Lobbying Battle Brewing Over Access To COVID-19 Vaccine

Lobbying battle brewing over access to COVID-19 vaccine | TheHill

Source: The Hill, by Alex Gangitano

The race for a COVID-19 vaccine is setting off a different kind of competition in Washington: Who will get it first?

Food suppliers argue their workers should be near the front of the line. Fifteen trade groups recently made their pitch to President Trump, citing his declaration that the food and agriculture sector is a critical component of the nation’s infrastructure.

Trump administration officials have signaled they will take a “tiered approach” to giving out the vaccine when it is ready and said that, depending on the results of clinical trials, high-risk individuals, people with pre-existing health conditions, and front-line health care workers will be prioritized.

After those groups, it’s anyone’s guess.

“Will it be people at highest risk? Will it be people who are key to spreading and transmission? Will it be politically effective lobby groups? Will it be people who can pay the most for it?” said Barry Bloom, a research professor at the Harvard T.H. Chan School of Public Health.

The nation’s food industry thinks it has a strong case to make.

Meat processing plants quickly became hotspots for the coronavirus, prompting several to temporarily close during the pandemic.

Trump later signed an executive order to compel meatpacking plants to stay open.

As of Thursday, nearly 31,000 meatpacking workers tested positive for coronavirus and over 3,300 food processing workers and 3,600 farmworkers, according to data from the Food & Environment Reporting Network.

The North American Meat Institute, which represents meat processing companies, was among the 15 groups that sent a letter to Trump requesting priority access to a vaccine.

Other groups on the letter included the American Frozen Food institute, the National Milk Producers Federation and the United Fresh Produce Association.

Anthony Fauci, the nation’s top infectious disease expert, said he is optimistic a coronavirus vaccine will be available by the beginning of next year. That leaves about six months for the federal government to determine its distribution plan.

Sen. Patty Murray (Wash.), the top Democrat on the Senate Health, Education, Labor, and Pensions Committee, said Trump needs to make that plan public now.

“The Trump Administration needs to follow the science and address how to prioritize distribution now as part of a larger comprehensive, national vaccine plan—and the cornerstone of that plan has to be public health and protecting vulnerable communities. We need to listen to the public health experts here, not the politicians, big corporations, or their lobbyists,” she told The Hill in a statement.

Bruce Gellin, former director of the National Vaccine Program, an office in the Department of Health and Human Services (HHS), said it’s not too early to start discussing distribution plans.

“It’s too hard to predict when a vaccine will be available but it’s not too early to start talking about the vaccination program because you don’t want to have the vaccination ready and then announce a plan that nobody has seen,” said Gellin, who is now president of global immunization at the Sabin Vaccine Institute.

Some trade groups say now is not the time to jockey for position.

“Our shared goal is to assure vaccination availability for every American and it would be premature to comment on specific distribution prioritization at this stage,” said Robyn Boerstling, vice president of infrastructure, innovation and human resources policy at the National Association of Manufacturers, an industry that has had essential employees working during the coronavirus shutdowns.

The National Restaurant Association, another group that signed onto the letter to Trump, argues that their workers should be considered just as vital as agriculture workers and others in the supply chain because the sector is interconnected.

“We need to take every step to ensure that restaurants remain a stable part of the food supply chain for America,” Sean Kennedy, executive vice president of public affairs, told The Hill. “We need to ensure that we have full safety from the farmer in the field to the server in the restaurant.”

The groups in the letter also pushed for the federal government, and not states, to coordinate vaccine distribution.

“Leaving vaccine distribution to the states will result in an inconsistent, inefficient process,” they wrote.

A senior administration official told The Hill that HHS is working on responding to the many letters it receives on this issue.

“It is our solemn obligation at HHS to provide a safe, effective and affordable vaccine to every American, including those on the front lines, as fast as possible,” the official said. “Any vulnerable American who needs the vaccine will receive the vaccine regardless of their ability to afford it. We have received letters from a number of groups during this pandemic, and the Department is working to respond.”

Gellin agreed that the guidance has to come from the federal level for distribution.

“I think the fairest approach would be to distribute a vaccine on a population basis to states and…states follow the federal guidance. Of course not all states are the same and they will likely make some adjustments to the federal guidance. What doesn’t make sense is for each state to figure out their own priority scheme,” Gellin told The Hill.

As more vaccine candidates move ahead with trials, there’s more pressure on the government to offer guidance on how things will look a few months from now.

Bloom stressed that decisions about allocating a vaccine must be transparent.

“Since the vaccine will not be ready instantaneously to 342 million Americans, we need to have a public discussion of the policy for its distribution, who should make the policy, and given the inevitable opposition of anti-vaccine activists, how do we assure a public consensus that it will be available in a fair and transparent way,” he said.

Trump Extends Paycheck Protection Program; What Owners Need To Know

Trump extends Paycheck Protection Program; what owners need to ...Source: Business Insider, by Thomas Pallini

President Donald Trump on Saturday signed into law an amendment to the Paycheck Protection Program that gives businesses affected by the coronavirus pandemic more time to apply for federal funds.

The law extends the deadline to apply for the federal government’s loan-based relief program to August 8. The original deadline to apply for the loans was June 30, but Congress moved quickly to extend the deadline after around $130 billion was left over from the initial $660 billion pot, NPR reported.

The Senate initially approved the extension on Tuesday with unanimous consent, and the House of Representatives followed suit the next day. Trump signed the bill on July 4, giving potential recipients just over a month to apply for the remaining funds.

As of June 30, more than 4.8 million loans have been approved totaling $520 billion, with the average loan amount around $107,000, according to the Small Business Administration.

Here’s what potential applicants should know before applying.

What are Paycheck Protection Program funds

Paycheck Program Funds are federally backed loans that businesses can apply for to help cover expenses and maintain worker levels. Though they start as loans, businesses that meet specific criteria from the SBA can apply to have their loans forgiven so that they don’t need to be paid back.

Part of the program is that no fees will be attached to the loans for small businesses, no collateral is required, and repayment starts after six months. Interest rates are also set at 1%, according to the SBA.

Who can apply for Paycheck Protection Program Funds

While the program is intended for small businesses, that title covers more than just family-owned hardware stores and ice cream shops. As Business Insider’s Dominick Reuter reported, freelancers and self-employed workers including gig-workers can also apply for funds.

Businesses with more than 500 employees can also access funds if they meet the SBA’s size standards. Business owners who are unsure of whether their enterprise counts as a small business can use the SBA’s size standards tool, located on its website.

What July and August applicants need to know

Loan applicants completing the process after June 5 are subject to new loan maturity guidelines. The SBA said recipients who applied before June 5 will be subject to a two-year maturity timeline while those applying after June 5 will have a five-year maturity timeline.

Loans are also processed through local banks and lenders to streamline the process as opposed to having the federal government do it. The SBA provides a list of which lenders can process applications for and issue PPP loans on its website.

How to get loans forgiven by the federal government

The SBA’s website says loan forgiveness will be based on “employee retention criteria” and only be given if the funds are spent on “eligible expenses.” The Payroll Protection Flexibility Act recently amended the program’s rules so that only 60% of funds received have to go to payroll expenses in order for loans to be forgiven, as Business Insider’s Joseph Zeballos-Roig reported.

Even if borrowers don’t use 60% on payroll, they can still apply for partial forgiveness. Businesses seeking this option need to fill out a five-page form that can be found on the SBA’s website to apply for forgiveness after reviewing the rules for forgiveness.

California Braces For A Spike In Coronavirus Deaths As Infections Soar. But How Bad Will It Be?

California coronavirus cases and hospitalizations surge - Los ...Source: Los Angeles Times, by Alex Wigglesworth, Anita Chabria, Emily Baumgaertner, Rong-Gong Lin II

New coronavirus cases roughly doubled in California over the last month. Hospitalizations have soared 88%, filling some medical centers close to capacity.

Now, public health officials are bracing for the grimmest phase of the cycle: a spike in COVID-19 fatalities.

So far, new deaths have remained relatively flat in California even as cases have surged. In the last six weeks, the state has recorded an average of 436 weekly coronavirus deaths, down from the previous six-week average of 510 weekly deaths, according to a Los Angeles Times data analysis. But deaths are a lagging indicator, and many experts predict an increase in the coming weeks.

California has seen far fewer coronavirus fatalities than some hot spots across the country, recording more than 6,400 deaths, compared with more than 32,000 in New York and 15,000 in New Jersey.

How much the death toll in California will rise is the subject of some debate. This new wave of infections is increasingly being driven by younger people, while outbreaks in skilled nursing facilities have slowed. For that reason, it’s possible that fewer of the recent cases will result in deaths.

“It’s hard to say because right now, it’s this cloud of information that needs to sort itself out,” said Dr. Neha Nanda, healthcare epidemiologist and medical director of infection prevention at Keck Medicine of USC.

But others on the front lines say the younger COVID-19 demographics won’t necessarily result in a decreased death toll. Adrienne Green, chief medical officer for UC San Francisco Medical Center, said she is worried about the current wave of infections among younger people leading to a subsequent wave for older people who have interacted with them.

“Perhaps there might be a lull in the death rates and then [they] catch up,” Green said. “I think it’s going to be a wave up and down.”

Answers should come soon. Experts say it can take three to four weeks after exposure to the virus for infected people to become sick enough to be hospitalized, and four to five weeks after exposure for some of the most vulnerable patients to die from the disease.

California recorded nearly twice the number of coronavirus cases in June as it did in May — 119,938 versus 61,694, according to a Times data analysis. Yet the number of deaths declined, with 2,128 people dying in May and 1,915 in June.

More younger people are also testing positive for the virus, a trend that has become apparent as the economy has reopened and working-age adults returned to jobs and resumed social gatherings.

Early in the pandemic, in March, about half of California’s new infections were identified among people ages 18 to 49, a Times data analysis found. In June, as the number of new cases began to climb sharply, that share increased to nearly 62%. So far in July, roughly 65% of new infections have been diagnosed among those 18 to 49. That’s despite the fact that just 45% of Californians fall into that age range.

“These are individuals who tend not to be as likely to get serious disease or require either hospitalization or to die from COVID-19,” said Timothy Brewer, professor of medicine and epidemiology at UCLA. “So particularly the 18- to 50-year-old age group is a group that has relatively low mortality rates, but there has been a big surge in infections.”

Meanwhile, outbreaks in skilled nursing and other long-term care facilities have slowed. That appears to be particularly true in Los Angeles County, which is home to nearly half the state’s cases and more than half the deaths.

In early May, L.A. County was reporting an average of 25 daily coronavirus deaths out of nursing home residents. By late June, the average daily death toll from nursing homes was around 10, Barbara Ferrer, the county health director, said last week.

Officials have said better use of personal protective equipment, such as masks, gowns and gloves, and increased testing, has helped reduce the impact of the pandemic on skilled nursing facilities.

Brewer said he suspects the decline in care facility outbreaks is having a beneficial effect on overall mortality rates, as residents of skilled nursing and assisted living facilities account for 49% of the state’s total COVID-19 deaths.

Nick Jewell, a UC Berkeley biostatistics expert who has tracked the pandemic, said the steady mortality rate may also reflect that those who were most susceptible to the virus — the elderly and the infirm — have already succumbed to it.

“To be crude, you wouldn’t expect as many nursing home deaths today as you would two or three months ago because the susceptibles in the nursing homes have been picked off,” said Jewell.

Improvements in the treatment and care of COVID-19 patients also may have made a difference, as doctors have learned more about how to treat the virus.

Medical staff have gotten better at managing the ventilation and oxygenation of critically ill patients, learning to do things such as positioning them on their bellies instead of on their backs, Brewer said.

Physicians also say they are generally intubating less frequently. Intubation — inserting a breathing tube down a person’s throat — can cause an array of complications, but doctors have been able to choose other options first, instead of quickly intubating a person who is struggling to breathe.

Dexamethasone, a corticosteroid that has been shown to improve survival in patients who require oxygen or mechanical ventilation, is now in standard use in hospitals across California, Brewer said. Remdesivir, an antiviral that has been linked to improved outcomes, is also being widely used, he said.

UCSF’s Green attributes better fatality rates to medications including Remdesivir but said the drug may soon be harder to come by.

Some point out that the declining numbers do not take into account the well-documented racial disparities seen in both infections and outcomes of COVID-19 cases. Across the country, researchers are finding that Black and Latino people are hit harder, and have worse survival rates than white counterparts.

In California as of Sunday, Latino people accounted for 55% of coronavirus cases and 42% of deaths, while making up about 39% of the state’s population, according to data from the California Department of Public Health. Black Californians account for 9% of the state’s deaths, while making up about 6% of the overall population. But even those figures may be low — 35% of cases are missing race and ethnicity data.

Stephen Lockhart, chief medical officer of Sutter Health, said it is too soon to know if reopening has made those disparities worse. Many of those who have worked through the pandemic or returned to work in recent weeks at jobs including retail, restaurants, agriculture and service sectors are people of color, he and other experts pointed out. Lockhart said that although the data are not yet available on how they are faring, he would “be surprised if that were not the case” that those workers of color will be hard hit in coming weeks.

“That is just my conjecture as a Black man seeing what I am seeing and my overall intuition,” Lockhart said. “I am imagining that the gap has widened.”

Dr. Yvonne Maldonado, a pediatric infectious disease specialist at Stanford, said the demographics of the epidemic have “really changed” in recent months.

“Now it has become much more in minority communities, much more blue-collar workers,” Maldonado said.

On Saturday, Maldonado did free testing in a low-income Silicon Valley neighborhood that is predominantly Asian and Latino. After testing about 300 people, she found about 3% were positive — what she considers a difficult rate to contain, despite higher rates in other parts of the state and country, and one coupled with health and wealth disparities that can increase the severity of the virus..

“We know that these are populations that have real health equity and access problems,” Maldonado said, pointing to more risk factors such as diabetes, more crowded living spaces and less financial ability to take time off work.

Some also fear that it’s only a matter of time before California sees a surge in COVID-19 deaths to match the increase in cases and hospitalizations. Many experts believe the increasing infections began around Memorial Day, meaning a corresponding increase in deaths may begin soon. They also point out that recent Independence Day celebrations could bring another bounce in coming months.

On Sunday, there were 5,790 people hospitalized in California with confirmed coronavirus infections. That’s an 88% increase from that number on June 5, when there were 3,072 hospitalized.

L.A. County on Sunday broke a record for the largest number of hospitalized patients with confirmed coronavirus infections. There were 1,969 such patients in hospitals in the county on Sunday; the previous record was on April 28, when 1,962 were in the hospital.

Jewell cautioned that “things are changing rapidly in the state.” He said that California, though not as bad as states such as Texas — where hospitals are already facing capacity issues — remains in “dangerous waters,” and he expects July to be a “real gut check.”

There are also concerns that the younger people who are currently testing positive at a higher rate and also tend to have a higher level of mobility will eventually transmit the virus to more people, including those who are more vulnerable, driving deaths even higher.

“It’s not until the first group [of infected individuals] goes out and infects the next larger group and gets a bit exponential” that we see those deaths, said a nurse who works in an intensive care unit in L.A.

“It’s the calm before the storm — I have no doubt,” she added.

Telehealth Can Be Life-Saving Amid COVID-19, Yet As Virus Rages, Insurance Companies Look To Scale Back

Despite COVID-19 increase, insurance companies to pull back telehealthSource: USA Today, Jayne O’Donnell and Ken Alltucker

Cynthia Peeters’ stomach started hurting in mid-February as COVID-19 began dominating the news.

By April, the pain was overwhelming, but she was too anxious about the virus to go to the doctor. Her gastroenterologist did a cellphone video visit with her and suggested a diet change. When it got worse last month, Dr. Christopher Ramos did another video call and told Peeters to come in for a colonoscopy.

The diagnosis: Colon cancer, caught just in time.

“If telehealth was not available, I fear that we would have gotten to her diagnosis too late, and the cancer would have spread,” said Dr. James Weber, CEO of Texas Digestive Disease Consultants, where Ramos works. “Telehealth access most certainly allowed us to take care of this patient and likely save her life.”

After federal regulators said Medicare would cover such phone and video telehealth visits starting March 1, major insurers followed as COVID-19 started to shut down much of the U.S.

Weber was happy to be reimbursed as the chain was losing money because patients were too scared to show up for screenings — and that was when his state was still spared from most of the virus’ wrath.

Now, as Texas shuts back down amid soaring COVID-19 cases, Weber and doctors across the now-hardest-hit states face insurers that are starting to back away from the widely embraced approach to doctor appointments. They are scaling back telehealth to pre-COVID levels, which were limited, resuming out-of-pocket payments and using time consuming prior authorizations which can deter doctors.

In early May, Blue Cross Blue Shield of Texas set the expiration date for telehealth expansion at May 31. It has moved the date three times since then, including twice in the last two weeks to an August 31 expiration date.

Most other insurers plan to reduce coverage of the visits in September even though Medicare and Medicaid is expected to cover them far more generously through the end of the year. Some of the expanded telehealth coverage was planned until the end of the “public health emergency,” which is ill defined with no end in sight, said Weber.

He seldom used telehealth before COVID-19 because of all the restrictions.

Other insurers have also set and moved deadlines for when they will stop covering these remote visits and started charging co-payments and cost sharing again for many, Nearly all say they are continually reevaluating their coverage. Further complicating matters for doctors and patients are employer health plans that are exempt from the telehealth coverage expansion.

In Arizona, COVID-19 is now surging and hospital ICU units are nearly full, both with patients who need life-sustaining breathing treatment and non-COVID cases. Until some recent last-minute changes, insurers there were starting to drop telehealth coverage.

Dr. Paul Berggreen, a gastroenterologist who is president of Arizona Digestive Health, said his office staff must constantly check insurers’ websites to see current policies. He said policies on payment rates and co-payment waivers for telehealth seem to change week to week.

The information is vital because patients might refuse telehealth and instead request an office visit if they are not covered at comparable levels.

A 2017 study found the average cost of a telemedicine visit was $79, far less than $146 for a doctor’s office visit. However, the study may not reflect existing charges with doctors often billing the same rates for virtual and in-office visits. The amount a consumer pays out of pocket varies based on plan details such as co-pays, deductibles and cost-sharing requirements.

Most Furloughed Workers Still Covered by Employer-Sponsored Plan

Most Furloughed Workers Still Covered by Employer-Sponsored Plan

Source: Health Payer Intelligence, by Kelsey Waddill

Overall, nationwide healthcare coverage levels have remained steady because many furloughed workers are still receiving healthcare coverage through an employer-sponsored plan, Commonwealth Fund researchers found.

The Commonwealth Fund researchers conducted a survey on employment and healthcare coverage from May to June 2020. The survey encompassed in 2,271 phone interviews.

“The large share of respondents who said they or a spouse or partner were still getting coverage through a furloughed job accounted for the relative stability of insurance coverage in the findings,” the researchers explained. “Whether those on furlough regain their jobs, or lose them permanently, will determine the longer-term effect of the pandemic on employer-based coverage.”

About one in five of the adults who participated in the survey responded that either they or a spouse or partner had been furloughed or lost their position due to coronavirus.

More than half of those who experienced job disruption due to coronavirus had been furloughed.

Over half of those who were furloughed (53 percent) retained their employer-sponsored health plan coverage.

Two in five adults had received healthcare coverage from their or their partner’s lost job. Some furloughed and laid off employees still have access to a different employer-sponsored health plan through a spouse or partner.

About three in ten respondents who did not have insurance through the affected job were uninsured. The data also indicated that most of these respondents were already uninsured before the coronavirus outbreak. Four factors influenced this:

  • * Eligibility based on immigration status
  • * Gaps in the nation’s healthcare coverage due to lack of Medicaid expansion
  • * High prices on the Affordable Care Act market
  • * Low consumer education on healthcare coverage options

Others whose job loss did not affect their health insurance were largely enrolled in Medicaid, Medicare, or the individual health insurance market (36 percent).

These findings corroborate Urban Institute research published in late April 2020 which found that income, immigration, and uninsurance prior to the pandemic all played a role in preventing the currently uninsured from obtaining coverage.

According to the Commonwealth Fund researchers, for many adults (59 percent), job loss or a furlough made no impact on their healthcare coverage because the job was not their source of healthcare coverage.

The current job and healthcare climate emphasized the potential turbulence that can result from having healthcare tied to employment, the researchers found.

“When health coverage is not connected to a job, coverage, and access to care can be more stable over time,” they argued. “And given the impact of rising employer plan premiums on many with low and moderate incomes, the availability of federal subsidies through marketplace plans may make such plans a more affordable option for many.”

The researchers offered both short-term and long-term solutions to insurance gaps. In the short-term, they suggested:

  • * Improving marketing around subsidized Affordable Care Act market plans or Medicaid eligibility
  • * Streamlining enrollment requirements

For more long-term solutions, the researchers urged the federal government to:

  • * Design a subsidized insurance option that would be available to the low-income uninsured populations in states that have not engaged in Medicaid expansion
  • * Improve affordability of subsidized options for higher-income enrollees on the Affordable Care Act market

For those who become unemployed, unemployment compensation can become a barrier to Medicaid eligibility in Medicaid expansion states, Kaiser Family Foundation research recently illuminated.

While Medicaid coverage is still higher in these states, workers who receive unemployment compensation and stimulus money can find themselves ineligible for healthcare coverage assistance because both are counted as income.

“Marketplace subsidies fill in a portion of the gap created by those 15 states’ refusal to expand their Medicaid programs, but until financial assistance is extended to those with lower incomes in those states, many of their residents will be left in highly vulnerable situations when medical needs arise,” the Kaiser Family Foundation researchers emphasized.

California May Expand Unpaid Family Leave Requirements for Small Business

California lawmakers move to expand paid family leave - Los ...Source: Manatt

Last week, just before adjourning for a COVID-19-shortened summer recess, the California State Senate passed a measure that, if it becomes law, would significantly expand the availability of unpaid family leave in the state. SB 1383 would extend family leave protections to employers with five or more employees and significantly add to the circumstances in which employees will be entitled to family leave and return rights to the same or a comparable job. Current state law, the California Family Rights Act (CFRA), applies to covered employers with 50 or more employees.

If enacted, effective January 1, 2021, the legislation, authored by Sen. Hannah-Beth Jackson (D-Santa Barbara), would require covered employers to provide eligible workers with up to 12 weeks of unpaid family leave for the birth, adoption or serious illness of a child; to care for a seriously ill parent or spouse, grandparent, or other listed relative; and so that an employee can deal with their own serious health condition or with the absence of a spouse, domestic partner, child or parent called to active duty in the U.S. armed forces.

To be eligible for family leave, an employee must have at least 12 months of service with the employer and at least 1,250 hours of service with the employer during the previous 12-month period.

SB 1383 passed the Senate with the bare minimum number of votes—21 of 40 senators voted for the expansion—despite the fact that Democrats hold 29 seats of the 40-member Senate. The bill must now pass the California Assembly before September 1 to become law this year. With Democrats holding 61 of the 80 seats in the Assembly, and only a simple majority vote of 41 members required to pass SB 1383, passage seems likely. However, given the havoc COVID-19 continues to wreak upon the economy generally, and small business specifically, passage of SB 1383 is not a foregone conclusion. That said, Governor Newsom has provided strong support for the legislation, demonstrated by his decision in June to put it on the list of bills he wanted the Legislature to enact as part of the extended state budget negotiations. In a press conference called to support the measure, he credited First Partner Jennifer Seibel Newsom with a continued push to change the law. Some Democratic senators objected to making the bill part of the budget process, and the bill has been “de-coupled” from the formal budget legislation, but it has significant support in the Assembly from key pro-labor Democrats, including the powerful Chair of the Assembly Appropriations Committee, Lorena Gonzalez, a co-author of the bill.

If the Assembly does pass the bill, Governor Newsom has made it clear he will sign it into law.

50% Spike in California COVID Hospitalizations

California coronavirus cases and hospitalizations surge - Los ...Source: Reuters, by Sharon Bernstein

New coronavirus cases soared in California over the July Fourth weekend, stressing some hospital systems and leading to the temporary closure of the state capitol building in Sacramento for deep cleaning, officials said on Monday.

The number of people hospitalized with COVID-19 has increased by 50% over the past two weeks to about 5,800, Governor Gavin Newsom said at a briefing.

About a third of those hospitalized were in Los Angeles County, state and local records showed, with about 630 confirmed and suspected coronavirus patients requiring intensive care.

And 25% of the hospitalizations in the county in July were among patients aged 18 to 40, health officials said, as new cases increasingly hit a younger population that may have been lax about safety precautions in recent weeks.

Farther north, nearly 1,400 inmates at San Quentin State Prison have been sickened by the virus, putting pressure on hospitals in Marin County, where the facility is located, Newsom said.

All told, 271,684 Californians have tested positive for the virus, including 11,529 in the past 24 hours, state records show. About 6,300 have died.

Determined to slow the spread of the disease over the holiday weekend, state alcohol regulators visited nearly 6,000 bars and restaurants to make sure they were complying with new rules banning indoor dining and closing bars that do not serve food, Newsom said.

Nearly half a million businesses were contacted by the state over the weekend and warned that failing to enforce social distancing guidelines, including a statewide mandate to wear face coverings, could lead to a citation, he said.

The virus also reached into the halls of government.

On Monday, Assemblywoman Autumn Burke, a Democrat from Los Angeles County, posted on Twitter that she and her daughter had tested positive for the virus after what state human resources representatives called a “mask-to-mask” transmission.

Lawmakers have been meeting in person at the state Capitol building in Sacramento since mid-May.

Burke did not immediately respond to a request for comment, but a spokeswoman for state Assembly Speaker Anthony Rendon said the building had been closed for a deep cleaning out of concern for “the health and safety of the Capitol community.”

Five people who worked at the capitol had been infected with the virus, spokeswoman Katie Talbot said.

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.”

Last Updated 07/08/2020

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