Mister Rogers-type nice isn't working in many parts of the country. It's time to make people scared and uncomfortable. It's time for some sharp, focused, terrifying realism.
This story was published on Wednesday, December 9, 2020 in Kaiser Health News.
I still remember exactly where I was sitting decades ago, during the short film shown in class: For a few painful minutes, we watched a woman talking mechanically, raspily through a hole in her throat, pausing occasionally to gasp for air.
The public service message: This is what can happen if you smoke.
I had nightmares about that ad, which today would most likely be tagged with a trigger warning or deemed unsuitable for children. But it was supremely effective: I never started smoking and doubt that few if any of my horrified classmates did either.
When the government required television and radio stations to give $75 million in free airtime for antismoking ads between 1967 and 1970 — many of them terrifyingly graphic — smoking rates plummeted. Since then, numerous smoking "scare" campaigns have proved successful. Some even featured celebrities, like Yul Brynner's posthumous offering with a warning after he died from lung cancer: "Now that I'm gone, don't smoke, whatever you do, just don't smoke."
As the United States faces out-of-control spikes from COVID-19, with people refusing to take recommended, often even mandated, precautions, our public health announcements from governments, medical groups and health care companies feel lame compared with the urgency of the moment. A mix of clever catchphrases, scientific information and calls to civic duty, they are virtuous and profoundly dull.
The Centers for Disease Control and Prevention urges people to wear masks in videosthat feature scientists and doctors talking about wanting to send kids safely to school or protecting freedom.
Quest Diagnostics made a video featuring people washing their hands, talking on the phone, playing checkers. The message: "Come together by spending time apart."
As cases were mounting in September, the Michigan government produced videos with the exhortation, "Spread Hope, Not Covid," urging Michiganders to put on a mask "for your community and country."
Forget that. Mister Rogers-type nice isn't working in many parts of the country. It's time to make people scared and uncomfortable. It's time for some sharp, focused, terrifying realism.
"Fear appeals can be very effective," said Jay Van Bavel, associate professor of psychology at New York University, who co-authored a paper in Nature about howsocial science could support COVID response efforts. (They may not be needed as much in places like New York, he noted, where people experienced the constant sirens and the makeshift hospitals.)
I'm not talking fear-mongering, but showing in a straightforward and graphic way what can happen with the virus.
From what I could find, the state of California came close to showing the urgency: a soft-focus videoof a person on a ventilator, featuring the sound of a breathing machine, but not a face. It exhorted people to wear a mask for their friends, moms and grandpas.
But maybe we need a PSA featuring someone actually on a ventilator in the hospital. You might see that person "bucking the vent" — bodies naturally rebel against the machine forcing pressurized oxygen into the lungs, which is why patients are typically sedated.
(Because I had witnessed this suffering as a practicing doctor, I was always upfront about the trauma with loved ones of terminally ill patients when they were trying to decide whether to consent to a relative being put on a ventilator. It sounds as easy as hooking someone to an IV. It's not.)
Another message could feature a patient lying in an ICU bed, immobile, tubes in the groin, with a mask delivering 100% oxygen over the mouth and nose — eyes wide with fear, watching the saturation numbers rise and dip on the monitor over the bed.
Maybe some PSAs should feature a so-called COVID long hauler, the 5% to 10% of people for whom recovery takes months. Perhaps a professional athlete like the National Football League's Ryquell Armstead, 24, who has been in and out of the hospital with serious lung issues and missed the season.
These PSAs might sound harsh, but they might overcome our natural denial. "One consistent research finding is that even when people see and understand risks, they underestimate the risks to themselves," Van Bavel said. Graphs, statistics and reasonable explanations don't do it. They haven't done it.
Only after Chris Christie, an adviser to President Donald Trump, experienced COVID, did he start preachingabout mask-wearing: "When you have seven days in isolation in an ICU, though, you have time to do a lot of thinking," Christie said, suggesting that people, "follow CDC guidelines in public no matter where you are and wear a mask to protect yourself and others."
We hear from many who resist taking precautions. They say, "I know someone who had it and it's not so bad." Or, "It's just like the flu."
Sure, most longtime smokers don't end up with lung cancer — or tethered to an oxygen tank — either. (That, in fact, was the justification of smokers like my father, whose two-pack-a-day habit contributed to his death at 47 of a heart attack.)
These new ads will seem hard to watch. "We live in a Pixar era," Van Bavel reflected, with traditional fairy tales now stripped of their gore and violence.
But studies have shown that emotional ads featuring personal stories about the effects of smoking were the most effective at persuading folks to quit. And quitting smoking is much harder than maintaining physical distance and mask-wearing.
Once a vaccine has proved successful and enough people are vaccinated, the pandemic may well be in the rearview mirror. In the meantime, the creators of public health messaging should stop favoring the cute, warm and dull. And — at least sometimes — scare you.
Committees responsible for vetting HHS nominations may not hold hearings on Biden's pick to lead HHS, until the Senate approves organizational details for the new Congress.
This article was published on Tuesday, December 8, 2020 in Kaiser Health News.
Senate Republicans are signaling they will delay considering President-elect Joe Biden's nominee to run the Department of Health and Human Services, threatening to slow the Biden administration's response to the pandemic that has killed more than 283,000 Americans.
On Monday, Republican spokespeople for the committees responsible for vetting HHS nominations said the Senate may not hold hearings on California Attorney General Xavier Becerra, Biden's pick to lead the department, until the Senate approves committee assignments and other organizational details for the new Congress.
Republicans, who will hold at least 50 seats next year, remain in control of the Senate until Jan. 20. But Georgia has two Senate runoff elections scheduled for Jan. 5, and those results will determine which party controls the chamber in the new, 117th Congress.
Political observers say the results could take days or even weeks.
"Every day is a wasted day," said Kathleen Sebelius, who served as President Barack Obama's first HHS secretary. (Sebelius is on the board of KFF, and KHN is an editorially independent program of KFF.)
On Monday, Biden announced he has asked Becerra to serve as HHS secretary. Becerra mounted a vigorous defense of Democratic health laws against the Trump administration and other Republicans. He led the effort by 20 states and the District of Columbia to fight a suit brought by Republican state officials and supported by President Donald Trump to overturn the Affordable Care Act. That case was argued before the Supreme Court last month.
The early reaction from Republicans signaled Becerra could face strong political opposition to his nomination, with critics like Arkansas Sen. Tom Cotton citing Becerra's opposition to abortion restrictions and calling him "unqualified" to lead HHS.
"I'll be voting no, and Becerra should be rejected by the Senate," he wrote on Twitter. Becerra also supported single-payer healthcare reform.
In addition, Biden intends to name Dr. Rochelle Walensky, chief of infectious diseases at Massachusetts General Hospital, as the head of the Centers for Disease Control and Prevention, and private equity executive Jeffrey Zients to be his COVID "czar" heading up a task force in the White House. Those jobs do not require Senate confirmation. Biden is nominating Dr. Vivek Murthy as surgeon general, who must face hearings before the Senate.
Becerra would be the first Latino to lead HHS. Before becoming attorney general, he served in the House of Representatives, representing Los Angeles for 24 years. There, he was a member of Democratic leadership and served on the Ways and Means Committee, the House committee charged with writing health-related tax policy.
Becerra returned to California in 2017, replacing the outgoing attorney general who had just been elected to the Senate — now Vice President-elect Kamala Harris.
The HHS secretary is responsible for one of the federal government's largest departments, coordinating not only the Centers for Medicare & Medicaid Services but also the Food and Drug Administration and the CDC — agencies critical to the nation's pandemic response.
Although Biden has created his own task force to address the pandemic, the White House lacks many of the powers of the HHS secretary — including the authority to implement its own recommendations, said Donna Shalala, who served as HHS secretary under President Bill Clinton for eight years.
"Any delay [in confirmation] delays COVID, despite a strong White House coordination," Shalala said, "because you've got to get the agencies in sync and you can't do that from the White House."
In 2009, as H1N1 flu began to spread and Obama's first HHS pick withdrew from consideration, the administration was forced to improvise. With no confirmed health secretary, Obama turned to Janet Napolitano, the Homeland Security secretary, to coordinate a plan to distribute vaccines with the CDC.
Sebelius was sworn in as HHS secretary in late April, two days after the Obama administration declared H1N1 a public health emergency.
It would be hard to mount a pandemic response without a secretary, she said. "That pressure falls on Congress," Sebelius said. "There's just a sense we can't screw around with this."
She also added that the Obama administration did not pursue any lower-level health appointments before confirming the secretary, a protocol that left many offices vacant. She expects Biden will follow the same process.
The Senate can, and often does, begin considering nominees before a new president is sworn in, in particular by arranging one-on-one meetings for senators and examining a nominee's qualifications and background. Presidents Donald Trump and George W. Bush's nominees for HHS secretary both received confirmation hearings before Inauguration Day, though Democrats later fought Trump's nominee, then-Rep. Tom Price (R-Ga.), by boycotting his committee vote.
Republicans say that until the Senate approves what is known as an organizing resolution, which formalizes details like which senators sit on which committees, they cannot move forward with confirmation hearings.
A further complication is that while Republicans already control the two committees tasked with vetting an HHS secretary, neither chairman is staying in that job next year. Sen. Lamar Alexander of Tennessee, who runs the Health, Education, Labor and Pensions Committee, is retiring from Congress. And due to term limits, Iowa Sen. Chuck Grassley, who runs the Finance Committee, will move to a different committee.
Senate Democrats, who would take control of the confirmation process next month should they win both of Georgia's Senate seats, praised the selection of Becerra and promised to push for a speedy process.
Becerra "has been a staunch defender of affordable healthcare and preexisting condition protections in the face of Trump's attacks in court and federal regulation," said Oregon Sen. Ron Wyden, the Finance Committee's top Democrat. "I look forward to Attorney General Becerra's hearing in the Finance Committee as soon as possible next year, so he is on the job quickly."
"Xavier Becerra is a highly qualified nominee, and I will be pushing for a swift, fair confirmation so we can get to work on the serious health issues our nation faces," said Sen. Patty Murray of Washington, the HELP Committee's top Democrat.
If Democrats win both of the Georgia elections next month, the Senate would be evenly split 50-50, likely leading to debates about how to divide control and distracting senators from nomination hearings.
When that happened in 2001, Senate Democrats held the majority for a couple of weeks until Bush was sworn in, making Vice President Dick Cheney the tie-breaking vote and giving Republicans the majority on Jan. 20. Bush's first HHS secretary, Tommy Thompson, was confirmed four days later.
Bill Dauster, who advised Democrats on the Senate's procedural rules for decades, said that the split took a long time to negotiate in 2001 but that it left behind a model that senators can use today.
Senate Republicans could follow the precedent of holding hearings before the inauguration, especially due to the urgency of responding to the pandemic, Dauster said.
"If they don't, it will clearly be foot-dragging," he said.
WASHINGTON, Mo. — In August, local officials in this small city an hour west of St. Louis voted against requiring residents to wear masks to prevent the spread of the coronavirus.
On Nov. 23, with COVID cases surging and the local hospital overflowing, the City Council brought a mask order back for another vote. As protesters marched outside, Councilman Nick Obermark, an electrician, was the sole member of the nonpartisan council to change his vote, causing the mandate to pass.
One of his many reasons? He has a child the same age as Washington Middle School student Peyton Baumgarth, 13, who on Halloween became the youngest person in Missouri to die of COVID complications.
"That hit pretty hard," Obermark said later. Though the councilman doesn't like wearing a mask, he said it's worth it if we can keep one or two people from getting COVID-19.
Washington became the latest community to flip its stance on masks and other restrictions while the coronavirus ravages the country.
As America enters a dark winter without national directives to curb the pandemic, numerous cities, counties and states must decide: enact more restrictions now or leave people to their own will? Some in this tightknit city of 14,000 have discovered that the answer — and the key to changing hearts and minds — lies in how close and real the danger seems.
After a spate of nursing home fatalities early on in Franklin County, where Washington is located, two months this summer passed without a death from COVID. Some residents saw the virus as a big-city problem and rejected preventive measures.
Families attended weddings with hundreds of guests. Downtown merchants held "Thirsty Thursday," with participants mingling over drinks. Even as officials at the city's hospital urged COVID restrictions, 356 people signed a letterto the local paper vowing their opposition to being "forced to cover our mouths in public."
Republican Missouri Gov. Mike Parson has declined to enact a statewide mask mandate. Franklin County Presiding County Commissioner Tim Brinker posted on Twitter July 29: "Franklin County MO. No mandates, low case counts, low to no hospitalizations. Logic! Keep hands clean, and if you don't have the space, cover your face. We love Freedom and respect human life. Come to Franklin County and raise your children in God's Country! #COVID."
Embracing freedom and tradition is as expected here as following deer hunting season or attending the Washington Town & Country Fair. The city's downtown, within view of the swirling brown Missouri River, is lined with historical red-brick buildings and quaint shops. The Missouri Meerschaum Co. still produces corn cob pipes on Front Street. Its motto: "Over 150 Years & Still Smokin'."
In the months before the election, yards sprouted signs for President Donald Trump, who has downplayed the threat of COVID-19 since the start of the pandemic.
But the virus crept closer in September when 74-year-old Ralph Struckhoff died of the disease. The Missourian newspaper published a story describing him as a healthy man who had just done a day of construction work at his church before he fell ill. "Please wear a mask in memory of Ralph," his widow, Jayne Struckhoff, wrote in a letter to the editor. "If this virus can take Ralph, it can take down anyone."
Some locals began asking: What would it take for this town to change? University of Missouri health communication assistant professor Yerina Ranjit said many factors influence health decisions. For instance, she said, people usually follow health advice if they believe an illness is serious and that they are susceptible to it.
"That's true with COVID as well," she said. Older people are more likely to wear masks and social distance. But others might not wear masks if they think the virus wouldn't make them very ill.
Symbolic threats, or things that people feel threaten their values, can also affect behavior. In a survey of U.S. adults yet to be published, Ranjit and her colleagues studied media viewing and found that the kind of information people are exposed to makes a real difference. Regardless of political affiliation, they found, Fox News viewers were more likely to think the pandemic threatens the American way of life, which made them less likely to wear masks. They were "buying into the idea that masks are against our identity," she said. On the other hand, people watching MSNBC felt more afraid of the virus, which caused them to wear masks.
But in November, Mayor Sandy Lucy noticed that attitudes were evolving. That's when residents heard about Peyton, the middle schooler, who declined rapidly and died days after being admitted to the hospital, his mother told KMOV. According to his obituary, he was known for his loveof Pokémon Go, flag football and the St. Louis Blues. "He loved his puppies Yadi and Louie who be lost without their buddy," it said. "He loved listening to music and singing in the school choir."
"Suddenly there was a death of a 13-year-old," Lucy said, "and you think, maybe this virus is more vicious than I give it credit for being."
Peyton's mother, Stephanie Franek, pleaded in a TV interview: "Wear a mask when you're in public, wash your hands and know that COVID is real."
Meanwhile, cases skyrocketed. Between the first and second mask votes, the total COVID count in Franklin County, with a population around 104,000, climbed from 728 to 4,594, and deaths rose from 19 to 75. In the week ending Nov. 23, 25% of COVID tests returned positive results.
Mercy Hospital Washington was running out of space. Hospital President Eric Eoloff tied rising hospitalizations and deaths to the absence of safety measures. "As a hospital administrator, I knew we would be on the receiving end of the choices not to wear the masks and not social distancing," he said.
In a surprise move Nov. 19, the Franklin County Board of Commissioners enacted a mandatory mask order. Presiding Commissioner Brinker told The Missourian that he had spoken to local doctors and the St. Louis regional pandemic task force, and the numbers "speak for themselves." Brinker did not respond to requests for comment for this story.
Although the order already applied to the city, the Washington City Council went further and approved its own mask rule four days later. Unlike the county order, which expires Dec. 20, the city's mandate will stay in force based on metrics related to the new COVID case rate, hospital admissions and deaths.
Dozens of protesters wielded flags and signs against mandatory masking outside City Hall the evening of the vote. Ali and Duncan Whittington came with their 4-year-old daughter. "I'm here because I feel my freedom is being violated," Ali Whittington said.
Councilman Obermark later said that he had lost a lot of sleep over his decision. "It wasn't one thing," he said. "It was several things that made me change my mind."
The high positivity rate, the lack of capacity at the hospital. Knowing healthy people whom COVID "knocked down" for days. His wife having to quarantine. And Peyton's death.
He said he knows masks aren't a cure-all, but they could help reduce the spread until vaccines arrive.
"We tried nothing and it isn't working," he said, "so we have to try something."
Although he would bring years of health politics and policy work to the role, none of it comes from front-line experience as an executive or administrator running public health programs, managing patient care or controlling the spread of disease.
This article was published on Tuesday, December 8, 2020 in Kaiser Health News.
Xavier Becerra, President-elect Joe Biden's choice to head the Department of Health and Human Services, is set to be a pandemic-era secretary with no public health experience. Whether that matters depends on whom you ask.
Becerra built his career in the U.S. House of Representatives before becoming California's attorney general, and some wonder whether his political and legal skills would be the right fit to steer HHS through a health catastrophe that's killing thousands of Americans every day.
Although he would bring years of health politics and policy work to the role, none of it comes from front-line experience as an executive or administrator running public health programs, managing patient care or controlling the spread of disease.
Yet beyond the immediate COVID-19 crisis, many Democrats see Becerra as an important ally to undo what they view as years of damage from the Trump administration's efforts to undermine the Affordable Care Act; the Medicaid program, which provides coverage for more than 70 million Americans; reproductive health; and more.
As California's attorney general since 2017, Becerra has been a thorn in the side of the Trump administration, filing 107 lawsuits to overturn federal action on the Affordable Care Act, contraception, immigration, workers' rights, LGBT rights, education, consumer protection, gun violence and the environment.
"COVID is the biggest issue on the table, but it is not the only issue on the table," said Dr. Georges Benjamin, executive director of the American Public Health Association. "If you look at his body of work, he is not your traditional attorney. His body of work in the health area is substantial. And I think that counts."
On Tuesday, Biden will formally introduce Becerra along with other candidates for top health jobs, many with deep public health experience.
They include Dr. Rochelle Walensky, an infectious disease expert at Harvard Medical School who practices at Massachusetts General Hospital in Boston, as the next director of the Centers for Disease Control and Prevention. Biden's choice for COVID "czar" is Jeffrey Zients, a private equity executive and former Obama administration official who will steer the pandemic response from the White House. Dr. Vivek Murthy is the nominee for U.S. surgeon general, a position he held in the final Obama years.
Biden has said he will let the federal government's longtime scientists guide his pandemic response, in particular those at the CDC, which is overseen by HHS. President Donald Trump sidelined the agency, damaging its reputation as the world's most trusted public health institution.
That Becerra's deepest experience is political makes some observers wary.
"I think there's always a danger of letting that sort of cloud the scientific and medical judgment of how best to do things. I hope they can manage that well," said Jeffrey Morris, a biostatistics professor at the University of Pennsylvania who has worked on COVID issues. He said he had mixed feelings about the Becerra selection. "What is the leadership style, and is there going to be micromanaging from the top down into these organizations? To me, that's the key aspect."
Garry South, a Los Angeles-based Democratic strategist, called Becerra's appointment "curious."
"A lot of people are raising eyebrows — even those who are pleased and proud that Biden picked another Californian to join his administration," South said. "If Republicans are looking to target a few Biden appointees for rejection, you can expect them to make the case that there is no logical nexus between a state attorney general and serving as secretary of Health and Human Services."
Still, Becerra, who as a member of Congress worked in the House Democratic leadership and was a member of the powerful Ways and Means Committee, has more health policy background and knowledge of U.S. healthcare finance and delivery systems than many previous heads of the sprawling HHS, which employs more than 80,000 people and has a $1.3 trillion budget.
For three years, Becerra has managed California's Justice Department, with a $1.1 billion budget and 4,800 employees. As attorney general, he's been deeply involved in crafting health policy. His office has gone after anti-competitive behavior from hospitals. And he's sponsored legislation to take on drugmakers and pay-for-delay schemes.
"He's gone after powerful healthcare interests," said Anthony Wright, executive director of the nonprofit Health Access California.
Antitrust enforcement is more commonly handled by the U.S. Department of Justice and the Federal Trade Commission. But Becerra made it a priority as California's top cop. In May 2018, he brought anantitrust case against nonprofit healthcare giant Sutter Health, accusing the system of monopolistic practices that drove up the cost of medical care in Northern California.
"This is a big 'F' deal," Becerra said at a news conference unveiling the lawsuit. The case — which encompassed years of work by the department and his predecessors and millions of pages of documents — alleged that Sutter had aggressively bought up hospitals and physician practices across the region and illegally exploited that market power for profit. Healthcare costs in Northern California, where Sutter dominates with its 24 hospitals, are 20% to 30% higher than in Southern California, even after adjusting for Northern California's higher cost of living, according to a2018 study from the Nicholas C. Petris Center at the University of California-Berkeley that was cited in the complaint.
In December 2019, Sutter agreed to pay $575 million to settle the case and promised to end a host of practices that Becerra alleged stifled competition.
Becerra channeled lessons learned from the Sutter case into anantitrust bill in the California legislature. The legislation ultimately failed, but it would have given the attorney general power to review private equity- or hedge fund-led mergers or acquisitions of a healthcare system or hospital.
"The Sutter case is a blueprint for a national policy that could start to restore competition for the healthcare system and save American healthcare consumers billions of dollars right away," said Glenn Melnick, a healthcare economist at the University of Southern California. He views Becerra as "a real expert in some of the most important issues facing our healthcare system, not just in California but nationally."
If confirmed by the Senate, Becerra supporters say, he will bring to the job a political acumen from his two decades-plus on Capitol Hill that's likely to be an asset for the Biden administration as it negotiates pandemic relief bills and other health legislation with a politically divided Congress.
Former California Democratic member of Congress Henry Waxman worked with nearly a dozen HHS secretaries during his time on the House Energy and Commerce Committee. He said he's not worried that Becerra lacks experience leading a vast healthcare bureaucracy. The HHS secretary job, he said, is one "where you need political skills to see how far you can get with other people in a political context." That's why most HHS secretaries, Republicans and Democrats, have had political backgrounds.
Becerra "understands the policies and has a deep commitment to them," he said. "I think he'll do well."
Public health officials say the job before Becerra is gigantic.
Dr. Gary Pace, the health officer in rural Lake County, California, said Becerra would be tasked with rebuilding a broken public health system.
"We want a federal partner who can give us good guidance — we haven't had that," Pace said. "For him, I'd say what we need first is starting to get the CDC back into a flagship public health role, with trusted and timely evidence-based guidance."
Born in Sacramento to Mexican immigrant parents, Becerra would be the first Latino HHS secretary. He was elected to Congress in his 30s and has been involved in national health legislation during the past two decades, even though he is more widely known for his involvement in immigration and tax issues. He joined the powerful House Ways and Means Committee, which oversees tax and health legislation, in the 1990s. The committee played a central role in the drafting of what would become the Affordable Care Act in 2010.
While HHS oversees major federal health agencies, including the CDC, the Centers for Medicare & Medicaid Services, the Food and Drug Administration and the National Institutes of Health, it also has a wide-ranging human services portfolio, including oversight of child care and welfare programs, Head Start, programs for seniors and refugee resettlement.
"It's not like any one person is going to have everything," said Dan Mendelson, a former Clinton administration health official, who called Becerra an "inspired choice." "I think that the most important point is that this is a leader of a team and not the be-all and end-all."
California Healthline staff writers Rachel Bluth and Samantha Young contributed to this story.
Until October, Andrea LaRew was paying $950 a month for health insurance through her job at the Northwest Douglas County Chamber & Economic Development Corp. in the metro Denver area.
Her company didn’t contribute anything toward the premium. Plus, LaRew and her husband had a steep $13,000 deductible for the plan. But the coverage and the premium cost were in line with other plans available to the company since options for such a small work group — just LaRew and another employee wanted to enroll — weren’t plentiful.
Now they’re trying a new approach. Instead of a traditional plan, the chamber established an “individual coverage health reimbursement arrangement” (sometimes referred to as ICHRA) to which it allocates $100 a month per employee that they must put toward comprehensive coverage on the individual insurance market. These employer contributions may be used to pay for expenses such as premiums or cost sharing.
The reimbursements don’t count as taxable income to workers.
Proponents of the plans say they’re a good option for companies that may not feel they can afford to offer a traditional plan to workers but want to give them something to help with health care expenses. But consumer advocates are concerned they may shortchange some workers.
These small businesses can’t afford to offer health care coverage as the premium prices rise, said Garry Manchulenko, a principal at GMBA Advisors Group in the Denver metro area, who suggested the arrangement to the chamber. “They want to help their employees, but they can’t sustain these increases, particularly at the small-group level.”
Manchulenko said he’s suggesting the new setup for some of his clients, noting that in certain places premiums on the individual market are lower than those for group plans.
LaRew, 48, bought a plan similar to the group plan, but with a monthly price tag of $730 after she factors in the company’s contribution, a savings of more than $2,600 a year.
“It’s still super expensive for two healthy people,” said LaRew, who oversees many of the chamber’s administrative functions. But she appreciates that her premiums are deducted from her pretax income, just as when she was on the group plan.
She also liked having her pick of several plans. “I could choose my own individual plan that suits my family best, and not be tied to a group plan that works great for a co-worker but not for me.”
The new coverage option was established through a rule issued by the Trump administration last year. It could be helpful for workers like LaRew whose income is too high to qualify for the Affordable Care Act’s tax credits that help pay for policies sold on the individual market. It may also be attractive to part-time or seasonal workers who don’t qualify for their employer’s coverage, according to insurance brokers and policy experts familiar with the new option.
But consumer advocates warned that it could encourage employers who had offered a traditional insurance plan to switch to the new arrangement because of the cost savings. That might leave their workers with a more cumbersome enrollment process and less generous coverage.
“I do think there are pitfalls for employees,” said Jason Levitis, a nonresident fellow at the USC-Brookings Schaeffer Initiative for Health Policy. “There’s confusion about the ICHRAs themselves.”
“And even if you know you need an ACA-compliant plan, how do you find one?” he asked, noting the prevalence of deceptive marketing of plans that don’t meet ACA standards.
In addition, because of a quirk in how the new rules work, lower-income workers who bought ACA marketplace plans because their employer didn’t offer coverage could lose the federal subsidies for their marketplace plans if their company puts an ICHRA in place.
Here’s how that could come into play. Only people earning 400% of the federal poverty level or less (about $51,000 for one person) are eligible for premium subsidies. In addition, in order to qualify the coverage offered by an employer must be considered unaffordable to the worker. If an employer offers an individual coverage health reimbursement arrangement, that means workers who would otherwise meet the poverty threshold would also have to contribute more than 9.78% of their income to buy the lowest-cost individual silver plan on the exchange. That amount would be based on the plan’s cost after factoring in the contribution from an employer.
If the worker’s contribution is lower than that standard, then the only assistance they are eligible for is through the ICHRA contribution. Federal rules don’t allow workers to accept both ICHRA contributions and premium tax credits.
“My concern is for people who are out there with a premium tax credit” who might lose that subsidy if they don’t meet the federal standard, said Peter Newell, director of the Health Insurance Project for the United Hospital Fund in New York, who authored an analysis of the new coverage option in October.
There are affordability caps in the ACA for regular employer-sponsored coverage, too, but those caps are generally lower than the caps for ICHRAs. As employers move to offer ICHRAs instead of traditional coverage, some workers will lose their premium tax credits because of the higher affordability threshold, Newell’s analysis found.
If this sounds complicated, it’s because it is, and brokers and advocates agree that many workers will need assistance figuring out what to do. In addition to running the numbers, people may need to work through where to buy a comprehensive plan that complies with the ACA. Such plans can be purchased on and off the exchange, but if workers want the company to deduct their premium costs from their salary, as LaRew did, they must purchase a plan outside of the exchange.
“There are so many paths to take and so many points of confusion, it’s super, super important that employees have some support going through this,” said Cat Perez, co-founder and chief product officer at Health Sherpa, whose technology platform helps people enroll in marketplace plans. It has incorporated information about ICHRAs.
Colorado is working with the broker community to drum up interest in the new product, said Kevin Patterson, chief executive officer of Connect for Health Colorado, the state’s insurance exchange.
“If we can get more people into the individual marketplace that makes it stronger,” Patterson said.
In theory that makes sense, but some analysts worry that the adoption of these new arrangements could drive up marketplace premiums by encouraging employers with sick workers to shift them into the individual market.
“This is a way to offer a lower premium option to some employers, but with the consequence of increasing premiums in the individual market and costs for the federal government via higher premium tax credits,” said Matthew Fiedler, a fellow in economic studies at USC-Brookings, who co-authored an analysis of the new offerings.
Still, larger employers aren’t currently very interested in embracing these new arrangements, said Jay Savan, a partner at human resources consultant Mercer.
The federal rules don’t allow employers to offer an employee both a traditional plan and an ICHRA simultaneously, and most large employers aren’t ready to replace their traditional plans.
“As long as it’s black-or-white, there are precious few employers of size that are willing to take that leap,” he said.
With two promising vaccines primed for release, likely within weeks, experts in ethics and immunization behavior say they expect attitudes to shift quickly from widespread hesitancy to urgent, even heated demand.
This article was published on Monday, December 7, 2020 in Kaiser Health News.
Americans have made no secret of their skepticism of COVID-19 vaccines this year, with fears of political interference and a “warp speed” timeline blunting confidence in the shots. As recently as September, nearly half of U.S. adults said they didn’t intend to be inoculated.
But with two promising vaccines primed for release, likely within weeks, experts in ethics and immunization behavior say they expect attitudes to shift quickly from widespread hesitancy to urgent, even heated demand.
“People talk about the anti-vaccine people being able to kind of squelch uptake. I don’t see that happening,” Dr. Paul Offit, a vaccinologist with Children’s Hospital of Philadelphia, told viewers of a recent JAMA Network webinar. “This, to me, is more like the Beanie Baby phenomenon. The attractiveness of a limited edition.”
Reports that vaccines produced by drugmakers Pfizer and BioNTech and Moderna appear to be safe and effective, along with the deliberate emphasis on science-based guidance from the incoming Biden administration, are likely to reverse uncertainty in a big way, said Arthur Caplan, director of the division of medical ethics at New York University School of Medicine.
“I think that’s going to flip the trust issue,” he said.
The shift is already apparent. A new poll by the Pew Research Center found that by the end of November 60% of Americans said they would get a vaccine for the coronavirus. This month, even as a federal advisory group met to hash out guidelines for vaccine distribution, a long list of advocacy groups — from those representing home-based health workers and community health centers to patients with kidney disease — were lobbying state and federal officials in hopes their constituents would be prioritized for the first scarce doses.
“As we get closer to the vaccine being a reality, there’s a lot of jockeying, to be sure,” said Katie Smith Sloan, chief executive of LeadingAge, a nonprofit organization pushing for staff and patients at long-term care centers to be included in the highest-priority category.
Certainly, some consumers remain wary, said Rupali Limaye, a social and behavioral health scientist at the Johns Hopkins Bloomberg School of Public Health. Fears that drugmakers and regulators might cut corners to speed a vaccine linger, even as details of the trials become public and the review process is made more transparent. Some health care workers, who are at the front of the line for the shots, are not eager to go first.
“There will be people who will say, ‘I will wait a little bit more for safety data,” Limaye said.
But those doubts likely will recede once the vaccines are approved for use and begin to circulate broadly, said Offit, who sits on the FDA advisory panel set to review the requests for emergency authorization Pfizer and Moderna have submitted.
He predicted demand for the COVID vaccines could rival the clamor that occurred in 2004, when production problems caused a severe shortage of flu shots just as influenza season began. That led to long lines, rationed doses and ethical debates over distribution.
“That was a highly desired vaccine,” Offit said. “I think in many ways that might happen here.”
Initially, vaccine supplies will be tight, with federal officials planning to ship 6.4 million doses within 24 hours of FDA authorization and up to 40 million doses by the end of the year. The CDC panel recommended that the first shots go to the 21 million health care workers in the U.S. and 3 million nursing home staff and residents, before being rolled out to other groups based on a hierarchy of risk factors.
Even before any vaccine is available, some people are trying to boost their chances of access, said Dr. Allison Kempe, a professor of pediatrics at the University of Colorado School of Medicine and expert in vaccine dissemination. “People have called me and said, ‘How can I get the vaccine?’” she said. “I think that not everyone will be happy to wait, that’s for sure. I don’t think there will be rioting in the streets, but there may be pressure brought to bear.”
That likely will include emotional debates over how, when and to whom next doses should be distributed, said Caplan. Under the CDC recommendations, vulnerable groups next in line include 87 million workers whose jobs are deemed “essential” — a broad and ill-defined category — as well as 53 million adults age 65 and older.
“We’re going to have some fights about high-risk groups,” said Caplan of NYU.
The conversations will be complicated. Should prisoners, who have little control over their COVID exposure, get vaccine priority? How about professional sports teams, whose performance could bolster society’s overall morale? And what about residents of facilities providing care for people with intellectual and developmental disabilities, who are three times more likely to die from COVID-19 than the general population?
Control over vaccination allocation rests with the states, so that’s where the biggest conflicts will occur, Caplan said. “It’s a short fight, I hope, in the sense in which it gets done in a few months, but I think it will be pretty vocal.”
Once vaccine supplies become more plentiful, perhaps by May or June, another consideration is sure to boost demand: requirements for proof of COVID vaccination for work and travel.
“It’s inevitable that you’re going to see immunity passports or that you’re required to show a certificate on the train, airplane, bus or subway,” Caplan predicted. “Probably also to enter certain hospitals, probably to enter certain restaurants and government facilities.”
But with a grueling winter surge ahead, and new predictions that COVID-19 will fell as many as 450,000 Americans by February, the tragic reality of the disease will no doubt fuel ample demand for vaccination.
“People now know someone who has gotten COVID, who has been hospitalized or has unfortunately died,” Limaye said.
“We’re all seeing this now,” said Kempe. “Even deniers are beginning to see what this illness can do.”
Looking back, Sam Bloechl knows that when the health insurance broker who was helping him find a plan asked whether he’d ever been diagnosed with a major illness, that should have been a red flag. Preexisting medical conditions don’t matter when you buy a comprehensive individual plan that complies with the Affordable Care Act. Insurers can’t turn people down or charge them more based on their medical history.
But Bloechl, now 31, didn’t know much about health insurance. So when the broker told him a UnitedHealthcare Golden Rule plan would cover him for a year for less than his marketplace plan — “Unless you like throwing money away, this is the plan you should buy,” he recalls the agent saying — he signed up.
That was December 2016. A month later Bloechl was diagnosed with stage 4 non-Hodgkin’s lymphoma after an MRI showed tumors on his spine.
To Bloechl’s dismay, he soon learned that none of the expensive care he needed would be covered by his health plan. Instead of a comprehensive plan that complied with the ACA, he had purchased a bundle of four short-term plans with three-month terms that provided only limited benefits and didn’t cover preexisting conditions.
Because they tend to be less expensive, short-term plans continue to find buyers, and they have been championed by the Trump administration, which has loosened restrictions on them, as an alternative for consumers.
With this year’s open enrollment period well underway, millions of people are looking for coverage on the federal and state marketplaces. Sometimes it’s hard to tell the difference between comprehensive plans sold there and “junk” plans with limited benefits and coverage restrictions.
“These plans continue to proliferate,” said Cheryl Fish-Parcham, director of access initiatives at Families USA, a consumer health care advocacy organization. “People need to be careful, whether they’re buying by phone or on a website.”
Bloechl assumed he was buying a comprehensive plan that would cover him for a life-threatening illness, although at the time he had no inkling he was sick. But when doctors said Bloechl needed a stem cell transplant, Golden Rule denied the request.
The reason: He had visited a chiropractor for back pain before he bought the plan. Bloechl had blamed the pain on the heavy lifting that came with running his Chicago landscaping business. But Golden Rule argued that he had sought medical treatment for a preexisting condition — cancer — so the plan didn’t have to cover it. It didn’t matter that he hadn’t been diagnosed when he purchased it.
The insurer didn’t cover any of his other bills for chemo and radiation either. Bloechl appealed the decision, but his appeals failed. He had more than $800,000 in bills for care — and that’s before the stem cell transplant he desperately needed.
“It’s just disgusting that these companies expect Joe Schmo or a guy like me to interpret [these policies] and then get screwed in the end,” Bloechl said.
UnitedHealthcare refused to discuss this case with KHN unless Bloechl signed a statement waiving his right to privacy. But he told KHN he did not feel comfortable signing a legal document provided by the insurer.
“Our agents work with individuals to help them understand their health insurance options and select a plan that best meets their needs,” said UnitedHealthcare’s communications director, Maria Gordon Shydlo, in an email. “We inform each individual of their coverage options, including associated costs, network size and if the selected plan covers pre-existing conditions. We adhere to a stringent application process that helps ensure consumers understand the plan they are purchasing before they make a final decision.”
Consumer advocates have long sounded alarm bells about short-term and other plans that don’t comply with the Affordable Care Act rules that require plans to provide comprehensive benefits to all comers, regardless of their health, and prohibit placing annual or lifetime dollar limits on coverage. ACA-compliant plans can also be purchased outside the marketplace, however, and that’s where shoppers may run into trouble, thinking they’re buying comprehensive coverage when they’re actually buying something much more limited.
“It’s a little bit of the Wild West out there,” said Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reforms. “We often get calls about these products, and sometimes it can be challenging to figure out what they even are.”
Short-term plans have garnered much attention in recent years. In 2017, the Obama administration limited their duration to less than three months to discourage people from relying on these limited plans for primary coverage rather than as a temporary coverage bridge for people switching plans, as intended. But these plans were championed by the Trump administration as a cheaper option for consumers, and it issued a rule in 2018 that permitted short-term plans with terms of up to 364 days, with an option to renew for up to 36 months. The rule requires short-term plan materials to explain that the plans are not comprehensive insurance and may not cover some medical costs.
Such plans can be appealing to healthy people who don’t expect to need medical care. But as Bloechl’s experience shows, life can throw curveballs.
“Our patients are often young and healthy,” said Ryan Holeywell, senior director of advocacy communications at the Leukemia & Lymphoma Society.
But these short-term plans are just the tip of the iceberg.
There are fixed indemnity plans that pay out a certain amount — $100 a day for a limited hospital stay or $150 for an OB-GYN visit, for example — that may not come close to covering the actual costs.
Accident and critical illness plans provide lump-sum cash benefits when people experience medical emergencies like a heart attack or stroke under certain circumstances.
Cancer-only plans may provide hospitalization coverage but not cover other services. “You may be treated with chemo and radiation but never go to the hospital,” said Anna Howard, a policy principal at the American Cancer Society’s Cancer Action Network. “So, the policy may never pay out.”
Then there are bundled plans that combine options, such as a short-term plan along with a prescription drug discount card and cancer coverage.
Unfortunately, consumers can’t always rely on insurance brokers to give them accurate information or steer them to comprehensive coverage, as Sam Bloechl discovered.
In August, the federal Government Accountability Office published a report about the experiences of “secret shoppers” who called 31 health insurance sales representatives and asked about plans, saying they had preexisting conditions such as diabetes and heart disease. In more than a quarter of cases, the sales reps “engaged in potentially deceptive marketing practices,” the report found, including falsely claiming that drugs such as insulin were covered, or offering a plan that didn’t cover preexisting conditions.
One reason brokers might encourage consumers to buy non-ACA plans: higher commissions.
“In our survey of brokers, they do report they pay higher commissions than ACA plans,” Corlette said. Some brokers reported they avoid noncompliant plans, however, because they pose risks for consumers.
The National Association of Health Underwriters, an organization for health insurance and employee benefits professionals, did not respond to a request for information and comment.
Consumers can be sure they’re getting a comprehensive, ACA-compliant plan if they buy it from marketplaces set up by that health law, Howard said.
Brokers can help people understand their options and buy a plan, including plans that comply with the ACA, but picking a broker can be challenging.
“Ideally go to someone in a brick-and-mortar building who has to bump into you in the grocery store,” Corlette said.
After his experience with Golden Rule, Sam Bloechl decided his best option was to offer a group plan to workers at his small landscaping company that he could also enroll in. He worked with a different broker, and he had lawyers look over the policies he was considering. He wanted to be sure that whatever plan he bought would cover his stem cell transplant.
The new plan did cover it. And by the time he went to work out payment on his $800,000-plus bill, his income had declined so much because of his illness that he qualified for charity care. The hospital wrote off his bill.
His cancer is in remission.
But the experience with the short-term policy still rankles. “Charity care picked up the one bill and [UnitedHealthcare Golden Rule’s] competitor paid for the transplant,” he said. “They got off the hook without paying a dime.”
Kurt Papenfus, a doctor in Cheyenne Wells, Colorado, started to feel sick around Halloween. He developed a scary cough, intestinal symptoms and a headache. In the midst of a pandemic, the news that he had COVID-19 wasn’t surprising, but Papenfus’ illness would have repercussions far beyond his own health.
Papenfus is the lone full-time emergency room doctor in the town of 900, not far from the Kansas line.
“I’m chief of staff and medical director of everything at Keefe Memorial Hospital currently in Cheyenne County, Colorado,” he said.
With Papenfus sick, the hospital scrambled to find a replacement. As coronavirus cases in rural Colorado, and the state’s Eastern Plains especially, surge to unprecedented levels, Papenfus’ illness is a test case for how the pandemic affects the fragile rural health care system.
“He is the main guy. And it is a very large challenge,” said Stella Worley, CEO of the hospital.
If she couldn’t find someone to fill in while he was sick, Worley might have to divert trauma and emergency patients nearly 40 miles north to Burlington.
“Time is life sometimes,” she said. “And that is not something you ever want to do.”
‘The ‘Rona Beast Is a Very Nasty Beast’
As deaths from the coronavirus have surpassed 250,000 in the U.S., new data show the pandemic has been particularly lethal in rural areas — it’s taking lives in those areas at a rate reportedly nearly 3.5 times higher than in metropolitan communities.
About 63 people in Cheyenne County have been diagnosed with COVID-19, most of them in the past three weeks.
Papenfus, a lively 63-year-old, was discharged after a nine-day stay at St. Joseph’s Hospital in Denver, and he was eager to sound the alarm about the disease he calls the ‘rona.
“The ‘rona beast is a very nasty beast, and it is not fun. It has a very mean temper. It loves a fight, and it loves to keep coming after you,” Papenfus said.
He isn’t sure where he picked it up but thinks it might have been on a trip east in October. He said he was meticulous on the plane, sitting in the front, last on, first off. But on landing at Denver International Airport, Papenfus boarded the crowded train to the terminal, and soon alarm bells went off in his head.
“There are people literally like inches from me, and we’re all crammed like sardines in this train,” Papenfus said. “And I’m going, ‘Oh, my God, I am in a superspreader event right now.'”
An airport spokeswoman declined to comment about Papenfus’ experience.
A week later, the symptoms hit. He tested positive and decided to drive himself the three hours to the hospital in Denver. “I’m not going to let anybody get in this car with me and get COVID, because I don’t want to give anybody the ‘rona,” he said. County sheriff’s deputies followed his car to ensure he made it.
Once in the hospital, chest X-rays revealed he’d developed pneumonia.
“Dude, I didn’t get a tap on the shoulder by ‘rona, I got a big viral load,” he texted a reporter, sending images of his chest scans that show large, opaque, white areas of his lung. Just a week earlier, his chest X-ray was normal, he said.
Back in Cheyenne Wells, Dr. Christine Connolly picked up some of Papenfus’ shifts, although she had to drive 10 hours each way from Fort Worth, Texas, to do it. She said the hospital staff is spread thin already.
“It’s not just the doctors; it’s the nurses, you know. It’s hard to get spare nurses,” she said. “There’s not a lot of spares of anything out that far.”
Besides himself, six other employees — out of a staff of 62 at Keefe Memorial — also recently got a positive test, Papenfus said.
Hospitals on the Plains often send their sickest patients to bigger hospitals in Denver and Colorado Springs. But with so many people around the region getting sick, Connolly is getting worried hospitals could be overwhelmed. Health care leaders created a new command system to transfer patients around the state to make more room, but Connolly said there is a limit.
“It’s dangerous when the hospitals in the cities fill up, and when it becomes a problem for us to send out,” she said.
‘Bank Robbers Wear Masks Out There’
The impact of Papenfus’ absence stretches across Colorado’s Eastern Plains. He usually worked shifts an hour to the northwest, at Lincoln Community Hospital in Hugo. Its CEO, Kevin Stansbury, said the town mostly dodged the spring surge and his facility could take in recovering COVID patients from Colorado’s cities. Now, Stansbury said, the virus is reaching places such as Lincoln County, population 5,700. It has had 144 cases, according to state data, and neighboring Kit Carson has had 301. Crowley County to the south, home to a privately managed state prison, has had 1,239 cases. It is far and away the No. 1 most affected county per capita in the state.
“So those numbers are huge,” Stansbury said. He said that as of mid-November about a half-dozen hospital staffers had tested positive for the virus; they think that outbreak is unrelated to Papenfus’ case.
Lincoln Community Hospital is ready once again to take recovering patients. Finances in rural health care are always tight, and accepting new patients would help.
“We have the staff to do that, so long as my staff doesn’t get ravaged with the disease,” Stansbury said.
Rural communities are particularly vulnerable. Residents tend to suffer from underlying health conditions that can make COVID-19 more severe, including high rates of cigarette smoking, high blood pressure and obesity. And Brock Slabach of the National Rural Health Association said 61% of rural hospitals do not have an intensive care unit.
“This is an unprecedented situation that we find ourselves in right now,” Slabach said. “I don’t think that in our lifetimes we’ve seen anything like what is developing in terms of surge capacity.”
A couple of hours east of Cheyenne Wells, COVID-19 recently hit Gove County, Kansas, hard.
The county’s emergency management director, the local hospital CEO and more than 50 medical staff members tested positive. In a nursing home, most of the more than 30 residents caught the virus; six have died since late September, according to The Associated Press. A county sheriff ended up in a hospital more than an hour from home, fighting to breathe, because of the lack of space at the local medical center.
Papenfus fretted about his home county and its odds of fighting off the virus.
“The western prairie isn’t mask country,” he said. “People don’t wear masks out there; bank robbers wear masks out there.” He is urging Coloradans to stay vigilant, calling the virus an existential threat. “It’s a huge wake-up call.”
Since being released from the hospital, Papenfus has had a rocky recovery. His wife, Joanne, drove him back to Cheyenne Wells, wearing an N95 mask and gloves, while he rode in the back on oxygen, coughing through the three-hour drive.
Once back at home after that initial nine-day stay, Papenfus hunkered down, with the occasional trip outside to hang out with his pet falcon.
But a week after going home, he started having nightly fevers. He had a CT scan done at Keefe Memorial, the hospital where he works. It revealed pneumonia in his lungs, so he went back to Denver, getting readmitted at St. Joseph’s Hospital. This time, Papenfus arrived via ambulance.
Finding a replacement for Papenfus at Keefe has been hard. The hospital is working with services that provide substitute physicians, but these days, with the coronavirus roaring across the country, the competition is fierce.
“They’re really scrambling to get coverage,” Papenfus texted from his hospital bed. “Whole county can’t wait for my return but this illness has really taken me down.”
He said he was now at Day 35 from his first symptoms, lying in his hospital bed in Denver, “wondering when I’ll ever get back.” Papenfus noted that COVID-19 has affected his critical thinking and that he will need to be cleared cognitively to return to work. He said he knows he won’t have the physical stamina to get back to full duty “for a while, if ever.”
Union officials say the county has also made personal protective equipment, such as masks and gloves, more available in recent months and put a greater emphasis on social distancing.
This article was published on Thursday, December 4, 2020 in Kaiser Health News.
A Maryland health department is taking new steps to protect its workers six months after a COVID-19 outbreak killed a veteran employee who was twice denied permission to work from home.
Chantee Mack, 44, died in May. More than 20 colleagues also caught the coronavirus, and some are suffering lasting problems.
Now, after a KHN and Associated Press story in July spurred an investigation, Prince George’s County officials say they have added an appeals process to their work-at-home policy and hired a consultant to identify “operational and management needs for improvement” in the department. Union officials say the county has also made personal protective equipment, such as masks and gloves, more available in recent months and put a greater emphasis on social distancing.
In an email to KHN, health department spokesperson George Lettis said officials can’t release results of the county investigation because of personnel and medical information. But a county official’s letter to Wallace shares the inquiry’s main conclusions: that the health department tried to get PPE in early March and advised employees about social distancing and proper hygiene via a newsletter.
“It must not be overlooked that this was a rapidly evolving situation,” said the letter from Dr. George Askew, deputy chief administrative officer for health, human services and education. “Best efforts were made to keep the community and Health Department employees safe and informed during this unprecedented time.” The letter does not acknowledge any lapses made by the county.
Some employees argue the investigation didn’t delve into the circumstances around Mack’s death and say the county should publicly acknowledge its role in what happened. At a news conference in July, County Executive Angela Alsobrooks said Mack’s death “deserves an investigation” and the county would “spare no time or expense.”
Mack, who worked in the department’s sexually transmitted diseases program, was denied permission to work from home in March even though she had health problems that put her at high risk for COVID-19 complications.
At least three other employees whose requests to work from home were denied around that time also got sick. Revonda Watts, a nurse and program manager, said she was allowed to work from home for one day before being called back to the office. Some of these employees worked face-to-face with the public at least part of the time.
A union document obtained by KHN detailed a conference call by department managers in which Diane Young, an associate director, laid out criteria for working from home, such as being 65 or older or having small children. She said decisions would be made case by case.
Meanwhile, protective masks, gowns and other safety equipment were in short supply nationally and at the health department, which distributed them only to certain workers. In early April, when Young asked Watts about PPE needs, Watts wrote in an email obtained by KHN: “N-95 masks are needed for all staff. We were given 1 mask to reuse. We have no face shields for the clinicians nor do we have gowns.”
Young responded that even though goggles were available, “face shields and gowns are in limited supply and will be used for those who are testing patients for COVID-19.”
Several employees described meetings and “morning huddles” in the office in March and April held without social distancing and during which few, if any, participants wore masks.
One employee after another got sick.
Watts, who is 58 and has asthma, developed bronchitis on top of COVID-19, then chest pain from spasms in her blood vessels. She spread the virus to her adult daughter.
Administrative aide Natania Bowen also spread the virus to her family, including her husband and 7-year-old daughter, who have since recovered. Bowen, a 47-year-old with asthma, experienced a bacterial lung infection along with COVID-19.
Receptionist Yolanda Potter, 53, had severe headaches for a month from her coronavirus infection. She developed a blood clot in her right leg and had to inject blood thinners into her stomach for 45 days to prevent it from breaking off and traveling to her lungs or brain. She and Carolyn Ferguson, an X-ray tech now on desk duty, suffer ongoing memory problems, while Bowen continues to have lung issues.
While Bowen now works from home, Watts, Potter and Ferguson are back at the office. As of mid-November, Lettis said, 141 health department employees were working fully on-site, 68 partly on-site and 196 at home.
Employees said they are pleased that social distancing is now the norm in the health department, that more places to sanitize hands exist and that PPE is easier to get. They’re also hopeful about the new policy on remote work.
The countywide rules include two levels of review for work-at-home requests: one by a supervisor and another by a higher-up boss who must give a reason if a worker’s request is denied. The employee can then ask the Office for Human Resource Management to review the denial.
Despite such measures, some employees still worry about contracting COVID-19 at work, especially as the state’s COVID dashboard puts the county’s cumulative caseload over 42,000.
Several employees are seeking long-term disability leave or talking to lawyers about getting workers’ compensation. Watts said she is awaiting a workers’ comp hearing and has asked again for permission to work from home as she deals with crushing fatigue and numbness in her legs and hands. Since returning to the office, she said, she has had to bring her own mask from home.
“I get frustrated with not being able to just bounce back,” she said. The health department officials “really let us down and didn’t do their due diligence to make sure the staff was protected.”
This story is a collaboration between The Associated Press and KHN.
California, like the rest of the nation, is seeing a dramatic rise in COVID infections and deaths — and Los Angeles County has some of the most dire statistics.
Health officials reported more than 7,500 new cases in the county on Tuesday, shattering the old record, set last week. Hospitalizations tripled in the past month, and on average 30 people are dying of COVID-19 in the county every day.
The most populous county in the country, Los Angeles leads all U.S. counties in raw numbers of both infections and deaths, according to statistics compiled by Johns Hopkins University.
On Monday, the county started a three-week stay-at-home order, and Gov. Gavin Newsom said a similar order for the whole state could prove necessary.
“If these trends continue, we’re going to have to take much more dramatic — arguably drastic — action,” Newsom said.
But even as the restrictions began in Los Angeles, leaders across California took heat for their do-as-I-say-not-as-I-do pandemic behavior.
Los Angeles County Supervisor Sheila Kuehl dined outdoors at a favorite restaurant shortly after she voted to ban outdoor dining, a local TV station reported.
San Jose Mayor Sam Liccardo apologized for spending Thanksgiving with eight people from five households in his extended family.
And the San Francisco Chronicle reported that San Francisco Mayor London Breed joined a party of seven to dine at the famed French Laundry restaurant the day after Newsom did, angering many.
The questionable behavior threatens to overshadow alarming news about pandemic trends. Tuesday, California reported 20,759 new cases, a few hundred less than the record number of the day before. The state is in its worst situation since the pandemic started. Yet despite the record case numbers, California is so populous that it’s far from the top of the list of states with the most new cases per capita. (That spot was held by Montana on Wednesday.)
Newsom said Monday that Southern California is forecast to run out of intensive care unit capacity by mid-December if trends continue. By Christmas Eve, ICU beds are forecast to be at 107% of capacity across the region. There’s no clear plan in place for what to do when hospital demand outstrips capacity.
All races and ethnicities are seeing increases in cases, but disparities are widening. In Los Angeles County, Hispanics’ infection rate is more than twice that of whites.
“Death rates among people in high rates of poverty are three times the death rate of people in more affluent areas,” county public health director Barbara Ferrer said Wednesday.
Health officials estimate that one in every 200 people in the county has the virus and is infectious.
The hope is that the new restrictions of the stay-at-home order in Los Angeles County will slow that spread.
The order is designed to keep people in their homes as much as possible. It prohibits gatherings with anyone outside of a household and reduces capacity at stores. K-12 schools will continue to operate but at 20% capacity. Outdoor areas like beaches, parks and trails will remain open, but people are not allowed to gather.
Officials say they are trying to find a sweet spot where they can keep people from gathering and spreading the virus, but still allow some stores to remain open. Thus far the rules are less stringent than those imposed in the spring, because businesses owners have pushed back hard against more restrictions. They are losing money and, unlike in the spring, have no federal aid to offset their losses.
This story is from a reporting partnership that includes KPCC, NPR and KHN.