Conflicting COVID Messages Create Cloud Of Confusion Around Public Health And Prevention

Conflicting COVID messages create cloud of confusion around public ...

Source: Kaiser Health News, by Shefali Luthra

Regina Fargis didn’t know what to do.

Fargis runs Summit Hills — a health and retirement community in Spartanburg, South Carolina, that offers skilled nursing, activities and communal meals for its residents, most of whom are over 60, the highest-risk category for coronavirus complications. In South Carolina, more than a hundred new cases were emerging daily. So she took precautions: no visitors, hand sanitizer everywhere and regular reminders for residents about the importance of social distancing.

For a time, it worked. Many similar facilities were hit hard by the virus, but Summit Hills remained COVID-free. Summit Hills’ first cases didn’t emerge until mid-June. Three residents and four employees have now tested positive and are being quarantined. For months, though, Fargis was able to protect her residents.

Still, even under the best circumstances, she couldn’t prevent one thing. By mid-May, two residents had become convinced that the COVID-19 death count — which has surpassed 125,000 people in the U.S. — was a talking point manufactured by Democrats. Some people may be dying, they said, but it wasn’t actually that severe. They didn’t think her precautions were necessary.

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

Since the start of the pandemic, the public has been barraged by conflicting messages in part because the country is dealing with a new and still poorly understood virus and in part because politicians and scientists deliver conflicting advice. But rumors, misinformation and outright falsehoods — some intentionally propagated — have also flourished in that cauldron of confusion.

As the nation reopens for business and retreats from protective stay-at-home orders, those widely circulating lies could prove deadly.

NewsGuard, a startup by two former journalists that vets the internet for misinformation, has identified 217 websites in Europe and the United States that publish “materially false” information about COVID-19. The volume is so great that NewsGuard, which was launched to check political fabrications, has pivoted to full-time COVID-19 fact-checking.

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

Health scares always spawn scurrilous stories. But with COVID-19, “there’s lots of opportunity for misinformation,” said Dhavan Shah, a professor of mass communication at the University of Wisconsin-Madison.

That is particularly true in the United States, where the coronavirus has somehow morphed into a right-versus-left political issue — and Americans increasingly reject information that doesn’t match their leanings.

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

Groups like anti-vaxxers, conspiracy theorists and immigration opponents have also used the virus to push their own misinformation, per a report from Data & Society, a research institute in New York.

“It’s become a political football now,” said Steven Brill, a co-CEO of NewsGuard. “That tends to get the misinformation and disinformation amplified. People on one side or the other tend to want to amplify what endorses or strengthens their position.”

Misinformation Grows In A Vacuum

Federal health officials from agencies such as the CDC and the Food and Drug Administration usually are tasked with providing the public with understandable, scientifically supported guidance. But the advice from experts like Dr. Anthony Fauci, who heads the National Institute of Allergy and Infectious Diseases, has consistently been undermined by Trump, who instead touts unproven treatments and frequently challenges the severity of the virus.

In fact, political figures like Trump have held outsize influence in shaping public understanding. “The news feed abhors a vacuum,” said Jeff Hancock, a professor of communication at Stanford University who has studied the implications of COVID misinformation. “Since the expertise of the CDC and others have been called into question … it exacerbates the problem.”

Experts’ initial confusion about how to respond to a new virus has also allowed for suspicion. When the coronavirus arrived in the United States, the prevailing thought was that asymptomatic patients couldn’t spread it and that people needn’t wear face coverings. Subsequent studies reversed those judgments.

All that helps explain why falsehoods took hold. Researchers from the University of Oxford’s Reuters Institute for the Study of Journalism reviewed 225 pieces of online misinformation about COVID-19. Misinformation spread by political figures and celebrities made up only 20% of the sample but accounted for 69% of engagement.

Independent groups, including NewsGuard and Hancock’s Stanford Social Media Lab, have launched projects meant to combat misinformation — teaching older people through peer-to-peer tutoring to navigate digital content or launching websites that point people toward more credible data and analysis. But these efforts, usually difficult, are almost impossible now in the age of social distancing.

The “volume and velocity” of social media spread means claims spread farther, faster, Shah said.

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

Some cons deliberately target seniors, offering more than misinformation: Bad actors pretended to have access to their victims’ stimulus checks, asking for bank account and Social Security information. Others sell fake protective equipment.

At Hebrew SeniorLife, a hospital and living center in Massachusetts, which operates rehab centers and senior-living facilities around the Boston area, misinformation and online scams — such as fake fundraisers on Facebook for first responders — are serious concerns, said Rachel Lerner, the organization’s general counsel.

Older Americans experience a “perfect storm,” Hancock said. “They’re more susceptible to the virus. They are targets of misinformation and online scams at a much higher rate than regular folks are.”

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

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

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

Newsom Signs California’s $202.1 Billion State Budget

Newsom signs California's $202.1 billion state budget ...

Source: San Francisco Chronicle, by Alexei Koseff

Gov. Gavin Newsom signed a $202.1 billion state budget Monday that largely avoids widespread cuts to public services to close a multibillion-dollar deficit caused by the coronavirus pandemic.

The budget, which takes effect July 1, maintains spending on schools and health and safety net programs by tapping reserve accounts, borrowing from special funds, delaying billions of dollars in payments until future years and temporarily limiting corporate tax credits to raise new revenue.

Some programs are nevertheless hit with steep reductions, including public universities, the court system, affordable-housing grants and state worker compensation. State officials hope to reverse $11 billion of those cuts if California receives a federal bailout by Oct. 15.

“In the face of a global pandemic that has also caused a recession across the world and here in California, our state has passed a budget that is balanced, responsible and protects public safety and health, education, and services to Californians facing the greatest hardships,” Newsom said in a statement.

The budget Newsom signed is about 9% smaller than the spending plan he proposed in January, which would have been a record. As the coronavirus forced Californians into their homes this spring, much of the economy ground to a halt and tax revenue dried up.

Facing a projected $54.3 billion deficit, the governor dropped some of the liberal priorities he wanted to adopt this year, such as an expansion of the state’s health care program for the poor to undocumented immigrant seniors. But in extended negotiations with legislative leaders, he agreed to forgo more extensive cuts he originally proposed to close the budget gap, including the elimination of a program to keep seniors out of nursing homes.

As the economic consequences of the pandemic become clearer, lawmakers will likely amend this budget. That could happen as soon as August, when the Legislature reconvenes after its summer recess with a more accurate sense of how much the state has collected in taxes. The deadline for filing taxes was pushed back by three months, to July 15.

Remdesivir, The First Coronavirus Drug, Gets A Price Tag

Remdesivir, the First Coronavirus Drug, Gets a Price Tag - The New ...

Source: The New York Times, by Gina Kolata

Remdesivir, the first drug shown to be effective against the coronavirus, will be distributed under an unusual agreement with the federal government that establishes nonnegotiable prices and prioritizes American patients, health officials announced on Monday.

The arrangement may serve as a template for distribution of new treatments and vaccines as the pandemic swells, said Ernst Berndt, a retired health economist at the Massachusetts Institute of Technology Sloan School of Management.

Remdesivir will be sold for $520 per vial, or $3,120 per treatment course, to hospitals for treatment of patients with private insurance, according to the Department of Health and Human Services and Gilead Sciences, the drug’s manufacturer.

The price will be set at $390 per vial, or $2,340 per treatment course, for patients on government-sponsored insurance and for those in other countries with national health care systems.

The drug will be sold only in the United States through September, meaning American patients will receive almost the entirety of Gilead’s output, more than 500,000 treatment courses.

H.H.S. and state health departments have been allocating the drug to hospitals nationwide based on need. After September, they will no longer have a role in determining where the drug is sent.

“This is a U.S.-first policy,” said Rena Conti, a health care economist at Boston University. “Access is guaranteed to the U.S., but worldwide demand could potentially outstrip supplies.”

“I am unaware of any other policy except perhaps in bioterrorism drugs where there might be country-specific supplies,” she added.

Remdesivir is so far the only treatment shown to speed recovery time in severely ill coronavirus patients. A large clinical trial, sponsored by the National Institutes of Health, found that the drug modestly shortened recovery time by four days, on average, but did not reduce fatalities.

The drug’s eventual cost has always been uncertain. “There is no playbook for how to price a new medicine in a pandemic,” Daniel O’Day, chief executive of Gilead, said in a statement.

Since the drug’s emergency authorization, Gilead has donated remdesivir to hospitals for treatment of patients with Covid-19, the illness caused by the coronavirus. The last shipments of donated drug were distributed on Monday.

The new pricing is not exorbitant, many experts said. Other promising drugs now in late-stage testing are already on the market for other purposes, Dr. Conti noted, and cost several times more than remdesivir.

The Institute for Clinical and Economic Review, a nonprofit group that calculates fair prices for drugs, estimated that Gilead would need to charge $1,600 per regimen to recoup its costs. But as much as $5,080 per treatment course would be still be a cost-effective price for insurers, given that patients would be able to leave the hospital sooner.

Critics have long accused Gilead of overcharging for groundbreaking drugs, including the first hepatitis C cures and Truvada, a daily pill to prevent H.I.V. infection.

In a statement on Monday, the Institute for Clinical and Economic Review warned, “Gilead has the power to price remdesivir at will in the U.S., and no governmental or private insurer could even entertain the idea of walking away from the negotiating table.”

But since many Wall Street analysts were expecting the drug to cost about $5,000 for a course of treatment, the lower price “can be viewed as a responsible decision from Gilead,” the institute added.

Public Citizen, the consumer advocacy group, described the new price as offensive, noting that remdesivir was developed with more than $70 million in public money.

But Jalpa Doshi, of the University of Pennsylvania, noted that one benefit of remdesivir might be intangible. “This treatment and others as well as vaccines may help reduce fear of the virus, an important factor in accounting for its value,” she said.

Just as unusual as the pricing of remdesivir will be its distribution.

The plan is for Gilead to ship the drug to AmerisourceBergen, one of several drug wholesalers that fulfill orders from individual health care providers like hospitals. Until the end of September, AmerisourceBergen will provide remdesivir to hospitals according to need, as described by state health departments and the Department of Health and Human Services.

After September, “once supplies are less constrained, H.H.S. will no longer manage allocation,” Gilead said. It is not clear how patient need will be factored into distribution decisions at that point.

An earlier effort was a fiasco. After remdesivir received emergency authorization in May, Gilead used AmerisourceBergen to allocate the drug. Needy hospitals received none, while hospitals with few coronavirus patients received supplies unasked. H.H.S. and state health departments stepped in to coordinate distribution instead.

The new plan “lets Gilead off the hook,” Dr. Berndt said. If there is more demand than supply this fall, Gilead will not be blamed for decisions about who gets the drug and who does not.

A Department of Health and Human Services official said on Monday that remdesivir would not be stockpiled for the fall, and Gilead said that there would be an adequate supply for all American patients who need it.

But no one really knows what will happen after September, Dr. Conti said: “We will see how access gets rolled out and assured.”

Trump Administration Asks Supreme Court to Strike Down Affordable Care Act

Trump Administration Asks Supreme Court to Strike Down Affordable ...

Source: The New York Times, by Sheryl Gay Stolberg

The Trump administration asked the Supreme Court late Thursday to overturn the Affordable Care Act — a move that, if successful, would bring a permanent end to the health insurance program popularly known as Obamacare and wipe out coverage for as many as 23 million Americans.

In an 82-page brief submitted an hour before a midnight deadline, the administration joined Republican officials in Texas and 17 other states in arguing that in 2017, Congress, then controlled by Republicans, had rendered the law unconstitutional when it zeroed out the tax penalty for not buying insurance — the so-called individual mandate.

The administration’s argument, coming in the thick of an election season — as well as a pandemic that has devastated the economy and left millions of unemployed Americans without health coverage — is sure to reignite Washington’s bitter political debate over health care.

In his brief, Solicitor General Noel J. Francisco argued that the health law’s two remaining central provisions are now invalid because Congress intended that all three work together.

“Nothing the 2017 Congress did demonstrates it would have intended the rest of the A.C.A. to continue to operate in the absence of these three integral provisions,” the brief said, using the abbreviation for the name of the health care law. “The entire A.C.A. thus must fall with the individual mandate.”

The Texas case is by far the most serious challenge to date for the 10-year-old health care law, President Barack Obama’s signature domestic achievement. The Supreme Court has already ruled on two legal challenges to the act, and both times it has left most of the law in place.

The court has not said when it will hear oral arguments, but they are most likely to take place in the fall, just as Americans are preparing to go to the polls in November.

Republicans have long said their goal is to “repeal and replace” the Affordable Care Act but have yet to agree on an alternative. They are bracing for the possibility that the effort to overturn the health law will cost them. Joel White, a Republican strategist, said in a recent interview that he considered it “pretty dumb to be talking about how we need to repeal Obamacare in the middle of a pandemic.”

Democrats, who view health care a winning issue and who reclaimed the House majority in 2018 on their promise to expand access and bring down costs, are trying to use the Supreme Court case to press their advantage. Speaker Nancy Pelosi has scheduled a vote for Monday on a measure to expand the health care law, in an effort to draw a sharp contrast between Democrats and Republicans.

“President Trump and the Republicans’ campaign to rip away the protections and benefits of the Affordable Care Act in the middle of the coronavirus crisis is an act of unfathomable cruelty,” Ms. Pelosi said in a statement late Thursday night, after the administration’s brief was filed.

“If President Trump gets his way,” she added, “130 million Americans with pre-existing conditions will lose the A.C.A.’s lifesaving protections and 23 million Americans will lose their health coverage entirely.”

The case the court will hear grows out of a lawsuit that Republican officials in 20 states, led by Texas, filed against the Department of Health and Human Services in February 2018, seeking to have the health law struck down. After Democratic victories in the 2018 midterm elections, two states, Wisconsin and Maine, withdrew.

When the case was argued in the trial court, the Trump administration, though a defendant, did not defend the law, siding instead with the plaintiffs. But unlike Texas and the other states, the administration argued at the time that only the law’s protections for people with pre-existing conditions should be struck down, but that the rest of the law, including its expansion of Medicaid, should survive.

Last year, however, the administration expanded its opposition, telling a federal appeals court that the entire law should be invalidated. In the meantime, another 17 states, led by California, intervened to defend the law, as did the House, now controlled by Democrats.

“Now is not the time to rip away our best tool to address very real and very deadly health disparities in our communities,” Attorney General Xavier Becerra of California said in a statement on Thursday, adding: “This fight comes at the most crucial time. The death toll from the coronavirus today is greater than the death toll of the Vietnam War.”

The Supreme Court has agreed to consider three legal questions in the case: whether Texas and two individual plaintiffs who have joined the suit have standing; whether Congress rendered the individual mandate unconstitutional; and, if it did, whether the rest of the law must fall with it.

If the court strikes down only the mandate, not much will change, according to an analysis by the Kaiser Family Foundation, which wrote that the “practical result will be essentially the same as the A.C.A. exists today, without an enforceable mandate.” But if the court decides that all or part of the law must be overturned, it would affect “nearly every American in some way,” the foundation wrote.

The Texas suit has created great uncertainty for the roughly 20 million people covered by the law, as well as for millions of others who have lost their jobs and health coverage during the coronavirus pandemic. A recent analysis by the liberal-leaning Center for American Progress estimated that 23 million people would lose coverage if the Affordable Care Act is abolished — including nearly two million in Texas and more than four million in California.

The lawsuit has also drawn opposition from hospitals and doctors, including the American Medical Association. In a friend of the court brief filed last month, it wrote that striking down the law “at a time when the system is struggling to respond to a pandemic that has infected nearly 1.4 million Americans and killed more than 80,000 at the time of this writing would be a self-inflicted wound that could take decades to heal.”

Grassley to Renew Drug-Pricing Push ‘With or Without Democrats’

Long-Delayed Drug-Price Bill Not Dead Yet, Grassley Says - BloombergSource: Bloomberg Tax, by Alex Ruoff

The chairman of the influential Senate Finance Committee will push for a vote on his drug-pricing measure without the help of critical allies: Senate Democrats.

Chuck Grassley (R-Iowa) will re-introduce a drug pricing package (S. 2543) he assembled with the ranking member of his committee, Ron Wyden (D-Ore.), and soon call on Senate leaders to allow debate on the measure, Grassley spokesman Michael Zona said.

The senator, term-limited as chairman of the Finance panel after this year, wants his measure included in the next coronavirus legislation and plans to move ahead “with or without Democrats,” Zona said.

The Covid-19 pandemic has both heightened the urgency of reining in pharmaceutical costs yet also made it harder for lawmakers to act. Drugmakers say limiting their profits could hamper efforts to create a vaccine against the virus, but medicines to treat it come with significant price tags. Gilead Sciences Inc. set the price for its widely used Remdesivir at $2,340 for a five-day treatment.

Gilead Chooses Middle Ground in Pricing of Its Coronavirus Drug

Both parties, with control of the Senate up for grabs in the November elections, swapped blame for inaction on drug prices.

“Democrats have left the negotiating table” at the urging of party leaders, Grassley said. “I can only assume the Democratic Party would rather use the issue of drug prices as a political hammer in November’s election than work to address it now,” he said in an op-ed in the Wall Street Journal Monday. “Perhaps they hope to pass more left-leaning legislation next year, if they win more power.”

Democrats are “not interested in aiding Republicans as they play political games and pretend to support lowering prescription drug prices,” Wyden said.

“Democrats have not walked away from the table on drug pricing—Republicans never showed up in the first place,” Wyden said in a statement. He said there’s no reason to expect the GOP-led chamber to allow a vote on the Grassley-Wyden bill.

Wyden noted that the House passed a measure to direct the government to demand lower prices from drugmakers last year (H.R. 3). Senate leaders, including Grassley, have said they won’t support that bill.

Uphill Battle

Garnering support for the legislation, which would cap drug costs for Medicare beneficiaries and force drug manufacturers to provide Medicare inflation rebates, has been an uphill battle for Grassley over the past year.

He gradually gained backing from more of his fellow Republicans in the Senate, often persuading them one-by-one to make shows of support since last summer. Democrats in the Senate were essential to getting the legislation even out of the Finance Committee, which approved it with the support of 13 Democrats and six Republicans in July 2019.

Grassley has previously said he needs at least 25 Republican co-sponsors to get his bill to the floor and sees backing from the White House as important in getting more votes. About a dozen Republicans other than Grassley have so far publicly expressed support for the legislation.

Grassley said he asked President Donald Trump earlier this month in a caucus meeting if he would support his legislation. Trump, who has backed the bill, gave an “emphatic yes,” Grassley said.

The Grassley-Wyden package would create a rebate system in Medicare Part B and Part D beginning in 2022 for brand-name drugs and biological products with prices that increase faster than inflation. Conservative groups and some Senate Republicans have opposed the rebate system for Part D, the prescription drug benefit program, but not for Part B, the outpatient services program.

House Passes Tweaks To Shore Up ACA, Lower Premiums

Dem ACA improvement plan hikes subsidies, incentivizes Medicaid ...

Source: Modern Healthcare, by Rachel Cohrs

House Democrats on Monday passed a bill that would bolster the Affordable Care Act by hiking premium subsidies and incentivizing states to expand Medicaid.

The bill passed largely along party lines, and it stands virtually no chance in the GOP-led Senate. Democrats are using the vote as a campaign messaging tool days after the Trump administration reiterated its call for the Supreme Court to strike down the ACA in its entirety.

The Trump administration issued a veto threat on Monday criticizing the bill. White House officials said the bill was spending billions to prop up the ACA and denounced a drug-price negotiation provision designed to bring prices for expensive, single-source drugs closer to prices paid in other countries. Republicans argue the drug-pricing measure will stifle innovation by reducing drugmakers’ research and development budgets during a pandemic.

“H.R. 1425 reads as if the coronavirus never emerged,” the Trump administration wrote.

The Patient Protection and Affordable Care Enhancement Act was slated for passage near the 10th anniversary of the ACA in March, but the deluge of COVID-19 relief legislation delayed the bill.

Rep. Richard Neal (D-Mass.), chair of the Ways & Means Committee, said the bill would reduce the number of uninsured Americans by 4 million.

But Neal’s Republican counterpart, Ways & Means ranking member Kevin Brady (Texas) called for Democrats to end uncertainty caused by the Trump administration’s lawsuit by introducing a bill that severs the individual mandate from the rest of the ACA.

“But House Democrats won’t do that. No. They find the political fearmongering to be too potent an election-year weapon,” Brady said on the House floor.

House Majority Leader Steny Hoyer (D-Md.) criticized Republicans’ lack of a detailed alternative healthcare plan if the ACA is struck down.

Democrats’ proposal would expand premium tax credits beyond individuals making more than 400% of the federal poverty line. Premiums for exchange plans would ultimately be capped at no more than 8.5% of income.

The bill would also direct HHS and state exchanges to establish network adequacy standards for exchange plans. HHS and states would be required to coordinate to protect consumers from rate hikes. The bill would provide $10 billion per year for states to pay reinsurance costs or lower out-of-pocket costs.

House Democrats’ proposal also targets the Trump administration’s healthcare agenda, and would rescind the Trump administration’s rule expanding short-term, limited-duration insurance plans and revoke guidance on 1332 waivers.

The new bill includes several incentives to expand Medicaid, including giving states that haven’t expanded Medicaid yet a renewed 100% in federal funds for the first three years post-expansion and reducing administrative matching funds for non-expansion states. Oklahoma is set to vote on a Medicaid expansion ballot initiative on Tuesday.

States would have to provide 12 months of continuous coverage for Medicaid and Children’s Health Insurance Program beneficiaries, which the Congressional Budget Office estimated would cost $204 billion over 10 years.

Medicaid programs across the country would be required to continue postpartum Medicaid eligibility for a year compared with the current mandate of 60 days.

To offset the bill’s price tag, Democrats attached the drug-price negotiation provision that the Congressional Budget Office estimated would save $582 billion over 10 years. The Trump administration attacked Democrats for leaving out other components of their signature drug-pricing legislation that had garnered more bipartisan support, such as capping outpatient drug costs for seniors.

The first major COVID-19 therapeutic pricing announcement came Monday, as Gilead announced a commercial price of $3,120 per five-day treatment course.

California’s Slide From Coronavirus Success To Danger Zone Began Memorial Day

California coronavirus spread took a turn on Memorial Day - Los ...

Source: Los Angeles Times, by Rong-Gong Lin II, Iris Lee, Sean Greene, Soumya Karlamangla

The seeds of the latest surge in coronavirus cases in California appear to have been planted around Memorial Day.

People had been pent up in their homes; businesses shuttered for months amid the stay-at-home order began to open. And as the reopening accelerated, a lot of people were ready to get out.

The beckon of summer rituals followed — day trips to the beach, Memorial Day barbecues, graduation celebrations, Father’s Day gatherings. Around the same time, historic protests began, triggered by outrage over the death in Minneapolis of George Floyd while in police custody, which sparked unprecedented demonstrations across the nation, including in the streets of California.

It would take a few weeks of incubation. But it’s now clear that Memorial Day was the beginning of California’s turn from coronavirus success story to cautionary tale. A Los Angeles Times analysis has found that new coronavirus hospitalizations in California began accelerating around June 15 at a rate not seen since early April.

Statewide, the daily number of people in hospitals with a confirmed infection of the coronavirus has jumped more than 50% from when it had been stable in mid-April, The Times analysis found. Several counties said hospitals are near capacity — Riverside County reported 99% of its normal supply of beds in intensive care units occupied — while others including Los Angeles County say such conditions may be weeks away.

And officials and experts say the worst is still yet to come. It can take two weeks for the virus to incubate in the body, and an additional week or two after that to result in the hospitalization of severely ill people. That means more people may have gotten exposed to the virus around the week of Memorial Day or shortly thereafter, said Dr. Robert Kim-Farley, a medical epidemiologist and infectious-diseases expert at the UCLA Fielding School of Public Health.

But the behavior that is causing the rapid spread is continuing. Businesses haven’t been adhering to health orders to wear masks in public and stay away from crowded situations. About half of the restaurants and bars visited by Los Angeles County inspectors over the weekend were not complying with the new mask rules, and officials have seen examples of overcrowding in public spaces.

Gov. Gavin Newsom’s move to shut down bars in L.A. County and other hot spots might help, but those establishments represent only a small part of the problem.

“I’ve had an explosion of new outbreaks in workplaces. One that got shut down this past weekend, it had over 115 infections,” said Barbara Ferrer, public health director for Los Angeles County, which surpassed 100,000 cumulative cases and 3,330 total deaths on Monday. “And we’ve had numerous examples of outbreaks happening because families are getting together with extended family members and friends to celebrate weddings, things they had postponed, and again, created higher risk, and there was transmission.”

Officials are looking with increased anxiety to the upcoming Fourth of July weekend, urging residents to only spend time in person with members of their households, avoid crowds and follow social distancing rules, while at the same time bracing for a surge in hospitalizations by people already exposed to the virus.

Los Angeles County announced beaches will close during the holiday weekend in hopes of reducing crowds.

It was clear from the outset that easing stay-at-home orders would result in a higher level of cases — but the rapid spread caught many by surprise.

Continuing to keep society shut down at such an extreme state for too long causes its own ill effects, whether it be more homelessness and deaths due to greater poverty or the effects of denying schoolchildren their in-person education, Kim-Farley said.

“It’s a luxury to shelter in place,” added Dr. Kirsten Bibbins-Domingo, chair of UC San Francisco’s Department of Epidemiology and Biostatistics. “We have to think about how we open and minimize risk. We’re going to be living with this virus for a long time.”

But there is no textbook to figure out how to reopen California safely amid the world’s worst pandemic in a century, faced with a never-before-seen coronavirus.

The only way to figure out how to open is to do it gradually and dial things back if the disease spreads so fast it might overwhelm hospitals later. And that’s what’s happening now, Kim-Farley said.

“Now, we’re recognizing things are going up. So we’re dialing it back down again,” Kim-Farley said.

A Times analysis found that as of Monday, 5.9% of coronavirus test results received over the last week are positive. That’s a significant jump from the figure the previous week, when it was 4.9%. Younger people are making up a greater share of those that are infected, a sign they are beginning to socialize again.

The rate is even worse in Los Angeles County: As of Monday, the seven-day average of coronavirus tests being confirmed as positive was 8.4%. In late May, it was 4.6%.

Closing bars in hard-hit counties marked the state’s biggest step in ramping back reopening plans. But it warns more drastic restrictions could be coming.

“The bottom line is: We’re doing this because we have seen an increase in the spread of this virus,” Newsom said. “We need to take further steps and that’s exactly what we did this weekend.”

State officials say the consumption of alcohol in bars impairs judgment and leads to decreased use of face coverings and failing to keep socially distant from other people. The spaces are also raucous, often requiring people to speak in louder voices, which can lead to the spray of potentially infectious oral droplets while talking.

As of Monday, 14 California counties have seen increases in hospitalizations that have exceeded 10% in the last three days, according to The Times’ California coronavirus tracker. They affect the state’s most populated regions: Southern California, the San Francisco Bay Area, San Diego County and the Central Valley.

Kim-Farley, a former senior health official with L.A. County and the national Centers for Disease Control and Prevention, said there are three protagonists — individuals, businesses and county governments — who each need to do their part to limit the spread of the disease.

Not only do government officials need to analyze data for worrisome trends, but individuals must wear face coverings and stay six feet away from other people, and business owners need to keep their establishments from getting crowded and regularly disinfect high-touch surfaces.

It’s possible too many Californians responded to the reopenings of businesses as a license to resume life as they did before the pandemic arrived, Kim-Farley said. Californians never endured the trauma New Yorkers did of seeing their hospital system get overloaded by COVID-19 patients in the spring.

“It may be that they’re no longer as conscious about masking and physical distancing,” Kim-Farley said.

Another factor is that the political discord in the U.S. and California over the response to the pandemic, such as political fights over using face masks, is hurting our ability to control the epidemic, experts say. Countries that have had a unified public response to broad pandemic control measures, such as New Zealand and Taiwan, have kept the virus from spiraling out of control, experts say.

The pandemic could have triggered the sense of unifying around a common enemy in the U.S.

“Unfortunately, we’ve made it such that it’s become very divisive and become very politicized,” Kim-Farley said.

A Los Angeles taco chain said Sunday it was forced to temporarily close two locations after a mounting onslaught of harassment from customers angered by the business’ “no mask, no service” policy.

Experts say they hope society will learn from the spike.

Dr. Otto Yang, professor of medicine and associate chief of infectious diseases at the David Geffen School of Medicine at UCLA, said he thought L.A. County reopened too quickly.

“For a lot of the things that really work to reduce transmission — like contact tracing and even masks — depend on your starting at a low [disease] control level,” Yang said. “It’s back to the fire analogy: If the fire isn’t down to just smoldering embers, but if there’s still active pockets of fire, then backing off will let stuff flare up very quickly.”

With the benefit of hindsight, it’s now clear that officials should have made more enforcement of social distancing and masking a higher priority. Earlier implementation of a mask-wearing order would’ve helped, too.

At this point, Yang said he doesn’t think the public would tolerate a return to the springtime stay-at-home order. So officials will instead need to focus on more targeted approaches, such as the shutting down of bars and prioritizing the highest-risk activities.

Appeals Court Says Trump Administration Can’t Force Drugmakers to Disclose Prices

Appeals court says Trump administration can't force drugmakers to ...

Source: The Hill, by John Bowden

A federal appeals court ruled against the Trump administration on Wednesday, finding that it does not have the legal authority to mandate that drug manufacturers display the prices of their medicines in television advertisements.

The Associated Press reported that the U.S. Court of Appeals for the District of Columbia Circuit ruled unanimously against the administration, finding that the Department of Health and Human Services’s rule was unlawful in its scope.

The rule, Judge Patricia Millett wrote in her opinion, is “a sweeping disclosure requirement that is largely untethered to the actual administration of the Medicare or Medicaid programs.”

“Because there is no reasoned statutory basis for its far-flung reach and misaligned obligations, the disclosure rule is invalid and is hereby set aside,” she continued.

The court’s ruling is a blow to the White House’s efforts to drive down prescription drug prices, a key issue cited by Americans in an election year. White House spokesman Judd Deere fired back in a statement to the AP, accusing the court of being part of the “D.C. Swamp.”

“It makes absolutely no sense to keep patients in the dark on the true cost of care, and only the ‘D.C. Swamp’ would support such a thing. While big pharma will do everything they can to avoid even a conversation on their astronomical list prices, President Trump remains committed to making pricing information available prior to the delivery of care,” Deere said.

The president previously vowed to sign a bipartisan bill to reduce prescription drug prices during his 2020 State of the Union address.

“I am calling for bipartisan legislation that achieves the goal of dramatically lowering prescription drug prices,” he said in February. “Get a bill to my desk, and I will sign it into law without delay.”

In Big Reversal, Treasury and SBA Agree to Disclose Details About Many Small Business Loan Recipients

SBA, Treasury Department reverse course on loan data after ...Source: The Washington Post, by Aaron Gregg and Jeff Stein

The U.S. Small Business Administration and Treasury Department announced Friday that they would release a data set showing which businesses received many taxpayer-funded Paycheck Protection Program loans, walking back an earlier stance that all of the business names would remain hidden because the Trump administration considered them proprietary.

The disclosures will include the names of recipients who received loans of more than $150,000 and it will also reveal a dollar range for each loan, such as whether it was between $1 million and $2 million. Precise dollar amounts will not be disclosed, the Trump administration said. Borrowers who obtained loans of less than $150,000 will not have their identities disclosed. The administration said nearly 75 percent of all loans were for $150,000 or more, so most borrowers would be revealed.

The announcement came after several weeks of tense negotiations with congressional leadership, in which members of both parties pressed for some form of disclosure. The plan announced Friday amounts to an attempted compromise in which most loan recipients will be made public while specific details would be obscured.

“We are striking the appropriate balance of providing public transparency, while protecting the payroll and personal income information of small businesses, sole proprietors, and independent contractors,” Treasury Secretary Steven Mnuchin said in a statement.

It was the Trump administration’s latest reversal on the matter. The SBA said in response to open records requests throughout April and May that it would release “individual loan data” in accordance with its past practice for subsidized loans. But Mnuchin claimed in a June 11 hearing before the Senate Committee on Small Business and Entrepreneurship that the business names and loan amounts were considered confidential and therefore would not be disclosed.

Several million small businesses have obtained the taxpayer-backed loans since the program was launched in April. The program has extended more than $500 billion in loans. If the borrowers meet certain requirements, such as using the majority of the money to pay workers, the loans will be paid off by the federal government.

Lawmakers have for weeks explored different possibilities for how to increase transparency around the program without forcing small businesses to reveal proprietary information that could compromise their operations. Treasury officials signaled their openness to a compromise measure, although they faced pressure from business groups concerned that revealing recipients’ names would be intrusive and unnecessary. Negotiators discussed measures such as including more data about the kinds of industries and locations that had received information, for instance.

The program was designed to extend loans of up to $10 million to smaller firms, those that have 500 or fewer employees. But it was built in such a way that many larger firms found ways to obtain the loans. President Trump at one point expressed frustration with Mnuchin over some of the large firms that had been revealed to have secured the small businesses funding, putting pressure on Treasury to demand that some money be returned. Later, the administration faced complaints that some firms had decided to forgo the money, as many small businesses faced closure and the national unemployment rate spiked to levels unseen since the Great Depression.
Sen. Marco Rubio (R-Fla.), who played a lead role in designing the program, said he was satisfied with the plan announced Friday.

“The American people deserve to know how effective the PPP was in protecting our nation’s small businesses and the tens of millions of Americans they employ. That is the standard by which we must measure the success of the PPP: how many paychecks were protected,” Rubio said in a statement.

But others said the new announcement came up short.

“This is absolutely not enough,” said Danielle Brian, executive director of the nonprofit Project on Government Oversight. “By grouping the loan amounts [into ranges] we’re still not going to have the kind of information we need to ensure that money is going to the right people . . . those who really need it.”

Senate Democrats took credit for the reversal. “The Treasury Department finally gave in to public pressure from Democrats because their position of hiding which businesses have received PPP loans was untenable,” Senate Minority Leader Charles E. Schumer (D-N.Y.) said in a statement.

The Paycheck Protection Program is a critical component of the Trump administration’s attempt to contain the economic damage caused by the coronavirus. The loans are processed by a network of government-approved banks and financial technology companies and regulated jointly by the Treasury Department and Small Business Administration.

The program launched in early April just one week after the $2 trillion Cares Act economic stimulus bill allocated $349 billion for subsidized small business loans. Its early rollout was frustrated by glitchy web portals and a chaotic, on-the-fly rulemaking process. Some major banks initially refused to participate due to a lack of clarity on the rules, and even later many of them were criticized for creating a two-tiered approval process that favored some lenders over others.

Despite its early issues the program managed to process about 4.5 million loans worth a total of $512 billion, most of it spent in April and May as the economic crisis deepened. It almost certainly contributed to a surprise drop in the national unemployment rate in May.

But concerns remain that the program’s design may have made it vulnerable to excessive, possibly historic levels of fraud and abuse.
In a frenetic bid to quickly pump loan dollars into the economy, the program’s architects did away with many of the usual guardrails designed to prevent banks and the federal government from fraud. Lenders were empowered to take borrowers at their word regarding need and eligibility, requiring very basic checks on the part of regulators.

And there have already been widely reported cases in which large, cash-rich operations managed to get small business loans.
Some national restaurant and hotel chains took advantage of a legal loophole allowing franchisees and other business affiliates to qualify. The Auto Nation car dealership, for example, received nearly $80 million in PPP loans through their nationwide dealership, coordinated by national executives.

Other wealthy organizations receiving the small business loans included Shake Shack, the Ashford Hospitality Trust, the Los Angeles Lakers, an exotic cruise operator, and the Aspen Institute. At least 300 publicly-traded companies received small business loans, prompting the SBA to retroactively change its rules with respect to those organizations. A number of firms returned the funds after it was disclosed that they received the money.

But the vast majority of loan recipients remain secret, making it hard to determine the extent of fraud or whether the program has worked.

The compromise announced Friday would reveal the names of about three-fourths of those receiving PPP loans, according to the Small Business Administration. It would not disclose the dollar amounts of the loans, but it will reveal a dollar range for each loan, saying whether the loans fit into a category of between $150,000 and $350,000; $350,000 to $1 million; $1 million to $2 million; $2 million to $5 million; and $5 million to $10 million. For loans below the $150,000 threshold, business names will be redacted, while Zip code, industry, business type and other demographic categories will be released in some detail, the SBA said.

The SBA has previously said it would release “individual loan data” for PPP recipients in accordance with the information currently on its Freedom of Information Act page, which includes specific loan data for various SBA subsidized loan programs going back to 1991. A lawsuit filed by 11 news organizations, including The Post, seeks business names and loan amounts for all PPP recipients, including those receiving smaller amounts of funding.

With California’s COVID-19 Hospitalizations Rising, Gavin Newsom Says Mask Order Isn’t Optional

Newsom points to rising COVID-19 cases to justify mask order | The ...

Source: The Sacramento Bee, by Andrew Sheeler

California is seeing a growing number of COVID-19-related hospitalizations and intensive care unit cases, Gov. Gavin Newsom said Monday, making it all the more necessary that people follow his mandatory mask order in public.

“The reason we’re doing this is simple. Wearing face coverings saves lives and mitigates spread,” Newsom said during his Monday press conference. “As we reopen, all I ask is that we are more vigilant than we have been.”

The Democratic governor said that while his administration is looking to local governments to enforce the mask order, he has the power to go after those who are “thumbing their nose” at the requirement. He said that while masks previously were recommended, they are now mandatory in situations in which people cannot be socially distant.

“There’s no ambiguity there,” he said.

Some local officials have questioned his move, saying no law allows them to cite individual offenders. In Sacramento over the weekend, people congregated at some bars with few face masks in sight.

But Newsom said the state if necessary has enforcement power through the state Department of Alcoholic Beverage Control, which issues and regulates liquor licenses, and Cal-OSHA, the Division of Occupational Safety and Health, which protects workers from safety hazards.

Newsom also called on the public to help with enforcement, such as by reporting restaurants that aren’t following state reopening guidelines.

In the last 14 days, the number of COVID-19-related hospitalizations has increased 16 percent, Newsom said, while the number of ICU cases is up 11 percent.

In addition, the positivity rate — how many people test positive for COVID-19 out of the total number tested — ticked up to 4.8 percent Sunday, Newsom said. It was 4.5 percent on June 14.

“Bottom line is, as we move forward, to be sober about the reality that again we are still in the first wave of this pandemic,” Newsom said.

California’s hospitals are currently at about 7 percent of capacity for COVID-19 hospitalizations, Newsom said.

The state has more than 73,000 hospital beds, Newsom said, with a surge capacity of more than 52,000 beds. In addition, the state has an ICU capacity of more than 4,100 ICU beds, with more than 11,600 ventilators.

“Despite an increase in hospitalizations, despite an increase in the total number of ICU patients, our capacity remains fairly stable compared to where it was a week ago, and certainly is in a much better position than we were a number of months ago,” Newsom said.

There have been 173,824 cases of COVID-19 in the state, with 5,495 fatalities, according to the most recent California Department of Public Health data. There have been more than 3,600 hospitalizations for COVID-19 or suspected COVID-19, including more than 1,300 ICU visits.

In addition, the state is continuing to provide technical support to 11 counties, down from 13 last week, in dealing with the spread of coronavirus, Newsom said.

Among the counties recently added to that list were Stanislaus, Riverside and San Bernardino counties.

Dr. Mark Ghaly, California Secretary of Health and Human Services, said those counties are starting to see additional spread in community settings.

Ghaly, reinforcing Newsom’s mask message, warned that a single infected person, unmasked, can spread COVID-19 to more than 400 people in a 30-day period. If the same person wears a mask, stays home as much as possible and socially distances, he said, that number drops to 2.5.

“And that is exactly how we control the spread in California,” Ghaly said.

Last Updated 07/01/2020

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