Johnathon Talamantes, of South-Central Los Angeles, broke his hip in a car accident on Oct. 22 and underwent surgery five days later at a public hospital near downtown.
His post-op recovery will keep him in the hospital, L.A. County+USC Medical Center, beyond Election Day, and as he prepared himself for the surgery, he wondered what that would mean.
“One of the first things I asked my nurse this morning was, ‘Oh, how am I going to vote?'” Talamantes, 30, said from his hospital bed the day before the operation.
He initially thought of asking his mom to rummage through a pile of papers at the home he shares with her and bring him the mail-in ballot that he, like all registered California voters, received for this election.
But then staffers at LAC+USC told him about another option: They could help him get an emergency ballot and cast his vote without having to get out of bed. So Talamantes told his mom not to bother.
“I don’t want her coming down here, because of the COVID restrictions,” he said.
California law protects the rights of voters who are in the hospital or other care facilities, or confined at home. It allows them to get help from anyone they choose — other than an employer or a union representative — and to cast an emergency ballot.
In some states, only family members can assist hospitalized patients with voting from the hospital.
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In California, New York and several other states, hospital employees and volunteers can help a patient complete an emergency ballot application. They can pick up the ballot for the patient and deliver the finished ballot back to the election office or deposit it in an official drop box.
In 18 states, the law allows local election boards to send representatives directly to patients’ bedsides, though six of those states have canceled that service this fall because of the COVID-19 pandemic, said Dr. Kelly Wong, founder of Patient Voting, a nonpartisan organization dedicated to increasing turnout among registered voters unexpectedly hospitalized around election time.
The group’s website features an interactive map of the United States with state-by-state information on voting while in the hospital. It also allows patients to check whether they are registered to vote.
Wong, an emergency room resident at Rhode Island Hospital in Providence, recalled that when she was a medical student working in an ER, patients who were about to be admitted to the hospital would tell her, “‘I can’t be admitted; I have let the dogs out, or I’m the sole caretaker of my grandmother.'” Then during the election of 2016, she heard, “‘I can’t stay. I have to go vote.'”
“That really caught my attention,” Wong said. She did research and learned patients could vote in the hospital using an emergency ballot — something none of her co-workers knew. “Our patients don’t know this, she said. “It should be our job to tell them.”
Some U.S. hospitals have been
A recent story in The Washington Post reported on the more than 700 women who’d tested positive for the novel coronavirus and given birth at the BYL Nair Charity Hospital in Mumbai, India. The hospital is a part of a group called PregCovid, which collects data regarding pregnancy and COVID-19.
Here in the United States, health departments reporting cases of COVID-19 during pregnancy to the Centers for Disease Control and Prevention can provide additional information to help us understand its effects during this critical period in a woman’s – and her child’s – life. Yet despite the growing pool of data about the coronavirus, our understanding of the effects of COVID-19 on pregnant women remains limited, which is troubling given that many states are struggling with the pandemic and the high stakes involved for mothers.
While researchers continue to collect and interpret available data, it is important that pregnant women be especially vigilant to protect themselves and their babies, including by – at minimum – taking basic precautions such as practicing social distancing and wearing masks.
As an infectious disease physician who recently gave birth to my new daughter, being pregnant during the coronavirus pandemic posed significant challenges both physically and intellectually. In my field, we practice evidence-based medicine, but with the novel coronavirus, we continue to learn more each day and to update our recommendations based on new information. For now, the evidence indicates that the best tools to help contain the spread of COVID-19 are social distancing and mask-wearing.
As states have opened up and restrictions have been relaxed, however, people may believe that the risks posed by the coronavirus are diminished and go about their lives without taking these precautions. Doing so may be particularly dangerous for pregnant women: Data published in a CDC report just this week found that expectant mothers with symptomatic COVID-19 were more likely than other infected women to end up in the ICU, to require invasive ventilation and to die.
In addition, the coronavirus may cause poor pregnancy outcomes such as preterm birth. While the CDC may update its information as more becomes available, these possibilities are concerning.
Meanwhile, one of the growing hopes to prevent the coronavirus’ spread is a vaccine. Yet the release of one may not be a panacea for pregnant women, who have been excluded from clinical trials. Given this, it will take some time before we understand if these vaccines are safe for mothers and their babies, so pregnant women may be advised against getting a vaccine should one otherwise become available.
Expectant mothers who previously had COVID-19 also aren’t necessarily in the clear, as the current science is still evolving regarding immunity from COVID-19 once a person has recovered from the disease. Though rare, there have been cases of people reportedly becoming reinfected, and even a recent reported case of someone who died after reinfection.
Given the potential risk associated with the virus, some health care professionals have separated moms from their newborns
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
As COVID-19 took hold in March, U.S. doctors limited in-person appointments — and many patients avoided them — for fear of infection. The result was a huge increase in the volume of remote medical and behavioral health visits.
Doctors, hospitals and mental health providers across the country reported a 50- to 175-fold rise in the number of virtual visits, according to a report released in May by the consulting firm McKinsey & Co.
The COVID-fueled surge has tapered off as patients venture back to doctors’ offices. But medical professionals and health experts predict that when the pandemic is over, telehealth will still play a much larger role than before.
“There are still a few doubting Thomases, but now that we’ve run our practices this way for three months, people have learned that it’s pretty useful,” says Dr. Joseph Kvedar, president of the American Telemedicine Association and a practicing dermatologist who teaches at Harvard Medical School in Boston.
For patients, the advantages of telemedicine are clear: You typically can get an appointment sooner, in the safety of your own home or workplace, saving time and money on gas and parking — in some cases, even avoiding a loss in wages for missing work.
James Wolfrom, a 69-year-old retired postal executive in San Francisco, has had mostly virtual health care appointments since the pandemic started. He particularly appreciates the video visits.
“It’s just like I’m in the room with the doctor, with all of the benefits and none of the disadvantages of having to haul my body over to the facility,” says Wolfrom, who has Type 2 diabetes. “Even after the pandemic, I’m going to prefer doing the video conferencing over having to go there.”
Telemedicine also provides care for people in rural areas who live far from medical facilities.
The growth of virtual care has been facilitated by Medicare rule changes for the COVID-19 emergency, including one that reimburses doctors for telemedicine at the same rate as in-person care for an expanded list of services. State regulators and commercial health plans also loosened their telehealth policies.
In California, the Department of Managed Health Care, which regulates health plans covering the vast majority of the state’s insured residents, requires commercial plans and most Medi-Cal managed care plans during the pandemic to pay providers for telehealth at parity with regular appointments and limit cost sharing by patients to no more than what they would pay for in-person visits. Starting Jan. 1, a state law — AB-744 — will make that permanent for commercial plans.
Five other states — Delaware, Georgia, Hawaii, Minnesota and New Mexico — have pay-parity laws already in effect, according to Mei Wa Kwong, executive director of the Center for Connected Health Policy. Washington state has one that also will begin Jan. 1.
If you are planning a telehealth appointment, be sure to ask your health plan if it is covered and how much the copay or coinsurance will be. The appointment may be through your in-network provider or a
What is also undeniable is how ill-prepared the health system seems to be to meaningfully help these COVID “long haulers” return to wellness. In fact, the presentation of this apparent post-viral syndrome has stumped experts and clinicians who have struggled to find guidance on how to treat the condition. This hard reality has prompted long haulers to create or join social media-based support groups in search of answers, advice or, at the very least, solidarity.
The question, then, is: Why are we so stumped by these post-COVID long haulers?
Many medical providers have not received training on how to diagnose or treat the types of complex multiorgan disease triggered through the disruption of immune, endocrine, nervous and cardiovascular systems. Moreover, this lack of training has perpetuated the stigma that ME/CFS and similar conditions are not real. This is aggravated by the lack of a diagnostic test and the fact that most of the usual medical tests, ordered for nonspecific symptoms such as fatigue, are likely to show no abnormalities.
Although these results can provide relief that the cause of a patient’s problems is not cancer or organ failure, the related “everything seems to be fine” talk minimizes the patients’ symptoms, invalidates their experiences and marks the beginning of a lonely road. Patients blame themselves for not shaking symptoms off. As time goes by, they may perceive or be outright told that their symptoms are psychological, implying they just need to try harder to feel better. Since ME/CFS appears to be an inflammatory brain condition that can also cause anxiety or depressive symptoms, many patients are referred to mental health services, reinforcing the perception that the problem must be “in their heads”.
To be sure, there is increasing recognition that treating post-COVID-19 syndrome will require biologic and holistic approaches, as well as extensive research. These insights have led to the creation of treatment centers to try to assist these patients. Experts have published management guidelines that can aid these centers.
However, initial approaches may create challenges. Although protocols that emphasize physical therapy and cardiovascular and respiratory rehabilitation offer a correct approach in general – particularly for those who were hospitalized – there are important caveats. Many patients with disabling symptoms will have normal respiratory and cardiac function, and related tests, although necessary, may not clarify the cause.
In addition, the traditional type of physical therapy recommended for ME/CFS by what is now considered a flawed study can backfire and make symptoms worse. In fact, research has shown that pacing is a pivotal component in the management of ME/CFS. Rehabilitation should be personalized, go slow and be monitored for relapse, recognizing that neuroinflammatory illness can “flame on” when pushed too hard.
As physicians and investigators ourselves, we understand the challenges of creating treatment guidelines in the absence of a significant body of research. However, while studies are being conducted, we ought to use the evidence that does exist on ME/CFS and related conditions, such as mast cell activation, to deploy the multidisciplinary