing service has reduced per-person ambulance use by at least 7%.

Only Ambulance in Town

When Brasfield was rushed to the hospital, her employer, Findlay City Schools, offered insurance plans only from Anthem, and none included the Hanco EMS ambulance service in its network. School system treasurer Michael Barnhart said the district couldn’t insist that Hanco participate. Starting Sept. 1, Barnhart said the school system will have a different insurer, UMR/United Healthcare, but the same plans.

“There is no leverage when they are the only such service around. If it were a particular medical procedure, we could encourage employees to seek another doctor or hospital even if it was further away,” Barnhart said in an email. “But you can’t encourage anyone to use an ambulance service from 50 miles away.”

There is great disagreement about what an ambulance ride is worth.

Brasfield’s insurer paid $347 for her out-of-network ambulance ride. She said Anthem representatives told her that was consistent with in-network rates and Hanco’s $1,206 charge was simply too high.

Jeff Blunt, a spokesperson for Anthem, said that 90% of ambulance companies in Ohio agree to Anthem’s payment rates; Hanco is among the few medical transport providers that don’t participate in its network. He said Anthem reached out to Hanco twice to negotiate a contract but never heard back.

Brasfield sent three letters appealing Anthem’s decision and called Hanco to negotiate the bill down. The companies wouldn’t budge. Hanco sent her a collections notice.

An Ohio school librarian took a 4-mile ambulance ride across Findlay, Ohio, to nearby Blanchard Valley Hospital for what turned out to be a relatively minor heart rhythm problem. But the trip led to a $1,206 ambulance bill.

Rob Lawrence of the American Ambulance Association pointed out that nearly three-quarters of the nation’s 14,000 ambulance providers have low transport volumes but need to staff up even when not needed, creating significant overhead. And because of the pandemic, ambulance providers have seen reduced revenue, higher costs and more uncompensated care, the association’s executive director, Maria Bianchi, said in an email.

Officials at Blanchard Valley Health System, which owns Hanco, said Brasfield’s ambulance charge was on par with the national average for this type of medical emergency, in which EMTs started an IV line and set up a heart monitor.

Fair Health, a nonprofit that analyzes billions of medical claims, estimates an ambulance ride costs $408 in-network and $750 out-of-network in Toledo, which is about 50 miles away from Findlay and has several ambulance companies. Even the higher of those two costs is $456 less than Brasfield’s bill.

Widespread Problem, No Action

Similar stories play out across the nation.

Ron Brooks, 72, received two bills of more than $690 each when his wife had to be rushed about 6 miles to a hospital in Inverness, Florida, after two strokes in November 2018. The only ambulance service in the county, Nature Coast EMS, was out-of-network for his insurer, Florida Blue. Neither had responded to requests for comment by publication time. Brooks’ wife died, and it took him months to pay off the bills.

“There should be an exception if there was no other option,” he said.

Sarah Goodwin of Shirley, Massachusetts, got a $3,161 bill after her now-14-year-old daughter was transported from a hospital to another facility about an hour away after a mental health crisis in November. That was the balance after her insurer, Tricare Prime, paid $491 to Vital EMS. Despite reaching out to the ambulance company and her insurer, she received a call from a collection agency.

“I feel bullied,” she said earlier this year. “I don’t plan to pay it.”

Since KHN asked the companies questions about the bill and the pandemic began, she said, she hadn’t gotten any more bills or calls as of late August.

In an emailed response to KHN, Vital EMS spokesperson Tawnya Silloway said the company wouldn’t discuss an individual bill, and added: “We make every effort to take patients out of the middle of billing matters by negotiating with insurance companies in good faith.”

Last year, an initial attempt at federal legislation to ban surprise billing left out ground ambulances. This February, a bill was introduced in the U.S. House that calls for an advisory committee of government officials, patient advocates and representatives of affected industries to study ground ambulance costs. The bill remains pending, without any action since the pandemic began.

In the meantime, consumer advocates suggest patients try to negotiate with their insurers and the ambulance providers.

Michelle Mello, a Stanford University professor who specializes in health law and co-authored the JAMA Internal Medicine study that examined surprise ambulance bills, was able to appeal to her insurer to pay 90% of such a bill she got after a bike accident last year.

That tactic, however, proved futile for Brasfield, the Ohio librarian. She set up a $100-a-month payment plan with Hanco and, eventually, paid off the bill.

From now on, she said, she’ll think twice about taking an ambulance unless she feels her life is in imminent danger. For anything less, she said, she’d ask a relative or friend to drive her to the hospital.

Lights, Camera, No Action: Insurance Woes Beset Entertainment Industry Workers

Before the coronavirus pandemic shut down the entertainment industry in March, Jeffrey Farber had a steady flow of day jobs in film and television, including work on “Hunters” and “Blue Bloods.” But when theaters, movies and TV shows stopped production, not only did Farber lose his acting income, he also stopped accruing the hours and earnings he needed to qualify for health insurance through his labor union, SAG-AFTRA.

Without the acting jobs, his insurance would be ending this month.

When the pandemic halted film and television production, Jeffrey Farber lost his acting income and stopped accruing the hours and earnings he needed to qualify for health insurance through his labor union, SAG-AFTRA.

“This is an unbelievable situation,” said Farber, 65, a survivor of pancreatic cancer. “There are going to be so many people who aren’t going to be able to make it.”

From Broadway to Hollywood, many actors, directors, backstage workers, musicians and others in the performing arts face similar coverage suspensions. Those in the entertainment industry often have several employers over the course of a year as they move from show to show. In some ways, they’re quintessential gig workers.

Their employers generally make financial contributions to a benefit fund under the terms of the union contract. And the workers pay premiums on their coverage. If workers accumulate a predetermined number of hours or earnings, they can qualify for coverage for up to a year. Coverage is typically comprehensive and quite inexpensive. Farber paid just $408 every three months to cover him and his husband.

It’s a model some academics think might work for others in the gig economy. “It makes coverage possible in industries like retail, construction and entertainment where it might not otherwise be offered,” said JoAnn Volk, a research professor at Georgetown University’s Center on Health Insurance Reforms.

[khn_slabs slabs=”241887″ view=”inline” /]

As the COVID pandemic period has shown, it doesn’t always work well. Someone in the entertainment industry may be able to weather a dry spell without any work because he’s already qualified for coverage based on past employment. But once coverage lapses, this system could leave entertainers at a disadvantage over other workers returning to a more conventional job, where coverage can start immediately. Plus, members may continue to owe union dues, even though they aren’t eligible for health benefits.

The timing of the shutdown couldn’t be worse for Farber, who needed just 12 days of work or $249 in earnings by the end of June to qualify for continued coverage in October. Accumulating that would have been “easy as pie,” he said.

In the entertainment unions’ benefit plans, “coverage is always prospective,” said Phyllis Borzi, a former assistant secretary in the Department of Labor who headed the Employee Benefits Security Administration and is now a consultant. “That works fine if you have a short interruption, but they’ve been out so long, to the extent they have hours banked, they must be out of them by now.”

SAG-AFTRA represents about 160,000 professionals in TV, radio, film and other media. The union requires that members this year generally must accumulate at least 84 days of qualifying work or earn $18,040 over four quarters to be eligible for coverage for the next four quarters.

Farber eventually got a temporary reprieve because he learned he could qualify for coverage with lower earnings under a separate category for people who are least 40 years old and have 10 or more years of health plan eligibility. But he doesn’t know how coverage changes planned for next year will affect his eligibility.

The health plan has taken some steps to alleviate concerns raised by members. In April, it cut health care premiums in half for the second quarter and this month announced a temporary reduction of COBRA premiums for some members.

The SAG-AFTRA benefit fund didn’t respond to requests for comment.

Even in the best of times, it can be difficult for those in the entertainment industry whose names appear in small print in the credits to string together enough work to qualify for coverage. If social restrictions were to ease and people could get work heading into fall, any accumulated hours and income may be too far in the past to count toward future coverage, leaving them no choice but to start accumulating them all over again.

In contrast, when employers hire someone eligible for on-the-job coverage, they typically can’t impose waiting periods longer than 90 days for health insurance under the Affordable Care Act.

Like people who work for a single employer, workers who lose coverage through their union benefit plan can continue their coverage for up to 18 months under federal COBRA law, but workers who make that choice generally have to pick up the entire cost of the plan. And COBRA coverage is not cheap. They may also enroll in a plan on their state marketplace set up by the Affordable Care Act or, if they qualify, in Medicaid, the federal-state program for low-income people.

When the pandemic hit in mid-March, Dee Nichols had logged 512 of the 600 hours he needed to accumulate in a six-month period to qualify for health coverage with the Motion Picture Industry health plan.

“You’re trying to fill a tub of water and it keeps getting holes,” says Dee Nichols, a camera operator in Los Angeles. “They’re fine with guys like me contributing and then not being able to pull [benefits] out of it. It drives me insane.”Nichols, a camera operator in Los Angeles who is a member of Local 600 of the International Cinematographers Guild, had two shows lined up in early March that would have brought him up to the threshold by March 21, the end of his qualifying period for coverage. Then production was canceled.

It wasn’t the first time that Nichols, 49, had missed the hours target for coverage through his union plan. “You’re trying to fill a tub of water and it keeps getting holes,” Nichols said. Meanwhile, he pays $400 a month for an individual marketplace plan with a $6,000 deductible. “They’re fine with guys like me contributing and then not being able to pull [benefits] out of it,” he said. “It drives me insane.”

The Motion Picture Industry health plan also offered some relief to members, including extending them some hours of credit, waiving premiums for dependents and offering COBRA subsidies.

But the assistance didn’t help Nichols qualify for coverage.

He and another member are part of a class action lawsuit arguing that the health plan has a responsibility under federal law to treat all plan participants equally.

The health plan didn’t respond to a request for comment.

Unclear When ‘We’ll Work Again’

To assist its members during the pandemic, the Actors’ Equity Association health plan waived premiums for three months starting in May and is temporarily offering a lower-cost plan through the end of the year.

But since these multi-employer plans are self-funded, they pay members’ claims directly. That can cause problems when work is scant and employers aren’t paying into the fund.

“All of these health funds have different financial positions, and they have to maintain reserves in order to maintain coverage for their members,” said Brandon Lorenz, communications director of the Actors’ Equity Association, which represents approximately 52,000 actors and stage managers.

SAG-AFTRA, which has projected a $141 million deficit in its health plan this year, announced far-reaching changes to coverage for next year, including higher thresholds on earnings and days worked to qualify for coverage.

That could prove an added challenge for Jeffrey Farber, who is concerned about what job opportunities will be available when the industry recovers.

“None of us knows when production is going to start again or if we’ll work again,” he said.

Luz, cámara… sin acción: problemas con el seguro de salud en Hollywood por COVID

Antes que la pandemia paralizara la industria del entretenimiento en marzo, Jeffrey Farber tenía un flujo constante de trabajo en cine y televisión, incluyendo apariciones en “Hunters” y “Blue Boods”.

Pero cuando se cancelaron las producciones teatro, cine y TV, Farber no sólo perdió sus ingresos como actor, sino que también dejó de acumular las horas y ganancias que necesitaba para calificar para el seguro médico a través de su sindicato, SAG-AFTRA.

Sin estos trabajos en actuación, su seguro terminaría en septiembre.

“Es una situación increíble”, dijo Farber, de 65 años y sobreviviente de cáncer de páncreas. “Va a haber mucha gente que no va a poder vivir así”.

Desde Broadway hasta Hollywood, muchos actores, directores, trabajadores de producción, músicos y otros se enfrentan a situaciones similares. Los trabajadores en la industria del entretenimiento a menudo tienen varios empleadores en el transcurso de un año, a medida que pasan de un espectáculo a otro. En cierto modo, son trabajadores por cuenta propia.

Sus empleadores generalmente hacen contribuciones financieras a un fondo de beneficios bajo los términos del contrato del sindicato. Y los trabajadores pagan primas por su cobertura.

Si acumulan un número predeterminado de horas o ganancias, pueden calificar para la cobertura por un año. La cobertura suele ser amplia y bastante económica. Farber pagaba sólo $408 cada tres meses para él y su esposo.

Es un modelo que algunos académicos piensan que podría funcionar para otros en este tipo de industria. “Hace posible la cobertura en sectores como la venta al por menor, la construcción y el entretenimiento donde de otra manera no se ofrecería”, señaló JoAnn Volk, investigadora del Centro de Reformas del Seguro de Salud de la Universidad Georgetown.

Pero como ha mostrado este tiempo de pandemia, no siempre funciona bien. Alguien en la industria del entretenimiento puede ser capaz de  sobrellevar un período de sequía, sin trabajo, porque califica para la cobertura basada en un empleo anterior.

Pero una vez que la cobertura caduca, este sistema podría dejar a los artistas en desventaja sobre otros trabajadores que regresan a un trabajo más convencional, donde la cobertura puede comenzar inmediatamente. Además, los miembros pueden seguir debiendo cuotas sindicales, aunque no sean elegibles para los beneficios de salud.

El momento del cierre no podría ser peor para Farber, que sólo necesitaba 12 días de trabajo o $249 en ingresos, a fines de junio, para calificar para la continuidad de la cobertura en octubre.

En los planes de los sindicatos del entretenimiento, “la cobertura siempre es prospectiva”, explicó Phyllis Borzi, ex secretaria adjunta del Departamento de Trabajo que dirigió la Administración de Seguridad de Beneficios del Empleado y que ahora es consultora. “Eso funciona bien si tienes una interrupción corta, pero han estado sin trabajo tanto tiempo, que si tuvieran horas acumuladas, ya las habrían perdido”.

SAG-AFTRA representa a unos 160,000 profesionales de la televisión, la radio, el cine y otros. El sindicato exige que los miembros de este año deberían acumular al menos 84 días de trabajo calificado o ganar $18,040 en cuatro trimestres para tener derecho a la cobertura de los próximos cuatro trimestres.

Farber finalmente obtuvo un aplazamiento temporal porque se enteró que podía calificar para la cobertura, con menores ingresos, en una categoría separada para las personas que tienen al menos 40 años y 10 o más de elegibilidad para el plan de salud. Pero no sabe cómo los cambios de cobertura planeados para el próximo año afectarán su elegibilidad.

El plan de salud ha tomado algunas medidas para aliviar las preocupaciones planteadas por los miembros. En abril, redujo las primas de atención médica a la mitad para el segundo trimestre y en septiembre anunció una reducción temporal de las primas de COBRA para algunos miembros.

El fondo de beneficios SAG-AFTRA no respondió a las solicitudes de comentarios.

Al igual que las personas que trabajan para un solo empleador, los trabajadores que pierden la cobertura de su plan de beneficios del sindicato pueden continuar su cobertura hasta 18 meses bajo la ley federal COBRA, pero los trabajadores que toman esa decisión generalmente tienen que pagar el costo total del plan.

Y la cobertura de COBRA no es barata. También pueden inscribirse en un plan en el mercado de su estado establecido por ACA o, si califican, en Medicaid, el programa federal-estatal para personas de bajos ingresos.

Cuando la pandemia golpeó a mediados de marzo, Dee Nichols había registrado 512 de las 600 horas que necesitaba acumular, en un período de seis meses, para calificar para la cobertura de salud con el plan de salud de la Industria Cinematográfica.

Nichols, un operador de cámara de Los Angeles que es miembro del Local 600 del International Cinematographers Guild, tenía programados dos contratos a principios de marzo que le habrían permitido alcanzar el umbral para el 21 de marzo, el final de su período de calificación para la cobertura. Pero la producción se canceló.

El plan de salud de la Industria Cinematográfica también ofreció cierto alivio a los miembros, incluyendo la extensión de algunas horas de crédito, la renuncia a las primas para los dependientes y la oferta de subsidios para COBRA.

Pero la asistencia no ayudó a Nichols a calificar para la cobertura.

Él y otro miembro forman parte de una demanda colectiva que argumenta que el plan de salud tiene la responsabilidad, según la ley federal, de tratar a todos los participantes por igual.

El plan de salud no respondió a una solicitud de comentarios.

No está claro cuándo “Volveremos a trabajar”

Para ayudar a sus miembros durante la pandemia, el plan de salud de la Actors’ Equity Association renunció a las primas durante tres meses a partir de mayo y ofrece, temporalmente, un plan de menor costo hasta fin de año.

Pero como estos planes de varios empleadores se autofinancian, pagan los reclamos de los miembros directamente. Eso puede causar problemas cuando el trabajo es escaso y los empleadores no pagan al fondo.

“Todos estos fondos de salud tienen diferentes capacidades financieras, y deben mantener reservas para preservar la cobertura de sus miembros”, explicó Brandon Lorenz, director de comunicaciones de la Actors’ Equity Association, que representa a aproximadamente 52,000 actores y directores.

SAG-AFTRA, que ha proyectado un déficit de $141 millones en su plan de salud este año, anunció cambios de gran alcance en la cobertura para el próximo año, incluyendo umbrales más altos en las ganancias y días trabajados para calificar para la cobertura.

Esto podría ser un desafío adicional para Jeffrey Farber, quien está preocupado por las oportunidades de trabajo que estarán disponibles cuando la industria se recupere.

“Nadie sabe cuándo se reanudarán las producciones o si volveremos a trabajar”, señaló.

Esta historia fue producida por Kaiser Health News, un programa editorial independiente de la 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.

USE OUR CONTENT

This story can be republished for free (details).

A Rewrite of Chapter 4 of the Big Book

In 2017 the book A Secular Sobriety was published. Written by Dale K, it contains a rewritten version of the first 164 pages of the Big Book. Here is a modern version of the fourth chapter, originally called We Agnostics.

By Dale K

Commentary: It’s difficult to articulate my feelings about the original Chapter 4. The chapter’s deceptive nature is quite repugnant. I could rant and rave, on and on. That might make me feel better, but my feelings are so negative that it would bring me down and you with me. Reading this chapter is the textual equivalent of watching “Reefer Madness.” One thing I’ve come to understand is this: When religious people read this, they believe it is spot on. Their opinion is the result of prejudice towards, and ignorance of, what it is to be agnostic or atheistic. Many of them, truly, believe they have the corner on righteousness all to themselves.

This chapter is, at best, a condescending charade. I find it to be very insulting and incompatible with any secular thinking. By using “We” in the title, it is insinuated that the authors are agnostic. That is so obviously untrue. The author is a Christian trying to save and convert agnostics. This is the part of the Big Book where their blatant proselytizing for god happens. Isn’t it odd that they would pretend to be agnostic for god? Attempting a conversion may be understandable, but their duplicity is detestable. I recommend that, if you read the original text, you read it with love in your heart, if possible. You must understand that it is a minefield for resentments.

* * *

For The Agnostic

IN THE PRECEDING chapters you have learned something of alcoholism. It is hoped the authors have made clear the distinction between the alcoholic and non-alcoholic. If, when you honestly want to, you find you cannot quit entirely, or if when drinking, you have little control over the amount you take, you are probably alcoholic. If that be the case, you may be suffering from an illness which only a spiritual or life-changing experience will conquer.

To one who is an atheist or agnostic such an experience is quite possible. To continue as you are would mean disaster. There is no such thing as a hopeless alcoholic. To be doomed to an alcoholic death or to live on a spiritual basis are not always easy alternatives to face.

But it isn’t so difficult. About half our original fellowship were of the secular type. At first some of us tried to avoid the issue, hoping against hope we were not true alcoholics. But after a while we had to face the fact that we must find a more loving basis of life—or else. Perhaps it is going to be that way with you. But cheer up, something like half of us were atheists or agnostics. Our experience shows that you need not be disconcerted.

If a mere code of ethics or a better philosophy of life were sufficient to overcome alcoholism, many of us would have recovered long ago. Merely intellectualizing such codes and philosophies is insufficient. The practical application of these principles is the key to success. By realigning your will to be more loving, and practicing this day by day, you will see how much nicer life and sobriety can be.

Lack of power, that was our dilemma. We had to find a power by which we could live, and it had to be a power greater than ourselves. This was obvious, but where and how were we to find this power?

Well, that’s exactly what this book is about. Its main object is to enable you to find a power greater than yourself which will help solve your problem. That means we have written a book which we believe to be spiritual, virtuous, principled and ethical. And it means, of course, that we are going to talk about god. This should not be a difficulty for agnostics. Accept that most people are religious and find their spirituality through a belief in gods. We should not be prejudiced about how anyone comes to this wonderful way of living. For atheists or agnostics, this power could be as simple as the person you would like to become or the fellowship within AA. Our only concern is the results.

We know how secular people may feel. We have shared an honest doubt and prejudice. Some of us have been violently anti-religious. To others, the word “god” brought up a particular idea with which someone had tried to impress upon them during childhood. We rejected this particular conception because it seemed inadequate. With that rejection we had abandoned the god idea entirely. We were bothered with the thought that dependence upon a supernatural power beyond ourselves was somewhat weak, even cowardly. We looked upon this world of warring individuals, warring theological systems, and inexplicable calamity, with deep skepticism. We looked askance at many individuals who claimed to be godly. How could a supernatural being have anything to do with it all? And who could comprehend a supreme being anyhow? Yet, at other moments, we found ourselves thinking, when enchanted by a starlit night, “The cosmos are so amazing!” There was a feeling of awe and wonder. We held on to that, knowing that we needed no god to be humbled by the immense power and enormous complexity of it all.

Yes, we of agnostic and religious temperaments have had negative thoughts, prejudices and experiences regarding one another. Let us make haste to reassure you. We found that as soon as both were able to lay aside prejudice and express even a willingness to believe in a power greater than ourselves, we commenced to get results, even though it was impossible for any of us, atheist or theist, to fully define or comprehend that power, which could be god, love, fellowship or whatever works for you.

Much to our relief, we discovered we did not need to consider another’s conception of a higher power. Our own conception was sufficient to make the approach and to effect a change in our thinking. As soon as we admitted the possible existence of a power greater than ourselves, we began to feel a new sense of power and direction, provided we took other simple steps. We found that these were not difficult terms. To us, the realm of love and selflessness is broad, roomy, all inclusive; never exclusive or forbidding to those who earnestly seek. It is open, we believe, to all persons.

When, therefore, this book uses the term “god” it means your own conception of a higher power. This also applies to other spiritual expressions which you find in this book. Do not let any prejudice you may have against spiritual terms deter you from honestly asking yourself what they mean to you. This was all we needed to commence spiritual growth, to effect our first conscious relation with a higher power as we understood it. Afterward, we found ourselves accepting many things which then seemed entirely out of reach. That was growth, but if we wished to grow we had to begin somewhere. So we used our own conception which may be unlimited.

We needed to ask ourselves but one short question. “Do I now believe, or am I even willing to believe, that there is a power greater than myself?” As soon as a person can say that they do believe, or is willing to believe, we emphatically assure them that they are on their way. It has been repeatedly proven among us that upon this simple cornerstone a wonderfully effective spiritual structure can be built. (Please be sure to read Appendix II on “Spiritual Experience.”)

That was great news for us if we thought spiritual principles were only for religious people. When people presented us with spiritual approaches, how frequently did we say, “That’s for religious people. It won’t work for me because I don’t believe in gods.” So it was comforting to learn that we could commence without religious beliefs.

Because of a misunderstanding of how spirituality could apply to secular people, we often found ourselves handicapped by obstinacy, sensitiveness, and unreasoning prejudice. Many of us have been so touchy that even casual reference to spiritual things made us bristle with antagonism. This sort of thinking had to be abandoned. Realizing that spirituality means nothing more than a profound new way of thinking about ourselves and others, we found no great difficulty in casting aside such feelings. Faced with alcoholic destruction, we soon became as open minded on these matters as we had tried to be on other questions. In this respect alcohol was a great persuader. It finally beat us into a state of reasonableness. Sometimes this was a tedious process; we hope no one else will be prejudiced for as long as some of us were.

The reader may still ask why they should believe in a power greater than themselves. We think there are good reasons. Let us have a look at some of them.

The practical individual of today is a stickler for facts and results. The twentieth century readily accepts scientific theories of all kinds, provided they are firmly grounded in fact. We have numerous theories, for example, about electricity. Everyone believes them without a murmur of doubt. Why this ready acceptance? Simply because, with the scientific method, it is possible to explain what we see, feel, direct, and use, because we have a reasonable assumption as a starting point.

Everybody nowadays, believes in scores of scientific ideas for which there is good evidence, but no perfect visual proof. Quite often, science demonstrates that visual evidence may not tell a complete story. It is being constantly revealed, as we study the material world, that outward appearances are not always inward reality. To illustrate:

The prosaic steel girder is a mass of electrons whirling around each other at incredible speed. These tiny bodies are governed by precise laws, and these laws hold true throughout the material world. Science tells us so. We have no reason to doubt it. Therefore, when the illogical assumption is suggested that underneath the material world and life as we see it, there is an all powerful, guiding, creative intelligence, right there our scientific understanding comes to the surface and we simply reaffirm to ourselves that there is no scientific evidence of it. We read wordy books and indulge in windy arguments, knowing this universe needs no god to explain it. For some who believe in god, these contentions that life originated out of nothing would indicate that life means nothing and proceeds nowhere. We agnostics understand that this explanation of the origins of life “means nothing” of the sort. There is much meaning in life and where it proceeds depends on the behavior we choose today.

We agnostics and atheists chose to believe our human intelligence is never the last word, the alpha and omega, the beginning and end of all. It is merely a tool we use to discover new truths.

We, who have traveled the path of sobriety, beg you to lay aside prejudice, even against organized religion. We have learned that whatever the human frailties of various faiths may be, those faiths have given purpose and direction to millions. All people, believers and non-believers, feel they have a logical idea of what life is all about. Just as we wish to be accepted, we should accept others personal ideas regarding spirituality. All people seek a degree of stability, happiness and usefulness. The path we may choose is not the important thing. The most important thing is our mutual goal of sobriety.

Sometimes we looked at the human defects of people and used their shortcomings as a basis of wholesale condemnation. We talked of intolerance, while we were intolerant ourselves. We missed the reality and the beauty of the forest because we were diverted by the ugliness of some of the trees. It is time to give the loving side of life a fair hearing.

In our personal stories you will find a wide variation in the way each teller approaches and conceives of the power which is greater than themselves. Whether we agree with a particular approach or conception seems to make little difference. Experience has taught us that these are matters about which, for our purpose, we need not be worried. They are questions for each individual to settle for themselves.

On one proposition, however, these men and women are strikingly agreed. Every one of them has gained access to, and believes in, a power greater than themselves. This power has in each case accomplished the seemingly impossible. As a celebrated American figure put it, “Let’s look at the record.”

Here are thousands of men and women, worldly indeed. They flatly declare that since they have come to believe in a power greater than themselves, to take a certain attitude towards that power, and to do certain simple things, there has been a revolutionary change in their way of living and thinking. In the face of collapse and despair, they found that a new power, peace, happiness, and sense of direction flowed into them. This happened soon after they wholeheartedly met a few simple requirements. Once confused and baffled by the seeming futility of existence, they show the underlying reasons why they were making heavy going of life. Leaving aside the drink question, they tell why living was so unsatisfactory. They show how change came over them. When many hundreds of people are able to say that the consciousness of the presence of a power greater than themselves is today the most important fact of their lives, they present a powerful reason why one should consider a power greater than themselves.

This world of ours has made more progress in the last century than in all the millenniums which went before. Almost everyone knows the reason. Students of ancient history tell us that the intellect of people in those days was equal to the best of today. Yet in ancient times progress was painfully slow. The spirit of modern scientific inquiry, research and invention was almost unknown. People’s minds were fettered by superstition, tradition, and all sorts of fixed ideas. Some of the contemporaries of Columbus thought a round earth preposterous. Others came near putting Galileo to death for his astronomical heresies.

Today, it is unnecessary to burden ourselves with fixed ideas like the ancients did. Nonetheless, even in the present century, American newspapers were afraid to print an account of the Wright brothers’ first successful flight at Kitty Hawk. Had not all efforts at flight failed before? Did not Professor Langley’s flying machine go to the bottom of the Potomac River? Was it not true that the best mathematical minds had proved people could never fly? Had not religious people said god had reserved this privilege to the birds? Only thirty years later the conquest of the air was almost an old story and airplane travel was in full swing.

But in most fields our generation has witnessed complete liberation of our thinking. Show any longshoreman a Sunday supplement describing a proposal to explore the moon by means of a rocket and he will say, “I bet they do it – maybe not so long either.” Is not our age characterized by the ease with which we discard old ideas for new, by the complete readiness with which we throw away the theory or gadget which does not work for something new which does?

We had to ask ourselves why we shouldn’t apply to our problems this same readiness to change our point of view. We were having trouble with personal relationships, we couldn’t control our emotional natures, we were a prey to misery and depression, we couldn’t make a living, we had a feeling of uselessness, we were full of fear, we were unhappy, we couldn’t seem to be of real help to other people – was not a basic solution of these bedevilments more important than whether we should see newsreels of lunar flight? Of course it was.

When we saw others solve their problems by a simple reliance upon spiritual principles, we had to stop doubting the power of love. Our ideas did not work. But the higher power idea did.

The Wright brothers’ faith that they could build a machine which would fly was the mainspring of their accomplishment. Without that, nothing could have happened. We agnostics and atheists were sticking to the idea that self-sufficiency would solve our problems. When others showed us that “group-sufficiency” worked with them, we began to understand why it took both of the Wright brothers to succeed in their accomplishment.

Logic is great stuff. We liked it. We still like it. We have the power to reason, to examine the evidence of our senses, and to draw conclusions. That is one of humankind’s magnificent attributes. We agnostically inclined would not feel satisfied with a proposal which does not lend itself to reasonable approach and interpretation. Hence we are at pains to tell why we think our ideas are reasonable, why we think it sane and logical, why we say our former thinking was soft and mushy when we tried to figure everything out by ourselves. It takes teamwork and fellowship to come up with all these wonderful new ideas for living a good and sober life.

When we became alcoholics, crushed by a self-imposed crisis we could not postpone or evade, we didn’t have to decide the issue of god. There is no need to debate the distinctions of theism and atheism. Whatever your beliefs are regarding this matter, they are sufficient starting points to build a good, strong sobriety.

Arrived at this point, we were squarely confronted with the question of whether the fellowship of Alcoholics Anonymous would work for us. We couldn’t duck the issue. Some of us had already walked far over the bridge of reason toward the desired shore of sobriety. The outlines and promises of a new way of living had brought lustre to tired eyes and fresh courage to flagging spirits. Friendly hands had stretched out in welcome. We were grateful that reason had brought us so far. With an open mind, we could easily step ashore. As agnostics, atheists and freethinkers, we lean heavily on reason for support. Combining our ability to reason with the serenity that accompanies love and peace, we receive great support in this last mile.

That was natural, but let us think a little more closely. Without knowing it, we may have been brought to where we stand by a certain kind of faith. For did we not believe in our own reasoning? Did we not have confidence in our ability to think? What was that but a sort of faith in ourselves? Yes, we had been faithful, abjectly faithful to our own ability to reason. So, in a small way, we have the common ground of faith with religious people. We discovered that faith in reason had been involved all the time!

We found that, although we were not worshippers, we were admirers. What a state of mental goose-flesh the word “worship” can bring on! Had we not, variously, admired people, sentiment, things, money, and ourselves? And then, with a better motive, had we not admirably beheld the sunset, the sea, or a flower? Who of us had not loved something or somebody? How much of these feelings, these loves, these admirations, have to do with pure reason? Sometimes, little or nothing, we saw at last. Were not these things the tissue out of which our lives were constructed? Did not these feelings, after all, determine the course of our existence? It was impossible to say we had no capacity for faith, or love, or admiration. In one form or another we had been living by these things often and, sometimes, by little else.

Imagine life without some kind of faith! Were nothing left but pure reason, it wouldn’t be much of a life. But we believed in life – of course we did. We can prove life just as we can prove a straight line is the shortest distance between two points. Could we still say the whole thing was nothing but a mass of electrons, created out of nothing, meaning nothing, whirling on to a destiny of nothingness? Of course we could. But, even the electrons themselves seemed more intelligent than that. At least, so the chemist said.

Hence, we see that reason isn’t everything. Neither is reason, as some of us use it, entirely dependable. Having said that, there is still no reason (pun intended) to throw it out. Reason emanates from our best minds. The people that proved people could never fly were wrong. At the time, they just didn’t understand all the physical science.

Yet we had been seeing another kind of flight, a spiritual liberation in this world, people who rose above their problems. They said love made these things possible, and we only smiled. We had seen spiritual release, but liked to tell ourselves it wasn’t true.

Actually we were fooling ourselves, for deep down in every man, woman, and child, is the fundamental idea of love. It may be obscured by calamity, by pomp, by admiration of other things, but in some form or other it is there. For love is a power greater than ourselves, and demonstrations of that power in human lives, are facts as old as human existence itself.

We finally saw that faith in some kind of goodwill was a part of our make-up, just as much as the feelings we have for a friend. Sometimes we had to search fearlessly, but it was there. It was as much a fact as we were. We found this great reality deep down within us. In the last analysis it is only there that love may be found. It was so with us.

We can only clear the ground a bit. If our testimony helps sweep away prejudice, enables you to think honestly, encourages you to search diligently within yourself, then, if you wish, you can join us on this broad journey of sobriety. With this attitude you cannot fail. The consciousness of your beliefs are sure to come to you.

* * *

Commentary: The last two pages of the original version of this chapter describe one alcoholic’s conversion to a belief in god. I believe it is, completely, irrelevant for secular people. I will not be including it here. I have no desire to change his story, but it has no place in a chapter entitled “We Agnostics.” I congratulate him for finding sobriety. We should be grateful for all that find sobriety. Each person must find their own way. Regardless of the fact that a deity doesn’t fit into an atheist’s life, we should understand and appreciate all paths to sobriety. My big hope is that religious people, as well, will congratulate us and be understanding and grateful for our sobriety.


A Secular SobrietyDale K. has lived in North Carolina since 2018. He grew up in Michigan and attended 12 years of Catholic school, but it didn’t “take.” He decided he was an atheist at the age of 13. He moved to South Florida in 1974. He first came to AA in 1980 and had his last drink in 1981. In the mid ‘80s a secular meeting was started in his home town of Boca Raton. He attended that meeting exclusively until he moved up the coast in 2010.

There he found traditional AA to be just like he had left it. In 2013 he discovered that AA had published a new edition of the Big Book in 2001. He was quick to read it and see the changes. Realizing there were none made to the “first 164 pages,” he decided it was time to make the changes himself. With that, he began writing his book, A Secular Sobriety. It was first published in June 2017 and has surpassed 1000 sales. It can be purchased on Amazon. A Secular Sobriety: Including a secular version of the first 164 pages of the Big Book.


For a review of the book, click here: A Secular Sobriety – Review.


 

The post A Rewrite of Chapter 4 of the Big Book first appeared on AA Agnostica.

Remembering 9/11’s first recorded victim

Addiction Recovery Bulletin

New York lost a very good man –  

Sept. 9, 2020 – “He was truly something special. He had certain charisma and charm.” He remembers Judge’s wit and how he liked to crack a joke.

“Even when I asked him to marry us a year in advance he said, ‘I cannot do it, I have funeral that day.’ I was really disappointed before he stopped me and said, ‘Dave it’s a year away, I don’t know what I will be doing, of course I will marry you.’

“I was overjoyed,” the firefighter recalls.

After receiving minor burns on the job, Fullam was admitted to the hospital late one night and was surprised when Judge appeared up in the early hours of the morning.

“I was just amazed that he showed up. You don’t expect people to visit after midnight. He sat and spent some time with me, making sure that I was okay.

“He apologized to me for not bringing wool socks. Whenever you visit a firefighter they always had wet feet as their boots are soaked,” Fullam explained.

When the news came that Judge had lost his life in the terrorist attacks, Fullam raced to the firehouse on 31st Street where Judge’s body was laid out in a makeshift shrine.

“When we got the news that afternoon we weren’t that far away. They had him laid out in the firehouse,” Fullam recalls.

“He is the only one that had an open casket funeral. I was happy I was able to kiss his hands. I think he knew that God had taken him for a reason. He was there for everybody else.”

more@IrishCentral

The post Remembering 9/11’s first recorded victim appeared first on Addiction/Recovery eBulletin.