rules

fitness

‘Nobody wants to see the gyms shut down’: Fitness centers cope with new COVID masking rules

RedZone Fitness in Weston has never known life without restrictions.

The gym opened in July, in the midst of the COVID-19 pandemic, and the facility’s members and staff have had to grapple with sanitizing, masking and socially distancing requirements ever since. That said, given the smallness of classes, patrons were able to stay far enough apart that they didn’t have to wear masks while working out, said Elana Goldblatt, part owner, studio manager and lead coach at RedZone Fitness

“People had to wear a mask while walking to their spot (and elsewhere in the gym),” Goldblatt said — just not while working out.

That has changed.

On Nov. 20, Gov. Ned Lamont signed an executive order that, among things, required patrons of all gyms and fitness centers in the state to wear masks at all times, “with no exceptions.”

Previously, establishments didn’t have to require that patrons wear a mask during workouts as long as they maintained at least 12 feet of social distance while exercising. The capacity limit at gyms was also reduced, from 50 percent to 25 percent.

The new regulations are an attempt to curb the spread of COVID-19 in Connecticut, which has spiked over the past several weeks. Requiring face coverings at all times can be potentially helpful in the gym environment, said Keith Grant, senior system director of infection prevention for Hartford HealthCare.

“One of the primary (COVID-19) symptoms that we’re most concerned with is coughing,” Grant said during a Tuesday press conference. “The mechanics of coughing is moving the actual particles forward. That is also seen with an increase in the rate of breathing, such as that which happen with exercising.”

Wearing a mask can help prevent those particles from being pushed out, and can keep spread down, Grant said.

Goldblatt said the new restrictions pose some challenges for clients. The gym offers different classes every day and, on Monday, the first day of classes at the gym following the mask requirement, RedZone had a cardio workout class.

“It was hard on Monday because it was a very intense day and the very first day (people were) wearing a mask to work out,” Goldblatt said. “But I think the longer you wear mask while working out, the easier it is. It’s like working out — the first day you do it is going be harder than the fifth day.”

It is another hurdle at a time that’s been full of them, but Goldblatt said if the new guidelines allow gyms like RedZone to remain operational, she and her clients will try to take them in stride.

“We are open,” Goldblatt said. “We still have clients. I will take this as a win.”

Greta Wagner, executive director of Chelsea Piers in Stamford, had a similar attitude. Before the new regulations, she said, “We had a few mask-free zones where people could work out because we had 12-foot distancing. It was very appreciated by clients. It made it much more enjoyable, when people could work out

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dentist

Quebec dentist kicked out of Cayman Islands for breaking quarantine rules



a man standing next to a body of water: Pascal Terjanian and his partner Christina Gurunian are not allowed to return to the Cayman Islands while COVID-19 restrictions are in place.


© Provided by The Gazette
Pascal Terjanian and his partner Christina Gurunian are not allowed to return to the Cayman Islands while COVID-19 restrictions are in place.

A Quebec dentist and his partner have been booted out of the Cayman Islands after breaking the territory’s quarantine rules.

Dr. Pascal Terjanian, a controversial dentist who practises in Terrebonne, and Christina Gurunian pleaded guilty to the charge and were each fined $1,000, according to local media reports.

The couple arrived in the Cayman Islands on Nov. 13 and breached quarantine rules several times.

Terjanian, 52, and Gurunian, 34, both pleaded guilty during a court appearance via a video link on Monday.

Upon arrival at the airport, they were fitted with electronic tracker wristbands and escorted to an apartment complex where they were supposed to isolate for 14 days because of the pandemic.

Police were called to the complex after staff notified them that the couple had left the apartment.

Gurunian failed to wear her mask upon arrival at the complex and on several other occasions when she walked from her apartment to put garbage in the dumpster, a Cayman news outlet reported.

The couple were also observed outside their apartment without their wristbands and were filmed swimming in the ocean. On another occasion, Gurunian jumped the complex’s wall to go grocery shopping.

The couple are not allowed to return to the islands while COVID-19 restrictions are in place.

Following the incident, the government will now require travellers to pass through an additional checkpoint at the airport to ensure the tracking bracelet has been fitted correctly, Dr. Tasha Ebanks-Garcia, the director of Travel Cayman, said in a news release.

Terjanian, who was once called a public menace by the Quebec Order of Dentists , has been the subject of many complaints about pricey, shoddy and painful dental work dating back to 1997.

In 2014, he was suspended from practising dentistry for 30 months after a disciplinary committee found him guilty of 38 infractions.

The board said the suspension was warranted “considering the gravity of the infractions and the apparent absence of remorse … and the possibility of recidivism,” the Montreal Gazette reported at the time.

During the investigation, Terjanian blocked attempts to investigate him by refusing to answer questions or hand over proper documentation.

In July 2010, he was suspended for sexual relations with a patient. The suspension was lifted the following month.

In an interview with the Montreal Gazette in 2015, Terjanian conceded overcharging and possibly doing an unnecessary root canal. He also admitted to having sex with the mother of a patient.

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health

California voters reject new rules for dialysis clinics

SAN FRANCISCO (AP) — California voters have rejected a ballot measure to require a doctor or highly trained nurse at each of California’s 600 dialysis clinics.

With more than 9 million votes tallied Tuesday, Proposition 23 had just 37% of votes. It is the second measure seeking to regulate dialysis clinics placed on the ballot in recent years by unions that represent health care workers and drew more than $110 million in spending.

Opponents, financed by dialysis clinic companies, say that under that mandate, between two and three doctors would be required at every facility because most are open at least 16 hours a day, creating a financial burden that could lead some clinics to close.


Proposition 23 was the second attempt by the unions to increase regulation of dialysis clinics in California, where DaVita Inc. and Fresenius Medical Care — two of the country’s largest for-profit dialysis providers — operate about three-quarters of the state’s dialysis market.

THIS IS A BREAKING NEWS UPDATE. AP’s earlier story follows below.

SAN FRANCISCO (AP) — California voters are deciding whether to require a doctor or highly trained nurse at each of the state’s 600 dialysis clinics whenever patients are being treated to improve patient care.

Proposition 23 was placed on the ballot by unions that represent health care workers and has attracted more than $110 million in political spending to persuade voters.

Opponents, financed by dialysis clinic companies, say that under that mandate, between two and three doctors would be required at every facility because most are open at least 16 hours a day, creating a financial burden that could lead some clinics to close.

Proposition 23 is the second attempt by the unions to increase regulation of dialysis clinics in California, where DaVita Inc. and Fresenius Medical Care — two of the country’s largest for-profit dialysis providers — operate about three-quarters of the state’s dialysis market.

In 2018, a separate initiative sought to cap dialysis clinics’ profits and force them to invest more of their profits in patient care. Voters rejected the measure, which became the most expensive initiative on the 2018 ballot and one of the most expensive in history, generating more than $130 million in campaign spending: $111 million from dialysis companies and $19 million from unions.

This time around, unions have raised nearly $9 million, while the coalition against Proposition 23 — led by DaVita and Fresenius, along with the California Medical Association and American Nurses Association-California — has raised more than $105 million.

The nonpartisan Legislative Analyst’s Office estimates dialysis companies make roughly $3 billion a year from their California operations.

Dialysis providers say most California clinics offer high-quality care and are regulated by federal and state authorities. They also point out that all patients already have a nephrologist — a kidney specialist who oversees their care — and that nephrologists direct each California clinic. Both initiatives have been part of a tactic to pressure dialysis companies to unionize workers.

Dialysis patients typically undergo four-hour treatments at

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health

When are Medicare secondary payers? Insurers, claims, rules, and more

Medicare beneficiaries do not have to rely exclusively on Medicare for their healthcare coverage. People can use other insurance plans to allow them access to more services and lower their healthcare spending.

If someone has two different forms of coverage, the primary payer covers most costs, and the secondary payer then steps in to cover some or all remaining expenses.

With Medicare, secondary payers contribute to copayments and coinsurance. Usually, Medicare is the primary payer, although sometimes it can act as the secondary payer.

This article looks at Medicare as a secondary payer and how it works with other insurers. It also discusses the benefits of having two insurers and who pays first. It then looks at how the claims process works with both primary and secondary payers.

We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:

  • Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
  • Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
  • Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.

A person can choose to have more than one insurance plan to cover their healthcare costs and Medicare works with other insurance providers to give people comprehensive coverage.

Each insurance pays their share of the healthcare service or products that someone receives.

Medicare secondary payer (MSP) means that another insurer pays for healthcare services first, making them the primary payer.

The secondary payer covers some or all of the remaining costs that the primary payer leaves unpaid.

When someone has two insurers, they benefit from broader healthcare coverage. Each insurer could cover services that the other does not, such as dental care, eye examinations, or alternative health therapies.

As an example, a primary insurer may offer prescription drug coverage, meaning that a person with original Medicare would not need a separate Medicare Part D plan or a Medicare Advantage plan that includes prescription drug coverage. This could lower a person’s overall healthcare costs.

If someone needs to stay in a hospital or a nursing facility for a long time, they may find it beneficial to have two insurers. For example, an individual’s primary insurer would pay up to their limits, and Medicare Part A benefits would kick in much later, extending the coverage period.

Having two insurance plans could mean a person has two monthly premiums. For most Medicare beneficiaries, this means they have the standard Part B premium, plus the premium for the primary insurer.

Careful consideration of the overall costs could mean a person’s expenses increase or decrease with a secondary insurance plan, but since a secondary payer could cover most out-of-pocket expenses, a person may find they save money despite paying two premiums.

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health

PM under pressure to toughen rules after highest death toll since May



a person standing in front of a building: Nottingham is set to join large areas of the North in Tier 3


© Getty
Nottingham is set to join large areas of the North in Tier 3

The prime minister is under mounting pressure to bring in tougher coronavirus rules after UK deaths hit their highest level for five months.

There were 367 deaths linked to the virus recorded on Tuesday, and nearly 23,000 more cases.

Downing Street has not rebuffed an internal projection from its SAGE experts that this winter could see more fatalities than the spring, with a spokesman calling latest figures “concerning”.



a man wearing a suit and tie: Boris Johnson is said to be under 'intense lobbying' to take action


© Getty
Boris Johnson is said to be under ‘intense lobbying’ to take action

The prime minister is coming under “intense” lobbying from experts such as chief scientific adviser Sir Patrick Vallance to ramp up restrictions, according to The Daily Telegraph.

It says government advisers fear that daily deaths could remain in the hundreds for at least three months.

They have also warned that the whole of England will need to be under the toughest Tier 3 restrictions by mid-December, The Sun reports.

The current official count of COVID-related deaths in the UK is nearly 59,000.

Dr Yvonne Doyle, medical director of Public Health England, warned on Tuesday that rising deaths were likely to “continue for some time”.

As the effort to suppress the rise in cases and deaths continues, West Yorkshire is rumoured to be the next heading for Tier 3 coronavirus rules – meaning extra restrictions on household mixing and shutting pubs that don’t serve food.

Warrington entered the top tier on Tuesday, while the Nottingham area is set to join from Thursday.

Liverpool City Region, Greater Manchester, Lancashire and South Yorkshire are already in Tier 3.

Staffordshire, meanwhile, is in line to be upgraded to Tier 2 – meaning no indoors household mixing – as soon as the weekend.

It means more than eight million people could be under the strictest lockdown by the end of the week, prompting calls for clarity on how the restrictions will be eased.

The concerns over a North-South divide has prompted Tory MPs in the new Northern Research Group to write to Boris Johnson urging a “clear road map” out of the lockdown.

Head of the group, Jake Berry, said “the cost of Covid and the virus itself threatens to send the North into reverse”.

It comes as the chair of the UK Vaccine Taskforce warned that the first generation of vaccines “is likely to be imperfect” and that they “might not work for everyone”.

Kate Bingham cautioned against over-optimism and said any vaccine might not work for everyone, or for very long.

In other significant coronavirus developments, France is said to be on the verge of another blanket national lockdown.

President Macron will address the nation later after the country’s death toll reached 523 – the highest since April – while cases topped 33,000.

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fitness

Federal judge rules against gym owner who sued CA governor

The front entrance at Fitness System’s health club in Sacramento, with a copy of the Bill of Rights taped to the door. A federal judge dismissed a lawsuit Tuesday, Oct. 27, 2020, that the owner had filed against California Gov. Gavin Newsom and other officials because of COVID-19 shutdowns. 

The front entrance at Fitness System’s health club in Sacramento, with a copy of the Bill of Rights taped to the door. A federal judge dismissed a lawsuit Tuesday, Oct. 27, 2020, that the owner had filed against California Gov. Gavin Newsom and other officials because of COVID-19 shutdowns. 

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A federal judge on Tuesday dismissed a lawsuit against Gov. Gavin Newsom and San Joaquin County and Lodi officials that had been filed by the owner of three Sacramento-area gyms after officials ordered the shutdown of fitness centers last spring because of COVID-19.

After a Zoom hearing in Sacramento federal court, U.S. District Judge John A. Mendez agreed to requests by the defendants that the lawsuit be dismissed and found that the coronavirus pandemic was so dangerous that officials were within their authority when they first ordered the closures.

The orders were “a constitutional response to an unprecedented pandemic,” Mendez said.

Attorney John Killeen argued for the state that since Newsom’s original stay-at-home orders the state has loosened restrictions on fitness centers, including allowing some outdoor exercising and indoor workouts in San Joaquin County at 10% of capacity.

“A number of restrictions have been lifted,” Mendez said.

“I just don’t see any basis for allowing this lawsuit to go forward in the district court,” he added.

The suit was brought by Sean Covell, owner of Fitness System gyms in Land Park, West Sacramento and Lodi, and argued that the shutdown orders violated the Constitution and were costing his operations huge amounts of revenues and lost memberships.

The lawsuit was one of numerous complaints filed by fitness centers, churches and businesses against orders Newsom and health officials issued to combat the spread of COVID-19.

The lawsuits have largely been unsuccessful, although some are pending and yet another involving gyms in Dixon and Sacramento was filed in federal court in Sacramento on Monday.

Sam Stanton has worked for The Bee since 1991 and has covered a variety of issues, including politics, criminal justice and breaking news.

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health

Government Payment Rules Are the Culprit on Infusion

Scientists work with a bioreactor at a Regeneron Pharmaceuticals facility in New York, Oct. 2.



Photo:

/Associated Press

Regarding Drs. Scott Gottlieb and Mark McClellan’s “Where Do I Go to Get My Covid Antibody Cocktail?”(op-ed, Oct. 19): They are right regarding the need for the government to prime the pump to stimulate the development of private infusion clinics for Covid patients. However, they overstate the associated problems.

Infusion clinics are quite simple, requiring only a room, one registered nurse, four patients and IV poles. Infusion pumps are generally not necessary. The big issue is the Centers for Medicare & Medicaid Services’ payment scheme for professional services, which is in the range of $60-$70 per infusion, regardless of how long it takes (many exceed four hours for allergy and neurology services). Hence, the profit in such centers hinges on the split between the cost of the drug and the amount a payor gets reimbursed for it. In such circumstances, volume is the key to financial stability.

If CMS will change its reimbursement methodology to reimburse professional services by the hour infused, and reimburse for drugs with modest profit for the provider, there will be no shortage of clinics.

Robert Chiffelle

Phoenix

Copyright ©2020 Dow Jones & Company, Inc. All Rights Reserved. 87990cbe856818d5eddac44c7b1cdeb8

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health

New outbreak delays easing of rules in Melbourne

MELBOURNE, Australia — A COVID-19 outbreak in the north of Melbourne has led health authorities in Australia’s Victoria state to hold off on any further easing of restrictions in the beleaguered city.

Victoria Premier Daniel Andrews withheld any announcement on an easing on Sunday as the state awaits results on 3,000 people who were tested in the city’s north in the past 24 hours.

He described it as a “cautious pause” – not a setback – to rule out there wasn’t widespread community transmission linked to the cluster.

Among the current restrictions are mandatory wearing of masks and no traveling beyond 25 kilometers (15 miles) from home. At the start of the second wave of cases two months ago, Andrews instituted an overnight curfew and shut down most businesses.

“I know it is frustrating,” Andrews said. “I know people are keen to have a long and detailed list of changes to the rules. It is not appropriate for us to do that now.”″

Victoria reported seven new coronavirus cases on Sunday, with six linked to the latest outbreak, which involves 39 people across 11 households.

No additional deaths kept the state toll at 817 and the national toll at 905.

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HERE’S WHAT YOU NEED TO KNOW ABOUT THE VIRUS OUTBREAK:

— Surging coronavirus colors White House race in closing days

— Europe, US watch case totals grow, debate new restrictions

— Colombia reaches 1 million confirmed coronavirus cases

— Iran’s supreme leader has urged authorities to prioritize public health above any economic or security concerns, amid the Mideast’s worst outbreak of the coronavirus. Iran’s death toll from the global pandemic topped 32,000 this week.

— Pope Francis met with the Spanish prime minister Saturday at the Vatican, which has had a rash of COVID-19 infections confirmed in recent days, but neither man used a face a mask during the public part of their meeting.

— Poland’s President Andrzej Duda has tested positive for the coronavirus; apologizes to those in quarantine because of contact, including Poland’s recent French Open winner.

— Police force in England says it will try to stop people from leaving Wales, which has started a 17-day lockdown to slow a surging rate of coronavirus infections.

___

Follow all of AP’s coronavirus pandemic coverage at http://apnews.com/VirusOutbreak and https://apnews.com/UnderstandingtheOutbreak

___

HERE’S WHAT ELSE IS HAPPENING:

COLOMBO, Sri Lanka — Sri Lankan authorities have terminated a number of passenger trains and widened the curfew as COVID-19 cases related to a new cluster at a garment factory continue to surge.

The Railway Department canceled at least 16 trains — mostly ran through busy office hours — after the number of commuters declined due to the curfew imposed in many parts of the country.

More than a dozen villages are isolated in densely populated Western province, which includes capital Colombo.

Authorities last week closed the island’s main fish market on Colombo’s outskirts after 49 traders tested positive for the coronavirus. By Sunday, the number of cases from the fish

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health

Hospitals are full but some parts of Idaho refuse mask rules

BOISE, Idaho (AP) — Moments after hearing an Idaho hospital was overwhelmed by COVID-19 patients and looking at sending people as far away as Seattle for care, members of a regional health department board voted Thursday to repeal a local mask mandate.

“Most of our medical surgical beds at Kootenai Health are full,” Panhandle Health District epidemiologist Jeff Lee told board members in the state’s third most populated county.

The hospital in Coeur d’Alene reached 99% capacity a day earlier, even after doubling up patients in rooms and buying more hospital beds. Idaho is one of several states where a surge of COVID-19 infections is overwhelming hospitals, likely in part because cooler weather is sending people indoors, U.S. health officials said.

“We’re facing staff shortages, and we have a lot of physician fatigue. This has been going on for seven months — we’re tired,” Lee said.


He introduced several doctors who testified about the struggle COVID-19 patients face, the burden on hospitals and how masks reduce the spread of the virus.

But the board voted 4-3 to end the mask mandate. Board members overseeing the operations of Idaho’s public health districts are appointed by county commissioners and not required to have any medical experience.

Board member Walt Kirby said he was giving up on the idea of controlling the spread of coronavirus.

“I personally do not care whether anybody wears a mask or not. If they want to be dumb enough to walk around and expose themselves and others, that’s fine with me,” Kirby said. “Nobody’s wearing the damned mask anyway. … I’m sitting back and watching them catch it and die. Hopefully I’ll live through it.”

Another member, Allen Banks, denied COVID-19 exists.

“Something’s making these people sick, and I’m pretty sure that it’s not coronavirus, so the question that you should be asking is, ‘What’s making them sick?’” he told the medical professionals who testified.

Similar scenes — with doctors and nurses asking officials for help, only to be met with reluctance or even open skepticism — have played out across the conservative state. Idaho is sixth in the nation for new coronavirus cases per capita, with the average number of confirmed cases increasing by more than 55% every day over the past two weeks.

Still, Republican Gov. Brad Little has declined to issue a statewide mask mandate or limit crowd sizes beyond requiring social distancing at large events and in businesses, which is seldom enforced. Instead, Little has left it up to local health departments and school districts to make the tough decisions that sometimes come with blowback from the public.

In the southern city of Twin Falls, hospital officials told health board members this week that they too were in danger of being overwhelmed, with one out of every four hospitalized patients sick with COVID-19. The region’s hospitals, operated by St. Luke’s Health System, have been forced to postpone non-emergency surgeries and ship patients elsewhere.

“I want to be very clear: Punting those decisions is saying

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health

Israel Confronts Revolt as Ultraorthodox Defy Covid Public-Health Rules

JERUSALEM—As Israel eases its second nationwide lockdown, a revolt among ultra-Orthodox Jews against public health guidelines is complicating efforts to control the coronavirus outbreak.

Across Israel, schools and most businesses are closed. People are required to wear masks in public, and outdoor gatherings over 20 people are banned. Police and city inspectors patrol the streets, handing out fines to rule breakers. Signs on highway banners and city billboards remind people to wear masks and social distance.

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But on a bright autumn morning in Jerusalem’s ultraorthodox stronghold of Mea Shearim, no police patrolled the narrow alleyways closed off behind stone walls. Thousands of children crowded into schools, and men, young and old, returned to their religious seminaries known as yeshivas, where they study all day. The only common sign in the neighborhood that mentions coronavirus is an advertisement for free ginger to boost the immune system.

“After eight months of not doing what we’re told to do by my government, we’re still alive and healthy, so there’s no reason to close the Torah institutes,” said one ultraorthodox man in his 20s who was chatting outside a yeshiva.

A deep distrust of the government and a desire to preserve a way of life is fueling a broad—but not uniform—backlash against government efforts to impose public health guidelines on the ultraorthodox community. Many members of the community also suspect the virus isn’t so dangerous as to disrupt the rhythms of their insular and conservative communities, in which many men study religion all day rather than work and gather thrice daily for collective prayers.

“When the number of deaths isn’t as large as has been purported, the community prefers slight physical damage rather than a massive spiritual blow,” says Rabbi Pinchas Zaltzman, a religious judge in the ultraorthodox city of Bnei Brak.

The death rate per 1,000 individuals in the ultraorthodox community is about half the rest of the country.



Photo:

atef safadi/Shutterstock

The ultraorthodox community hasn’t been immune from the virus that causes Covid-19. While the ultraorthodox make up around 12.5% of the population, they have accounted for up to 65% of infections nationwide in the first wave in the spring and more than 40% in the current second wave, according to a study based on the Ministry of Health data by Eran Segal, a computational biologist at the Weizmann Institute of Science based in central Israel. At the same time, the death rate per 1,000 individuals in the ultraorthodox sector is about half the rest of the country, largely because government figures show it is a much younger population.

After four weeks of a second nationwide lockdown, Israel was able to reduce the infection rate from more than 8,000 new cases a day to under 1,500. Now Israeli health officials fear the ultraorthodox decision to prematurely open the schools and religious seminaries could lead to yet another lockdown.

“If the

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