HILLSBOROUGH COUNTY, FL — The coronavirus didn’t simply introduce a new pathogen into society. It brought along a host of new problems and exacerbated existing ones that the country will be left to deal with long after the coronavirus symptoms have passed.
They might not be visible under a microscope, but accompanying the pandemic are a host of mental health issues. Isolation, job loss, financial hardships, learning difficulties, drug abuse and domestic violence go hand in hand with an increase in anxiety, fear, panic attacks, physical outbursts, depression, anger and hopelessness caused by the pandemic.
For the deputies at the Hillsborough County Sheriff’s Office, these problems aren’t new. Deputies have long been dealing with drug abusers committing crimes of desperation, jobless families members taking out their frustrations on their spouses, and lonely, unstable people threatening to kill themselves or others.
But with the coronavirus pandemic, deputies trained to keep order and investigate crimes have also taken on the roles of social worker, family mediator and peacekeeper, said Master Deputy Tobias Smith, who’s spent 24 years dealing with mental health calls for the sheriff’s office.
In a typical year, the Hillsborough County Sheriff’s Office receives 1.6 million calls from the public and other agencies. Of those, 540,000 calls come through the sheriff’s 911 emergency lines.
Deputies have no way of knowing which 911 call will lead to a volatile situation that could turn deadly.
But now the Hillsborough County Sheriff’s Office will fight fire with sympathy and understanding thanks to the newly formed Behavioral Resources Unit.
Sheriff Chad Chronister announced the formation of the new Behavioral Resources Unit at a news conference Monday.
The unit, made up of deputies, licensed mental health counselors and licensed clinical social workers, will focus on identifying people who repeatedly come into contact with law enforcement due to mental health issues or homelessness.
The Behavioral Resources Unit will work one on one with these people, connect them with the services they need before crisis in the hopes of keeping them out of the criminal justice system.
Smith said it’s not unusual for deputies to get a call about a person acting strangely due to a mental health problem. But, until now, the sheriff’s office’s only resource was to use the Baker Act to involuntarily hold the person in a psychiatric facility. A few days later, the deputy would see the person back on the streets.
The Florida Mental Health Act of 1971 (Florida Statute 394), commonly known as the “Baker Act,” allows the involuntary institutionalization and examination of a mentally ill person who is behaving erratically or presenting a danger to themselves or others.
Oftentimes, the behavior is caused by their refusal to take or refill prescribed medication, or follow up with mandatory counseling sessions. Since many are homeless or transient, there’s no way for social services to follow up with the person.
“Some have been Baker Acted 20 to 30 times,” Smith said. “If we can get them into some more effective treatment,
Intermountain Healthcare CEO Marc Harrison and Sanford Health CEO Kelby Krabbenhoft announced a merger on Monday in Sioux Falls. (Photo: Gabrielle Pike)
Sanford Health CEO Kelby Krabbenhoft announced Monday that Sanford is planning to merge with Intermountain Health, a Salt Lake City based health system and Utah’s largest private employer.
The alliance shifts top leadership to Intermountain Health, as Krabbenhoft serves as president emeritus and Dr. Marc Harrison, president and CEO of Intermountain, serves as president and CEO. Headquarters will also move to Utah while corporate offices will be in Sioux Falls.
The merger creates a sprawling $15 billion health system whose service area spans the western United States and Upper Midwest. Besides health care, both entities operate a private health insurance business, and Sanford also owns the Evangelical Lutheran Good Samaritan Society.
Both organizations will keep their current names for the “foreseeable future.” The parent company will be Intermountain Healthcare.
‘A match made in heaven’
The organizations plan to officially combine by summer 2021, pending regulatory approvals. Harrison and Krabbenhoft started discussing the merger after meeting in April. Krabbenhoft said he was introduced to Harrison by Utah Gov. Mike Leavitt while on a business trip to Salt Lake City.
“In many ways this is a match made in heaven,” Harrison said during Monday’s announcement.
On paper, the two systems are similar. Intermountain operates 24 hospitals and 215 clinics in Utah, Nevada and Idaho. The system employs 41,700 people, including 2,971 physicians and advanced-practice providers.
Sanford employs 47,757 at its 46 medical centers and 210 clinics. Of those, 2,633 are physicians or advanced-practice providers. Sanford is South Dakota’s largest private employer.
Both systems operate large hospitals in their metropolitan service areas as well as operate in rural settings. The combined organization will employ more than 89,000 people and operate 70 hospitals.
“You get a cultural match that really is quite powerful,” Krabbenhoft said.
“This is two really strong organizations coming together,” Harrison said. “It’s not me sending a check to Kelby, and it’s not him sending one to me.”
But where the two organizations differ is in the strength of their private health insurance businesses, Krabbenhoft said. Intermountain’s health insurance business, SelectHealth, has more than 900,000 members and about $4 billion in revenue. The Sanford Health Plan has about 210,000 members and about $1 billion in revenue.
Krabbenhoft said that Sanford has been stymied over the years in its efforts to build up a stronger insurance pool and that the merger “really solves a problem for us.”
“It’s just a scale issue,” he said.
Sanford Health has history of expansion
Monday’s announcement confirmed rumors that had been swirling for weeks in Sioux Falls, and it marks another chapter in Sanford’s drive to expand, which included the system’s merger with the Good Samaritan Society in 2018. A decade ago, Sanford merged with North Dakota-based MeritCare, which deepened its reach into the Upper
Most of the health care workers hospitalized with the coronavirus are nurses, according to a new Centers for Disease Control and Prevention report.
The report found that nearly 6% of all patients hospitalized with COVID-19 were health care workers, with 36.3% of those patients being nurses. More than two-thirds, 67.4%, had direct patient contact and more than 4% of the health care workers who were hospitalized died.
Photos: Daily Life, Disrupted
The CDC’s report included medical records from nearly 7,000 coronavirus patients who were in the hospital between March 1 and May 31.
Nearly 90% of health care workers who were hospitalized with the virus had at least one underlying medical condition, with the most common, 73%, being obesity.
According to the report, the median age of the hospitalized health care worker was 49, compared to 62 among the general population. Most health care workers in the hospital with COVID-19 were women, with a large proportion being Black.
Additionally, the report found that the median length of hospitalization among the providers with COVID-19 was four days and 27.5% of providers were admitted to the intensive care unit for a median of six days.
The CDC said the findings were comparable to those reported among health care providers with COVID-19 in China.
In the U.S., nursing-related occupations account for a large proportion of the health care workplace, and in 2019 registered nurses represented approximately one-third of health care providers.
OMAHA, Neb. (AP) — Nebraska’s health care providers and elderly and vulnerable residents will be first in line to get a coronavirus vaccination when it becomes available as early as this year, state officials said Monday.
Gov. Pete Ricketts and public health officials said they plan to give those groups top priority in their plans to distribute their limited share of the vaccine, once it’s developed and shipped.… Read More
COVID Spikes Worsen Health Worker Shortages in Great Plains, Rocky Mountains | Healthiest Communities
COVID-19 cases are surging in rural places across the Mountain States and Midwest, and when it hits health care workers, ready reinforcements aren’t easy to find.
In Montana, pandemic-induced staffing shortages have shuttered a clinic in the state’s capital, led a northwestern regional hospital to ask employees exposed to COVID-19 to continue to work and emptied a health department 400 miles to the east.
“Just one more person out and we wouldn’t be able to keep the surgeries going,” said Dr. Shelly Harkins, chief medical officer of St. Peter’s Health in Helena, a city of roughly 32,000 where cases continue to spread. “When the virus is just all around you, it’s almost impossible to not be deemed a contact at some point. One case can take out a whole team of people in a blink of an eye.”
In North Dakota, where cases per resident are growing faster than any other state, hospitals may once again curtail elective surgeries and possibly seek government aid to hire more nurses if the situation gets worse, North Dakota Hospital Association President Tim Blasl said.
“How long can we run at this rate with the workforce that we have?” Blasl said. “You can have all the licensed beds you want, but if you don’t have anybody to staff those beds, it doesn’t do you any good.”
Photos: Daily Life, Disrupted
The northern Rocky Mountains, Great Plains and Upper Midwest are seeing the highest surge of COVID-19 cases in the nation, as some residents have ignored recommendations for curtailing the virus, such as wearing masks and avoiding large gatherings. Montana, Idaho, Utah, Wyoming, North Dakota, South Dakota, Nebraska, Iowa and Wisconsin have recently ranked among the top 10 U.S. states in confirmed cases per 100,000 residents over a seven-day period, according to an analysis by The New York Times.
Such coronavirus infections — and the quarantines that occur because of them — are exacerbating the health care worker shortage that existed in these states well before the pandemic. Unlike in the nation’s metropolitan hubs, these outbreaks are scattered across hundreds of miles. And even in these states’ biggest cities, the ranks of medical professionals are in short supply. Specialists and registered nurses are sometimes harder to track down than ventilators, N95 masks or hospital beds. Without enough care providers, patients may not be able to get the medical attention they need.
Hospitals have asked staffers to cover extra shifts and learn new skills. They have brought in temporary workers from other parts of the country and transferred some patients to less-crowded hospitals. But, at St. Peter’s Health, if the hospital’s one kidney doctor gets sick or is told to quarantine, Harkins doesn’t expect to find a backup.
“We make a point to not have excessive staff because we have an obligation to keep the cost of health care down for a community — we just don’t have a lot of slack in our rope,” Harkins said. “What we don’t account for is a mass exodus
It didn’t take very much soft drink consumption for people to see elevated risk of cardiovascular disease (CVD), a large cohort study in France suggested.
People who drank the most sugary drinks (a median 185 ml or 6.26 fl oz per day — barely half a can of ordinary soda) were more likely to experience a CVD event compared with non-consumers of these drinks (HR 1.20, 95% CI 1.04-1.40), according to a group led by Eloi Chazelas, a PhD candidate at Sorbonne Paris Nord University.
Similarly, those who drank relatively more artificially sweetened beverages (176.7 ml or 5.97 fl oz per day) had higher CVD risk over a median 6.6 years of follow-up compared with non-consumers of the drinks (HR 1.32, 95% CI 1.00-1.73), the investigators reported in a research letter online in the Journal of the American College of Cardiology.
The statistics reflected adjustment for other dietary habits, including consumption of alcohol, red and processed meats, whole grains, legumes, and fruits and vegetables, as well as overall calorie counts and comorbidities such as hypertension and type 2 diabetes.
The data suggest that artificially sweetened beverages may not be a healthy substitute for sugary drinks containing 5% or more sugar, Chazelas and colleagues concluded, noting the current debate on taxes, labeling, and regulation of both types of drinks.
The researchers noted that sugar substitutes are thought to have various metabolic effects, including gut microbiota perturbation.
For the study, the team counted first incident cases of stroke, transient ischemic attack, myocardial infarction, acute coronary syndrome, and angioplasty in the CVD endpoint.
At lower intake levels, neither sugary drinks (median 46.7 ml or 1.58 fl oz per day; HR 1.05, 95% CI 0.92-1.20) nor artificially sweetened drinks (40.0 ml or 1.35 fl oz per day; HR 1.15, 95% CI 0.94-1.42) showed a link to CVD.
The study was based on the French NutriNet-Santé cohort launched in 2009. The 104,760 people who volunteered had been asked to complete 24-hour dietary records every 6 months. The investigators linked their files to records from the French national health insurance system and the French national mortality registry.
Study participants had a mean age of 42.9 years, and 78.6% were women. Average body mass index was 23.7, and 17.2% of people were current smokers at baseline. Nearly one in three had a family history of CVD. The prevalence of type 2 diabetes was 1.4%, of high cholesterol was 8.0%, of hypertension was 8.2%, and of hypertriglyceridemia was 1.4%.
The researchers collected an average 5.7 dietary records per person over follow-up.
Study limitations, Chazelas and co-authors said, included potential residual confounding despite the adjustments for covariates. They attempted to account for reverse causality by excluding CVD events in the first 3 years of follow-up. Establishing a causal relationship between sugar substitutes and CVD will require replication in other large-scale prospective cohorts and further mechanistic investigation, the team added.
The U.S. is averaging more daily coronavirus cases than at any previous point in the pandemic.
Data from Johns Hopkins University shows the nation’s seven-day average for infections is near 69,000 daily cases. The former highest peak came in July at an average of over 67,000 cases per day.
The development comes as the U.S. has entered the third peak of its outbreak. The weekend saw massive numbers of new cases, with more than 83,000 infections added on both Friday and Saturday.
Photos: Daily Life, Disrupted
The U.S. reports the most infections and fatalities out of any country, with more than 8.6 million infections and over 225,000 deaths, according to Johns Hopkins University’s tracker. Every region is seeing an increase in cases, with the South and the Midwest reporting the majority of new infections, according to data from The COVID Tracking Project.
Experts are concerned that as the country heads deeper into fall and winter, cold weather will push more people indoors, possibly increasing the spread of the virus. The challenge could also be compounded by the flu season.
“We are likely to see a very dense epidemic,” former Food and Drug Administration Commissioner Scott Gottlieb told CNBC on Monday. “I think we are right now at the cusp of what is going to be exponential spread in parts of the country.”
Gottlieb said the U.S. is at a “tipping point” but added that “if we took some aggressive, targeted steps right now we could potentially forestall the worst of it.”
But the Trump administration has a very different message as to the state of the country’s outbreak, with President Donald Trump repeatedly claiming that it is “rounding the corner.”
White House chief of staff Mark Meadows on Sunday said the federal government would focus on developing vaccines and therapeutics rather than controlling the outbreak.
“We are not going to control the pandemic. We are going to control the fact that we get vaccines, therapeutics and other mitigation areas,” Meadows told CNN.
Meanwhile, the virus has infiltrated Vice President Mike Pence’s inner circle, infecting his chief of staff and other top aides, but Pence has decided not to quarantine and is instead continuing on his regular scheduling with Election Day nearing.
They told Herbert that they’d need to put the criteria in place if the coronavirus trend continues, Greg Bell, president of the Utah Hospital Association, told the Tribune.
“At the end of the day, some senior person, versus some healthy young person, probably would not get the nod,” Bell said.
Bell said Utah is suffering from a “phenomenal case growth and spread rate” of Covid-19.
The state reported more than 1,000 new cases per day for the last 12 days. On Sunday, Utah had its highest seven-day average for new daily cases, according to data from Johns Hopkins University.
Since the beginning of the pandemic, more than 104,882 people in Utah have been infected with coronavirus, and at least 572 people have died.
Even before a formal rationing of health care, one Utah mother who suffered a heart attack was delayed in getting adequate treatment due to the Covid-19 surge.
Eventually, Terry was taken to a hospital that had the specialized care she needed, but her condition has gotten worse.
“We’ve seen, in the past couple of weeks, that our health care system is at capacity,” state epidemiologist Dr. Angela Dunn said.
“I don’t know what to do anymore,” she said. “I’m really not trying to scare anyone. I’m just trying to inform you of what’s going on and give you the facts.”
Herbert had one wish for the public:
“I would hope that people will take this seriously,” the governor said.
CNN’s Holly Yan and Martin Savidge contributed to this report.Read More
DentaQuest Partnership and 120 Industry Leaders Create New Framework For More Sustainable Oral Health System
Three Domain Framework is the future of dentistry
Boston, Oct. 26, 2020 (GLOBE NEWSWIRE) — Even as the COVID-19 pandemic exacerbates the nation’s broken oral health care system, it has created an opportunity for the industry to move toward a new, more sustainable model centered around the patient, primary care and prevention. The DentaQuest Partnership for Oral Health Advancement released a report today — based on the work of the Community Oral Health Transformation Initiative learning community — that establishes a primary care-like structure for oral health care delivery, facilitates value-based payment models and enables patients to invest in their own oral health.
120 of the industry’s most prominent organizations and leaders contributed to the development of the Three Domain Framework, which lays out a clear path for providers and practices to expand access to care, improve health outcomes and reduce the cost burdens associated with poor quality of life due to oral disease.
The framework gives patients and dental and medical providers the freedom to collaborate on treatment plans that work best for a given situation within the context of overall health. And it emphasizes patient and provider safety while addressing critical gaps in both patients’ access to care and providers’ financial viability.
“Oral health is directly linked to overall health, but our current system doesn’t reflect that reality,” said Dr. Sean Boynes, vice president of health improvement for the DentaQuest Partnership for Oral Health Advancement. “And COVID-19 has shined a bright spotlight on this flaw. The Three Domain Framework outlines a new approach for oral health — one that focuses on prevention and healthy outcomes, facilitates value-based payment models, and will help address deep disparities in care and access. We are grateful to the many contributors who are working together to put our oral health system on a new and better path. This is the future of dentistry.”
The three domains can be adopted in any order, meaning the care team can determine where to begin. Providers can safely begin shifting their models of dentistry by starting in a domain that supports their unique needs and those of their patients.
Domain One: Advancements in Teledentistry
The pandemic has increased interest in and utilization of teledentistry, but widespread adoption requires defining new treatment codes and rethinking the flow of care for a variety of dental visits. Domain One focuses on the identification, development and adoption of telehealth strategies and builds an accessible evidence-based virtual delivery approach specific to oral health that can enhance disease prevention and whole-person health.
Domain Two: Prioritization of Minimally Invasive Care
The pandemic also sparked interest in Minimally Invasive Care (MIC), as providers sought treatment methods, like sealants and silver diamine fluoride, that limit aerosols and the spread of COVID-19. MIC can reverse or slow early disease stages using a program of anticipatory guidance and collaborative decision-making with patients. Domain Two prioritizes the use of MIC for oral health management and maintenance.
Domain Three: Integration and Personalization of Oral Care Delivery
By Robin Foster and E.J. Mundell
MONDAY, Oct. 26, 2020 (HealthDay News) — As the United States witnessed record-breaking daily coronavirus case counts over the weekend, public health experts warned that hospitals may soon reach a breaking point.
More than 41,000 COVID-19 patients are hospitalized across the country, a 40 percent rise in the past month, The New York Times reported.
But in sharp contrast to the early days of the pandemic, more of these patients are being cared for in sparsely populated parts of the country, where the medical infrastructure isn’t as strong as it is in metropolitan areas, the Times reported.
In Utah last week, hospital administrators warned Gov. Gary Herbert that they would soon have to ration access to intensive care units, and requested state approval for criteria to decide which patients should get priority, The Salt Lake Tribune reported.
“We told him, ‘It looks like we’re going to have to request those be activated if this trend continues,’ and we see no reason why it won’t,” Greg Bell, president of the Utah Hospital Association, told the Tribune, the Times reported.
In Kansas City, medical centers turned away ambulances this month because they had no room for more patients. In Idaho, a hospital that was 99 percent full has warned it might have to send coronavirus patients to hospitals as far away as Seattle and Portland, Ore., the Times reported.
Hospitals in hard-hit parts of the country are resorting to a tactic commonly used during the pandemic as it depletes medical resources: limiting other medical services, the newspaper said.
In Tennessee, the Maury Regional Medical Center on Saturday suspended all elective procedures requiring an overnight stay to make room for COVID-19 patients. In Texas, Gov. Greg Abbott has asked the federal government to authorize the use of a military hospital at Fort Bliss, outside El Paso, to treat civilian non-coronavirus patients, the Times reported. In places like Milwaukee and Salt Lake City, field hospitals are already being opened.
Things will likely get worse: The latest surge of coronavirus infections has brought the seven-day average of new daily cases to heights not seen since the pandemic began, CNN reported.
The seven-day average of new cases hit 68,767 on Sunday, topping the previous peak of 67,293 reported on July 22. Friday and Saturday were record-breaking days, with more than 83,000 new cases added each day, CNN reported.
Remdesivir gets full FDA approval to treat COVID-19
Last week, the antiviral drug remdesivir got full approval from the U.S. Food and Drug Administration. The approval comes after the agency granted it emergency use authorization last spring. It is given intravenously to hospitalized patients.
California-based Gilead Sciences Inc. is selling the drug under the brand name Veklury. It cut the time to recovery from COVID-19 by five days — from 15 days to 10, on average — in a large study led by the U.S. National Institutes of Health, the FDA announced in a statement.
“Today’s approval is