Category: From California Healthline.org

After shutting down in the spring, America’s empty gyms are beckoning a cautious public back for a workout. To reassure wary customers, owners have put in place — and now advertise — a variety of coronavirus control measures. At the same time, the fitness industry is trying to rehabilitate itself by pushing back against what it sees as a misleading narrative that gyms have no place during a pandemic.

In the first months of the coronavirus outbreak, most public health leaders advised closing gyms, erring on the side of caution. As infections exploded across the country, states ordered gyms and fitness centers closed, along with restaurants, movie theaters and bars. State and local officials consistently branded gyms as high-risk venues for infection, akin to bars and nightclubs.

In early August, New York Gov. Andrew Cuomo called gym-going a “dangerous activity,” saying he would keep them shut — only to announce later in the month that most gyms could reopen in September at a third of the capacity and under tight regulations.

New York, New Jersey and North Carolina were among the last state holdouts — only recently allowing fitness facilities to reopen. Many states continue to limit capacity and have instituted new requirements.

The benefits of gyms are clear. Regular exercise staves off depression and improves sleep, and staying fit may be a way to avoid a serious case of COVID-19. But there are clear risks, too: Lots of people moving around indoors, sharing equipment and air, and breathing heavily could be a recipe for easy viral spread. There are scattered reports of coronavirus cases traced back to specific gyms. But gym owners say those are outliers and argue the dominant portrayal overemphasizes potential dangers and ignores their brief but successful track record of safety during the pandemic.

A Seattle gym struggles to comply with new rules and survive

At NW Fitness in Seattle, everything from a set of squats to a run on the treadmill requires a mask. Every other cardio machine is off-limits. The owners have marked up the floor with blue tape to show where each person can work out.

Esmery Corniel, a member, has resumed his workout routine with the punching bag.

“I was honestly just losing my mind,” said Corniel, 27. He said he feels comfortable in the gym with its new safety protocols.

“Everybody wears their mask, everybody socially distances, so it’s no problem here at all,” Corniel said.

There’s no longer the usual morning “rush” of people working out before heading to their jobs.

Under Washington state’s coronavirus rules, only about 10 to 12 people at a time are permitted in this 4,000-square-foot gym.

“It’s drastically reduced our ability to serve our community,” said John Carrico. He and his wife, Jessica, purchased NW Fitness at the end of last year.

Meanwhile, the cost of running the businesses has gone up dramatically. The gym now needs to be staffed round-the-clock to keep up with the frequent cleaning requirements, and to ensure people are wearing masks and following the rules.

Keeping the gym open 24/7 — previously a big selling point for members — is no longer feasible. In the past three months, they’ve lost more than a third of their membership.

“If the trend continues, we won’t be able to stay open,” said Jessica Carrico, who also works as a nurse at a homeless shelter run by Harborview Medical Center.

Given her medical background, Jessica Carrico was initially inclined to trust the public health authorities who ordered all gyms to shut down, but gradually her feelings changed.

“Driving around the city, I’d still see lines outside of pot shops and Baskin-Robbins,” she said. “The arbitrary decision that had been made was very clear, and it became really frustrating.”

Even after gyms in the Seattle area were allowed to reopen, their frustrations continued — especially with the strict cap on operating capacity. The Carricos believe that falls hardest on smaller gyms that don’t have much square footage.

“People want this space to be safe, and will self-regulate,” said John Carrico. He believes he could responsibly operate with twice as many people inside as currently allowed. Public health officials have mischaracterized gyms, he added, and underestimated their potential to operate safely.

“There’s this fear-based propaganda that gyms are a cesspool of coronavirus, which is just super not true,” Carrico said.

Gyms seem less risky than bars. But there’s very little research either way

The fitness industry has begun to push back at the pandemic-driven perceptions and prohibitions. “We should not be lumped with bars and restaurants,” said Helen Durkin, an executive vice president for the International Health, Racquet & Sportsclub Association (IHRSA).

John Carrico called the comparison with bars particularly unfair. “It’s almost laughable. I mean, it’s almost the exact opposite. … People here are investing in their health. They’re coming in, they’re focusing on what they’re trying to do as far as their workout. They’re not socializing, they’re not sitting at a table and laughing and drinking.”

Since the pandemic began, many gyms have overhauled operations and now look very different: Locker rooms are often closed and group classes halted. Many gyms check everyone for symptoms upon arrival. They’ve spaced out equipment and begun intensive cleaning regimes.

Gyms have a big advantage over other retail and entertainment venues, Durkin said, because the membership model means those who may have been exposed in an outbreak can be easily contacted.

A company that sells member databases and software to gyms has been compiling data during the pandemic. (The data, drawn from 2,877 gyms, is by no means comprehensive because it relies on gym owners to self-report incidents in which a positive coronavirus case was detected at the gym, or was somehow connected to the gym.) The resultant report said that the overall “visits to virus” ratio of 0.002% is “statistically irrelevant” because only 1,155 cases of coronavirus were reported among more than 49 million gym visits. Similarly, data collected from gyms in the United Kingdom found only 17 cases out of more than 8 million visits in the weeks after gyms reopened there.

Only a few U.S. states have publicly available information on outbreaks linked to the fitness sector, and those states report very few cases. In Louisiana, for example, the state has identified five clusters originating in “gym/fitness settings,” with a total of 31 cases. None of the people died. By contrast, 15 clusters were traced to “religious services/events,” sickening 78, and killing five of them.

“The whole idea that it’s a risky place to be … around the world, we just aren’t seeing those numbers anywhere,” said IHRSA’s Durkin.

A study from South Korea published by the Centers for Disease Control and Prevention is often cited as evidence of the inherent hazards of group fitness activities.

The study traced 112 coronavirus infections to a Feb. 15 training workshop for fitness dance instructors. Those instructors went on to teach classes at 12 sports facilities in February and March, transmitting the virus to students in the dance classes, but also to co-workers and family members.

But defenders of the fitness industry point out that the outbreak began before South Korea instituted social distancing measures.

The study authors note that the classes were crowded and the pace of the dance workouts was fast, and conclude that “intense physical exercise in densely populated sports facilities could increase the risk for infection” and “should be minimized during outbreaks.” They also found that no transmission occurred in classes with fewer than five people, or when an infected instructor taught “lower-intensity” classes such as yoga and Pilates.

Public health experts continue to urge gym members to be cautious

It’s clear that there are many things gym owners — and gym members — can do to lower the risk of infection at a gym, but that doesn’t mean the risk is gone. Infectious disease doctors and public health experts caution that gyms should not downplay their potential for spreading disease, especially if the coronavirus is widespread in the surrounding community.

“There are very few [gyms] that can actually implement all the infection control measures,” said Saskia Popescu, an infectious disease epidemiologist in Phoenix. “That’s really the challenge with gyms: There is so much variety that it makes it hard to put them into a single box.”

Popescu and two colleagues developed a COVID-19 risk chart for various activities. Gyms were classified as “medium high,” on par with eating indoors at a restaurant or getting a haircut, but less risky than going to a bar or riding public transit.

Popescu acknowledges there’s not much recent evidence that gyms are major sources of infection, but that should not give people a false sense of assurance.

“The mistake would be to assume that there is no risk,” she said. “It’s just that a lot of the prevention strategies have been working, and when we start to loosen those, though, is where you’re more likely to see clusters occur.”

Any location that brings people together indoors increases the risk of contracting the coronavirus, and breathing heavily adds another element of risk. Interventions such as increasing the distance between cardio machines might help, but tiny infectious airborne particles can travel farther than 6 feet, Popescu said.

The mechanics of exercising also make it hard to ensure people comply with crucial preventive measures like wearing a mask.

“How effective are masks in that setting? Can they really be effectively worn?” asked Dr. Deverick Anderson, director of the Duke Center for Antimicrobial Stewardship and Infection Prevention. “The combination of sweat and exertion is one unique thing about the gym setting.”

“I do think that, in the big picture, gyms would be riskier than restaurants because of the type of activity and potential for interaction there,” Anderson said.

The primary way people could catch the virus at a gym would be coming close to someone who is releasing respiratory droplets and smaller airborne particles, called “aerosols,” when they breathe, talk or cough, said Dr. Dean Blumberg, chief of pediatric infectious diseases at UC Davis Health.

He’s less worried about people catching the virus from touching a barbell or riding a stationary bike that someone else used. That’s because scientists now think “surface” transmission isn’t driving infection as much as airborne droplets and particles.

“I’m not really worried about transmission that way,” Blumberg said. “There’s too much attention being paid to disinfecting surfaces and ‘deep cleaning,’ spraying things in the air. I think a lot of that’s just for show.”

Blumberg said he believes gyms can manage the risks better than many social settings like bars or informal gatherings.

“A gym where you can adequately social distance and you can limit the number of people there and force mask-wearing, that’s one of the safer activities,” he said.

Adapting to the pandemic’s prohibitions doesn’t come cheap

In Bellevue, Washington, PRO Club is an enormous, upscale gym with spacious workout rooms — and an array of medical services such as physical therapy, hormone treatments, skin care and counseling. PRO Club has managed to keep the gym experience relatively normal for members since reopening, according to employee Linda Rackner. “There is plenty of space for everyone. We are seeing about 1,000 people a day and have capacity for almost 3,000,” Rackner said. “We’d love to have more people in the club.”

The gym uses the same air-cleaning units as hospital ICUs, deploys ultraviolet robots to sanitize the rooms and requires temperature checks to enter. “I feel like we have good compliance,” said Dean Rogers, one of the personal trainers. “For the most part, people who come to a gym are in it for their own health, fitness and wellness.”

But Rogers knows this isn’t the norm everywhere. In fact, his own mother back in Oklahoma believes she contracted the coronavirus at her gym.

“I was upset to find out that her gym had no guidelines they were following, no safety precautions,” he said. “There are always going to be some bad actors.”

This story is part of a partnership that includes NPR and Kaiser Health News, an editorially independent program of the Kaiser Family Foundation. Carrie Feibel, an editor for the NPR-KHN reporting partnership, contributed to this story.

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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CLEVELAND — Families skipping or delaying pediatric appointments for their young children because of the pandemic are missing out on more than vaccines. Critical testing for lead poisoning has plummeted in many parts of the country.

In the Upper Midwest, Northeast and parts of the West Coast — areas with historically high rates of lead poisoning — the slide has been the most dramatic, according to the Centers for Disease Control and Prevention. In states such as Michigan, Ohio and Minnesota, testing for the brain-damaging heavy metal fell by 50% or more this spring compared with 2019, health officials report.

“The drop-off in April was massive,” said Thomas Largo, section manager of environmental health surveillance at the Michigan Department of Health and Human Services, noting a 76% decrease in testing compared with the year before. “We weren’t quite prepared for that.”

Blood tests for lead, the only way to tell if a child has been exposed, are typically performed by pricking a finger or heel or tapping a vein at 1- and 2-year-old well-child visits. A blood test with elevated lead levels triggers the next critical steps in accessing early intervention for the behavioral, learning and health effects of lead poisoning and also identifying the source of the lead to prevent further harm.

Because of the pandemic, though, the drop in blood tests means referrals for critical home inspections plus medical and educational services are falling, too. And that means help isn’t reaching poisoned kids, a one-two punch, particularly in communities of color, said Yvonka Hall, a lead poisoning prevention advocate and co-founder of the Cleveland Lead Safe Network. And this all comes amid COVID-related school and child care closures, meaning kids who are at risk are spending more time than ever in the place where most exposure happens: the home.

“Inside is dangerous,” Hall said.

The CDC estimates about 500,000 U.S. children between ages 1 and 5 have been poisoned by lead, probably an underestimate due to the lack of widespread testing in many communities and states. In 2017, more than 40,000 children had elevated blood lead levels, defined as higher than 5 micrograms per deciliter of blood, in the 23 states that reported data.

While preliminary June and July data in some states indicates lead testing is picking up, it’s nowhere near as high as it would need to be to catch up on the kids who missed appointments in the spring at the height of lockdown orders, experts say. And that may mean some kids will never be tested.

“What I’m most worried about is that the kids who are not getting tested now are the most vulnerable — those are the kids I’m worried might not have a makeup visit,” said Stephanie Yendell, senior epidemiology supervisor in the health risk intervention unit at the Minnesota Department of Health.

Lifelong Consequences

There’s a critical window for conducting lead poisoning blood tests, timed to when children are crawling or toddling and tend to put their hands on floors, windowsills and door frames and possibly transfer tiny particles of lead-laden dust to their mouths.

Children at this age are more likely to be harmed because their rapidly growing brains and bodies absorb the element more readily. Lead poisoning can’t be reversed; children with lead poisoning are more likely to fall behind in school, end up in jail or suffer lifelong health problems such as kidney and heart disease.

That’s why lead tests are required at ages 1 and 2 for children receiving federal Medicaid benefits, the population most likely to be poisoned because of low-quality housing options. Tests are also recommended for all children living in high-risk ZIP codes with older housing stock and historically high levels of lead exposure.

Testing fell far short of recommendations in many parts of the country even before the pandemic, though, with one recent study estimating that in some states 80% of poisoned children are never identified. And when tests are required, there has been little enforcement of the rule.

Early in the pandemic, officials in New York’s Erie County bumped up the threshold for sending a public health worker into a family’s home to investigate the source of lead exposure from 5 micrograms per deciliter to 45 micrograms per deciliter (a blood lead level that usually requires hospitalization), said Dr. Gale Burstein, that county’s health commissioner. For all other cases during that period, officials inspected only the outside of the child’s home for potential hazards.

About 700 fewer children were tested for lead in Erie County in April than in the same month last year, a drop of about 35%.

Ohio, which has among the highest levels of lead poisoning in the country, recently expanded automatic eligibility for its Early Intervention program to any child with an elevated blood lead test, providing the opportunity for occupational, physical and speech therapy; learning supports for school; and developmental assessments. If kids with lead poisoning don’t get tested, though, they won’t be referred for help.

In early April, there were only three referrals for elevated lead levels in the state, which had been fielding nine times as many on average in the months before the pandemic, said Karen Mintzer, director of Bright Beginnings, which manages them for Ohio’s Department of Developmental Disabilities. “It basically was a complete stop,” she said. Since mid-June, referrals have recovered and are now above pre-pandemic levels.

“We should treat every child with lead poisoning as a medical emergency,” said John Belt, principal investigator for the Ohio Department of Health’s lead poisoning program. “Not identifying them is going to delay the available services, and in some cases lead to a cognitive deficit.”

Pandemic Compounds Worries

One of the big worries about the drop in lead testing is that it’s happening at a time when exposure to lead-laden paint chips, soil and dust in homes may be spiking because of stay-at-home orders during the pandemic.

Exposure to lead dust from deteriorating paint, particularly in high-friction areas such as doors and windows, is the most common cause of lead exposure for children in the U.S.

“I worry about kids in unsafe housing, more so during the pandemic, because they’re stuck there during the quarantine,” said Dr. Aparna Bole, a pediatrician at Cleveland’s University Hospitals Rainbow Babies & Children’s Hospital.

The pandemic may also compound exposure to lead, experts fear, as both landlords and homeowners try to tackle renovation projects without proper safety precautions while everyone is at home. Or the economic fallout of the crisis could mean some people can no longer afford to clean up known lead hazards at all.

“If you’ve lost your job, it’s going to make it difficult to get new windows, or even repaint,” said Yendell.

The CDC says it plans to help state and local health departments track down children who missed lead tests. Minnesota plans to identify pediatric clinics with particularly steep drops in lead testing to figure out why, said Yendell.

But, Yendell said, that will likely have to wait until the pandemic is over: “Right now I’m spending 10-20% of my time on lead, and the rest is COVID.”

The pandemic has stretched already thinly staffed local health departments to the brink, health officials say, and it may take years to know the full impact of the missed testing. For the kids who’ve been poisoned and had no intervention, the effects may not be obvious until they enter school and struggle to keep up.

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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SACRAMENTO — In California, the cradle of renowned tech startups and the Silicon Valley, elementary school students have had to figure out how to work remotely, but lawmakers have not.

Since March, Californians have scrambled to comply with public health orders that required most office and school work to occur at home. But in one of the most iconic office spaces in the state — the Capitol building in Sacramento — most lawmakers and their staffers have gathered in large numbers for months (except when COVID-19 infections forced them to take unplanned recesses).

And as the end-of-session frenzy gripped them in late August, pandemic no-nos spiked: Lawmakers huddled closely, let their masks slip below their noses, smooshed together for photos and shouted “Aye!” and “No!” when voting in the Senate, potentially spraying virus-laden particles at their colleagues.

“It’s terrible role-modeling,” said Dr. Sadiya Khan, assistant professor of cardiology and epidemiology at Northwestern University. “Why do we have to do this if they’re not doing it?”

Legislative leaders are divided on whether remote voting violates the state constitution. Nonetheless, it was authorized — should it be needed — on a limited basis by both chambers in late July.

In the last week of the session, the Democratic leader of the state Senate ordered 10 Republican senators who lunched together to vote via video after one of them, Sen. Brian Jones (R-Santee), announced he had tested positive for the coronavirus. The lone Republican senator who did not dine with them was allowed to vote on the floor.

But the remote-voting option didn’t extend to others such as Assembly member Buffy Wicks (D-Oakland), who brought her newborn onto the floor for a late-night vote on Aug. 31.

.@BuffyWicks should’ve been home with her baby voting by proxy. That she came to #caleg is a testament to her but it didn’t have to be this way. Expecting + new moms can be “in the room where it happens” by being in the zoom where it happens. #WeSaidEnough https://t.co/Bh00nohICv

— Christine Pelosi (@sfpelosi) September 2, 2020

Lawmakers insist the guiding forces behind their decision-making have been “science-based protocols.”

But the science is pretty clear: Stay home, wear a mask that covers your nose and mouth, wash your hands and keep at least 6 feet away from people indoors. Maybe let your pregnant and nursing colleagues work from home.

Here at California Healthline, we let science and data guide our decisions, so we ran some of the legislators’ behavior by epidemiologists and infectious disease experts.

This isn’t (solely) to COVID-shame our elected officials for violating local, state and national recommendations governing how to conduct themselves in a pandemic — while crafting and debating the laws that govern our lives. Instead, we aim to be constructive. The pandemic rages on, and lawmakers may face similar conditions when they return in December to swear in newly elected members, or possibly sooner if Gov. Gavin Newsom calls for a special legislative session this fall.

Should Lawmakers Meet Indoors?

Health officials have pleaded with the public to stay home when possible to minimize the spread of COVID-19. The virus, they say, is extremely contagious, especially indoors.

But elected officials around the country continue to meet in person.

In California’s Capitol, everyone must wear masks, the number of visitors to the Assembly and Senate floors were limited to provide more social-distancing space among members, and plexiglass dividers were installed in both chambers.

“These are absolutely unprecedented times in the California State Senate, and there was no prior experience with live remote voting or participation,” Senate President Pro Tem Toni Atkins said in a statement to California Healthline. “So, we proceeded with a method that maximized participation while respecting public safety and meeting the legislature’s constitutional duties, which, as you know, private businesses do not have to consider in their remote decision making.”

Despite the precautions, congregating indoors is not wise, public health experts say.

“I don’t think it’s a good idea for any large group to have gathered, even if you were all wearing masks in an indoor environment,” Khan said.

“We know that wearing a mask — consistently and correctly — substantially reduces the risk of coronavirus spread but certainly does not eliminate it,” said Dr. Leana Wen, an emergency physician and visiting public health professor at George Washington University. “And in this time of a pandemic, we should all be doing what we can to switch to virtual meetings and gatherings, when possible.”

Broken Social-Distancing Rules

Time after time, California lawmakers flagrantly broke social-distancing rules.

Some didn’t wear masks that properly sealed their faces, or pulled their masks down to sip coffee. Impassioned senators yelled to cast votes, while their colleagues in the Assembly quietly voted at their desks by simply pushing a button. And lawmakers in both chambers huddled closely to confer.

“Physical distance is quite important, actually,” said Dr. George Rutherford, a professor of epidemiology and biostatistics at the University of California-San Francisco. It’s the “second layer” of protection after masks, he said.

“I realize it doesn’t lend itself well to this kind of business, but you have to figure it out,” he said.

Thank you Majority Leader @IanCalderon for your incredible service to our legislature & all Californians! You’ll be dearly missed but you’ve earned some well deserved quality time with your family. I know we’ll see you in service again. Until then, wish you nothing but happiness! pic.twitter.com/phXFcXVPKf

— Ash Kalra 🌱 (@Ash_Kalra) September 2, 2020

Lawmakers, Rutherford noted, are prone to dramatic speeches and like to yell passionately into microphones to make a point, which is not particularly good behavior under COVID.

“I mean, the louder you talk, the greater your exhalational force, the more likely you are to overwhelm the protections of the mask,” he said.

The Cry Heard ’Round the World

A baby’s cry from the Assembly floor triggered national rebuke of California’s legislature. When Wicks came to the floor to vote on a housing bill Aug. 31, her month-old daughter, Elly, wasn’t pleased that her late-night feeding had been interrupted.

And Elly agrees! #CALeg https://t.co/U3E1KIChmA pic.twitter.com/ETodCXCjv3

— M Franco (@rjactivista) September 1, 2020

Wicks had asked Assembly leadership if she could vote by proxy but was told she was not at high risk for COVID-19. Assembly Speaker Anthony Rendon later apologized.

“Inclusivity and electing more women into politics are core elements of our Democratic values,” Rendon said in a statement. “Nevertheless, I failed to make sure our process took into account the unique needs of our Members. The Assembly needs to do better. I commit to doing better.”

The photo of Wicks holding her swaddled baby in her arms went viral — a rallying cry for mothers across the country balancing the demands of work with children at home. Plus, requiring that she appear in person was not only unnecessary, Wen said, but dangerous.

“Newborns are extremely high-risk because they have no immunity, other than the immunity that they obtained from their mother, said Wen, who is the mother of a 5-month-old. “Every employer, every entity needs to do everything they can to be flexible during this time of a pandemic.”

Why Not Legislate Virtually?

Congress continues to gavel into session in person, and many state constitutions require legislatures to meet in person. At least 30 states have allowed remote voting, extended bill deadlines or made other legislative accommodations since the start of the pandemic, according to the National Conference of State Legislatures.

Only Wisconsin and Oregon already had rules in place for remote voting in case of an emergency.

California dabbled with online hearings this spring and summer and witnesses testified remotely. There were the usual trip-ups: mute buttons still engaged, a crackly phone line or a lawmaker caught uttering a bad word.

This moment says everything about 2020. State Sen. @ScottWilkCA, struggling with mute on his Zoom voting in Senate session, looked to have mouthed one of those not-so-nice words in frustration. The chamber laughed and his face was priceless.

Senator, thanks for this moment! pic.twitter.com/2yphFgOp3M

— John Myers (@johnmyers) August 28, 2020

But the technology is available to conduct the people’s business, and public health experts urged lawmakers to consider updating their rules.

“It’s not the same as being in person for sure. It is really hard to accomplish things the same way,” Khan acknowledged. But “in 2020, we’re very blessed with a million different ways to remotely interact for video and audio that should be explored and exhausted before saying that there is no better option.”

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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The headlines from this week will be about how President Donald Trump knew early on how serious the coronavirus pandemic was likely to become but purposely played it down. Potentially more important during the past few weeks, though, are reports of how White House officials have pushed scientists at the federal government’s leading health agencies to put politics above science.

Meanwhile, Republicans appear to have given up on using the Affordable Care Act as an electoral cudgel, judging, at least, from its scarce mention during the GOP convention. Democrats, on the other hand, particularly those running for the U.S. House and Senate, are doubling down on their criticism of Republicans for failing to adequately protect people with preexisting health conditions. That issue was key to the party winning back the House in 2018.

This week’s panelists are Julie Rovner of Kaiser Health News, Joanne Kenen of Politico, Mary Ellen McIntire of CQ Roll Call and Sarah Karlin-Smith of the Pink Sheet.

Among the takeaways from this week’s podcast:

• The Affordable Care Act has become a political vulnerability for Republican officials, who have no interest in reopening the debate on it during this campaign. Trump vowed before his 2016 election to repeal the law immediately after taking office and members of Congress had berated it for years. But they could not gain the political capital to overturn Obamacare.
• Trump’s comments to journalist-author Bob Woodward about holding back information on the risks of the coronavirus pandemic from the public may not have a major effect on the election since so many voters’ minds are already set on their choices. For many, the president’s statements are seen by partisans as identifying what they already believe: for Trump’s supporters, that he is protecting the public; for his critics, that he is a liar.
• The number of COVID-19 cases appears to have hit another plateau, but it’s still twice as high as the count last spring. Officials are waiting to see if end-of-the-summer activities over the Labor Day holiday will create another surge.
• The stalemate on Capitol Hill over coronavirus relief funding shows no sign of easing soon. Republicans in the Senate are resisting Democrats’ insistence on a massive package, but it’s not exactly clear what the GOP can agree on.
• The vaccine being developed by AstraZeneca ran into difficulty this week as experts seek to determine whether a neurological problem that developed in one volunteer was caused by the vaccine. Some public health officials, such as NIH Director Francis Collins, said this helps show that even with the compressed testing timeline, safeguards are working.
• Nonetheless, another vaccine maker, Pfizer, said it might still have its vaccine ready before the election.
• The recent controversy at the FDA over the emergency authorization of plasma to treat COVID patients and the awkward decision at the Centers for Disease Control and Prevention to change guidelines for testing asymptomatic people have created a credibility gap among some Americans and played into concerns that the administration is undercutting science.

Also this week, Rovner interviews KHN’s Elizabeth Lawrence, who reported the August NPR-KHN “Bill of the Month” installment, about an appendectomy gone wrong, and the very big bill that followed. If you have an outrageous medical bill you would like to share with us, you can do that here.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: ProPublica’s “A Doctor Went to His Own Employer for a COVID-19 Antibody Test. It Cost $10,984,” by Marshall Allen

Joanne Kenen: The Atlantic’s “America Is Trapped in a Pandemic Spiral,” by Ed Yong

Sarah Karlin-Smith: Politico’s “Emails Show HHS Official Trying to Muzzle Fauci,” by Sarah Owermohle

Mary Ellen McIntire: The Atlantic’s “What Young, Healthy People Have to Fear From COVID-19,” by Derek Thompson

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunes, Stitcher, Google Play, Spotify, or Pocket Casts.

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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Nurses at Alta Bates Summit Medical Center were on edge as early as March when patients with COVID-19 began to show up in areas of the hospital that were not set aside to care for them.

The Centers for Disease Control and Prevention had advised hospitals to isolate COVID patients to limit staff exposure and help conserve high-level personal protective equipment that’s been in short supply.

Yet COVID patients continued to be scattered through the Oakland hospital, according to complaints to California’s Division of Occupational Safety and Health. The concerns included the sixth-floor medical unit where veteran nurse Janine Paiste-Ponder worked.

COVID patients on that floor were not staying in their rooms, either confused or uninterested in the rules. Staff was not provided highly protective N95 respirators, said Mike Hill, a nurse in the hospital intensive care unit and the hospital’s chief representative for the California Nurses Association, which filed complaints to Cal/OSHA, the state’s workplace safety regulator.

“It was just a matter of time before one of the nurses died on one of these floors,” Hill said.

Two nurses fell ill, including Paiste-Ponder, 59, who died of complications from the virus on July 17.

The concerns raised in Oakland also have swept across the U.S., according to interviews, a review of government workplace safety complaints and health facility inspection reports. A KHN investigation found that dozens of nursing homes and hospitals ignored official guidelines to separate COVID patients from those without the coronavirus, in some places fueling its spread and leaving staff unprepared and infected or, in some cases, dead.

As recently as July, a National Nurses United survey of more than 21,000 nurses found that 32% work in a facility that does not have a dedicated COVID unit. At that time, the coronavirus had reached all but 17 U.S. counties, data collected by Johns Hopkins University shows.

KHN discovered that COVID victims have been commingled with uninfected patients in health care facilities in states including California, Florida, New Jersey, Iowa, Ohio, Maryland and New York.

A COVID-19 outbreak was in full swing at the New Jersey Veterans Home at Paramus in late April when health inspectors observed residents with dementia mingling in a day room — COVID-positive patients as well as others awaiting test results. At the time, the center had already reported COVID infections among 119 residents and 46 virus-related deaths, according to a Medicare inspection report.

The assistant director of nursing at an Iowa nursing home insisted April 28 that they did “not have any COVID in the building” and overrode the orders of a community doctor to isolate several patients with fevers and falling oxygen levels, an inspection report shows.

By mid-May, the facility’s COVID log showed 61 patients with the virus and nine dead.

Federal work-safety officials have closed at least 30 complaints about patient mixing in hospitals nationwide without issuing a citation. They include a claim that a Michigan hospital kept patients who tested negative for the virus in the COVID unit in May. An upstate New York hospital also had COVID patients in the same unit as those with no infection, according to a closed complaint to the federal Occupational Safety and Health Administration.

Federal Health and Human Services officials have called on hospitals to tell them each day if they have a patient who came in without COVID-19 but had an apparent or confirmed case of the coronavirus 14 days later. Hospitals filed 48,000 reports from June 21 through Aug. 28, though the number reflects some double or additional counting of individual patients.

COVID patients have been mixed in with others for a variety of reasons. Some hospitals report having limited tests, so patients carrying the virus are identified only after they had already exposed others. In other cases, they had false-negative test results or their facility was dismissive of federal guidelines, which carry no force of law.

And while federal Medicare officials have inspected nearly every U.S. nursing home in recent months and states have occasionally levied fines and cut off new admissions for isolation lapses, hospitals have seen less scrutiny.

The Scene Inside Sutter

At Alta Bates in Oakland, part of the Sutter Health network, hospital staff made it clear in official complaints to Cal/OSHA that they wanted administrators to follow the state’s unique law on aerosol-transmitted diseases. From the start, some staffers wanted all the state-required protections for a virus that has been increasingly shown to be transmitted by tiny particles that float through the air.

The regulations call for patients with a virus like COVID-19 to be moved to a specialized unit within five hours of identification — or to a specialized facility. The rules say those patients should be in a room with a HEPA filter or with negative air pressure, meaning that air is circulated out a window or exhaust fan instead of drifting into the hallway.

Initially, in March, the hospital outfitted a 40-bed COVID unit, according to Hill. But when a surge of patients failed to materialize, that unit was pared to 12 beds.

Since then, a steady stream of virus patients have been admitted, he said, many testing positive only days after admission — and after they’d been in regular rooms in the facility.

From March 10 through July 30, Hill’s union and others filed eight complaints to Cal/OSHA, including allegations that the hospital failed to follow isolation rules for COVID patients, some on the cancer floor.

So far, regulators have done little. Gov. Gavin Newsom had ordered workplace safety officials to “focus on … supporting compliance” instead of enforcement except on the “most serious violations.”

State officials responded to complaints by reaching out by mail and phone to “ensure the proper virus prevention measures are in place,” according to Frank Polizzi, a spokesperson for Cal/OSHA.

A third investigation related to transport workers not wearing N95 respirators while moving COVID-positive or possible coronavirus patients at a Sutter facility near the hospital resulted in a $6,750 fine, Cal/OSHA records show.

The string of complaints also says the hospital did not give staff the necessary personal protective equipment (PPE) under state law — an N95 respirator or something more protective — for caring for virus patients.

Instead, Hill said, staff on floors with COVID patients were provided lower-quality surgical masks, a concern reflected in complaints filed with Cal/OSHA.

Hill believes that Paiste-Ponder and another nurse on her floor caught the virus from COVID patients who did not remain in their rooms.

“It is sad, because it didn’t really need to happen,” Hill said.

Polizzi said investigations into the July 17 death and another staff hospitalization are ongoing.

A Sutter Health spokesperson said the hospital takes allegations, including Cal/OSHA complaints, seriously and its highest priority is keeping patients and staff safe.

The statement also said “cohorting,” or the practice of grouping virus patients together, is a tool that “must be considered in a greater context, including patient acuity, hospital census and other environmental factors.”

Concerns at Other Hospitals

CDC guidelines are not strict on the topic of keeping COVID patients sectioned off, noting that “facilities could consider designating entire units within the facility, with dedicated [staff],” to care for COVID patients.

That approach succeeded at the University of Nebraska Medical Center in Omaha. A recent study reported “extensive” viral contamination around COVID patients there, but noted that with “standard” infection control techniques in place, staffers who cared for COVID patients did not get the virus.

The hospital set up an isolation unit with air pumped away from the halls, restricted access to the unit and trained staff to use well-developed protocols and N95 respirators — at a minimum. What worked in Nebraska, though, is far from standard elsewhere.

Cynthia Butler, a nurse and National Nurses United member at Fawcett Memorial Hospital in Port Charlotte, on Florida’s west coast, said she actually felt safer working in the COVID unit — where she knew what she was dealing with and had full PPE — than on a general medical floor.

She believes she caught the virus from a patient who had COVID-19 but was housed on a general floor in May. A similar situation occurred in July, when another patient had an unexpected case of COVID — and Butler said she got another positive test herself.

She said both patients did not meet the hospital’s criteria for testing admitted patients, and the lapses leave her on edge, concerns she relayed to an OSHA inspector who reached out to her about a complaint her union filed about the facility.

“Every time I go into work it’s like playing Russian roulette,” Butler said.

A spokesperson for HCA Healthcare, which owns the hospital, said it tests patients coming from long-term care, those going into surgery and those with virus symptoms. She said staffers have access to PPE and practice vigilant sanitation, universal masking and social distancing.

The latter is not an option for Butler, though, who said she cleans, feeds and starts IVs for patients and offers reassurance when they are isolated from family.

“I’m giving them the only comfort or kind word they can get,” said Butler, who has since gone on unpaid leave over safety concerns. “I’m in there doing that and I’m not being protected.”

Given research showing that up to 45% of COVID patients are asymptomatic, UCSF Medical Center is testing everyone who’s admitted, said Dr. Robert Harrison, a University of California-San Francisco School of Medicine professor who consults on occupational health at the hospital.

It’s done for the safety of staff and to reduce spread within the hospital, he said. Those who test positive are separated into a COVID-only unit.

And staff who spent more than 15 minutes within 6 feet of a not-yet-identified COVID patient in a less-protective surgical mask are typically sent home for two weeks, he said.

Outside of academic medicine, though, front-line staff have turned to union leaders to push for such protections.

In Southern California, leaders of the National Union of Healthcare Workers filed an official complaint with state hospital inspectors about the risks posed by intermingled COVID patients at Fountain Valley Regional Hospital in Orange County, part of for-profit Tenet Health. There, the complaint said, patients were not routinely tested for COVID-19 upon admission.

One nursing assistant spent two successive 12-hour shifts caring for a patient on a general medical floor who required monitoring. At the conclusion of the second shift, she was told the patient had just been found to be COVID-positive.

The worker had worn only a surgical mask — not an N95 respirator or any form of eye protection, according to the complaint to the California Department of Public Health. The nursing assistant was not offered a COVID test or quarantined before her next two shifts, the complaint said.

The public health department said it could not comment on a pending inspection.

Barbara Lewis, Southern California hospital division director with the union, said COVID patients were on the same floor as cancer patients and post-surgical patients who were walking the halls to speed their recovery.

She said managers took steps to separate the patients only after the union held a protest, spoke to local media and complained to state health officials.

Hospital spokesperson Jessica Chen said the hospital “quickly implemented” changes directed by state health authorities and does place some COVID patients on the same nursing unit as non-COVID patients during surges. She said they are placed in single rooms with closed doors. COVID tests are given by physician order, she added, and employees can access them at other places in the community.

It’s in contrast, Lewis said, to high-profile examples of the precautions that might be taken.

“Now we’re seeing what’s happening with baseball and basketball — they’re tested every day and treated with a high level of caution,” Lewis said. “Yet we have thousands and thousands of health care workers going to work in a very scary environment.”

Nursing Homes Face Penalties

More than 40% of the people who’ve died of COVID-19 lived in nursing homes or assisted living facilities, researchers have found.

Patient mixing has been a scattered concern at nursing homes, which Medicare officials discovered when they reviewed infection control practices at more than 15,000 facilities.

News reports have highlighted the problem at an Ohio nursing home and at a Maryland home where the state levied a $70,000 fine for failing to keep infected patients away from those who weren’t sick — yet.

Another facing penalties was Fair Havens Center, a Miami Springs, Florida, nursing home where inspectors discovered that 11 roommates of patients who tested positive for COVID-19 were put in rooms with other residents — putting them at heightened risk.

Florida regulators cut off admissions to the home and Medicare authorities levied a $235,000 civil monetary penalty, records show.

The vice president of operations at the facility told inspectors that isolating exposed patients would mean isolating the entire facility: Everyone had been exposed to the 32 staff members who tested positive for the virus, the report says.

Fair Havens Center did not respond to a request for comment.

In Iowa, Medicare officials declared a state of “immediate jeopardy” at Pearl Valley Rehabilitation and Care Center in Muscatine. There, they discovered that staffers were in denial over an outbreak in their midst, with a nursing director overriding a community doctor’s orders to isolate or send residents to the emergency room. Instead, officials found, in late April, the assistant nursing director kept COVID patients in the facility, citing a general order by their medical director to avoid sending patients to the ER “if you can help it.”

Meanwhile, several patients were documented by facility staff to have fevers and falling oxygen levels, the Medicare inspection report shows. Within two weeks, the facility discovered it had an outbreak, with 61 residents infected and nine dead, according to the report.

Medicare officials are investigating Menlo Park Veterans Memorial Home in New Jersey, state Sen. Joseph Vitale said during a recent legislative hearing. Resident council president Glenn Osborne testified during the hearing that the home’s residents were returned to the same shared rooms after hospitalizations.

Osborne, an honorably discharged Marine, said he saw more residents of the home die than fellow service members during his military service. The Menlo Park and Paramus veterans homes — where inspectors saw dementia patients with and without the virus commingling in a day room — both reported more than 180 COVID cases among residents, 90 among staff and at least 60 deaths.

A spokesperson for the homes said he could not comment due to pending litigation.

“These deaths should not have happened,” Osborne said. “Many of these deaths were absolutely avoidable, in my humble opinion.”

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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Florida Gov. Ron DeSantis tried to alleviate fears of flying during the pandemic at an event with airline and rental car executives. “The airplanes have just not been vectors when you see spread of the coronavirus,” DeSantis said during a discussion at Fort Lauderdale-Hollywood International Airport on Aug. 28. “The evidence is the evidence. And I think it’s something that is safe for people to do.”

Is the evidence really so clear?

DeSantis’ claim that airplanes have not been “vectors” for the spread of the coronavirus is untrue, according to experts. A “vector” spreads the virus from location to location, and airplanes have ferried infected passengers across geographies, making COVID-19 outbreaks more difficult to contain. Joseph Allen, an associate professor of exposure assessment science at Harvard University called airplanes “excellent vectors for viral spread” in a press call.

In context, DeSantis seemed to be making a point about the safety of flying on a plane rather than the role airplanes played in spreading the virus from place to place.

When we contacted the governor’s office for evidence to back up DeSantis’ comments, press secretary Cody McCloud didn’t produce any studies or statistics. Instead, he cited the Florida Department of Health’s contact tracing program, writing that it “has not yielded any information that would suggest any patients have been infected while travelling on a commercial aircraft.”

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Florida’s contact tracing program has been mired in controversy over reports that it is understaffed and ineffective. For instance, CNN called 27 Floridians who tested positive for COVID-19 and found that only five had been contacted by health authorities. (The Florida Department of Health did not respond to requests for an interview.)

In the absence of reliable data, we decided to ask the experts about the possibility of contracting the virus while on a flight. On the whole, airplanes on their own provide generally safe environments when it comes to air quality, but experts said the risk for infection depends largely on policies airlines may have in place regarding passenger seating, masking and boarding time.

So How Safe Is Air Travel?

According to experts, the risk of catching the coronavirus on a plane is relatively low if the airline is following the procedures laid out by public health experts: enforcing mask compliance, spacing out available seats and screening for sick passengers.

“If you look at the science across all diseases, you see few outbreaks” on planes, Allen said. “It’s not the hotbed of infectivity that people think it is.”

Airlines frequently note that commercial planes are equipped with HEPA filters, the Centers for Disease Control-recommended air filters used in hospital isolation rooms. HEPA filters capture 99.97% of airborne particles and substantially reduce the risk of viral spread. In addition, the air in plane cabins is completely changed over 10 to 12 times per hour, raising the air quality above that of a normal building.

Because of the high air exchange rate, it’s unlikely you’ll catch the coronavirus from someone several rows away. However, you could still catch the virus from someone close by.

“The greatest risk in flight would be if you happen to draw the short straw and sit next to or in front, behind or across the aisle from an infector,” said Richard Corsi, who studies indoor air pollution and is the dean of engineering at Portland State University.

It’s also important to note that airplanes’ high-powered filtration systems aren’t sufficient on their own to prevent outbreaks. If an airline isn’t keeping middle seats open or vigilantly enforcing mask use, flying can actually be rather dangerous. Currently, the domestic airlines keeping middle seats open include Delta, Hawaiian, Southwest and JetBlue.

The reason for this is that infected people send viral particles into the air at a faster rate than the airplanes flush them out of the cabin. “Whenever you cough, talk or breathe, you’re sending out droplets,” said Qingyan Chen, professor of mechanical engineering at Purdue University. “These droplets are in the cabin all the time.”

This makes additional protective measures such as mask-wearing all the more necessary.

Chen cited two international flights from earlier stages of the pandemic where infection rates varied depending on mask use. On the first flight, no passengers were wearing masks, and a single passenger infected 14 people as the plane traveled from London to Hanoi, Vietnam. On the second flight, from Singapore to Hangzhou in China, all passengers were wearing face masks. Although 15 passengers were Wuhan residents with either suspected or confirmed cases of COVID-19, the only man infected en route had loosened his mask mid-flight and had been sitting close to four Wuhan residents who later tested positive for the virus.

Traveling Is Still a Danger

Even though flying is a relatively low-risk activity, traveling should still be avoided unless absolutely necessary.

“Anything that puts you in contact with more people is going to increase your risk,” said Cindy Prins, a clinical associate professor of epidemiology at the University of Florida College of Public Health and Health Professions. “If you compare it to just staying at home and quick trips to the grocery store, you’d have to put it above” that level of risk.

The real danger of traveling isn’t the flight itself. However, going through security and waiting at the gate for your plane to dock are both likely to put you in close contact with people and increase your chances of contracting the virus. In addition, boarding — when the plane’s ventilation system is not running and people are unable to stay distanced from one another — is one of the riskiest parts of the travel process. “Minimizing this time period is important to reduce exposure,” wrote Corsi. “Get to your seat with your mask on and sit down as quickly as possible.”

Viral Outbreaks Related to Planes

All in all, it’s too early to determine how much person-to-person transmission has occurred on plane flights.

Julian Tang, an honorary associate professor in the Department of Respiratory Sciences at the University of Leicester in England, said he is aware of several clusters of infection related to air travel. However, it is challenging to prove that people have caught the virus on a flight.

“Someone who presents with COVID-19 symptoms several days after arriving at their destination could have been infected at home before arriving at the airport, whilst at the airport or on the flight — or even on arrival at their destination airport — because everyone has a variable incubation period for COVID-19,” Tang said.

Katherine Estep, a spokesperson for Airlines for America, a U.S.-focused industry trade group, said the CDC has not confirmed any cases of transmission onboard a U.S. airline.

The absence of confirmed transmission is not necessarily evidence that fliers are safe. Instead, the lack of data reflects the fact that the U.S. has a higher infection rate relative to other countries, said Chen. Since the U.S. has so many confirmed cases, it’s more difficult to determine exactly where somebody contracted the virus. ​

(KFF)

[partner-box]The public is deeply skeptical about any coronavirus vaccine approved before the November election, and only 42% would be willing to get a vaccine in that scenario, according to a new poll.

The results of the poll by KFF reveal widespread concern that the Trump administration will bring pressure on drug regulators to approve a vaccine before the election without ensuring it is safe and effective. (KHN is an editorially independent program of KFF.)

Six of 10 adults said they were worried the Food and Drug Administration will rush to allow a vaccine because of political pressure. The concern is held by 85% of Democrats, 35% of Republicans and 61% of independent voters.

Resistance to taking the vaccine is strong among respondents of all stripes, with 60% of Republicans saying they would not want to be inoculated if a vaccine were available before the Nov. 3 election. Among Democrats, 46% would decline the vaccine.

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The wariness may reflect the ongoing political jockeying over a vaccine, and it may also be influenced by strains of general anti-vaccine sentiment in the populace. The Trump administration has suggested a vaccine could be ready by November, and the Centers for Disease Control and Prevention has instructed states to be prepared to distribute a vaccine by Nov. 1.

Democrats have raised fears that President Donald Trump is trying to accelerate vaccine approval to boost his reelection chances. Forty-three percent of the public approves of Trump’s handling of the pandemic — an improvement since July, when just a third liked his response.

Partisans are largely united in doubting that a vaccine will be available before the presidential election, with 81% expecting it will take longer. The poll found the public divided on whether the worst of the pandemic is over or still to come, although optimism has increased since July. Nearly 1 in 5 Americans said the virus, which has stricken more than 6 million and killed more than 190,000 people in the U.S., is not a major problem and won’t become one.

(KFF)

Trust in the government’s health experts and institutions has become highly partisan, the poll found. Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, and the CDC have the widest level of trust, with more than two-thirds of Americans believing they are providing reliable information. But the credibility of both has decreased since April.

Only 48% of Republicans trust Fauci, while 70% trust Dr. Deborah Birx, the response coordinator for the White House Coronavirus Task Force, who has remained in Trump’s good graces more than has Fauci. Conversely, 86% of Democrats have confidence in Fauci while only 44% trust Birx.

Democrats still trust the CDC more than Republicans do, but more than half of Democrats say the CDC and the FDA pay too much attention to politics. Overall, only 43% of the public says the two agencies pay the appropriate amount of attention to science.

The poll also found that intense hostility to the Affordable Care Act among Republicans has decreased substantially since the 2018 midterm elections. Only 5% of Republicans in September identified repealing the ACA as the most important health issue influencing their vote, down from 18% in October 2018.

The survey found nearly half of the public holds at least one misconception about coronavirus treatment. Twenty percent said that a face mask is dangerous to wear, and 24% said hydroxychloroquine, a drug touted by Trump but not yet validated by rigorous studies, is an effective treatment for COVID-19. Just more than half of Republicans believe in hydroxychloroquine and a third say face masks are ineffective.

Fourteen percent of Americans believe there is already a cure for the coronavirus.

The telephone poll was conducted Aug. 28-Sept. 3 among a nationally representative random sample of 1,199 adults. The margin of sampling error is plus or minus 3 percentage points.

El gobernador de Florida, Ron DeSantis, trató de aliviar el temor a volar durante la pandemia en un evento con ejecutivos de aerolíneas y compañías de alquiler de autos.

“Los aviones simplemente no han sido vectores cuando se observa la propagación del coronavirus”, dijo DeSantis en el encuentro en el Aeropuerto Internacional Fort Lauderdale-Hollywood el 28 de agosto.  “La evidencia es la evidencia. Y creo que es algo que la gente puede hacer con seguridad “, agregó.

¿La evidencia es realmente tan clara?

La afirmación de DeSantis de que los aviones no han sido “vectores” de la propagación del coronavirus es falsa, según expertos. Un “vector” disemina el virus de un lugar a otro, y los aviones han transportado a pasajeros infectados a través de distintas regiones, lo que hace que los brotes de COVID-19 sean más difíciles de contener.

Joseph Allen, profesor asociado en la Universidad de Harvard y experto en exposiciones a virus, calificó a los aviones como “excelentes vectores para la propagación viral” en una llamada de prensa.

En contexto, DeSantis parecía estar haciendo hincapié en la seguridad de volar en avión en lugar del papel que desempeñaron los aviones en la propagación del virus de un lugar a otro.

Cuando se le consultó a la oficina del gobernador sobre datos que respaldaran los comentarios de DeSantis, el secretario de prensa Cody McCloud no presentó ningún estudio ni estadística. En cambio, citó el programa de rastreo de contactos del Departamento de Salud de Florida y escribió que “no ha proporcionado ninguna información que sugiera que algún paciente se haya infectado mientras viajaba en un vuelo comercial”.

El programa de rastreo de contactos de Florida se ha visto envuelto en una controversia sobre informes que denuncian que no tiene suficiente personal y que es ineficaz. CNN llamó a 27 residentes del estado que dieron positivo para COVID-19 y descubrió que solo cinco habían sido contactados por las autoridades de salud. (El Departamento de Salud de Florida no respondió a las solicitudes de entrevista).

Expertos aseguran que, en general, los aviones brindan ambientes seguros en lo que respecta a la calidad del aire, pero agregaron que el riesgo de infección depende en gran medida de las políticas que las aerolíneas puedan tener sobre los asientos de los pasajeros, el uso de máscaras y el tiempo de embarque.

Según indicaron, el riesgo de contraer el coronavirus en un avión es relativamente bajo si la aerolínea sigue los procedimientos de salud pública: hacer cumplir la regla de usar máscara, espaciar los asientos disponibles y examinar a los pasajeros enfermos.

“Si observas otras enfermedades, ves pocos brotes en aviones”, dijo Allen. “No son los semilleros de infección que la gente cree que son”.

Las aerolíneas señalan con frecuencia que los aviones comerciales están equipados con filtros de aire HEPA, recomendados por los Centros para el Control y Prevención de Enfermedades (CDC), que se utilizan en las salas de aislamiento de los hospitales.

Los filtros HEPA capturan el 99,97% de las partículas en el aire y reducen sustancialmente el riesgo de propagación viral. Además, el aire en las cabinas se renueva por completo entre 10 y 12 veces por hora, elevando la calidad del aire por encima de la de un edificio normal.

Debido a la alta tasa de renovación del aire, es poco probable que se contraiga el coronavirus de alguien sentado a varias filas de distancia. Sin embargo, sí podría ocurrir el contagio de alguien cercano.

“El mayor riesgo durante el vuelo sería si el pasajero se sienta cerca de alguien que pueda infectar”, dijo Richard Corsi, quien estudia la contaminación del aire en interiores y es decano de Ingeniería en Universidad Estatal de Portland.

También es importante señalar que los sistemas de filtración de alta potencia de los aviones no son suficientes por sí solos para prevenir brotes. Si una aerolínea no mantiene libres los asientos del medio ni hace cumplir rigurosamente el uso de máscaras, volar puede ser bastante peligroso. Actualmente, las aerolíneas nacionales que mantienen abiertos los asientos intermedios incluyen Delta, Hawaiian, Southwest y JetBlue.

La razón de esto es que las personas infectadas envían partículas virales al aire a un ritmo más rápido que el que los aviones las expulsan fuera de la cabina. “Siempre que tose, habla o respira, está enviando gotitas”, dijo Qingyan Chen, profesor de ingeniería mecánica en la Universidad Purdue. “Estas gotas están en la cabina todo el tiempo”.

Esto hace que las medidas de protección adicionales, como el uso de máscaras, sean aún más necesarias.

Chen citó dos vuelos internacionales anteriores a la pandemia donde las tasas de infección variaron según el uso de mascarillas. En el primer vuelo, ningún pasajero llevaba máscaras y un solo pasajero infectó a 14 personas mientras el avión viajaba de Londres a Hanoi, Vietnam. En el segundo vuelo, de Singapur a Hangzhou, en China, todos los pasajeros llevaban máscaras faciales.

Aunque 15 pasajeros eran residentes de Wuhan con casos sospechosos o confirmados de COVID-19, el único hombre infectado en el recorrido se había aflojado la máscara en pleno vuelo y había estado sentado cerca de cuatro residentes de Wuhan que luego dieron positivo para el virus.

Pero, aunque volar es una actividad de riesgo relativamente bajo, se debe evitar viajar a menos que sea absolutamente necesario.

“Cualquier cosa que te ponga en contacto con más personas aumentará el riesgo”, dijo Cindy Prins, profesora clínica asociada de Epidemiología en la Escuela de Salud Pública y Profesiones de la Salud de la Universidad de Florida.

El verdadero peligro de viajar no es el vuelo en sí. Sin embargo, pasar por el control de seguridad y esperar en la puerta de embarque es probable que ponga a la persona en contacto cercano con otros y aumente sus posibilidades de contraer el virus.

Además, abordar, cuando el sistema de ventilación del avión no está funcionando y las personas no pueden mantenerse alejadas entre sí, es una de las partes más riesgosas. “Reducir este tiempo es importante para bajar la exposición”, escribió Corsi. “Hay que llegar al asiento con la máscara y sentarse lo más rápido posible”.

Con todo, es demasiado pronto para determinar cuánta transmisión de persona a persona ha ocurrido en vuelos.

Julian Tang, profesor asociado honorario en el Departamento de Ciencias Respiratorias de la Universidad de Leicester, en Inglaterra, dijo que está al tanto de varios grupos de infecciones relacionadas con los viajes aéreos. Sin embargo, es un desafío demostrar que las personas contrajeron el virus en un vuelo.

“Alguien que presenta síntomas de COVID-19 varios días después de llegar a su destino podría haberse infectado en casa antes de llegar al aeropuerto, mientras estaba en el aeropuerto o en el vuelo, o incluso al llegar al aeropuerto de destino, porque todo el mundo tiene un período de incubación variable”, dijo Tang.

Katherine Estep, vocera de Airlines for America, un grupo comercial de la industria centrado en Estados Unidos, dijo que los CDC no han confirmado ningún caso de transmisión a bordo de una aerolínea estadounidense.

La ausencia de transmisión confirmada no es necesariamente una prueba de que los viajeros estén seguros. En cambio, la falta de datos refleja el hecho de que Estados Unidos tiene una tasa de infección más alta en comparación con otros países, dijo Chen. Dado que tiene tantos casos confirmados, es más difícil determinar exactamente dónde alguien contrajo el virus.

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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New Mexico Health Connections’ decision to close at year’s end will leave just three of the 23 nonprofit health insurance co-ops that sprang from the Affordable Care Act.

One co-op serves customers in Maine, another in Wisconsin, and the third operates in Idaho and Montana and will move into Wyoming next year. All made money in 2019 after having survived several rocky years, according to data filed with the National Association of Insurance Commissioners.

They are also all in line to receive tens of millions of dollars from the federal government under an April Supreme Court ruling that said the government inappropriately withheld billions from insurers meant to help cushion losses from 2014 through 2016, the first three years of the ACA marketplaces. While those payments were intended to help any insurers losing money, it was vitally important to the co-ops because they had the least financial backing.

Lauded as a way to boost competition among insurers and hold down prices on the Obamacare exchanges, the co-ops had more than 1 million people enrolled in 26 states at their peak in 2015. Today, they cover about 128,000 people, just 1% of the 11 million Obamacare enrollees who get coverage through the exchanges.

The nonprofit organizations were a last-minute addition to the 2010 health law to satisfy Democratic lawmakers who had failed to secure a public option health plan — one set up and run by the government — on the marketplaces. Congress provided $2 billion in startup loans. But nearly all the co-ops struggled to compete with established carriers, which already had more money and recognized brands.

State insurance officials and health experts are hopeful the last three co-ops will survive.

“These are the three little miracles,” said Sabrina Corlette, a research professor and co-director of the Center on Health Insurance Reforms at Georgetown University, in Washington, D.C.

Maine Aided in Supreme Court Victory

The Maine co-op, Community Health Options, helped bring competition to the state’s market, which has had trouble at times attracting insurance carriers, said Eric Cioppa, who heads the state’s bureau of insurance.

“The plan has added a level of stability and has been a positive for Maine,” he said.

The co-op has about 28,000 members — down from about 75,000 in 2015 — and is building up its financial reserves, Cioppa said. Community Health Options is one of three insurers in the Obamacare marketplace in Maine, the minimum number experts say is needed to ensure vibrant competition.

Kevin Lewis, CEO of the plan, attributed its survival to several factors, including an initial profit in 2014, the year the ACA marketplaces opened, that put the plan on a secure footing before several years of losses. He also credited bringing most functions of the health plan in-house rather than contracting out, diversifying to sell plans to small and large employers, and securing lower rates from two health systems during a couple of difficult years.

Jay Gould, 60, a member who offers the plan to workers at his small grocery in Clinton, has been happy with the plan. “They have great customer service, and it’s good to know when I am talking to someone that they are from Maine,” he said.

Central Aroostook Association, a Presque Isle nonprofit that helps children with intellectual disabilities, switched to the co-op last year to save 20% on its health premiums, said administrator Tammi Easler. Having a Maine insurer means any issues can be dealt with quickly, she said. “They are readily available, and I never have to wait on hold for an hour.”

The co-op, which made a $25 million profit each of the past two years, has proposed dropping its average premiums by about 14% in 2021, Lewis said.

Community Health was one of the lead plaintiffs in the case before the Supreme Court and expects to get $59 million in back payments from the settlement.

The federal decision to suspend those so-called risk corridor payments — designed to help health plans recover some of their losses — was one of the factors that caused many of the co-ops to fail, Corlette said. Republican critics of the ACA, however, blame poor management by the plans and lack of oversight by the Obama administration.

Insurers are in talks with the Trump administration about whether the $13 billion due the carriers must be added to their 2020 balance sheet or could be counted toward operations from prior years. This year, insurers are generally banking large profits since many people have delayed non-urgent care because of the COVID-19 pandemic. Since the ACA limits insurers’ profit margins, adding that federal windfall to this year’s ledger might mean many insurers would have to pay out most of the money to their consumers. If the money is applied to earlier years, the insurers could likely keep more of it to add to their reserves.

Too Much Competition in New Mexico

The Supreme Court ruling came too late for New Mexico Health Connections, which lost nearly $60 million from 2015 to 2017. The co-op would have received $43 million in overdue payments, but, in an effort to raise needed cash, it sold that debt to another insurer in 2017 for a much smaller amount.

Marlene Baca, CEO of the co-op, which made a $439,000 profit in 2019, said its goal of bringing competition into the market was achieved, since five other companies will be enrolling customers this fall for 2021. Yet, that competition eventually led to the plan’s decision to end operations, announced last month.

With only 14,000 members, it made no sense to continue operating due to high fixed administrative costs, she said. Her plan was also hurt by the slumping economy this year, which pushed many state residents out of work and made more than 3,000 members eligible for Medicaid, the state-federal health program for the poor.

“We did our very best,” Baca said, noting that her company is closing with enough money to pay its outstanding health claims. Many other co-ops that shuttered were closed out by their states and unable to meet all their debts to health providers, she said.

Montana’s Co-Op Is Expanding

The Mountain Health Co-Op, with about 32,000 members, has just two competitors in its home state of Montana and four in Idaho.

A big factor behind its survival was that the plan received a $15 million loan in 2016 from St. Luke’s Health System, Idaho’s largest hospital provider, said CEO Richard Miltenberger. Although he wasn’t working for the co-op at that time, Miltenberger said, it is his understanding that the hospital wanted to help maintain competition in that marketplace.

The co-op is expecting $57 million from the Supreme Court victory.

“We are in excellent shape,” Miltenberger said. The plan, which paid back the St. Luke’s loan and made a $15 million profit in 2019, added vision benefits this year and is offering a dental exam benefit for next year. It’s also providing most insulin and medications for asthma and chronic obstructive pulmonary disease to members without any copayment to help ensure compliance.

The insurer is moving into Wyoming for 2021, which will end the Blue Cross plan monopoly in that state’s Obamacare marketplace, he said.

Wisconsin’s Mystery Donor

Wisconsin’s Common Ground Healthcare Cooperative was on the verge of ending operations in 2016 when it received a lifesaving $30 million loan, said CEO Cathy Mahaffey. The insurer has refused to identify the benefactor other than to say it was not a person or company doing business with the plan.

In 2018, Common Ground was the only health plan in seven northeastern Wisconsin counties, she said. Today, the co-op has about 54,000 members and faces competition from two to five carriers in the 20 counties where it operates.

Common Ground, which recorded a $73 million profit last year, expects to receive about $95 million from the Supreme Court case victory.

Wisconsin’s decision not to expand Medicaid under the health law has benefited the co-op because people with incomes from 100% to 138% of the federal poverty level ($12,760 to $17,609 for an individual) are ineligible for Medicaid and must stay with marketplace plans for coverage. In states that expanded Medicaid, everyone with incomes under 138% of the poverty level is eligible.

Another factor was its decision in 2016 to eliminate the broad provider network offering and sell a plan offering only a narrow network of doctors and hospitals, allowing it to benefit from lower rates from its providers, according to Mahaffey.

“We are very strong financially,” she said.

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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If your life these days is anything like mine, a pre-pandemic routine that included regular exercise and disciplined eating has probably given way to sedentary evenings on a big chair, binge-watching reruns of your favorite TV series while guzzling chocolate ice cream or mac ’n’ cheese.

But let’s not beat ourselves up about it. Several doctors I spoke with recently said most of their patients and many of their colleagues are struggling to maintain healthy habits amid the anxiety of the pandemic. “The Quarantine 15” (pounds, that is) is a real phenomenon.

The double challenge of protecting our health, including our immune systems, while battling unhealthy temptations “is a struggle everyone is dealing with,” says Dr. David Kilgore, director of the integrative medicine program at the University of California-Irvine.

Well before COVID-19, more than 40% of U.S. adults were obese, which puts them at risk for COVID-19’s worst outcomes. But even people accustomed to physical fitness and good nutrition are having trouble breaking the bad habits they’ve developed over the past five months.

Karen Clark, a resident of Knoxville, Tennessee, discovered competitive rowing later in life, and her multiple weekly workouts burned off any excess calories she consumed. But the pandemic changed everything: She could no longer meet up with her teammates to row and stopped working out at the YMCA.

Suddenly, she was cooped up at home. And, as for many people, that led to a more sedentary lifestyle, chained to the desk, with no meetings outside the house or walks to lunch with colleagues.

“I reverted to comfort food and comfortable routines and watching an awful lot of Netflix and Amazon Prime, just like everybody else,” Clark says. “When I gained 10 pounds and I was 25, I just cut out the beer and ice cream for a week. When you gain 12 pounds at 62, it’s a long road back.”

She started along that road in July, when she stopped buying chips, ice cream and other treats. And in August, she rediscovered the rowing machine in her basement.

But don’t worry if you lack Clark’s discipline, or a rowing machine. You can still regain some control over your life.

A good way to start is to establish some basic daily routines, since in many cases that’s exactly what the pandemic has taken away, says Dr. W. Scott Butsch, director of obesity medicine at the Cleveland Clinic’s Bariatric and Metabolic Institute. He recommends you “bookend” your day with physical activity, which can be as simple as a short walk in the morning and a longer one after work.

And, especially if you have kids at home who will be studying remotely this fall, prepare your meals at the beginning of the day, or even the beginning of the week, he says.

If you haven’t exercised in a while, “start slow and gradually get yourself up to where you can tolerate an elevated heart rate,” says Dr. Leticia Polanco, a family medicine doctor with the South Bay Primary Medical Group, just south of San Diego. If your gym is closed or you can’t get together with your regular exercise buddies, there are plenty of ways to get your body moving at home and in your neighborhood, she says.

Go for a walk, a run or a bike ride, if one of those activities appeals to you. Though many jurisdictions across the United States require residents to wear masks when out in public, it may not be necessary — and may even be harmful to some people with respiratory conditions — while doing strenuous exercise.

“It’s clearly hard to exercise with a mask on,” says Dr. Yvonne Maldonado, a pediatrician specializing in infectious diseases at Stanford University’s School of Medicine. “We go hiking up in the foothills and we take our masks with us and we don’t wear them unless somebody starts coming the other way. Then we will put the mask on, and then we take it off and we keep going.”

If you prefer to avoid the mask question altogether, think of your house as a cleverly disguised gym. Put on music and dance, or hula-hoop, Polanco suggests. You can also pump iron if you have dumbbells, or find a cable TV station with yoga or other workout programs.

If you search on the internet for “exercise videos,” you will find countless workouts for beginners and experienced fitness buffs alike. Try one of the seven-minute workout apps so popular these days. You can download them from Google Play or the Apple Store.

If you miss the camaraderie of exercising with others, virtual fitness groups might seem like a pale substitute, but they can provide motivation and accountability, as well as livestreamed video workouts with like-minded exercisers. One way to find such groups is to search for “virtual fitness community.”

Many gyms are also offering live digital fitness classes and physical training sessions, often advertised on their websites.

If group sports is your thing, you may or may not have options, depending on where you live.

In Los Angeles, indoor and outdoor group sports in municipal parks are shut down until further notice. The only sports allowed are tennis and golf.

In Montgomery County, Maryland, the Ron Schell Draft League, a softball league for men 50 and older, will resume play early this month after sitting out the spring season due to COVID-19, says Dave Hyder, the league’s commissioner.

But he says it has been difficult to get enough players because of worries about COVID.

“In the senior group, you have quite a lot of people who are in a high-risk category or may have a spouse in a high-risk category, and they don’t want to chance playing,” says Hyder, 67, who does plan to play.

Players will have to stay at least 6 feet apart and wear masks while off the field. On the field, the catcher is the only player required to wear a mask. That’s because masks can steam up glasses or slip, causing impaired vision that could be dangerous to base runners or fielders, Hyder explains.

Whatever form of exercise you choose, remember it won’t keep you healthy unless you also reduce consumption of fatty and sugary foods that can raise your risk of chronic diseases such as obesity, diabetes and hypertension — all COVID-19 risk factors.

Kim Guess, a dietitian at UC-Berkeley, recommends that people lay in a healthy supply of beans and lentils, whole grains, nuts and seeds, as well as frozen vegetables, tofu, tempeh and canned fish, such as tuna and salmon.

“Start with something really simple,” she said. “It could even be a vegetable side dish to go with what they’re used to preparing.”

Whatever first steps you decide to take, now is a good time to start eating better and moving your body more.

Staying healthy is “so important these days, more than at any other time, because we are fighting this virus which doesn’t have a treatment,” says the Cleveland Clinic’s Butsch. “The treatment is our immune system.”

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).