hospitals – R&R – Reachout and Rebuild

Slap in the Face of New Yorkers

David Posnett — Wed, 15 Apr 2020 20:07:35 +0000

Long Island needs a leader right now, not a rubber stamp for the Trump administration’s irresponsible policies and erratic procedures. That’s not how a member of Congress should act.

Congressional District NY-01 in Suffolk County should have a representative who will demand fairness for his residents. Instead, we have Lee Zeldin, who is too busy covering for Donald Trump’s antics and failure to respond responsibly to this crisis.

Recently, Congress passed a 3rd stimulus package with support from both parties. But guess what? New York State got short-changed and Zeldin did nothing, despite two important facts:

Our state has suffered more than any other state from the pandemic with 35% of confirmed Coronavirus cases and 42% of all the deaths in the US. The Trump administration has ignored our plight and decided to allocate hospital aid based on old data, instead of basing it on the number of Coronavirus cases. This decision will bankrupt our hospitals and leave healthcare workers to do without. It is a slap in the face to our heroes on the frontlines.
New Yorkers have the highest costs of living nationally, particularly in the New York Metro region. Yet we face the same financial criteria for direct cash payments as people from other parts of the country with a much lower cost of living.

These two problems that New Yorkers are facing must be addressed in the next stimulus package. Lee Zeldin should be doing everything in his power to make sure that our state gets the relief it needs. But he won’t. Instead, he will just raise his hand and vote however the leadership in his party tells him to. That’s unacceptable. A good member of Congress should fight for his constituents.

From Perry Gershon

From London: If you are over 65 with COVID-19, good luck

David Posnett — Mon, 30 Mar 2020 17:49:52 +0000

The numbers are normalized per 100,000 population. Since the US is a far larger country the number of deaths will be far larger. Daily deaths are predicted to peak after around three months if people don’t change their behaviour. Image: Imperial College COVID-19 Response Team

From a medical consultant in London. This was sent initially to his family on Sat March 28th, 2020. It is a frank assessment. Expect the same situation here in New York and elsewhere in the USA. (NB: this was sent to me via my British family)

Dire Report from Epicenter Bergamo

David Posnett — Sun, 22 Mar 2020 21:27:56 +0000

Click and watch this disturbing video from a Bergamo hospital

A new report published by the New England Journal of Medicine (NEJM; arguably the top medical journal in the world) makes the point that hospitals are major sites of corona-virus transmission and home care (community-centered care) would be a better model. It is also a dramatic plea for help.

At the Epicenter of the Covid-19 Pandemic and Humanitarian Crises in Italy: Changing Perspectives on Preparation and Mitigation.

March 21, 2020.

By Mirco Nacoti, MD,, Andrea Ciocca, MEng, Angelo Giupponi, MD, Pietro Brambillasca, MD, Federico Lussana, MD, Michele Pisano, MD, Giuseppe Goisis, PhD, Daniele Bonacina, MD, Francesco Fazzi, MD, Richard Naspro, MD, et al.

In a Bergamo hospital deeply strained by the Covid-19 pandemic, exhausted clinicians reflect on how to prepare for the next outbreak.

Summary

In a pandemic, patient-centered care is inadequate and must be replaced by community-centered care. Solutions for Covid-19 are required for the entire population, not only for hospitals. The catastrophe unfolding in wealthy Lombardy could happen anywhere. Clinicians at a hospital at the epicenter call for a long-term plan for the next pandemic.

We work at the Papa Giovanni XXIII Hospital in Bergamo, a brand-new state-of-the-art facility with 48 intensive-care beds. Despite being a relatively small city, this is the epicenter of the Italian epidemic, listing 4,305 cases at this moment — more than Milan or anywhere else in the country (Figure 1). Lombardy is one of the richest and most densely populated regions in Europe and is now the most severely affected one. The World Health Organization (WHO) reported 74,346 laboratory-confirmed cases in Europe on March 18 — 35,713 of them in Italy.

Figure 1 .

Our own hospital is highly contaminated, and we are far beyond the tipping point: 300 beds out of 900 are occupied by Covid-19 patients. Fully 70% of ICU beds in our hospital are reserved for critically ill Covid-19 patients with a reasonable chance to survive. The situation here is dismal as we operate well below our normal standard of care. Wait times for an intensive care bed are hours long. Older patients are not being resuscitated and die alone without appropriate palliative care, while the family is notified over the phone, often by a well-intentioned, exhausted, and emotionally depleted physician with no prior contact.

But the situation in the surrounding area is even worse. Most hospitals are overcrowded, nearing collapse while medications, mechanical ventilators, oxygen, and personal protective equipment are not available. Patients lay on floor mattresses. The health care system struggles to deliver regular services — even pregnancy care and child delivery — while cemeteries are overwhelmed, which will create another public health problem. In hospitals, health care workers and ancillary staff are alone, trying to keep the system operational. Outside the hospitals, communities are neglected, vaccination programs are on standby, and the situation in prisons is becoming explosive with no social distancing. We have been in quarantine since March 10. Unfortunately, the outside world seems unaware that in Bergamo, this outbreak is out of control.

Western health care systems have been built around the concept of patient-centered care, but an epidemic requires a change of perspective toward a concept of community-centered care. What we are painfully learning is that we need experts in public health and epidemics, yet this has not been the focus of decision makers at the national, regional, and hospital levels. We lack expertise on epidemic conditions, guiding us to adopt special measures to reduce epidemiologically negative behaviors.

For example, we are learning that hospitals might be the main Covid-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients. Patients are transported by our regional system,1 which also contributes to spreading the disease as its ambulances and personnel rapidly become vectors. Health workers are asymptomatic carriers or sick without surveillance; some might die, including young people, which increases the stress of those on the front line.

This disaster could be averted only by massive deployment of outreach services. Pandemic solutionsare required for the entire population, not only for hospitals. Home care and mobile clinics avoid unnecessary movements and release pressure from hospitals.2 Early oxygen therapy, pulse oximeters, and nutrition can be delivered to the homes of mildly ill and convalescent patients, setting up a broad surveillance system with adequate isolation and leveraging innovative telemedicine instruments. This approach would limit hospitalization to a focused target of disease severity, thereby decreasing contagion, protecting patients and health care workers, and minimizing consumption of protective equipment. In hospitals, protection of medical personnel should be prioritized. No compromise should be made on protocols; equipment must be available. Measures to prevent infection must be implemented massively, in all locations and including vehicles. We need dedicated Covid-19 hospital pavilions and operators, separated from virus-free areas.

This outbreak is more than an intensive care phenomenon, rather it is a public health and humanitarian crisis.3 It requires social scientists, epidemiologists, experts in logistics, psychologists, and social workers. We urgently need humanitarian agencies who recognize the importance of local engagement. WHO has declared deep concern about the spread and severity of the pandemic and about the alarming levels of inaction. However, bold measures are needed to slow down the infection. Lockdown is paramount: social distancing reduced transmission by about 60% in China. But a further peak will likely occur when restrictive measures are relaxed to avoid major economic impact.4 We strongly need a shared point of reference to understand and fight this outbreak. We need a long-term plan for the next pandemic.

Coronavirus is the Ebola of the rich and requires a coordinated transnational effort. It is not particularly lethal, but it is very contagious. The more medicalized and centralized the society, the more widespread the virus. This catastrophe unfolding in wealthy Lombardy could happen anywhere.

Bombing Hospitals in Syria: a Crime against Humanity

David Posnett — Sun, 13 Oct 2019 19:06:58 +0000

I just saw a documentary on a Syrian underground hospital: The Cave. It should be compulsory viewing for everyone. INCLUDING Rep. Lee Zeldin. He too lived thru a period where his premature born twin girls where in the NICU. Might he identify with the story of a 30 year old pediatrician running an underground hospital in northern Syria under horrendous conditions and constant bombardment? I have spoken with Lee Zeldin, and he is aware of how lucky his family was.

Here is a review of The CAVE: https://www.thewrap.com/the-cave-film-review-syrian-documentary-goes-underground-to-find-a-new-face-of-tragedy/

And here is the trailer: https://www.firstshowing.net/2019/official-trailer-for-the-cave-doc-film-about-a-hidden-syrian-hospital/

If you have any doubt about the culprits, read more in the NY Times (Oct. 13). There is an 8 min video attached to the article and it contains ample proof of Russian planes specifically targeting hospitals. https://www.nytimes.com/2019/10/13/world/middleeast/russia-bombing-syrian-hospitals.html

In my book this is a crime against humanity. It should be prosecuted at The Hague. And the prime suspects/culprits are Syrian President Assad and Russian President Putin.

This all is relevant to our most recent national disaster in foreign policy: inviting Turkey to invade parts of northern Syria, where our previous allies, the Kurds, live. The bombs have started falling as reported today. The players are likely to have blood on their hands. Erdogan? Donald Trump? And Lee Zeldin ? He habitually supports Trump, irrespective of common sense.

Short Hospital Stocks!

David Posnett — Tue, 10 Oct 2017 16:36:14 +0000

I have been waiting for this: Wall street is jittery about Hospital stocks. Here is why:

(1) Investors are approaching hospital stocks cautiously

As Les Masterson has said:

“Some unfavorable financial trends and an air of uncertainty for healthcare’s future has led to an environment not particularly friendly for major investment…as hospitals continue to struggle with fewer inpatient admissions, lower reimbursements and potential increases in uncompensated care, investors are growing wary”

“The current environment caused disappointing second quarters and lower earnings projections for major for-profit systems like HCA, Community Health Systems (CHS) and Tenet Healthcare…. The results led stock prices to tumble.”

(2) Hospital Sector Slides:

The Financial Times notes that US hospital operators‘ stock prices are sliding down following a report that President Donald Trump will sign an executive order this week to withdraw some insurance requirements laid out under Obamacare. Tenet Healthcare, Community Health Systems, Surgery Partners, HCA Healthcare, DaVita shares tumbled losing up to 10% in stock prices.

(3) some are suggesting “Checking in on the Canadian Healthcare Stocks“ Ha!

I wonder whether Donald Trump and the rest of his cronies have already sold their healthcare stocks? And how about Lee Zeldin’s “concern” (?) about the hospitals in Suffolk county. It is the biggest sector of the local economy.