DYING, ILLNESS, AND AGING WITH GRACE

Updated 4-29-2020 (click refresh button to get updated version)

(Sheltering in Place)

• Avoid close contact with people who are sick.
• The most common symptoms of coronavirus disease (COVID-19, officially SARS-CoV-2) are fever, dry cough, and shortness of breath -- and, in severe cases, difficulty breathing. In late April CDC added these less common symptoms, by themselves or combined with others: Chills, shaking with chills (rigors), muscle pain, headache, sore throat, new loss of taste or smell.
• Real-time tracking of self-reported symptoms to predict potential COVID-19 (Nature Medicine, 5-11-2020).Association between symptoms and SARS-CoV-2 infection, and ROCs for prediction of the risk of a positive test (see chart)--in declining order: Loss of smell, skipped meals, fatigue, fever, persistent cough, diarrhea, delirium, hoarse voice, shortness of breath, abdominal pain, chest pain. (H/T Abby Rasminsky)
• Experts tell White House coronavirus can spread through talking or even just breathing (CNN, 4-2-2020)
• See also This 3-D Simulation Shows Why Social Distancing Is So Important (NY Times, 4-14-2020) "But as this simulation suggests, and scientists have argued, droplets can travel farther than six feet. And small droplets known as aerosols can remain suspended or travel through the air before they eventually settle on surfaces. This is how they could disperse over the next 20 minutes."
• Avoid touching your eyes, nose, and mouth. Don't pick your nose! The disease is passed mostly by people touching their hands to their face. It's hard to resist, and one reason to wear a mask or bandanna over your nose and mouth may be to train yourself not to touch your face.
• Stay home when you are sick. Keep 6 feet between you and others. If you walk with someone, stand to one side of them (as well as behind or in front of them) to be out of the line of fire if the person in front coughs--as the droplets may still be in the air by the time the person behind gets to the spot where the cough occurred.
• Wash your hands often with soap and water, especially after touching possibly contaminated surfaces. Wet them with warm or cold, clean, running water and then apply soap. When lathering, make sure to get the backs of your hands, between fingers and under nails. Wash your hands for at least 20 seconds, especially after going to the bathroom; before eating; and after blowing your nose, coughing, or sneezing. Always wash hands with soap and water if hands are visibly dirty. See World Health Organization's instructions on handwashing, plus this Times article on Why Soap Works (Ferris Jabr, NY Times, 3-13-2020) and The Do’s and Don’ts of Handwashing (illustrated, Katie Camero, Wall Street Journal, 3-12-2020) At the molecular level, soap breaks viruses apart. Remember this the next time you have the impulse to bypass the sink: Other people’s lives are in your hands.
• If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 60% alcohol--preferably 70%. See CDC on handwashing.
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash. The virus is dispersed through respiratory droplets.
• NOTE THAT MANY OF THE SUPPLIES MENTIONED ARE NOT AVAILABLE CURRENTLY, BECAUSE STORES ARE RUNNING SHORT.  Stores will restock. Don't panic, and don't hoard.
• Clean and disinfect frequently touched and shared objects and surfaces, including phones (constantly), remote controls, countertops, and refrigerator handles, using a regular household cleaning spray or wipe. ("The dirtiest places in the house are the fridge and the cupboard. Nobody knows who touched the items we've brought home from the store," says a retired NIH employee.) Sanitize the objects you and lots of other people touch, especially people outside your family--like door handles, shared keyboards at schools, salad bar tongs, etc. Here's a list of household cleaning products that will kill viral pathogens. (Center for Biocide Chemistries, American Chemical Council). A long list of products that can be used to disinfect at home—a number of Clorox and Lysol products as well as many other products. Unfortunately, many of these may well be sold out (shelves of many of these products were nearly  empty at my largest nearby supermarket on March 12). See Advice for the Public: Basic protective measures (World Health Organization, 2019, updated regularly, with posters). See also CDC's Environmental Cleaning and Disinfection Recommendations (CDC) Interim Recommendations for US Households with Suspected/Confirmed Coronavirus Disease 2019. For a really long, detailed report see Guideline for Hand Hygiene in Health-Care Settings (Morbidity and Mortality Weekly Report, 10-25-02)
• The Coronavirus May Linger On Plastic And Stainless Steel For Days, A Preliminary Study Found (Stephanie M. Lee, Buzzfeed, 3-11-2020)
• Clean your phones and cellphones NIGHTLY (and other obvious germ carriers, such as door knobs and banisters, when possible. If you do touch them, wash your hands.
• Wear gloves; wash or change them daily.
• Wash towels you have touched with unclean hands. Temporarily, make use of paper towels.
• Simple DIY masks could help flatten the curve. We should all wear them when out in public. (Jeremy Howard, Washington Post, 3-28-2020) When historians tally up the many missteps policymakers have made in response to the coronavirus pandemic, the senseless and unscientific push for the general public to avoid wearing masks should be near the top. The evidence not only fails to support the push, it also contradicts it. Masks effective at "flattening the curve" can be made at home with nothing more than a T-shirt and a pair of scissors. See CDC on use of face coverings (how-to, illustrated)
• We should all wear masks — store-bought or homemade — whenever we're out in public. See Who should wear masks and why?
• CDC and the Surgeon General initially discouraged the use of face masks, because there was a critical shortage and they were needed more urgently by medical personnel -- and we're in need of the medical personnel. The use of facemasks is crucial for health workers and people who are taking care of someone in close settings (at home or in a health care facility) to prevent their catching the virus.  As production of facemasks ramps up and there is no shortage, whenever you go out you should use a facemask (especially if you show symptoms of COVID-19) to help prevent the spread of the disease to others. If nothing else, facemasks keep YOU from touching your own mouth and nose. Read Guidance against wearing masks for the coronavirus is wrong – you should cover your face (Boston Globe) Blocking access to your nose, throat, and eyes will prevent infection from the coronavirus, flu, and any other several other respiratory viruses, which is why medical workers must wear them.
• Develop a care plan. "A care plan is a form that summarizes a person’s health conditions and current treatments. Many care plans include a summary of your health conditions, medications, healthcare providers, emergency contacts, and end-of-life care options (for example, advance directives). People complete their care plans in consultation with their doctor, and if needed, with help from a family member or home nurse aide. Download a fillable care plan form." (CDC)

Further advice from virologist James Robb, MD UC San Diego. Robb has worked with this coronavirus for almost 50 years: COVID-19 has an affinity for pulmonary receptors that is extraordinary. It is most likely to be widespread in the US by mid to late March and April, he says. Here are the precautions Dr. Robb takes and will take (with some comments added). These are the same precautions he currently uses during our influenza seasons, except for the mask and gloves:

1) NO HANDSHAKING! Use a fist bump, slight bow, elbow bump, etc. Or do jazz hands , as CDC recommends.

2) Use ONLY your knuckle to touch light switches. elevator buttons, etc. Lift the gasoline dispenser with a paper towel or use a disposable glove. (Carry disposable gloves in your car.)

3) Open doors with your closed fist or hip - do not grasp the handle with your hand, unless there is no other way to open the door. Especially important on bathroom and post office/commercial doors.

4) Use disinfectant wipes at the stores when they are available, including wiping the handle and child seat in grocery carts.

5) Wash your hands with soap for 10-20 seconds and/or use a greater than 60% alcohol-based hand sanitizer whenever you return home from ANY activity that involves locations where other people have been.

6) Keep a bottle of hand sanitizer (60% alcohol) available at each of your home's entrances. AND in your car for use after getting gas or touching other contaminated objects when you can't immediately wash your hands.

7) If possible, cough or sneeze into a disposable tissue and discard. Use your elbow only if you have to. The clothing on your elbow will contain infectious virus that can be passed on for up to a week or more!

Dr. Robb adds: What I have stocked in preparation for the pandemic spread to the US:

1) Latex or nitrile latex disposable gloves for use when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas. Note: This virus is spread in large droplets by coughing and sneezing. This means that the air will not infect you! BUT all the surfaces where these droplets land are infectious for about a week on average - everything that is associated with infected people will be contaminated and potentially infectious. The virus is on surfaces and you will not be infected unless your unprotected face is directly coughed or sneezed upon. This virus only has cell receptors for lung cells (it only infects your lungs) The only way for the virus to infect you is through your nose or mouth via your hands or an infected cough or sneeze onto or into your nose or mouth.

 2) When there is ample stock (which so far is not true), acquire disposable surgical masks. Their main value is to to prevent you from touching your [own] nose and/or mouth (We touch our nose/mouth 90X/day without knowing it!). This is the only way this virus can infect you - it is lung-specific.

3) When possible, stock up with hand sanitizers and latex/nitrile gloves (get the appropriate sizes for your family). The hand sanitizers must be alcohol-based and greater than 60% alcohol to be effective.

4) Zinc lozenges may be helpful. (This page from McGill states that Robb was misquoted and, more important, that there is no evidence to support a benefit of zinc for corona virus. There is slight evidence that zinc supplements can reduce the duration of the common cold which is a coronavirus infection, but also zinc can be toxic if you take too much.) There will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available.

• It’s Going to Be Difficult (David Leonhardt, NY Times, 4-10-2020) Here is the cruel reality: The places that return too quickly — and cause new outbreaks — will be the ones that end up suffering the longest periods of social distancing in the end. The four next phases: 1. The new abnormal: Large gatherings where people come in close contact, like sporting events, concerts and conferences, could still be a long time off. 2. Testing, testing, testing. The United States remains behind on testing and will need to continue catching up in coming weeks. 3. Contact tracing. Very laborious. 4. Quarantine. People with new cases must be kept away from everyone else, immediately.
• Comprehensive Social Distancing Is Difficult and Necessary. Here's How to Keep Your Family Safe (Asaf Bitton, MD, MPH, on WBUR, 3-14-2020) Originally published as Social Distancing: This Is Not a Snow Day (Ariadne Labs)
• Earthcam: Times Square, New York. And check out a few other cities.
• What We Need to Understand About Asymptomatic Carriers if We’re Going to Beat Coronavirus (Caroline Chen, ProPublica, 4-2-2020) 'What I discovered is that not only can people be infected and experience no symptoms or very mild symptoms for the first few days, but this coincides with when the so-called viral load — the amount of virus being emitted from an infected person's cells — may be the highest...a WHO team found that about 75% of people who were initially classified as "asymptomatic" went on to develop symptoms.

The reason direct contact is more deadly is the viral load. (But still, wipe things down.)
• Social Distancing, Quarantine, and Isolation (CDC) Particulars of keeping your distance to slow the spread.
• Why ‘flattening the curve’ may be the world’s best bet to slow the coronavirus (Helen Branswell, STAT, 3-11-2020) “If you look at the curves of outbreaks, they go big peaks, and then come down. What we need to do is flatten that down,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told reporters Tuesday. “That would have less people infected. That would ultimately have less deaths. You do that by trying to interfere with the natural flow of the outbreak.” See also Does closing schools slow the spread of coronavirus? Past outbreaks provide clues (Jennifer Couzin-Frankel, Science, 3-10-2020) "We know from past epidemics of multiple types of viruses that school closure works. We know that it interrupts adult transmission even if the kids are not vectors. Here, it’s likely that kids are vectors, and preliminary evidence from China suggests that they can be."
• Take Steps to Counter the Loneliness of Social Distancing (Jane E. Brody, NY Times, 3-23-2020) Attempts to avoid coronavirus can increase the risk of physical and emotional harm from limited social contact.
• Social distancing could buy U.S. valuable time against coronavirus (Carolyn Y. Johnson, Lena H. Sun and Andrew Freedman WaPo, 3-10-2020). The United States is at a make-or-break moment with coronavirus that will test of one of the most basic, but inconvenient and disruptive, public health tools in the book: social distancing...The goal isn’t to stop the virus; not anymore. It is to slow it down....By the time it stops feeling silly to consider major life changes, it may be too late.
• The social-distancing deniers have arrived (Zachary B. Wolf, CNN, 4-17-2020) In February and much of March the conservative outlet Fox News fed the coronavirus deniers...Now conservatives are fomenting rebellion against public health guidelines. In their warped telling, people who venture out in public aren't vectors for infection but rather freedom fighters standing up to oppression. Trump appears to back those protesting social distancing measures (The Hill) Fighting with governors about who will "call the shots," Trump's rhetoric jumps toward "Liberate X" messages to states where Republicans are protesting the extension of stay-at-home orders (and where Trump did well in last election), even when official White House guidelines "remain conservative in terms of loosening social distance guidelines." See also 7 Midwestern governors announce their states will coordinate on reopening (CNN, 4-17-2020). In the face of Trump's shilly-shallying about health policy, governors are assuming greater command of pandemic management.
• It’s Okay to Be a Different Kind of Parent During the Pandemic (Mary Katharine Ham, The Atlantic, 4-8-2020) When something outside your control changes your life, it’s what you do with what you can control that really shapes your children.
• Parent Resources (Maryland State Department of Education) Links to many excellent resources to "educate" children and keep them engaged in smart ways. Let me know if there are more pages like this online.
• The Dos and Don’ts of ‘Social Distancing’ (Kaitlyn Tiffany, The Atlantic, 3-12-2020) Experts weigh in on whether you should cancel your dates, dinner parties, and gym sessions. Recommendations for “social distancing”—a term that epidemiologists are using to refer to a conscious effort to reduce close contact between people and hopefully stymie community transmission of the virus.
• Surfaces? Sneezes? Sex? How the Coronavirus Can and Cannot Spread(Heather Murphy, NY Times,3-2-2020) What you need to know about how the virus is transmitted. That page should take you to live updates on the virus, also. See also Heather Cox Richardson's Facebook post, comparing the Philadelphia and St. Louis responses to the 1918 flu epidemic. A political appointee in Philadelphia went ahead with a big parade to raise money for the Liberty Bonds that were funding WWI, wanting to keep morale up. By the end of the season, 12,000 Philadelphians had died. By contrast, the public health commissioner in St. Louis shut down the city, incurring the wrath of local businessmen, but slowing down the infection rate, so by the end of the season only 1,700 died in St. Louis, half the rate in Philadelphia. "The novel coronavirus is spreading in America, but we can still slow it down by social distancing and avoiding crowds." It spreads exponentially. "As grim as things seem right now, the future is ours to shape."
• Why We Should Still Try to Contain The Coronavirus (Healy and Khan, Los Angeles Times, 3-11-2020) "The goal is no longer to prevent the virus from spreading freely from person to person, as it was in the outbreak’s early days. Instead, the objective is to spread out the inevitable infections so that the healthcare system isn’t overwhelmed with patients. Public health officials have a name for this: Flattening the curve."
• Sheltering in Place: What You Need to Know (KQED) What is considered an essential activity, what activities outside the home are okay, and what are essential businesses and infrastructures, etc.
• How to Seek a Safe Respite Outdoors While Social Distancing (Lynn Jolicoeur and Lisa Mullins, KQED, 3-25-2020) Move about as much [as possible], rather than being stagnant ... for prolonged periods of time.
• How Kids' Lit Is Responding to the Coronavirus (Alex Green, Publishers Weekly, 3-17-2020) Children’s authors and publishers are going digital to provide kids with ways to read, draw, engage, and support other children who might need a helping hand. PW lists online resources to help stay-at-home famillies: a free writing course for kids, bilingual videos and teaching guides, a coloring book designed by acclaimed illustrators, access to free books for educators, parents, and librarians, and a hashtag to search for more content on social media.

Who should wear masks and why?

(PPE means "personal protective equipment")
• PPE: Types of personal protective equipment used to combat COVID-19 (George Petras and Janet Loehrke, USA Today) Personal protection gear, essential for coronavirus workers, is in critically short supply.
• Instructions on how to make a hand-sewn mask (PDF, Johns Hopkins Medicine)
• Deaconess asks public to sew CDC-compliant face masks for staff (Thomas B. Langhorne, Evansville Courier & Press, 3-18-2020) Another set of instructions for home-made masks.
• How to make a mask Instructions for making a mask using a handkerchief and elastic hair bands. Not appropriate for medical personnel
• Everyone Thinks They’re Right About Masks (Ed Yong, The Atlantic, 4-1-2020) How the coronavirus travels through the air has become one of the most divisive debates in this pandemic. “People envision these clouds of viruses roaming through the streets coming after them, but the risk of [infection] is higher if you’re closer to the source,” says Linsey Marr, who studies airborne disease transmission at Virginia Tech. “The outside is great as long as you’re not in a crowded park.” Many successful mask-using countries relied on other measures, such as extensive testing and social distancing, and many were ready for the pandemic because of their prior run-in with the 2003 SARS epidemic.

• So what if I think I might be infected? (WashingtonPost, 3-13-2020) If you feel sick and are worried about the coronavirus, call your doctor. Don’t rush to the ER. Testing is still limited, and most cases are relatively mild. There is no treatment for COVID-19.

• Steps to take if you're sick
• How to Protect Yourself (CDC)

Know how it spreads. (See below)

Take steps to protect yourself: Clean your hands often. Avoid close contact.

Take steps to protect others: Stay home if you’re sick. Cover coughs and sneezes. Wear a face mask if you are sick. Clean and disinfect (with instructions).
•Psst, After You Wash Your Hands, Clean Your Smartphone (Slate)
• COVID NEAR YOU How are you feeling? Contribute your health status daily and help track the COVID-19 pandemic.
• How to Clean and Disinfect Yourself, Your Home, and Your Stuff (Jess Grey, Wired, 3-19-2020) Including how to do your laundry!

Failure to control the virus will mean millions of deaths.

• So what if I think I might be infected? (WashingtonPost, 3-13-2020) If you feel sick and are worried about the coronavirus, call your doctor. Don’t rush to the ER. Testing is still limited, and most cases are relatively mild. There is no treatment for COVID-19.

• Steps to take if you're sick
• How to Protect Yourself (CDC)

Know how it spreads. (See below)

Take steps to protect yourself: Clean your hands often. Avoid close contact.

Take steps to protect others: Stay home if you’re sick. Cover coughs and sneezes. Wear a face mask if you are sick. Clean and disinfect (with instructions).
• Food Safety Tips (YouTube video, Dr. Jeffrey VanWingen) He demonstrates how to unpack your groceries. See also Food Safety and Coronavirus: A Comprehensive Guide (J. Kenji López-Alt, Serious Eats, 3-20-2020) Questions about COVID-19 and food safety, answered.
• Keeping the Coronavirus from Infecting Health-Care Workers (Atul Gawande, New Yorker, 3-21-2020) What Singapore’s and Hong Kong’s success is teaching us about the pandemic."The factors that appear to be important in protecting health-care workers from the disease have been insuring meticulous hand hygiene and cleaning; restricting clinics and hospitals to necessary patient visits; shifting as much care as possible to virtual channels (such as phone and video); and applying standard droplet precautions (surgical mask, gloves, and gown) with respiratory patients."
• Coronavirus grocery list: What items you need to buy in case of self-quarantine (Today show) The foods you may need to have in case you or your family needs to self-quarantine.
• Matt Walker: Why sleep matters now more than ever Having sleep problems? Listen to this TED talk by Matt Walker, neuroscientist and author of Why We Sleep, including whether "blue light" or other types of light are a problem.
• When Mr. Trump and Dr. Fauci disagree, listen to Dr. Fauci.

• Remdesivir Shows Modest Benefits in Coronavirus Trial (Gina Kolata, Peter Baker and Noah Weilan, NY Times, 4-29-2020) Hope soared nonetheless. The F.D.A. is likely to issue an emergency approval, a senior official said. The improvement in recovery times “doesn’t seem like a knockout 100 percent,” Dr. Fauci conceded, but “it is a very important proof of concept, because what it has proven is that a drug can block this virus.” Sitting at Dr. Fauci’s side, President Trump said, “Certainly it’s positive, it’s a very positive event.” In past weeks, he has repeatedly hailed remdesivir as a potential “game changer,” despite spotty evidence. Business leaders, scientists and politicians alike are scrambling to find ways to fight an insidious epidemic and to reopen a devastated economy. The virus has claimed at least 60,000 lives in the United States, and more than 200,000 worldwide. There have been precious few reasons for optimism, and the markets seized on the news.
• Remdesivir Just Became The First Drug to Show a 'Clear-Cut' Effect in Treating COVID-19 (Issam Ahmed, Science Alert, 4-30-2020)
• Data on Gilead drug raises hopes in pandemic fight, Fauci calls it 'highly significant' (Deena Beasley, Manas Mishra, Reuters, 4-29-2020) Preliminary results from a U.S. government trial showing that patients given remdesivir recovered 31% faster than those given a placebo, were hailed by Dr. Anthony Fauci as “highly significant.” “This is really quite important,” Fauci told reporters at the White House, likening it to a moment in 1986 “when we were struggling for drugs for HIV and we had nothing.” See Reuters Explainer: What does new data say about Gilead's experimental coronavirus drug? (Nancy Lapid, 4-29-2020) The data also suggest a possible survival benefit with remdesivir, although the difference was not statistically significant, meaning it might have been due to chance and not Gilead’s drug. Comparing the drug to a placebo should give researchers definitive answers about remdesivir’s effect on the illness. While the study did meet its primary goal, the promising NIAID data are from an interim analysis. The trial’s final results will likely not be known until sometime next month.

Reliable sources for updates on COVID-19

• Coronavirus Disease 2019 (COVID-19) Situation Summary (CDC updates) Includes background information, including relationship to MERS and SARS betacoronaviruses.This is an emerging, rapidly evolving situation and CDC will provide updated information as it becomes available, in addition to updated guidance. Follow CDC Twitter feed: @CDCgov
• Covid19 Cases in United States (CDC map and data) and Preventing and treating coronavirus disease 2019 (COVID-19) (CDC)
• Rolling updates on coronavirus disease (COVID 19) (World Health Organization) "We need facts, not fear, we need science, not rumors, we need solidarity, not stigma.”
• Kaiser Health Network, Kaiser Family Foundation (invaluable resource, especially on policy) Follow @KHNews And/or listen to KHN's What the Health? podcasts
• MedlinePlus Twitter feed (National Library of Medicine, NIH, @MedlinePlus)
• Spotlight on Coronavirus (Science Friday with Ira Flatow, National Public Radio, @scifri). Listen to useful explanations such as Coronavirus: Sanitizing, According to Science
• Boston’s infectious disease specialists’ message to the public: Don’t be cavalier about the coronavirus (Boston Infectious Disease Specialists, Boston Globe, 3-13-2020) Main take-aways:
(1) Testing capacity is still woefully lacking, and we therefore must conserve Covid-19 testing for those most in need.
(2) The community must begin social distancing immediately.
(3) The public should help in conserving vital medical resources, such as health care provider time and personal protective equipment, such as masks and gloves.
• Preventing COVID-19 Spread in Communities (CDC)
• CDC Guidance for Travelers
• The best way to see where the disease has spread, and how much: COVID-19 map (Johns Hopkins University & Medicine). See also their Coronavirus Resource Center and its Situation Reports.
• Coronavirus updates, NY Times . See especially Tracking Every Coronavirus Case in the U.S.: Full Map (Jerome Groopman, 4-1-2020)
• Washington Post: daily live updates
• NIH Updates on coronavirus (National Institutes of Health)
• Annals of Internal Medicine
• Coronavirus articles (STAT)
• The New Yorker’s coronavirus news coverage and analysis temporarily free for all readers. See A New Study Questions the Effectiveness of a Potential “Game Changer” Against the Coronavirus
• PBS News updates
• BBC News, including Coronavirus and fake news – what to believe?.
• Fact Checker (Glenn Kessler, WaPo). See Fact-checkers, right, left, an center (sites checking for truthfulness and accuracy).
• Helen Branswell, Scientific American.
• Coronavirus stories (Politico) Politico Nightly: Coronavirus Special Edition
• What We Need to Understand About Asymptomatic Carriers if We’re Going to Beat Coronavirus (Caroline Chen, ProPublica, 4-2-2020)
• Hydroxychloroquine For COVID-19: Cure-All Or Flim-Flam? (Anita Bartholomew, Forbes, 4-8-2020) Clear and balanced reporting.
• Coronavirus podcasts:
--- Coronavirus Daily podcast (NPR, audio)
--- Coronavirus: Fact vs Fiction (CNN, host: Dr. Sanjay Gupta)
--- COVID-19: What you need to know (ABC Audio)

When Mr. Trump and Dr. Fauci disagree, listen to Dr. Fauci. Fighting coronavirus requires scientific knowhow, not presidential cheerleading.

• Coronavirus Misinformation Tracking Center (NewsGuard) Sites identified as publishing materially false information about the virus.
• The coronavirus ‘infodemic’ is real. We rated the websites responsible for it (JohnGregory, STAT, 2-28-2020)
• Tech Companies Aim to Stop COVID-19 Disinformation (Tim Mak, Morning Edition, NPR, 3-16-2020) "Fake news spreads faster and more easily than this virus and is just as dangerous."~ World Health Organization's Director-General Tedros Adhanom.
       John Gregory, the deputy editor of health at NewsGuard, says there are three big buckets of coronavirus misinformation circulating right now. "No. 1, conspiracies about the origins of the virus; two, bad health cures, either ineffective or both ineffective and harmful. And three, minimizing the outbreak, saying it's not as big of a deal as the media is making it out to be."

• Why even a super-accurate Covid-19 test can fail (Umair Irfan, Vox, 5-1-2020) Public health officials know that some infected people can spread the virus without showing symptoms, sometimes for weeks. That makes testing to identify and isolate the infected the most important way to slow the spread of the virus. But the shortage of tests means officials don’t yet know how many are still out there, or how many have already recovered. It also turns out that the tests are not always that great. Both the genetic tests for Covid-19 (that look for active infections) and the serological antibody tests (that can identify past infections) have had issues with accuracy. The prevalence of the disease influences the chances of a correct test result. Many researchers agree that the United States needs to be testing millions of people per day, yet the country is struggling to test more than 200,000 in a day. And since a test is just a snapshot in time, many people, particularly in high-risk jobs, will have to be tested over and over.
• FDA pushed through scores of inaccurate antibody tests without agency review. (Zachary Brennan and David Lim, Politico, 4-27-2020) Some are giving too many false positive results, which could mislead some people into thinking they have already been infected.
• Dr. Sanjay Gupta takes coronavirus antibody test(CNN, 4-21-2020) He walks us through his coronavirus antibody test and highlights key details regarding this type of testing. See also WebMD's explanation: Antibody Testing for COVID-19. Elsewhere Dr. Gupta explained on CNN the difference between three types of Covid-19 test and says "so far the tests we have are giving a lot of false positives.":
---PCR diagnostic test confirms if person is positive or negative for the virus. (PCR stands for polymerise chain reaction.)

---Serology test detects antibodies which mean person has been infected
---Antigen test detects viral proteins typically made for flu & strep screenings. With a throat swab you can get quick results. See a fuller description of these three types of test here: Different paths to the same destination: screening for Covid-19 (Chloe Kent, Medical Device Network, 4-3-2020)
• Feds Make $631 Million Available to States to Pay for Coronavirus Testing, Contact Tracing (William Wan, WashPost,4-23-2020) CDC announced that it is sending $631 million to state and local health departments to increase their capacity to do contact tracing and testing for the novel coronavirus — a fraction of what many officials say they need to safely restart their economies.
• Seniors With COVID-19 Show Unusual Symptoms, Doctors Say (Judith Graham, KHN, 4-24-2020) "COVID-19 is typically signaled by three symptoms: a fever, an insistent cough and shortness of breath. But older adults — the age group most at risk of severe complications or death from this condition ― may have none of these characteristics. Instead, seniors may seem “off” — not acting like themselves ― early on after being infected by the coronavirus. They may sleep more than usual or stop eating. They may seem unusually apathetic or confused, losing orientation to their surroundings. They may become dizzy and fall. Sometimes, seniors stop speaking or simply collapse."
• 1 In 5 New Yorkers May Have Had Covid-19, Antibody Tests Suggest (Goodman and Rothfeld, NY Times, 4-23-2020) One of every five New York City residents tested positive for antibodies to the coronavirus, according to preliminary results described by Gov. Andrew M. Cuomo on Thursday that suggested that the virus had spread far more widely than known (and the death rate may therefore be lower than previously thought). Accurate antibody testing is a critical tool to determine if the pandemic has slowed enough to begin restarting the economy. A top health official in New York City cautioned that the tests being used were not a reliable indicator of immunity.
• COVID Tests Are Free, Except When They’re Not (Carmen Heredia Rodriguez, KHN, 4-29-2020) Her doctor worried she had COVID-19 but couldn’t test her for it until she ruled out other things. That test cost a bundle. (Scroll down to The Takeaway for practical advice.)
•  The Strongest Evidence Yet That America Is Botching Coronavirus Testing (Robinson MeyerAlexis C. Madrigal, The Atlantic, 3-6-2020) “I don’t know what went wrong,” a former CDC chief told The Atlantic.
• A New Statistic Reveals Why America’s COVID-19 Numbers Are Flat (Robinson Meyer and Alexis C. Madrigal,The Atlantic, 4-17-2020) "At least 630,000 people nationwide now have test-confirmed cases of COVID-19, according to The Atlantic’s COVID Tracking Project, a state-by-state tally conducted by more than 100 volunteers and experts. But an overwhelming body of evidence shows that this is an undercount...".(We don't know our prevalence rate because we haven't tested enough.) "The U.S. still lags far behind other countries in the course of fighting its outbreak. South Korea — which discovered its first coronavirus case on the same day as the U.S. — has tested more than half a million people, or about 1 percent of its population, and discovered about 10,500 cases. The U.S. has now tested 3.2 million people, which is also about 1 percent of its population, but it has found more than 630,000 cases. So while the U.S. has a 20 percent positivity rate, South Korea’s is only about 2 percent — a full order of magnitude smaller....Each of those uncounted cases is a small tragedy and a microcosm of all the ways the U.S. testing infrastructure is still failing."
• Chicago Plans for a Slow Recovery from the Coronavirus (Peter Slevin, New Yorker, 4-22-2020) Chicago Mayor Lori Lightfoot has spoken of her frustration with the White House’s response to the coronavirus and believes Chicago is “not testing nearly enough people.”
• Testing Falls Woefully Short as Trump Seeks an End to Stay-at-Home Orders (Abby Goodnough, Katie Thomas and Sheila Kaplan, NY Times, 4-15-2020) Flawed tests, scarce supplies and limited access to screening have hurt the U.S.’s ability to monitor Covid-19, governors and health officials warn. Most of the country is not conducting nearly enough testing to track the path and penetration of the coronavirus in a way that would allow Americans to safely return to work, public health officials and political leaders say. So far there is not enough national capacity for either diagnostic or antibody testing. Testing is critical for detecting and stamping out smaller outbreaks before they get big. Many say the biggest challenge is getting not the diagnostic tests themselves but the supplies to process them, including chemical reagents, swabs and pipettes. One expert said 'confusion over which laboratories were accepting tests, and “convoluted” systems connecting providers to labs, meant his facilities were running about 200 to 300 tests per day when they could handle 1,000.'

• Thousands of coronavirus tests are going unused in US labs (Amy Maxmen, Nature, 4-9-2020) Experts say the lack of a national strategy is largely to blame. "A Nature investigation of several university labs certified to test for the virus finds that they have been held up by regulatory, logistic and administrative obstacles, and stymied by the fragmented US health-care system. Even as testing backlogs mounted for hospitals in California, for example, clinics were turning away offers of testing from certified academic labs because they didn’t use compatible health-record software, or didn’t have existing contracts with the hospital." (Worth a read.)
• Local officials on watch for unauthorized COVID-19 test sites (Cheryl Clark, Covering Health, AHCJ, 4-16-2020) Cities, counties and states around the country are probably on heightened alert for unauthorized pop-up COVID-19 testing operations after San Diego County took steps to shut down one such clinic Wednesday, lest a bogus test give someone a false result and jeopardize public health.
• Where Can I Get a Drive-Thru Coronavirus (COVID-19) Test Near Me? (GoodRx, 4-16-2020 )
• Despite Promises, Testing Delays Leave Americans ‘Flying Blind’ (Sheila Kaplan and Katie Thomas, NY Times, 4-6-2020) Testing availability remains a signature failure of the battle against the coronavirus in the United States, despite President Trump’s boast last week that he got a rapid test and results within minutes. On a per capita basis, the United States had tested far fewer people than several other countries. Even as new and faster tests become available, lengthy delays to obtain results continue and test materials are running low, compounding the crises hospitals are facing. Demand for testing has overwhelmed many labs and testing sites and swabs and chemicals needed to run the tests are in short supply in many of the nation’s hot zones. Excellent overview of where things stand from many viewpoints.
• ‘We're behind the curve’: U.S. hospitals confront the challenges of large-scale coronavirus testing (Jon Cohen, Science, 3-11-2020) “The reality is most people will not be able to get a test this week, and most people will not be able to get a test next week,” says physician and epidemiologist Michael Mina, who helps run the diagnostic lab at Brigham and Women’s Hospital in Boston and has been critical of the Trump administration in blistering tweets. Mina "also anticipates that there will be—or may already be—a shortage of reagents needed to run the test kits."
• The 4 Key Reasons the U.S. Is So Behind on Coronavirus Testing (Olga Khazan, The Atlantic, 3-13-2020) Bureaucracy, equipment shortages, an unwillingness to share, and failed leadership doomed the American response to COVID-19.

(1) Red Tape. Dozens of labs in the U.S. were eager to make tests and willing to test patients, but they were hamstrung by emergency use authorization (EUA) regulations for most of February, even as the virus crept silently across the nation.

(2) Hard-to-get virus samples.Miller said it would help if researchers, governments, and companies firmed up pathogen-sharing contracts in advance of an outbreak.

(3) “We don’t have a nationalized health-care system where you put the same equipment in all the hospitals,” Wu says. “We have all these independent hospital systems with their own equipment in their own labs.” Even though some hospitals actually have the new, functional CDC tests, the extraction machines and reagents that are used to perform them are in short supply.

(4) Leadership and coordination problems. For months, President Trump made light of the coronavirus. “Much of what he’s said publicly about the virus has been wrong, a consequence of downplaying any troubles on his watch.” Trump put Mike Pence, who has no public health experience, in charge, late, and there was infighting between and little coordination among departments.
• The Dangerous Delays in U.S. Coronavirus Testing Haven’t Stopped (Robinson MeyerAlexis C. Madrigal, The Atlantic, 3-9-2020)
• Reviewing Public Health Record of Coronavirus Commander Mike Pence (KHN, 2-28-2020) KHN Midwest editor and correspondent Laura Ungar appeared on “CNN Newsroom with Brooke Baldwin” to discuss Vice President Mike Pence’s appointment to lead the nation’s response to the novel coronavirus in light of how he handled a 2015 HIV outbreak when he was governor of Indiana. Prevention and quick evidence-based action are the most important steps to take in these health crises and Pence took neither in 2015.
• Key Missteps at the CDC Have Set Back Its Ability to Detect the Potential Spread of Coronavirus (Caroline Chen, Marshall Allen, Lexi Churchill and Isaac Arnsdorf, ProPublica, 2-28-2020) The CDC designed a flawed test for COVID-19, then took weeks to figure out a fix so state and local labs could use it. New York still doesn’t trust the test’s accuracy.
• Drive through testing begins at Edinburgh hospital (BBC News, 2-28-2020)
• New California Coronavirus Case Reveals Problems with U.S. Testing Protocols (Anna Maria Barry-Jester and Rachel Bluth, KHN, 2-27-2020)
• Estimates fall short of the F.D.A.’s pledge for 1 million coronavirus tests. Health care supply companies and public health officials have cast doubt on the federal U.S. government’s assurances of greatly ramped-up testing for the virus, as complaints continue that the need for testing remains far greater than the capacity. Some companies developing tests say their products are still weeks away from approval. See also What went wrong with the coronavirus tests in the U.S. (Carolyn Y. Johnson and Laurie McGinley, WaPo, 3-7-2020)
•‘It’s Just Everywhere Already’: How Delays in Testing Set Back the U.S. Coronavirus Response (Sheri Fink and Mike Baker, NY Times, 3-10-2020).
• The Strongest Evidence Yet That America Is Botching Coronavirus Testing (Robinson Meyer and Alexis C. Madrigal, The Atlantic, 3-6-2020) "The haphazard debut of the tests—and the ensuing absence of widespread data about the epidemic—has hamstrung doctors, politicians, and public-health officials as they try to act prudently during the most important week for the epidemic in the United States so far....the capacity to test for the coronavirus varies dramatically—and sometimes dangerously—from state to state."

Failure to control the virus will mean millions of deaths.

• What does the coronavirus do in my body? (Shauna Bennett and Signe Aasberg at NTNU Norway, illustrated by Elfy Chiang and Taiwan) This illustrated story covers how the virus works in the body, how the immune system fights back, and what people can do to protect themselves and improve their immune health. (Click right arrow to advance the story.)
• "SARS-CoV-2 is the virus. COVID-19 is the disease that it causes. The two aren’t the same. " ~ Ed Yong, Why the Coronavirus Is So Confusing (The Atlantic, 4-29-2020) A guide to making sense of a problem that is now too big for any one person to fully comprehend. People can spread the virus before showing symptoms.
• Here’s the Biggest Thing to Worry About With Coronavirus (Aaron E. Carroll, NY Times, 3-12-2020) "A crucial thing to understand about the coronavirus threat — and it’s playing out grimly in Italy — is the difference between the total number of people who might get sick and the number who might get sick at the same time.... Our country has only 2.8 hospital beds per 1,000 people. We don’t have enough ventilators and I.C.U. beds if there’s a significant surge of new cases. As with Italy, the health system could become overwhelmed."  We must "flatten the curve."
• Dr. Karen Duca explains Covid-19 (Episode 1: Explaining Covid-19). An  excellent YouTube/Zoom series of explanations and Q&As hosted by Kristen Kosinski asking Dr. Duca questions. Follow introductory session with sessions Part 2, Part 3, Part 4,Part 5, Part 6. Find those that follow by searching for the names of the two women. In the first one I landed on (referred by a friend), the doctor was wearing a knitted cap and I thought she was a homeless woman and wondered how she was coming up with such good explanations.
• Do You Want to Die in an I.C.U.? Pandemic Makes Question All Too Real (Paula Span, NY Times, 4-24-2020) Sobering statistics for older patients sharpen the need to draw up advance directives for treatment and share them with their families. See this handy Shared Decision Making Tool for Covid-19 from national hospice group.
• How the Pandemic Will End (Ed Yong, The Atlantic, 3-25-2020) The U.S. may end up with the worst COVID-19 outbreak in the industrialized world. This is how it’s going to play out.
• This virus is absolutely brutal. @MaggieAstor thread on Twitter: 'My husband and I are recovering from COVID-19. We’re getting better. But it’s taken more than two weeks to say that, and that was with the “mild” version, meaning no trouble breathing. This virus is absolutely brutal. “Mild” is not mild by any normal definition.'
• For Americans With Bills to Pay, Help Is on the Way. Sort Of. ( Paul Kiel and Jeff Ernsthausen, ProPublica, 4-2-2020) Politicians have touted debt relief, but the various proposals are patchwork. Many homeowners and renters won’t get much help; those struggling with credit card, car and other loan payments will get none.
• What the Health: All Coronavirus All the Time (KHN podcast, early April 2020, plus summary) "The ACA was passed on the heels of the Great Recession. The coronavirus outbreak has produced the first big economic downturn since then, and the law’s provisions to expand Medicaid and to provide an insurance option to those without jobs could provide a critical safety net during this crisis.
       "About a dozen states running their own ACA insurance marketplaces have opened up enrollment again to let people who did not enroll in the fall but are feeling the pinch from the coronavirus pandemic to reconsider. President Donald Trump said this week that he is mulling a similar move, but the messages from the administration on such action have been confusing.
         "People who had insurance through work and have lost their jobs don’t need a special enrollment period to sign up for an Obamacare plan. They are eligible because their job situation changed. However, the administration has not been publicizing that message."
• The Coronavirus, by the Numbers (James Gorman, NY Times, 3-5-2020) Adam Kucharski, a mathematician who studies the spread of disease, explains some of the figures that keep popping up in coronavirus news.
• Exponential growth and epidemics: How is COVID-19 currently growing? (video, 3blue1brown.com) A good primer on exponential and logistic growth.
• Coronavirus: A primer (Dr. Jane A. Culp's excellent explanation of basics, Herald-Star, 3-3-2020; bolding added) "There are seven strains of coronavirus known to cause disease in humans. Four of these strains are the alpha form, and three strains are in the beta form. The world has experienced two other outbreaks of beta coronavirus. The first was in 2002 when severe adult respiratory syndrome was first noted in a Chinese province. This beta coronavirus originated in bats and transmitted the virus to another species — the skivat cat. The skivat cat transmitted the virus to humans. The mortality rate for SARS was 9 percent to 10 percent.

     "The second outbreak of a beta coronavirus occurred in 2012 with Middle Eastern respiratory syndrome. MERS originated in camels with transmission to humans. The mortality rate for MERS was at least 36 percent and in some reports listed as being close to 50 percent.

     "That brings us to the present with the novel (new) third beta coronavirus causing the disease COVID19. The animal (possibly a bat) to human transmission first occurred in the Chinese city of Wuhan, home to 11 million people. The mortality rate for COVID19 is estimated at 2 percent to 2.5 percent." There are no vaccines yet.
• Analysis: One Sure Thing About COVID-19: No Telling How Many People Have It (Elisabeth Rosenthal, Kaiser Health News, 3-3-2020) It has been nearly three months since the first cases of a new coronavirus pneumonia appeared in Wuhan, China, and it is now a global outbreak. And yet, the world still doesn’t have a clear picture of some basic information about this outbreak.
• The New Coronavirus Is a Truly Modern Epidemic (Ed Yong, The Atlantic, 2-3-2020) New diseases are mirrors that reflect how a society works—and where it fails.
• Here’s a Glossary for the Ongoing Coronavirus Outbreak’s Vocabulary (Dan Robitzski, Futurism/Neoscope, 3-2-2020)

Matt Pearce (a Los Angeles Times reporter) tweeted: "I imagine all the closures and cancellations give people a sense of ominousness. But it's really an amazing act of social solidarity: We're sacrificing so we can give nurses, doctors and hospitals a fighting chance. Start from there and hopefully we can figure out the rest."

• Answers to frequently asked questions about COVID-19 (Harvard Health Publishing) Including What are the symptoms? What should I do if I feel sick? If a loved one gets it, how do I care for them? How do I keep from getting it?
• Running Essential Errands (CDC) Grocery Shopping, Take-Out, Banking, Getting Gas, and Doctor Visits. To protect yourself when getting your prescriptions:
---Call in prescription orders ahead of time.
---Use drive-thru windows, curbside services, mail-order, or other delivery services.
---Try to make one trip, picking up all medicine at the same time. During this time, you may also want to contact your Medicare prescription drug plan to see if they've temporarily waived certain requirements to help prevent the spread of COVID-19 — like waiving prescription refill limits or relaxing restrictions on home or mail delivery of prescription drugs.
• Sanitizing Amazon boxes, taking Uber and getting food properly during the coronavirus pandemic (Kim Komando, USA Today, 4-3-2020)
• Safety Advice If You Must Visit the Grocery Store (Sumathi Reddy, Wall Street Journal, 4-3-2020) Deliveries are safer during the coronavirus pandemic, but sometimes a store visit is unavoidable. Here are the precautions to take.
• When and how to use masks (WHO, Advice for the public)
• 'Under No Circumstance': Lysol Maker, Officials Reject Trump's Disinfectant Idea (Colin Dwyer, NPR, 4-24-2020) After hearing about research reflecting the disinfectant capabilities of ultraviolet light on surfaces, Trump mused that scientists might try to find a way to place strong disinfectants directly inside the body to treat a patient's infection.

        As many experts have stated since horrified expressions crossed faces all over the country, THIS IS A HORRIBLE, DEADLY IDEA. Reported Domenico Montanaro of NPR on 4-25: ’"With the president facing criticism for seemingly thinking out loud behind the lectern at these briefings, floating untested ideas, Friday’s session was cut short to just over 20 minutes. Axios reported that the president may reduce the length of them or not appear daily....advisers to the president, in and out of the White House, reportedly think these briefings are hurting his image." Indeed.
• Myth Busters (World Health Organizations) Things that are not true about covid 19.
• Stories of Hope (The Obama Foundation) Tell us about the stories—big and small—that are lifting your spirits.
• COVID-19 - Some Drug-Related Issues (The Medical Letter)
• COVID-19 Loan and Relief Resources for Small Businesses (Gusto editors) Click on "COVID-19 Relief Resources for Small Businesses" to get updated spreadsheet.
• Trump's mismanagement helped fuel coronavirus crisis (Dan Diamond, Politico, 3-7-2020) Current and former administration officials blame the president for creating a no-bad-news atmosphere that stifled attempts to combat the outbreak. Fortunately, we're learning to listen to Dr. Fauci instead of Trump.
• Not His First Epidemic: Dr. Anthony Fauci Sticks to the Facts (Denise Grady, NY Times, 3-9-2020) Dr. Anthony Fauci, the nation’s leading expert on infectious diseases, is widely respected for his ability to explain science without talking down to his audience and to correct the president. Seealso “I Have No Ideology. My Ideology Is Health”: Dr. Anthony Fauci on the Tactics of Dealing With the Novel Coronavirus—And Trump (Gabriel Sherman, Vanity Fair, 3-31-2020) “We are by no means out of the woods,” Fauci says. But his insistence on facts, and science, may be finally changing the trajectory of the pandemic.
• The Use of Bleach (Hong Kong health department during SARS crisis). Bleach is a good disinfectant but it's dangerous if misused. Follow instructions!
• Interim Guidance for Responding to COVID-19 among People Experiencing Unsheltered Homelessness Key actions that local and state health departments, homelessness service systems, housing authorities, emergency planners, healthcare facilities, and homeless outreach services can take to protect people experiencing homelessness from the spread of COVID-19.
• Whether planned surgery should proceed (Centers for Medicare & Medicaid Services). Determining essential vs. elective surgery. "At all times, the supply of personal protective equipment (PPE), hospital and intensive care unit beds, and ventilators should be considered, even in areas that are not currently dealing with COVID-19 infections."
• Does Everyone Over 60 Need to Take the Same Coronavirus Precautions? (Judith Graham, KHN, 3-24-2020) If you’re going to the store, consider wearing cloth gloves, because viruses don’t survive as well on soft surfaces. Try not to handle your smartphone when you’re out of the house. “A phone is a hard plastic surface that can easily get contaminated,” she said. Are you frail? Answer these questions:

F: Are you consistently fatigued?

R, for resilience: Can you climb a flight of stairs?

A, for aerobic: Can you walk a block?

I, for illnesses: If you’ve got five or more, that’s bad.

L, for loss of weight: That’s not good.”

If you answer yes to three or more of those questions, you should be “really careful and self-isolate,” Morley said. ...even healthy people are becoming sick.
• Life on Lockdown in China (Peter Hessler, Letter from Chengdu, New Yorker, 3-30-2020) Forty-five days of avoiding the coronavirus. 'There seems to be a brief window—perhaps two or three days—when people are infectious but not yet showing symptoms. Gabriel Leung, the dean of medicine at the University of Hong Kong, told me that he believes between twenty and forty per cent of infections come from people who don’t yet seem sick. “They could be spreading it through droplets, say during eating or speaking,” he said. “These droplets could contaminate surfaces, and this is how it spreads.”' [Not touching your face is the critical preventive step--that plus washing your hands when you've touched possibly contaminated surfaces.]
• U.S. Health Workers Responding to Coronavirus Lacked Training and Protective Gear, Whistle-Blower Says (Emily Cochrane, Noah Weiland and Margot Sanger-Katz, NY Times, 2-27-2020) Team members were not properly trained, lacked necessary gear and moved freely around and off military bases where Americans were quarantined, a whistleblower complains.
• How prepared are you for disaster? Sites geared to helping you prepare for hurricanes, earthquakes, tornadoes, floods and flash floods, and to increase child and campus security. Many of the steps are helpful in a pandemic.
• Help fight Medicare fraud (Medicare.gov) Guard your Medicare card like it’s a credit card.
• Why Texas is so far behind other states on virus response(Politico, 3-18-2020) Texas leaders have been reluctant to set restrictions conservative voters might consider draconian and business leaders oppose. They’ve also opposed steps to expand health insurance coverage. The state, which didn’t expand Medicaid, has the highest uninsured rate in the country, meaning millions of people don’t have doctors to call if they show symptoms.
• What am I supposed to do about my fundraising event: Event planning and COVID-19: (Vimeo video, Laura Pierce of Washington Nonprofit and Rebecca Zanatta of Ostara Group, a nonprofit consulting group) Cancel? or something else?
• Worries about medical bills and lost pay may hamper coronavirus efforts in the United States (Amy Goldstein, Washington Post, 3-2-2020) The race to curb the spread of the new coronavirus could be thwarted by Americans fearful of big medical bills if they get tested, low-income workers who lose pay if they take time off when sick, and similar dilemmas that leave the United States more vulnerable to the epidemic than countries with universal health coverage and sturdier safety nets. As the test for the virus becomes more widely available, health-care experts predict that some people with flu-like illnesses — or those who may have been exposed — will avoid finding out whether they have been infected because they are uninsured or have health plans that saddle them with much of the cost of their care.
• These Common Household Products Can Destroy the Novel Coronavirus (Consumer Reports) On surfaces, that is, and why you need to clean using the right stuff. Soap and water is right up there with disinfectants.
• Tipsheet for Journalists: Covering the Coronavirus Epidemic Effectively without Spreading Misinformation (Laura Helmuth, TheOpenNotebook, 3-2-2020) See tip sheets for journalists below.
• Avoid cruise ships, says State Department (Noah Weiland and Maggie Haberman, NY Times, 3-9-2020) “Absolutely don’t get on a cruise ship,” says Dr. Anthony Fauci, who has overseen epidemics for decades at NIH/NIAID.
• Coronavirus: Fake health advice you should ignore (BBC News, 3-8-2020) Drinking water every 15 minutes (and eating garlic) cannot kill the virus. You should remain well-hydrated, however.
• I.O.C.’s Reassurance About the Tokyo Olympics Rankles Some Athletes (NY Times, 3-18-2020) Some athletes on a conference call about whether to cancel the Summer Olympics in Tokyo in July were left dumbfounded when an athlete representative from Europe made a comment playing down the severity of the virus and blaming the news media for hyping its risks. The I.O.C. is insisting the games will go on; the athletes are worried about the health risk. (In late March the games were postponed a year.)
• What you need to know about the coronavirus (Washington Post, 3-3-2020)
• Online training as a weapon to fight the new coronavirus (World Health Organization, 2-7-2020) This free learning resource is available to anyone interested in novel coronavirus on WHO’s open learning platform for emergencies, OpenWHO.org.
• Here Is What a WHO Global Health Emergency Means (Washington Post) While the recommendations aren’t enforceable, there’s considerable pressure for countries to abide by the WHO’s advisories.
• You’re Likely to Get the Coronavirus (James Hamblin, The Atlantic, 2-24-2020) Most cases are not life-threatening, which is also what makes the virus a historic challenge to contain. (WHO)
• Basic protective measures against the new coronavirus (ANSInet, 2-29-2020)
• Growing Concerns Of Coronavirus Should Spur Plans – Not Panic – In The Workplace (Julie Appleby, Kaiser Health News, 2-28-2020)
• World experts and funders set priorities for COVID-19 research (WHO, 2-12-2020)

• CPJ Safety Advisory: Covering the coronavirus outbreak (Committee to Protect Journalists, updated 4-6-2020) Detailed practical advice about how to protect yourself while covering this story. See also CPJ’s interviews with journalists covering the pandemic.
• COVID-19 Reporting Diaries: March 25–31, 2020 (Shira Feder, TheOpenNotebook, 4-7-2020) "Nothing that has come before in the infectious-diseases beat is remotely as huge as this story," says STAT reporter Helen Branswell, one of five journalists reporting on their coverage of this crisis. "The biggest lesson I’ve learned is that when covering a rapidly evolving event like this pandemic, it’s important to be open to new evidence and data, even if it goes against what I’d previously reported," says Garcia de Jesus. "We’re watching science happen in real-time—sometimes that involves conflicting information."
• How can states keep nursing home residents safe during the pandemic? (Liz Seegert, Covering Health, AHCJ, 4-30-2020) An important round-up of info on resources, trends, sources.
• PEN America’s Guide on COVID-19 and Disinformation (PEN America, 3-25-2020)
• How COVID-19 is threatening press freedom: An interview with Joel Simon (Ann Cooper, Journalist's Resource, 4-13-2020) "It’s sobering to see how many governments have taken action against journalists for their COVID-19 coverage....political leaders are being told by experts that they must take dramatic action to stem the spread of a deadly disease but they are worried about the economic and social consequences of doing so. Of course one way to avoid making a difficult decision is suppress any reporting that suggests that COVID-19 is spreading rapidly, and many governments are doing just that."
• Coronavirus: Resources for reporters (First Draft News)
• The COVID Tracking Project collects and publishes the most complete testing data available for US states and territories.
• Data Drum: COVID-19 Data (data from the European Centre for Disease Prevention. Also available as a mobile app.)
• COVID-19 Open Research Dataset (CORD-19) (the Allen Institute for AI in partnership with leading research groups) a free resource of over 45,000 scholarly articles, including over 33,000 with full text, about COVID-19 and the coronavirus family of viruses for use by the global research community.
• Covering COVID-19 and the coronavirus: 5 tips from a Harvard epidemiology professor (Denise-Marie Ordway, Journalist's Resource, 3-6-2020) Choose experts carefully. Distinguish what is known to be true from what is thought to be true — and what’s speculation or opinion. Use caution when citing research findings from “preprints,” or unpublished academic papers. Ask academics for help gauging the newsworthiness of new theories and claims. To prevent misinformation from spreading, news outlets also should fact-check op-eds. Read the work of journalists who cover science topics well.
• The Five Questions Reporters Need to Ask Hospitals and Local Officials About Coronavirus (Charles Ornstein, ProPublica, 3-17-2020) Including: How many beds does each hospital in your state/region have? How many of those beds are already occupied?
• Coronavirus Rumor Control (FEMA)
• Covering the Coronavirus Pandemic (National Association of Broadcasters) Webcast and other resources.
• The Newsroom Guide to COVID-19
• Covering Coronavirus: Resources for Journalists (Dart Center for Journalism & Trauma, 2-28-2020)
• Coronavirus, SARS and Flu Resources (Mike Reilley, Journalist's Toolbox, 4-1-2020) The most extensive set of links for journalists--both general and very specific!
• Presenting Trump and Science as Equals Isn’t Balanced, It’s Dangerous (Neil deMause, Fairness & Accuracy in Reporting, or FAIR, 3-23-2020) Stopping the coronavirus pandemic from taking millions of lives may require news organizations to take sides—but if it’s on the side of science, that’s the kind of bias that journalism needs.
• Tipsheet: Covering the Coronavirus Epidemic Effectively without Spreading Misinformation (Laura Helmuth, The Open Notebook, 3-2-2020)
• I Lived Through SARS and Reported on Ebola. These Are the Questions We Should Be Asking About Coronavirus. (Caroline Chen, ProPublica, 3-5-2020) Instead of asking: How many test kits do you have? Ask this: How many samples are you running per patient? Instead of saying: The mortality rate is X%. Say this: Scientists estimate the mortality rate is X%, based on the information they have.
• Mapping coronavirus, responsibly (Kenneth Field, ESRI, 2-25-2020)
• Covering Coronavirus: Expert Tips for Journalists and Communicators (YouTube video, CDC at National Press Club, 2-10-2020, 1 hr 26 minutes) Streamed live, available with comments via LiveStream replay.
• Use caution when reporting on pandemic potential of Wuhan coronavirus (Bara Vaida, Association of Health Care Journalists, 1-23-2020)
• Despite pronouncements, no quick turnaround likely for COVID-19 treatments, vaccines (Bara Vaida, Covering Health, AHCJ, 3-20-2020)  "An inaccurate statement that President Trump made during a March 19 news briefing - that the malaria drug hydroxychloroquine had been approved as a COVID-19 treatment - demonstrates how skeptical journalists should remain when covering the unfolding story about treatments and preventative measures. While there are more than 85 trials for vaccines and treatments underway for COVID-19, scientists don't expect them to be available to the public soon, despite what some headlines suggest." President Trump is absolutely NOT a reliable source, and some of the things he's said have caused harm. See Two studies have some good news and bad news for potential coronavirus treatments (Zeeshan Aleem, Vox, 4-11-2020) Remdesivir looks “hopeful” but hydroxychloroquine has serious side effects, and its benefits for Covid-19 patients are not yet proven.
• Finding the latest COVID-19 studies — and covering them thoughtfully (Tara Haelle, Covering Health, AHCJ, 3-20-2020) In the early days of the coronavirus pandemic, most data came from news reports, clinical summaries and preprints. Now more and more peer-reviewed studies are coming out each day, and it's challenging to keep up with them. Several journals have set up dedicated coronavirus sites that can help in keeping up with the research. The Lancet's COVID-19 Resource Centre, JAMA Network's COVID-19 resource center and NEJM's Coronavirus (COVID-19) page all include the newest studies, commentary and related data and information on the pandemic.
• The Simplest Way to Spot Coronavirus Misinformation on Social Media (Will Oremus, OneZero, 3-4-2020) A digital literacy expert shares his method. Fact-check!
• The many challenges of covering the coronavirus (Jon Allsop, CJR, 3-9-2020) The challenge here is to communicate nuance and uncertainty in formats—headlines, tweets, and so on—that reward brevity and clarity.
• What Investigative Reporters Around the World Need to Be Asking About COVID-19 (Amruta Byatnal, Global Investigative Journalism Network, 3-10-2020) Q&A with Thomas Abraham, an expert on infectious disease and global health security, and the author of Twenty-first Century Plague: The Story of SARS and of Polio: The Odyssey of Eradication. Remember that science evolving as rapidly as this is hedged by huge amounts of uncertainty.
• How newsrooms can tone down their coronavirus coverage while still reporting responsibly (Al Tompkins, Poynter, 3-4-2020) When you do anecdotal stories about sickness and death from coronavirus, infuse them with the data that points out the wider context of the issue.
• How to name a coronavirus ( Merrill Perlman, CJR, 2-24-2020)
• 10 tips for journalists covering COVID-19 (Taylor Mulcahey, International Journalism Network, 3-5-2020)
• How to Report on the COVID-19 Outbreak Responsibly (Bill Hanage, Marc Lipsitch, Scientific American, 2-23-2020) Reporting "should distinguish between at least three levels of information: (A) what we know is true; (B) what we think is true—fact-based assessments that also depend on inference, extrapolation or educated interpretation of facts that reflect an individual’s view of what is most likely to be going on; and (C) opinions and speculation."
• COVID-19 reports (Imperial College London‌)
• COVID-19 Webinar Series (Session 1 of many sessions in Alliance for Health Policy webinar series) Other sessions are listed and linked to along the right side of website.
• FactCheck.org on coronavirus coverage

• CIDRAP COVID-19 Resource Center (Center for Infectious Disease Research and Policy) "You can make a vaccine against anything very quickly. But it needs to be effective and safe. This is a long process that can take months to years, even under optimal conditions." ~ -Michael Osterholm, PhD, MPH

• How the Pandemic Will End (Ed Yong, The Atlantic, 3-25-2020) [Scroll down to II. The Endgame.] There are no existing vaccines for coronaviruses—until now, these viruses seemed to cause diseases that were mild or rare—so researchers must start from scratch. For one vaccine that has been developed, an "initial trial will simply tell researchers if the vaccine seems safe, and if it can actually mobilize the immune system. Researchers will then need to check that it actually prevents infection from SARS-CoV-2. They’ll need to do animal tests and large-scale trials to ensure that the vaccine doesn’t cause severe side effects. They’ll need to work out what dose is required, how many shots people need, if the vaccine works in elderly people, and if it requires other chemicals to boost its effectiveness....“Even if it works, they don’t have an easy way to manufacture it at a massive scale,” said Seth Berkley of Gavi....Berkley and others estimate that it will take 12 to 18 months to develop a proven vaccine, and then longer still to make it, ship it, and inject it into people’s arms."
•COVID-19 Vax Moving at Brisk Clip, but Will It Be Soon Enough? (Ed Susman, MedPage Today, 3-10-2020) At a medical conference, "Anthony Fauci, MD, said the time from sequencing of the virus -- which arose in central China in late December 2019 -- to human trials of a vaccine candidate is expected to move with unprecedented speed -- around 2 months. [But that is just Step 1.] Zunyou Wu, MD, of the Chinese Center for Disease Control and Prevention, shared some key insights on COVID-19 from China:
---The majority of cases arise from close contact of symptomatic cases
---Transmission is driven by family clusters
---Second-degree household attack rates were around 10% early in the outbreak, but fell to 3% with faster isolation
---Virus shedding is highest early in the disease course and can occur 24-48 hours before symptom onset
---Virus shedding usually continues for 7-12 days in mild/moderate cases and for >2 weeks in severe cases.
• Trump is pushing a dangerous, false spin on coronavirus — and the media is helping him spread it (Margaret Sullivan, Washington Post, 3-1-2020) A vaccine is NOT coming along "rapidly." It will probably take a year to a year and a half, says NIH expert Anthony Fauci. [He has since revised that estimate upward because new steps are being taken.] As for Dr. Oz's advocacy for HCQ as a covid treatment, Dr. Anthony Fauci responds: "That was not a very robust study." Fauci also says some may "feel" HCQ is an effective treatment, and "there is a suggestion" it could be, but we can't "make that majestic leap" to assume it's a cure. And Trump, in pushing HCQ as a solution, has helped make the drug scarce for people who rely on it for treating serious conditions.

Swine Flu (H1N1) was very contagious but not very fatal. SARS virus was very fatal but not very contagious. Covid19 is both fatal and very contagious.

• Coronavirus (World Health Organization) Coronaviruses are zoonotic, meaning they are transmitted between animals and people. Detailed investigations found that SARS-CoV was transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known coronaviruses are circulating in animals that have not yet infected humans.
• "In 2002, SARS spread virtually unchecked to 37 countries, causing global panic, infecting more than 8,000 people and killing more than 750. MERS appears to be less easily passed from human to human, but has greater lethality, killing 35% of about 2,500 people who have been infected." ~ The Guardian
• Middle East respiratory syndrome coronavirus (MERS-CoV) (WHO Fact Sheet, 3-11-19) Symptoms, source, method of transmission, prevention and treatment, etc. Approximately 35% of reported patients with MERS-CoV infection have died. Approximately 80% of human cases have been reported by Saudi Arabia.
• COVID-19, MERS & SARS (NIH/NIAID) Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV). A novel coronavirus (nCoV) is a new strain that has not been previously identified in humans.

     Research evidence suggests that SARS-CoV-2, MERS-CoV, and the original SARS-CoV all originated in bats. SARS-CoV then spread from infected civets to people, while MERS-CoV spreads through infected dromedary camels to people. Scientists are trying to determine how SARS-CoV-2 spread to people.    
• Middle East respiratory syndrome coronavirus (MERS-CoV) (WHO)
• Severe Acute Respiratory Syndrome (SARS)

Flu: Quick Start Resources
• CDC's Flu Overview
• Emergency Flu Symptoms (VeryWellHealth) Symptoms such as difficulty breathing, shortness of breath, and chest pain or severe abdominal pain indicate a need to go to the hospital. Click here for all symptoms and more information: https://www.verywellhealth.com/when-you-should-go-to-the-hospital-with-the-flu-770306
• Flu Prevention Prevent the flu to the best of your ability by taking certain key steps such as vaccinating and keeping your hands and common surfaces clean. Learn more tips here: www.healthyessentials.com/wellness-solutions/cold-flu-prevention-tips
• Flu Vaccine Finder (CDC)

Flu Vaccine Fact List
• Flu Shot Fact and Fiction (NPR)
• Flu Vaccine Side Effects
• Complete Guide to the 2019-2020 Influenza Vaccine

Overcoming Flu Vaccine Hesitancy

When Flu Facts Aren't Enough, Use Persuasion: Managing Vaccine Resistant Attitudes and Beliefs
• Talking Points About the Flu
• Flu Shots and Persuasion
• Seven Ways to Talk to the Vaccine Hesitant that might actually change their minds.
• How to Respond to Vocal Vaccine Deniers in Public (Best Practice Guidance)
• Explaining 'Herd Immunity' May Convince More People to Get Flu Shots
• Anonymous Nurse: Convincing Patients to Get Vaccinated Is Becoming More Difficult
• Patients Skeptical of the Flu Vaccine? Here’s How to Reason With Them
• Understanding Extreme Vaccine Hesitancy Anti-Vaxxers: Singular in Focus, Varied in Argument. Four distinct types of anti-vaccination content seen in Facebook posts: 1) Mistrust of scientific community ("doctors uneducated, parents need to educate selves"), mandatory vaccination threatens ability to make decisions about own children; 2) mistrust of chemicals in vaccines, preference for homeopathic approaches; 3) Safety-- belief that vaccines cause autism, that kids who don't get vaccinated are healthier; 4) 'Conspiracy: government "hides" information that anti-vaccination groups believe to be facts.'

Wikipedia provides a useful overview of Autopsy. For example: The four main types of autopsies:

Medico-Legal Autopsy or Forensic or coroner's autopsies seek to find the cause and manner of death and to identify the decedent. They are generally performed, as prescribed by applicable law, in cases of violent, suspicious or sudden deaths, deaths without medical assistance or during surgical procedures.

Clinical or Pathological autopsies are performed to diagnose a particular disease or for research purposes. They aim to determine, clarify, or confirm medical diagnoses that remained unknown or unclear prior to the patient's death.

Anatomical or academic autopsies are performed by students of anatomy for study purpose only. Virtual or medical imaging autopsies are performed utilizing imaging technology only, primarily magnetic resonance imaging (MRI) and computed tomography (CT).
• When and why are autopsies done? (WebMD) Autopsies don't always have to be done. If you do need one, it's usually both a medical and a legal process. Every local government has an official who records deaths. She's called either a coroner or a medical examiner. All but a handful of states require medical examiners to be doctors. Coroners may be doctors as well, but don't have to be.
• What Happens in an Autopsy? Tara Long, The Seeker, 8-26-14) We've all seen autopsies performed on television shows. Are these depictions accurate? Tara explains everything that happens during an autopsy.
• How Autopsies Work (Robert Valdes & Patrick J. Kiger, How Stuff Works)
• Without Autopsies, Hospitals Bury Their Mistakes (Marshall Allen, Pro Publica, 12-15-11) Hospital autopsies have become a rarity. As a result, experts say, diagnostic errors are missed, opportunities to improve medical treatment are lost, and health-care statistics are skewed.
• A Day in the Life of an Embalmer (YouTube, Tobin Brothers Funerals, 10-minute video)
• Verbal autopsies used in push to better track global deaths (Christina Larson and Mike Stobbe, AP in WaPo, 10-6-19) A "verbal autopsy" is an interview in which a trained health worker asks a close relative or caretaker about a recently deceased person. Increasingly, health officials are using these tools and their computer algorithms to learn more about the global course of human disease. About 50 countries have attempted verbal autopsy projects, and the list is growing. Bloomberg Philanthropies — a major funder of international health data initiatives — is funding verbal autopsies as well as cancer registries and other programs intended to help developing countries gather accurate data about the health of their citizens. An estimated 60 million people in the world will die this year, and half will have no death certificates or other records describing what killed them. Most will be in low- and middle-income countries, particularly in Africa and parts of Asia. That means the common understanding of overall disease and mortality trends in the developing world often relies upon broad estimates and guesswork. Knowing what's killing people can be tricky. U.S. doctors are required to sign death certificates, but recent studies suggest some doctors put down certain conditions as a default, which is one reason some experts believe heart disease has been over-reported as a cause of death in the U.S.
• Verbal autopsy methods questioned (Declan Butler, Nature, 2010) Controversy flares over malaria mortality levels in India.
• Use of verbal autopsy to determine mortality patterns in an urban slum in Kolkata, India (Suman Kanungo et al, WHO, 2010)
• Searching cause of death through different autopsy methods: A new initiative (Abhishek Das and Ranadip Chowdhury, NCBI: Family Med Prim Care. 2017;6(2):191–195. doi:10.4103/jfmpc.jfmpc_194_16) Extensive bibliography leads to unexpected articles.
• Bill And Melinda Gates: Autopsies Could Prevent Epidemics, Save Countless Lives (Dominique Mosbergen, HuffPost, 5-15-15) Bill and Melinda Gates believe that performing "minimal autopsies" on dead children could save countless lives. Last week, the Gates Foundation announced that it was investing $75 million in a series of "disease surveillance sites" that will conduct post-mortem examinations on children in order to figure out "how, where and why children are getting sick and dying." Dubbed the Child Health and Mortality Prevention Surveillance Network, or CHAMPS, the program will initially be launched in six locations in Africa and South Asia. Knowing what children are dying from could help pinpoint a new disease or nip an emerging epidemic in the bud. Gates said he believes that such a system could have proved exceedingly useful in the case of the recent Ebola epidemic, for instance. See also Bill Gates's Quest to Determine Why Children Are Dying (Olga Khazan, The Atlantic, 5-6-15) The Gates Foundation's 'Child Health and Mortality Prevention Surveillance Network, or CHAMPS, will be spread initially throughout six locations in Africa and South Asia. It will rely on field workers to take biopsies of children who have perished and on beefed-up laboratories that will perform medical testing... a "global warning and response system" that's geared toward outbreaks like Ebola.'
• Breakthrough in how autopsy practice is conducted worldwide (Science Daily, 5-24-17) A ground-breaking study by Guy Rutty and Bruno Morgan from the University of Leiceste (pathologists and radiologists) could represent a breakthrough in how autopsy practice is conducted in the United Kingdom and around the world. A previous study of PMCT published in the Lancet in 2012 showed promise for using medical imaging to investigate the cause of natural death, but with a major weakness: the inability to diagnose coronary artery disease, the most common cause of natural death. Professor Morgan explained: "In clinical CT scanning, a contrast agent is injected into a vein and circulation delivers it around the body. This allows the CT scan to show the state of blood vessels anywhere in the body. However, the lack of circulation in cadavers means these techniques cannot be used." This has been overcome by developing a novel minimally invasive coronary artery angiography technique.

Following are my notes from a screening by the American Film Institute of TRUE JUSTICE: BRYAN STEVENSON'S FIGHT FOR EQUALITY, the documentary that opened the AFI Doc Festival in DC on June 19, 2019. Based on Bryan Stevenson's book Just Mercy: A Story of Justice and Redemption, an Amazon bestseller that got 3,603 customer reviews (averaging five stars).

There have been four stages of racial injustice in the United States, says Stevenson:
• Slavery
• Lynching, 1877-1950
• Segregation
• Mass incarceration.

 
Lynching, 1877-1950. The North prevailed after the Civil War, but the South won the narrative. An 1876 Supreme Court decision allowed lynching to go for decades -- and, in the South, a reign of terror and violence.Between 1877 and 1950, there were 4,075 lynchings of African Americans in 12 Southern States, according to the Equal Justice Initiative. Two hundred bills were introduced in Congress to make lynching illegal, but none succeeded in being enacted into legislation until two decades into the 21st century (2018). See The U.S. Finally Made Lynching a Federal Crime (Brigit Katz, Smithsonian, 12-21-18)

Segregation. In Brown v. Board of Education, 347 U.S. 483 (1954), the Supreme Court outlawed segregated public education facilities for blacks and whites at the state level. The Civil Rights Act of 1964 superseded all state and local laws requiring segregation.

Mass incarceration and the death penalty. Statistics for 1980 thru 2019 are shocking. Look at statistics on the U.S. state and federal prison population from 1925 through 2017, on this Trends in U.S. Corrections. According to The Sentencing Project "The United States is the world's leader in incarceration with 2.2 million people currently in the nation's prisons and jails — a 500% increase over the last forty years. Changes in sentencing law and policy, not changes in crime rates, explain most of this increase. These trends have resulted in prison overcrowding and fiscal burdens on states to accommodate a rapidly expanding penal system, despite increasing evidence that large-scale incarceration is not an effective means of achieving public safety."
Fear and anger are the essential ingredients of injustice—why we put so many people wrongfully in prison. We spend all that money to keep people in prison in a system where enough money can buy "not guilty."
A 2005 Supreme Court decision made it illegal to give children a death sentence. Instead, many of those in prison for life sentences are children who were tried in adult courts. One in three black male children now expect to go to prison (and the number of black women in prison is increasing, too). Many of these prisons are now privately fun. See What's wrong with America's prisons.

Stevenson's focus is on all those black people who are improperly convicted (without a proper defense) or unfairly sentenced. As for the death penalty: "Since 1973, 166 people have been released from death row after evidence of their innocence was uncovered. A shocking rate of error has emerged: for every nine people executed in this country, one innocent person has been exonerated."  One in ten wrongful executions is an unjustifiable standard. We have to do better at winning the narrative battle, says Stevenson. "Truth-telling changes you."

Visit the new National Memorial for Peace and Justice, informally known as the National Lynching Memorial, a national memorial to commemorate the victims of lynching in the United States -- to acknowledge past racial terrorism and advocate for social justice in America. 

Excerpt from

The Black Family and Mass Incarceration by Bruce Western and Christopher Wildeman

(see also The Moynihan Report)

"Mass imprisonment of the late 1990s can be traced to two basic shifts in politics and economics. The growth of harsh sentencing policies and a punitive approach to drug control began with a rightward shift in American politics, first visible at the national level in the mid-1960s. Barry Goldwater's ill-fated presidential run in 1964 was pivotal (Beckett 1997; Gest 2001). Goldwater, in accepting the Republican nomination, warned that crime and disorder were threats to human freedom, and freedom must be 'balanced so that liberty lacking order will not become the license of the mob and of the jungle.' The Republican campaign of 1964 linked the problem of street crime to civil rights protest and the growing unease among whites about racial violence.
"Although Goldwater was roundly defeated by Lyndon B. Johnson, conservatives within the Republican Party had brought to the national stage a new kind of politics. Historically, responsibilities for crime control were divided mostly between state and local agencies. The Republicans had placed the issue of crime squarely on the national agenda. What is more, by treating civil rights protest as a strain of social disorder, veiled connections were drawn between the crime problem, on one hand, and black social protest, on the other."

assembled by Pat McNees, updated 4-23-24
• A Guide to the Seasonal Flu for Seniors (National Council for the Aging)
• Flu Shots (elsewhere on this website)
• Influenza virus in China remains potential pandemic threat (Bara Vaida, Covering Health, AHCJ, 12-5-18) A strain of an influenza virus now circulating in China remains a potential pandemic threat while many gaps remain in preparing for such an event, a group of global health experts at the National Academy of Sciences (NAS) warned last month. The virus spreading in China, called H7N9 (flu virus names reflect their protein makeup) first emerged among poultry workers in 2013 and has sickened 1,567 people and killed 615.
• A Century After the 1918 Flu Pandemic: Why Are We Still Concerned Today? (National Academy of Medicine event, 11-26-18) Webcast said to be available.
• In the Flu Battle, Hydration and Elevation May Be Your Best Weapons (Kate Murphy, NY Times, 1-12-18). A good explanation of how the flu works and how to deal with it. Drink a cup or so of water or other liquid every hour, and avoid alcoholic and caffeinated beverages. Over-the-counter medications that suppress your cough and dry your sinuses may not be the best idea; you want to get rid of the infection. 'Although you want to rest, lying flat all the time can be problematic because it collapses your lungs so you can’t cough as efficiently, trapping bacteria in your respiratory tract. If the virus destroys enough cells in your bronchial tubes it creates openings for bacteria to get into your lungs, which can lead to pneumonia, a potentially life-threatening complication of the flu. When your lungs are vertical rather than horizontal, “you’re able to breathe deeply and freely  Read More 

After links to dictionary-style online sites come links to helpful sites with a more specific focus. Alphabetical order.
• Cochran Library Evidence-based medicine. Review. Database. Trials. More resources.
• The Dartmouth Atlas of Health Care (slow loading)
• Drugs.com (a free drug information service)
• First Aid (Mayo Clinic's alphabetical links to how to  Read More 

Some deaths come too soon and Helen Sarchielli's was one of them. When she succumbed to lung cancer on October 11, 2000, she was not yet 61—and she was a young 60. It was not only that she was too young to die—it was that she was so unlikely a person to stop being alive. Being alive was what Helen Jean did best.

by Pat McNees (updated 7-30-19;  orig. published 11-11-15)
Why are our medical bills so high? Why aren't drug prices regulated, as they are in other countries? Where is most of our health care budget spent? Where can we improve the system? Why do we overtreat the rich and undertreat the poor? Who is in charge, when a patient needs complex chronic care? Has our market-driven medical care system served us well or do we suffer from its perverse incentives? Ours is the most expensive health care system in the world but it is not delivering the most effective health care. What can we do? Here are links to key articles explaining the high cost of medical care in the United States -- and whether we're getting what we're paying for.
• Pharma is showering Congress with cash, even as drug makers race to fight the coronavirus (Lev Facher and Kaitlyn Bartley , STAT, 8-10-2020) The world’s biggest drug makers and their trade groups have cut checks to 356 lawmakers ahead of this year’s election — more than two-thirds of the sitting members of Congress, according to a new STAT analysis. It’s a barrage of contributions that accounts for roughly $11 million in campaign giving, distributed via roughly 4,500 checks from the political action committees affiliated with the companies. The drug industry has a clear stake in keeping the Senate in Republican hands — and its political spending in 2020 reflects that priority. Lots of details on who gets and supports what (or not).
• The Health Insurance Hustle: Why Your Health Insurer Doesn’t Care About Your Big Bills Patients may think their insurers are fighting on their behalf for the best prices. But saving patients money is often not their top priority. Just ask Michael Frank. (Marshall Allen, ProPublica, 5-25-18)
• Hospitals’ Trauma Care Prices Differed Wildly In 2023: Study (KFF Health News) A new study found prices were so unpredictable between hospitals that some insured patients needing trauma care even ended up with more bills than uninsured people did. Stat, meanwhile, covers tech startups who are making money out of hospital price transparency rules.
• A small group of patients account for a whole lot of spending (Drew Altman, Kaiser Family Foundation, 7-29-19) "Among people who get their coverage from a large employer, just 1.3% of employees were responsible for almost 20% of overall health spending, averaging a whopping $88,000 per year. A very small group of patients with major illnesses is responsible for an outsized share of health care spending, and new data show that prescription drugs are a big part of the reason their bills are so high....They often have HIV, MS, cystic fibrosis, rheumatoid arthritis, diabetes, cancer and other serious conditions requiring frequent and often costly care....Prescription drugs account for about 40% of this group’s costs, not counting rebates — compared with just 10% for the country as a whole. Their bills just for prescription drugs average out to about $34,000 per year. That’s much more than the average premium for family coverage. These are exactly the people our insurance system is failing. They have insurance and a major illness, but still struggle with their medical bills as deductibles and other out-of-pocket costs keep rising faster than wages. One solution might be to exempt this small group of high spenders with serious illnesses from drug or other copays, and limit their deductibles."
• Health Insurers Make It Easy for Scammers to Steal Millions. Who Pays? You. ((Marshall Allen, ProPublica and Vox, 7-19-19) Health insurers are regarded as fierce defenders of health care dollars. But the case of David Williams shows one reason America’s health care costs continue to rise. The personal trainer spent years posing as a doctor and billing the nation’s top insurers, making off with millions.
• What Can Be Done Right Now to Stop a Basic Source of Health Care Fraud (Marshall Allen, ProPublica, 7-19-19) Fraud is one reason we all pay so much for health care. But there are simple fixes that would make it more difficult for scammers to operate: Check to see whether people getting federal ID numbers that allow them to bill insurers have valid licenses. Require insurance companies to verify that the people they are paying are licensed medical providers. Require insurance companies to report cases of suspected fraud to state and federal regulators. Audits and the potential for fines may be needed to spur the insurers to file the reports.
• Outrageous medical bills (examples, explained--but not justified!)
• Pulling back the curtain on surprise medical bills
• What you can do to challenge excessive medical bills
• Government efforts to protect against wrongful medical billing
• Hospital Financial Analysis: True Cost of Healthcare (David Belk MD, True Cost of Healthcare). What do the carefully researched numbers reveal? "The revenue for any health insurance company is tied directly to its expenses. In other words, the more a health insurance company spends each year, the more revenue they can earn (through premium increases the next year). Therefore, the last thing any health insurance company would want is for their overall expenses to drop. If their expenses were to drop, they couldn’t justify raising (or even maintaining) the amount they charge policy holders in premiums. That would be a disaster for them.
Since hospital utilization has been declining overall, it would be hard for private health insurance companies to continue to show an increase in their costs each year unless they deliberately overpaid hospitals, so that’s exactly what they do. Hospitals don’t mind being overpaid, so they’re not complaining. Since hospital bills always show enormous discounts from the insurance companies (due to persistent over-billing) most people wouldn’t suspect what the insurance companies are really doing. This way, both sides can work together to profit from our ignorance."
• Marshall Allen Unearths Waste in Health Care ( Rachel Zamzow, Open Notebook, 2-13-18) "In 2012, ProPublica reporter Marshall Allen came across a staggering statistic: The U.S. health care system wastes an estimated $765 billion each year....Last year, Allen decided to root out the sources of squandered funds within the system—an investigation that culminated in a series called Wasted Medicine. Allen discovered how hospitals discard unused medical supplies, how some drug expiration dates are meaningless, and how drug companies knowingly make oversized eyedrops—a story that prompted a group of U.S. senators to introduce legislation to reduce wasteful packaging of medicines.
• Wasted Medicine: Squandered Health Care Dollars (ProPublica Series). Includes A Hospital Charged $1,877 to Pierce a 5-Year-Old’s Ears. This Is Why Health Care Costs So Much. (Marshall Allen, ProPublica and NPR's Shots blog, 11-28-17). When a surgeon doing surgery on a child offers to throw in ear piercing as well, think twice about accepting.
--Paying Till It Hurts In her series on the cost of health care, Elisabeth Rosenthal interviews patients, physicians, economists, hospital and industry officials to examine the high price of health care. Buy her book: An American Sickness: How Healthcare Became Big Business and How You Can Take It Back . And read the series here--including the readers' comments (from both patients and doctors).
• Part 1: Colonoscopy: A case study in high costs The $2.7 Trillion Medical Bill: Colonoscopies Explain Why U.S. Leads the World in Health Expenditures (Elisabeth Rosenthal, Health, NY Times, 6-1-13) While the American medical system is famous for expensive drugs and heroic care at the end of life, a more significant factor in the nation’s annual health care bill may be the high price tag of ordinary services.
• Part 2. Pregnancy: Cash on delivery. American Way of Birth, Costliest in the World (Elisabeth Rosenthal, Health, NY Times, 6-30-13). Cash on delivery.
• Part 3. Joint replacement: A trip abroad. In Need of a New Hip, but Priced Out of the U.S. (Elisabeth Rosenthal, NY Times, 8-3-13)
• Part 4. Prescriptions. No room to negotiate. The Soaring Cost of a Simple Breath (Elisabeth Rosenthal, NY Times, 10-12-13)
• Part 5. E.R. Visit As Hospital Prices Soar, a Stitch Tops $500 (Elisabeth Rosenthal, NY Times, 12-2-13)
• Think the E.R. Is Expensive? Look at How Much It Costs to Get There (Elisabeth Rosenthal, NY Times, 12-5-13) Ambulances, once free, are now generally run as businesses that contribute to America’s escalating medical bills.
• Part 6. Dermatology. The high earners. Patients’ Costs Skyrocket; Specialists’ Incomes Soar (Elisabeth Rosenthal, NY Times, 1-18-13) Check out reader responses on three questions: In your experience, do doctors and patients discuss cost as part of care, and, if so, how does that affect the doctor-patient relationship? When do costs influence care? If you are a provider, how have the financial incentives of the current payment system in the United States affected your practice? If you are a provider, how have the financial incentives of the current payment system in the United States affected your practice?
• Part 7. Chronic illnesses. Even Small Medical Advances Can Mean Big Jumps in Bills (Elisabeth Rosenthal, NY Times, 4-5-13)
• Health Care’s Road to Ruin (Elisabeth Rosenthal, NY Times, 12-21-13) There are ways to lower costs. Is there the will?

• Why do drug companies charge so much? Because they can. (Marcia Angell, Washington Post, 9-25-15) "Unlike every other advanced country, the United States permits drug companies to charge patients whatever they choose. ...Drug companies say high prices are necessary to cover their research and development costs" but most drugs "are invented not by the companies that sell them now but by someone else. Then, like big fish swallowing little fish, larger companies either buy small firms outright or license promising drugs from them. Very often, the original discovery occurs in a university lab with public funding from the National Institutes of Health (NIH), then licensed to a start-up company partly owned by the university and then to a large company. There is very little innovation at the big drug firms. Instead, their major creative output is trivial variations of top-selling medications that are already on the market (called “me-too drugs”), to cash in with treatments just different enough to justify new patents." Pharmaceutical companies are among the most profitable and "they spend more on marketing and administration than on R&D." ... "Congress has blocked Medicare from negotiating the price of drugs or creating a formulary for patients. It’s time that we, too, move to stop price-gouging by the pharmaceutical industry — even when no one notices."

• CVS Health Is Sued Over 'Clawbacks' of Prescription Drug Co-Pays (Jef Feeley and Jared S Hopkins, Bloomberg, 8-9-17) CVS Health Corp. was sued by a California woman who accused the drugstore operator of charging customers co-payments for certain prescription drugs that exceed the cost of medicines. CVS, the largest U.S. pharmacy chain, overbilled consumers who used insurance to pay for some generic drugs and wrongfully hid the fact that the medicines’ cash price was cheaper. Woman says she paid $166 for medicine that actually cost $92. Chains worked with benefit managers on billings, suits say.

• When the Patient Is a Gold Mine: The Trouble With Rare-Disease Drugs (Benjamin Elgin, Doni Bloomfield, and Caroline Chen, BloombergBusinessWeek, 3-24-17) With a flagship treatment that helps fewer than 11,000 people, how is Alexion making so much money? In the U.S., an orphan drug is defined as one that treats a disease affecting fewer than 200,000 people in the country. Orphan drugs accounted for a disproportionate share, 41 percent, of all medications brought to market in 2014. These drugs have helped millions of people...but have also caused a seismic shift in treatment costs....A fraction of a teaspoon of Soliris, administered in a single 35-minute treatment, costs more than $18,000, and patients might need 26 treatments a year for the rest of their lives. With this single drug accounting for almost all its revenue, Alexion has created enormous wealth out of an estimated 11,000 customers." This is an ugly story about drug company marketing practices".... History: "To address neglected research areas, Congress in 1983 passed the Orphan Drug Act, which gave drugmakers federal grants, tax incentives, and seven years of marketing exclusivity for new rare-disease treatments (vs. three to five years of exclusivity for a more common new drug). In the ensuing 34 years, more than 600 orphan drugs have been approved in the U.S., compared with 10 in the decade before the law was passed. But government-protected monopolies, combined with desperate patients, led to today’s prices." Do your homework. Read this article.
• Reducing Medical Costs Where to start.
Collusion between Hollywood script writers and pharmaceutical companies isn’t new. Nor is the call to regulate it. (Mary Chris Jaklevic, HealthNewsReview.org, 6-1-17) 'Plenty has been written about a recent “disease awareness” plotline in ABC’s General Hospital that indirectly promoted ruxolitinib, the only prescription drug approved to treat a rare blood cancer called polycythemia vera (PV). The drug’s manufacturer, Incyte, said in a news release that it “teamed up” with the show and actress Finola Hughes, whose character was diagnosed with PV, “to raise awareness and inspire patients and caregivers impacted by these under-recognized blood cancers.”
non-branded “disease awareness” campaigns aren’t regulated like traditional direct-to-consumer ads, which are subject to explicit requirements including balanced portrayals of a drug’s efficacy and risks. Coverage highlighted an opinion piece in the Journal of the American Medical Association, in which oncologists Vinay Prasad and Sham Mailankody said disease awareness efforts “can lead to unintended consequences, including wasteful diagnostic testing, overdiagnosis, and inappropriate therapy.” They said “attempts may be necessary to regulate disease awareness promotions” including “collaboration and input from the FDA regarding the content of advertisements or disease awareness campaigns.”
• What Broke My Father's Heart by Katy Butler (NY Times Magazine, 6-18-10). How putting in a pacemaker wrecked a family's life. Katy Butler's father drifted into what nurses call “the dwindles”: not sick enough to qualify for hospice care, but sick enough to never get better. She writes, of her parents: "I watched them lose control of their lives to a set of perverse financial incentives — for cardiologists, hospitals and especially the manufacturers of advanced medical devices — skewed to promote maximum treatment. At a point hard to precisely define, they stopped being beneficiaries of the war on sudden death and became its victims." Do read the whole article. Here's another excerpt: "Had we been at the Mayo Clinic — where doctors are salaried, medical records are electronically organized and care is coordinated by a single doctor — things might have turned out differently. But Middletown is part of the fee-for-service medical economy. Doctors peddle their wares on a piecework basis; communication among them is haphazard; thinking is often short term; nobody makes money when medical interventions are declined; and nobody is in charge except the marketplace." You may also want to read Knocking on Heaven's Door: The Path to a Better Way of Death

• Pharmaceutical Product Hopping: A Proposed Framework For Antitrust Analysis (Michael Carrier and Steve Shadowen, Health Affairs blog, 6-1-17) One "reason for high prices has flown under the radar. When drug companies reformulate their product, switching from one version of a drug to another, the price doesn’t dramatically increase. Instead, it stays at a high level for longer than it otherwise would have without the switch. Although more difficult to discern than a price spike, this practice, when undertaken to prevent generic market entry, can result in the unjustified continuation of monopoly pricing, burdening patients, the government, and the health care system as a whole."
• The Healthcare Industry and the USSR (YouTube video, Jeanne Pinder's wonderful talk, Ignite Health Foo 2013). See also Taking the mystery out of health care prices and the wonderful stories about Clear Health Prices.
• Bitter Pill: Why Medical Bills Are Killing Us (Steven Brill, Time Magazine, Health & Family, 2-10-13). In the longest article Time has published, Brill tries to answer the question: “Why exactly are the bills so high?” Long but worth reading, on the outrageously excessive prices hospitals, pharmaceutical companies, doctors, and equipment manufacturers charge and how Medicare and other insurers deal with it, or not. See Steven Brill’s 26,000-word health-care story, in one sentence (Sarah Kliff, Wonkblog, Washington Post, 2-23-12). (The sentence: "The American health-care system does not use rate-setting." (In other countries, which set rates for what both private and public plans can charge for various procedures, health-care costs have not risen so much.) And don't ignore the Comments.

• Equitable Access to Care — How the United States Ranks Internationally (Karen Davis and Jeromie Ballreich, New England Journal of Medicine, 10-23-14) "Notwithstanding Americans' impression that other countries ration care, for lower-income adults, obtaining timely primary care is a bigger problem in the United States than in other industrialized countries... even Americans with above-average income...are more likely than adults with above-average income elsewhere to report that during the past year, costs kept them from visiting the doctor for medical problems, from filling prescriptions or taking all recommended doses, or from getting recommended tests, treatment, or follow-up."

• Patenting the PKU Test — Federally Funded Research and Intellectual Property (Diane B. Paul, New England Journal of Medicine, 8-29-13). "Norms governing what should count as a freely available public good have fundamentally changed since 1965. The shift began in the 1970s, when an 'economic competitiveness agenda,' prompted by the oil crisis and concern about Japanese competition, began displacing narratives of science's role in fighting communism and defeating disease." " The Bayh–Dole Act was followed by other bills promoting the commercialization of publicly funded research, a phenomenon soon exported worldwide. Aggressive commercialization of university research has since become the norm, with universities embracing patenting as an efficient way to transform knowledge into products, generate new income sources, recoup product-development costs, and motivate scientists." " The key principles debated in the Guthrie case underlie the conflicts that remain to this day between political and economic imperatives to commercialize research and the social and moral imperatives to promote public health."

• Money-Driven Medicine: The Real Reason Health Care Costs So Much by Maggie Mahar. Among other points made: Today's market-driven medical system emerged over the past century thanks to trends that gradually stripped power from doctors and gave it to corporations, turning patients into profit centers.

• 5 Things I Didn't Know About Health Care (Until I Got Sick) (C. Coville, Cracked, 3-11-14) Three of them: The medical system is outdated, it doesn't allow for mental limits in the sick, if it doesn't understand your condition it will think you are crazy. "Sick people with potentially curable illnesses are shunted around between separate specialists who don't pay attention to anything except the body part they've been trained to focus on, a problem known as care fragmentation... Because of care fragmentation, sick people often have to coordinate their own care if they want to get treated correctly. But that's not as easy as it sounds, because ..."

• Lies, Damned Lies, and Medical Science (David H. Freeman, The Atlantic, 10-4-10). Much of what medical researchers conclude in their studies is misleading, exaggerated, or flat-out wrong. So why are doctors—to a striking extent—still drawing upon misinformation in their everyday practice? Dr. John Ioannidis has spent his career challenging his peers by exposing their bad science.

• Home Alone: Family Caregivers Providing Complex Chronic Care (Susan C. Reinhard, Carole Levine, and Sarah Samis, AARP's Public Policy Institute, Oct. 2012) "In a fragmented health care system, it is often difficult to pinpoint individual or institutional responsibility for action. As a result, people with chronic conditions and their family caregivers too often move from the care of one professional to another or from one care setting to another without a clear sense of who is in charge. All too often, no one is in charge. Expecting family caregivers to perform the medical/nursing tasks described in this report without substantial professional involvement is unrealistic and unacceptable."

• The Diseases We Spend Our Health Dollars On (Drew Altman, WSJ, 3-3-15) An excellent chart breaking down our health spending dollar by disease. "The BEA found that spending for common illnesses such as a cold or strep throat grew faster than anything else over the 10-year period. Then came spending to treat endocrine disorders such as high cholesterol or diabetes. The bureau also found that the cost of treatment–-a combination of price and the complexity of services and technology used in treatment–-was the main culprit behind spending increases for diseases, not the number of cases treated."

• The Thousand-Dollar Pap Smear (Cheryl Bettigole, New England Journal of Medicine, 10-17-13). "The first time a patient called me to say that she'd been billed more than $600 for her Pap smear, I was sure it was a mistake. The second time, I was less sure, and these days I am no longer surprised to find laboratory charges of $1,000 or more for a test that until recently cost only $20 or $30. ... we physicians and our staff are responsible for ordering these unnecessary tests and hence responsible for the huge bills our patients are receiving. Yet we are not doing this alone. Laboratories have learned that one easy way to increase revenue is to make it easy for clinicians to order more tests" Do read this one!

• Treating vs. Healing: Understanding What Wellness Means to Patients (Johnny Hourmozoi,, Pacific Standard, 3-31-15) For those accustomed to Western medicine, it may seem crazy to refuse doctor-prescribed medicine. But to truly be a healer, doctors must understand what makes a patient feel well. "Evidence is the currency of contemporary Western medicine... In Iran, the emphasis is placed on healing, a concept intimately tied to notions of spirit and comfort—not morbidity and mortality."

• How We Do Harm: A Doctor Breaks Ranks About Being Sick in America, a book by Otis Webb Brawley and Paul Goldberg, exposes the underbelly of healthcare today—the overtreatment of the rich, the undertreatment of the poor, the financial conflicts of interest that determine the care that physicians’ provide, insurance companies that don’t demand the best (or even the least expensive) care, and pharmaceutical companies concerned with selling drugs, regardless of whether they improve health or do harm.

• Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer by Shannon Brownlee. Our health care is staggeringly expensive, yet one in six Americans has no health insurance. We have some of the most skilled physicians in the world, yet one hundred thousand patients die each year from medical errors. Brownlee dissects what she calls “the medical-industrial complex” and lays bare the backward economic incentives embedded in our system.

• Medicine’s Top Earners Are Not the M.D.s (Elisabeth Rosenthal, NY Times, 5-17-13) "The biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine. The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries."

• U.S. Health Care Lags Worldwide for Those Over 65 (Paula Span, Caring and Coping, NY Times, 12-12-14) A Commonwealth Fund report card comparing health care in industrialized countries since 1998 shows "mortifying lapses and problems" in the U.S., "despite spending more on health care than any other country in the world." The U.S. Medicare system provides "excellent coverage" overall, provides good coverage for seniors, but what Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom "share (aside from doing a better job for their elders than the United States, at lower cost) is that their systems cover all ages. Their elders are less likely to arrive at 65 trying to catch up after years without adequate medical care....Before they became Medicare-eligible, American seniors may have forgone preventive treatments or let conditions worsen because they couldn’t afford care."

• How much are U.S. doctors worth? Depends who you ask (Harris Meyer, Modern Healthcare 6-24-14). High U.S. physician pay is only a minor component of sky-high U.S. healthcare costs (and U.S. doctors face a higher cost of medical education and medical liability premiums than doctors elsewhere). "And other professionals in healthcare, notably hospital, health plan and pharmaceutical executives, generally make even more money."

• Why Are American Health Care Costs So High? (John Green on YouTube, 8-20-13) A little hyper, but worth a listen.

• Hospitals Fail To Protect Nursing Staff From Becoming Patients (Daniel Zwerdling, All Things Considered, NPR, 2-4-15) Most hospitals have not taken aggressive action to protect the nursing staff from back injuries from lifting patients. Only slowly, reluctantly are hospitals adopting patient-lifting equipment. (Part 1 of a series on injured nurses.) Part 2: Even 'Proper' Technique Exposes Nurses' Spines To Dangerous Forces (2-11-15). And Part 3: Hospital To Nurses: Your Injuries Are Not Our Problem

• Cost of medical school: USA vs France (Kevin Pho, KevinMD.com, 5-8-14) Visuals show dramatic differences. "If you want to pay me like a French doctor, also give me the French cost of medical school and the French medical malpractice system."

• The Malpractice Mess (Atul Gawande, Annals of Medicine, New Yorker, 11-14-05) Who pays the price when patients sue doctors? "General surgeons pay anywhere from thirty thousand to two hundred thousand dollars a year in malpractice-insurance premiums, depending on the litigation climate of the state they work in; neurosurgeons and obstetricians pay upward of fifty per cent more." Paying into an insurance fund for those actually harmed by doctors might mean fewer mammoth, random windfalls but under the current system in America most of those who are harmed are not compensated (except the lawyers).

• When Health Costs Harm Your Credit (Elisabeth Rosenthal, NY Times, 3-8-14)

• Benefits Questioned in Tax Breaks for Nonprofit Hospitals (Elisabeth Rosenthal, NY Times, 12-17-13) Cities still reeling from the recession are challenging the billions of dollars in tax breaks granted to the nation’s nonprofit hospitals.

• When Doctors Sell Out, Hospitals Cash In (Community Oncology Alliance, 7-8-13) Everything was the same about Mike Rosenberg’s routine visit to Atlanta Cancer Care in February – everything, that is, but the bill. Rosenberg went to the same office and saw the same staff to get the same blood work and the same medication he gets every month. But the cost difference was remarkable: Rosenberg’s out-of-pocket charge increased from $20 to $212. What his insurer had to pay exploded from $2,735 to $5,661.

• New Analysis Shows Many 340B Hospitals Provide Minimal Charity Care; Small Percentage of 340B Hospitals Provide More (Community Oncology Alliance, 3-25-14)

• Health Plans Seek Leverage When Physicians Submit Extremely High Bills (Joseph Burns, Managed Care, Aug 2011). One doctor demands $39,000 for a child’s surgery; another bills $56,890 for a bedside consultation. Aetna sued several New Jersey physicians over medical bills for out-of-network care, bills Aetna said were unconscionable.

• How Doctors Are Paid Now, And Why It Has to Change (John Carroll, Managed Care, Dec. 2007). Everyone knows about the perverse incentive of fee-for-service medicine, but that hasn’t had much effect on its use. warped the way medicine is practiced, devaluing vital services such as doctor-patient discussions while pumping up rewards for expensive procedures and bigger volumes.

• Patents, Profits, and the American People — The Bayh–Dole Act of 1980 (Howard Markel, N Engl J Med 2013; 369:794-796, August 29, 2013, DOI: 10.1056/NEJMp1306553). It's time for Congress to recalibrate Bayh–Dole. "When the Bayh–Dole Act was written, its aim was primarily to stimulate economic growth by more efficiently mining the untapped scientific riches of hospitals, laboratories, and universities. Much has changed since then.... Profits and patents can be powerful incentives for scientists, businesspeople, and universities, but new and ongoing risks — including high prices that limit access to lifesaving technologies, reduced sharing of scientific data, marked shifts of focus from basic to applied research, and conflicts of interests for doctors and academic medical centers — should be mitigated or averted through revisions of the law. All Americans should be able to share in the bounties of federally funded biomedical research."

• Data uncover nation’s top Medicare billers ( Peter Whoriskey, Dan Keating and Lena H. Sun, Washington Post, 4-9-14). "Jonathan S. Skinner, a Dartmouth economist..."there are people who are operating in the gray area of health care who are causing Medicare to spend enormous amounts on health care that may be harmful to their patients.'”'

• The top 10 Medicare billers explain why they charged $121M in one year (Jason Millan, Wonkblog, 4-9-14) "Some doctors said they were just passing through the payment to drug companies. But the Medicare payment system also incentivizes physicians to choose more expensive drugs, since they’re reimbursed for the average price of the drug plus 6 percent." See comments section for links to articles about pending big changes in Medicare payments to providers.

• Manufactured Medicare outrage (Charles Lane, Opinion, Wash Post, 3-18-15) "Last fall, the Department of Health and Human Services released a comprehensive analysis showing that MA costs grew faster than they would have under fee-for-service between 2004 and 2013 — and that only upcoding, not patient demographics or other neutral factors, could explain this.