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The Health 202: Los Angeles antibody test results are a warning to states thinking of reopening

with Paulina Firozi

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There’s new evidence from Los Angeles County that the novel coronavirus may have infected around 4 percent of its population.

That’s both good news and bad news.

Officials in the nation’s most populous county announced results yesterday from an antibody testing effort, in which a randomized sample of residents were given blood serology tests to determine whether their bodies had already fought off the virus — and could now have some immunity to it. Los Angeles County is the first major U.S. municipality to announce the results of its antibody testing, which is deemed essential by public health officials to safely reopen the country.

Based on their findings, the researchers estimate between 2.8 percent and 5.6 percent of Los Angeles county adults have antibodies to the virus. 

Apply that rate to the county’s 8 million adult population, and it would mean that between 221,000 and 442,000 adults have been infected — many times more than the nearly 8,000 confirmed cases when the study was carried out in early April.

This is a glass-half-empty-versus-glass-half-full situation.

On one hand, the low infection rate shows L.A.’s strict social distancing orders have likely been working. 

A large swath of the population appears not to have been infected yet. And it provides evidence the virus isn’t as deadly as scientists had initially feared, as the deaths stem from many more infections than previously known.

“We could maybe say the good news is the fatality rate is lower than what we thought it would be,” said Neeraj Sood, public policy professor at the University of Southern California and lead investigator in the study.

Vox founder Ezra Klein:

But Sood warned that’s not the only number on which to focus. 

There’s still a large population the virus could burn through once people start reintegrating back into society. 

“What the findings show is only 4 percent of our population has been infected, which means we are very early in the epidemic and many more people in L.A. County could potentially be infected,” Sood said.

“As those infections rise, so will the number of hospital ICU admissions,” he added.

Conducting widespread antibody tests is a prominent part of virtually every plan being floated to start reopening parts of the country. Discovering who is protected from the virus could help officials make decisions about who can go back to work and school and how quickly. Experts say it’s likely different areas of the country will show differing infection rates; more people in New York City, for example, could have been infected because it’s the hottest of all hot spots. New York has started its own massive antibody testing effort as it begins to contemplate a post-peak future.

Nate Silver, editor of FiveThirtyEight:

Yet there are also serious concerns about the quality and accuracy of antibody tests at the same time as the Trump administration has struggled to expand diagnostic testing that would confirm how many Americans are sick with the virus. 

As our colleague Laurie McGinley reported over the weekend, the Food and Drug Administration has allowed more than 90 serology tests on the market without first reviewing them. Many scientists warn the tests haven’t yet proved someone has immunity from the virus and isn’t at risk of becoming reinfected. 

FDA Commissioner Stephen Hahn said in a Washington Post Live interview last week that “people should be very cautious” about tests that haven’t gotten a full agency review.

Sood said he feels confident the tests used in L.A. have a high accuracy rate, based on two analyses researchers conducted.

The researchers also reported that African Americans and men were most likely to test positive for antibodies a finding they said they weren’t yet prepared to interpret. Of the 800 participants in the , 7 percent of African Americans tested positive, compared with 6 percent of whites and 2.5 percent of Latinos. Six percent of men tested positive, compared with 2 percent of women.

Soumya Karlamangla, a health reporter for the L.A. Times:

L.A. County plans to conduct more such randomized tests over the next few weeks using kits provided by the Minneapolis-based company Premier Biotech. Additional tests will give officials more reliable information as they consider how to ease the area’s strict lockdown.

But for now, officials say the findings reinforce the need for people to continue staying at home. 

If hundreds of thousands of L.A. resident have antibodies, that means people are often infected with the coronavirus and can pass it along without experiencing any symptoms, or just mild ones.

“This means … we need to assume that at any time we could be infected,” said Barbara Ferrer, director of the L.A. County Department of Public Health. “That means keeping our distance, using our face coverings and staying home if you’re sick so you don’t expose anybody else to any of your germs.”

Ahh, oof and ouch

AHH: The White House and Congress are close to a deal to boost funds for small businesses. 

White House officials and lawmakers are working on another giant bailout to tackle the economic and health fallout from the pandemic and resulting lockdowns, our colleague Erica Werner reports. But there are last-minute hurdles over loan access and testing. 

“If a deal is reached, the nearly $500 billion measure would become the fourth virus-related bill rushed through Congress in just two months at a total price tag of almost $3 trillion,” she writes. “The new package would amount to roughly $470 billion in new spending, with $370 billion directed to small businesses, $75 billion going to hospitals, and $25 billion set aside for testing.” 

“We have I believe come to terms on the principles of the legislation, which is a good thing, but it’s always in the fine print,” House Speaker Nancy Pelosi (D-Calif.) said on CNN last night. “And so now we’re down to fine print, but I feel very optimistic and hopeful that we’ll come to a conclusion tonight so that it can be taken up [Tuesday] in the Senate and Wednesday in the House of Representatives.”

Lawmakers are working amid massive job losses, but they’re also facing bipartisan outrage about how some of the bailout programs have been handled so far, particularly the uneven distribution of loans to small businesses.

During last night’s coronavirus briefing, Trump called the emerging deal a “great plan” and saying he hoped for a Senate vote today.

“We’re talking about $75 billion for hospitals and other health-care providers,” Trump said. “Many providers and their employees have taken a huge financial hit in recent weeks. … Hospitals have really been fantastic.”

OOF: Hospitals may restart elective surgeries and procedures soon. 

Some medical centers are preparing to resume non-emergency surgeries and procedures, following guidance from federal officials on Sunday. It’s a sign of hope for patients needing care and overwhelmed hospitals in need of revenue as they continue to tackle the ongoing pandemic, our colleagues Frances Stead Sellers, Amy Goldstein and Lenny Bernstein report

Hospitals in communities with relatively few coronavirus cases began readying some procedures for cancer and heart patients, as well as other care that was postponed after the federal government issued voluntary guidelines last month to preserve resources for health-care workers grappling with the surge of covid-19 patients suffering from the disease the virus causes. 

Some medical centers say they’re able to handle the extra cases.

The University of Pittsburgh Medical Center system, for example, a 40-hospital system with 5,500 beds, had just 116 people admitted for covid-19, who were using 7 percent of intensive care unit beds and 6 percent of ventilators.

“We think we’re able to serve what’s really a pent-up demand,” said Donald M. Yealy, chairman of the Department of Emergency Medicine at the University of Pittsburgh School of Medicine and the UPMC. “There’s a lot of necessary care that can be scheduled. There’s even some urgent care that has been put off.”

OUCH: The economic lockdowns could push tens of millions in the United States into poverty.

New projections warn the coronavirus-fueled shutdowns and resulting economic downturn could drive the poverty rate in the United States to its highest levels in more than five decades. 

The stay-at-home orders have led to sidelined businesses and unprecedented job losses. If unemployment reaches and stays at 30 percent, “one widely used measure of poverty would skyrocket more than 50 percent, from 12.4 percent to 18.9 percent,” our colleague Christopher Ingraham reports, citing a report by Zachary Parolin and Christopher Wimer at Columbia University’s Center on Poverty and Social Policy. 

The result would be 21 million more people in poverty and the highest poverty rate since at least 1967. 

The pandemic’s impact on states

Some states have announced plans to partly reopen soon. 

The Republican governors of Georgia, South Carolina and Tennessee announced plans to ease restrictions

  • Georgia Gov. Brian Kemp said certain businesses can reopen as early as Friday. These businesses include fitness centers, bowling alleys, barbers, hair and nail salons. Restaurants and theaters may reopen Monday, with guidelines to be announced this week, and bars and nightclubs will remain closed.
  • Tennessee Gov. Bill Lee said the statewide stay-at-home order will expire April 30, and a large majority of businesses in 89 counties will be allowed to reopen on May 1. Some businesses, especially in less-populated areas, will start to reopen as soon as Monday.
  • South Carolina Gov. Henry McMaster said many retail outlets will be allowed to reopen this week. Previous guidelines, like five customers per 1,000 square feet, or 20 percent of occupancy limits, will remain. Salons, gyms and inside dining will still be closed.

Yet Georgia hasn’t met the White House’s standards for easing restrictions. 

Last week, the White House presented metrics by which states could assess if they’re ready to reopen. They include measures of both the spread of coronavirus symptoms and actual cases. States meet the benchmark on symptoms if they see a downward trend on reports of influenza-like illnesses and a decline in covid-19-like illnesses. If it sees a decline in either daily cases or the rate at which people are testing positive, it meets the benchmark on cases.

“In Georgia’s region, there has been a two-week downward trend in reports of covid-19-like illness,” our colleague Philip Bump reports. “But in Georgia itself, the most recent public data on flu-like illness, confirmed case increases and positive tests all indicate that Georgia isn’t ready to reopen.” 

From Tom Bossert, who served as homeland security adviser to Trump from 2017 to 2018:

NBC News’s Katy Tur: 

Florida’s Republican Gov. Ron DeSantis is also eager to reopen the state for business. He announced the creation of a “Re-Open Florida Task Force” as a stay-at-home order is set to soon expire there, Lori Rozsa reports for The Post. 

States are struggling to find the funds needed for all the residents applying for unemployment. 

New York called on the federal government for $4 billion in a no-interest loan to cover unemployment payments after it used half of its trust-fund money on hand from the end of February to the middle of this month, the Wall Street Journal’s Sarah Chaney reports. Massachusetts has also used up almost half of the funds it has available. 

“Nearly half of U.S. states have logged double-digit percentage declines in their trust-fund balances since the end of February, the month before the coronavirus pandemic triggered shutdowns that led to widespread job losses and record numbers of jobless claims,” she writes. “ … Economists say the cash drain means additional states in the coming weeks could run out of money for paying regular unemployment benefits, raising the possibility others also could seek help by getting loans from the federal government.” 

The requests for federal loans to refill state trust funds don’t need congressional approval, she adds. 

New York nurses are suing the state and two hospitals to push them to provide critical equipment. 

The New York State Nurses Association filed a suit against the state’s department of health, Montefiore Medical Center and the parent company of the Westchester Medical Center, calling on the judge to force them to provide adequate protective equipment, including face masks, Reuters’s Gabriella Borter reports. 

“The court filings said the hospitals were ignoring requirements by the state’s COVID-19 task force that healthcare workers receive an N95 respirator mask daily, and that the health department was not enforcing it,” she adds. “The Department of Health said it has taken every step necessary to ensure that healthcare workers have the needed support and supplies.” 

“These lawsuits were filed to protect our nurses, our patients and our communities from grossly inadequate and negligent protections,” Pat Kane, the association’s executive director, said in a statement.

Maryland acquired 500,000 coronavirus tests from South Korea, with the help of his wife Yumi Hogan. 

Gov. Larry Hogan (R) said his wife was instrumental in closing a deal to secure hundreds of thousands of tests. Over the weekend, she joined the governor as they welcomed “the first-ever Korean Air passenger plane to land at Baltimore-Washington International Marshall Airport, which the governor said was carrying more tests than ‘four of the top five states in America’ combined have completed,” our colleague Ovetta Wiggins reports. 

The White House’s coronavirus response

There are questions about Trump’s use of a health insurer to dole out coronavirus relief funds.

A senior White House economist with previous financial ties to UnitedHealth Group is now playing an important role in advising the $30 billion recovery program administered by the same health insurance company, Politico’s Maggie Severns and Daniel Lippman report

An HHS official told Politico that Stephen Parente, an economist at the Council of Economic Advisers, is one of three key decision-makers who decide how funds are doled out to providers. 

“The choice of UnitedHealth, a leading health insurer, to serve as a conduit in funneling billions of dollars to hospitals and other providers, surprised many in health care, including employees at the Department of Health and Human Services who had assumed that HHS would administer the program itself,” Maggie and Daniel report. “Though UnitedHealth says it will make no profit off of the deal, its role in handing out billions of federal dollars to hospitals could boost its relationships with the White House and the public during a tumultuous year and possibly provide it with valuable health care data, experts say.” 

Coronavirus latest

The latest developments to catch up on this morning: 

The Trump administration’s response: 
  • Trump said at Monday’s daily briefing he didn’t know if businesses that reopen will be liable if employees get sick. “I’ll give you a legal answer to that one. We’ll look it up,” Trump said. “But we had tried to take liability away from these companies, which just don’t want that because we want the companies to open and open strong.” Pressed on whether the administration has discussed the issue, he added: “Nobody’s discussed it. No. But we will now.”
  • Trump’s testing czar, Brett Giroir, was in 2015 forced out of his job working on vaccine development projects at Texas A&M University. “Now President Trump has given Giroir the crucial task of ending the massive shortfall of tests for the novel coronavirus. Some governors have blasted the lack of federal help on testing, which they say is necessary to enact Trump’s plan for reopening the economy,” our colleague Michael Kranish reports.
  • The White House has asked federal agencies to start readying employees to return to their offices, Bloomberg News’s Justin Sink reports. “Agencies are encouraged to allow federal employees and contractors to return to the office in low-risk areas,” Office of Management and Budget Director Russell Vought wrote in a memo to federal department and agency heads.
  • Trump’s public remarks regarding hydroxychloroquine, the decades-oil malaria drug he has touted as a coronavirus treatment, have slowed down markedly over the last week, Politico’s Quint Forgey reports.
  • The Food and Drug Administration is working to ease the shortage of medicines needed for covid-19 patients who are put on ventilators, Stat News’s Ed Silverman reports.
The hardest hit: 
  • Nearly 1 in 10 nursing homes across the country have reported coronavirus outbreaks, our colleagues Debbie Cenziper, Joel Jacobs and Shawn Mulcahy report.
On the front lines: 
  • These EMTs grieved the loss of a two of their fellow emergency medical technicians, but then they kept working, our colleague Ariana Eunjung Cha reports.
Part of a new reality: 
  • People isolated at home may be more willing to pick up calls from phone banks that they may have normally sent to voice mail, the Wall Street Journal’s Aaron Zitner writes. But that also may mean emotional conversations with call agents who are bearing new burdens. “Sometimes I just have to get off the phone and cry,” said one woman working for a call-center company.
Work continues in the nation’s capital:
  • Some drug manufacturers, including Inovio Pharmaceuticals and Arcturus Therapeutics, and major corporations, including General Motors and 3M, have boosted their lobbying efforts amid the pandemic, Stat News’s Lev Facher reports.

Sugar rush

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