Public Health Experts Have Undermined Their Own Case for the COVID-19 Lockdowns – Reason.com

In theory, the mass protests following the alleged murder of George Floyd put public health officials who have ceaselessly inveighed against mass gatherings in a difficult position. They have called for a moratorium on most types of public activities, but particularly gathering in large crowds where increased aerosolization from loud talking and yelling could spread the COVID-19 virus to massive groups.

But when it comes to the protests against police brutality, many medical experts think there should be an exemption to the COVID-19 lockdown logic.

More than a thousand public health experts signed an open letter specifically stating that “we do not condemn these gatherings as risky for COVID-19 transmission. We support them as vital to the national public health and to the threatened health specifically of Black people in the United States.”

The letter conceded that mass protests carried the risk of spreading coronavirus, and offered some good—if naive—advice for people who are going out anyway: wear masks, stay home if sick, attempt to maintain six feet of distance from other protesters. Many protesters are wearing masks, but others are not. And while we can blame the police for forcefully corralling people into close quarters, it’s a bit rich for public health experts to endorse protesting under conditions that they know are impossible for protesters to meet.

Indeed, for the purposes of offering health care advice, the only thing that should matter to doctors is whether their harm-reduction recommendations are being followed: how big is the event, is it outdoors, are masks being worn, etc. However, the letter distinguishes police violence protesters from “white protesters resisting stay-home orders,” as if the virus could distinguish between the two types of events. While I am not a doctor, my understanding is that it cannot.

The letter led a Slate writer to claim that “Public Health Experts Say the Pandemic Is Exactly Why Protests Must Continue.” The argument here is that coronavirus is more deadly for black people because of systemic racism and that protesting systemic racism is a sort of medical intervention.

“White supremacy is a lethal public health issue that predates and contributes to COVID-19,” the letter continues.

There is much truth to this! Black people in America do have worse health outcomes, but so do low-income people of every race and ethnicity. Is it medically acceptable for a poor person to protest against lockdown-induced economic insecurity? For people who live paycheck to paycheck to protest looming evictions and foreclosures? What about people experiencing loneliness, depression, and bereavement? Again, my understanding is that the virus does not think and thus does not choose to infect us based on what we’re protesting.

Many people all over the country were prevented from properly mourning lost loved ones because policymakers and health officials limited public funerals to just 10 people. For months, public health officials urged people to stay inside and avoid gathering in large groups; at their behest, governments closed American businesses, discouraged non-essential travel, and demanded that we resist the basic human instinct to seek out companionship, all because COVID-19 could hurt us even if we were being careful, even if we were going to a funeral rather than a nightclub. All of us were asked to suffer a great deal of second-order misery for the greater good, and many of us complied with these orders because we were told that failing to slow the spread of COVID-19 would be far worse than whatever economic impact we would suffer as a result of bringing life to a complete standstill.

People who failed to follow social distancing orders have faced harsh criticism and even formal sanction for violating these public health guidelines. To take just one extreme example, New York City Mayor Bill de Blasio threatened to use law enforcement to break up a Jewish funeral.

After saying no to so many things, a significant number of public health experts have determined that massive protests of police brutality are an exception to the rules of COVID-19 mitigation. Yes, these protests are outdoors, and yes, these experts have encouraged protesters to wear masks and observe six feet of social distance. But if you watch actual footage of protests—even the ones where cops are behaving badly themselves—you will see crowds that are larger and more densely packed than the public beaches and parks that many mayors and governors have heavily restricted. Every signatory to the letter above may not have called for those restrictions, but they also didn’t take to a public forum to declare them relatively safe under certain conditions.

“For many public health experts who have spent weeks advising policymakers and the public on how to reduce their risk of getting or inadvertently spreading the coronavirus, the mass demonstrations have forced a shift in perspective,” The New York Times tells us.

But they could have easily kept the same perspective: Going out is dangerous, here’s how to best protect yourself. The added well, this cause is important, though, makes the previous guidance look rather suspect. It also makes it seem like the righteousness of the cause is somehow a mitigating factor for spreading the disease.

Examples of this new framing abound. The Times interviewed Tiffany Rodriguez, an epidemiologist “who has rarely left her home since mid-March,” but felt compelled to attend a protest in Boston because “police brutality is a public health epidemic.” NPR joined in with a headline warning readers not to consider the two crises—racism and coronavirus—separately. Another recent New York Times article began: “They are parallel plagues ravaging America: The coronavirus. And police killings of black men and women.”

Police violence, white supremacy, and systemic racism are very serious problems. They produce disparate harms for marginalized communities: politically, economically, and also from a medical standpoint. They exacerbate health inequities. But they are not epidemics in the same way that the coronavirus is an epidemic, and it’s an abuse of the English language to pretend otherwise. Police violence is a metaphorical plague. COVID-19 is a literal plague.

These differences matter. You cannot contract racism if someone coughs on you. You cannot unknowingly spread racism to a grandparent or roommate with an underlying health condition, threatening their very lives. Protesting is not a prescription for combatting police violence in the same way that penicillin is a prescription for a bacterial infection. Doctors know what sorts of treatments cure various sicknesses. They don’t know what sorts of protests, policy responses, or social phenomena will necessarily produce a less racist society, and they shouldn’t leverage their expertise in a manner that suggests they know the answers.

It’s clear that we’ve come to the point where people can no longer be expected to stay at home no matter what. Individuals should feel empowered to make choices about which activities are important enough to incur some exposure to COVID-19 and possibly spreading it to someone else, whether that activity is reopening a business, going back to work, socializing with friends, or joining a protest against police brutality. Health experts can help inform these choices. But they can’t declare there’s just one activity that’s worth the risk.

This content was originally published here.

Among U.S. Health Workers, COVID-19 Deaths Near 300, With 60,000 Sick : Shots – Health News : NPR

Registered nurses and other health care workers at UCLA Medical Center in Santa Monica, Calif., protest in April what they say was a lack of personal protective equipment for the pandemic’s front-line workers.

Mario Tama/Getty Images


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Registered nurses and other health care workers at UCLA Medical Center in Santa Monica, Calif., protest in April what they say was a lack of personal protective equipment for the pandemic’s front-line workers.

The coronavirus continues to batter the U.S. health care workforce.

More than 60,000 health care workers have been infected and close to 300 have died from COVID-19, according to new data from the Centers for Disease Control and Prevention.

The numbers mark a staggering increase from six weeks ago when the CDC first released data on coronavirus infections and deaths among nurses, doctors, pharmacists, EMTs, technicians and other medical employees. On April 15, the agency reported 27 deaths and more than 9,000 cases of infection in health care workers.

The latest tally doesn’t provide a full picture of illness in this essential workforce, because only 21% of the case reports sent to the CDC included information that could help identify the patient as a health care worker. Among known health care workers, there was also missing information about how many of those people actually died.

Still, the growing number of health care workers infected by the coronavirus provides sobering evidence that many are still working in high-risk settings without reliable or adequate protection against the virus.

“It is underreported,” says Zenei Cortez, president of National Nurses United (NNU), the largest union of nurses in the country.

The union has compiled its own count of more than 530 health care fatalities from COVID-19, using publicly available information like obituaries. A recent NNU survey of 23,000 nurses found that more than 80% had not yet been tested for the coronavirus.

Across the country, many nurses say they still don’t have enough personal protective equipment (PPE) such as masks and gowns and are required to reuse N95 masks and other supplies — practices that were considered substandard before the pandemic. Many hospitals and nursing homes continue to operate with inadequate supplies and are rationing them.

“Everything is under lock and key. If you are going to respond to an emergency, you sometimes have to wait for someone to unlock a cabinet,” Cortez says of some hospitals’ PPE supplies.

Cortez cites the death of a nurse from Southern California who rushed to the bedside of a COVID-19 patient who had stopped breathing. The nurse was wearing only a surgical mask, which offers less protection against airborne infection than the closer-fitting N95 respirator mask.

“Fourteen days after that incident, she died because she contracted the virus,” Cortez says. “If the PPE was readily available, she maybe could have put on the N95 mask and been prevented from getting the virus.”

Cortez worries that some of these unsafe practices around infection control have become normalized in U.S. health care settings and will persist in the coming months as the country reopens.

NPR recently reported that in the spring of 2017 the Trump administration halted the final implementation of new federal regulations that would have required the health care industry to prepare for an airborne infectious disease pandemic. Consequently, there are no federal workplace rules that specifically protect health care workers from deadly airborne pathogens such as influenza, tuberculosis or the coronavirus.

“The really sad thing is not having solid numbers from many states,” Pat Kane, executive director of the New York State Nurses Association, says regarding the number of COVID-19 cases and deaths among health care workers.

Early in the outbreak, Kane says, many nurses could not get tested. Her own statewide union has lost more than 30 nurses in the pandemic.

“Some of them actually died outside of the hospital, trying to recover at home,” she says.

More than half of the nurses in the New York state union still report not having enough personal protective equipment.

“In some places, we still see people operating under contingency and crisis guidelines,” she says.

In early May, New York Gov. Andrew Cuomo touted the results of an antibody testing survey that showed a 12% infection rate among health care workers in New York City, compared with the 20% infection rate among residents citywide.

But Kane says that lower number isn’t something to celebrate.

“Our members showed up and many of them made the ultimate sacrifice,” she says. “And many of them got sick. That was Round 1. We should be better informed by our experience.”

As more regions in the United States reopen, the safety of health care workers needs to be a key benchmark for decision-makers, Kane says, and must include enforceable precautionary standards — not just voluntary guidelines for employers, which shift according to the amount of PPE available.

At Northwestern University, Dr. James Adams says the number of health care workers with COVID-19 dropped significantly after his hospital started requiring everyone on-site to wear masks.

Adams says closely tracking the full extent of the COVID-19 burden among health workers will be crucial as access to testing improves.

“Up to this point, we have largely not known what is going on with the workforce and this infection rate,” says Adams, a professor of emergency medicine. “What we need is the confidence of health care workers, and we should track this in order to ensure their health.”

This content was originally published here.

Unarmed specialists, not LAPD, would handle mental health, substance abuse calls under proposal

Several Los Angeles City Council members called Tuesday for a new emergency-response model that uses trained specialists, rather than LAPD officers, to render aid to homeless people and those suffering from mental health and substance abuse issues.

A motion submitted by City Council members Nury Martinez, Herb Wesson, Marqueece Harris-Dawson, Curren Price and Bob Blumenfield asks city departments to work with the Los Angeles Police Department and Los Angeles Homeless Services Authority to develop a model that diverts nonviolent calls for service away from the LAPD and to “appropriate non-law enforcement agencies.”

The LAPD now has a “greater role in dealing with homelessness, mental health and even COVID-19-related responses” the motion states, blaming budget cuts to social service programs for the city’s increased reliance on police officers.

“We have gone from asking the police to be part of the solution, to being the only solution for problems they should not be called on to solve in the first place,” the motion said.

The petition is the latest eruption of a longstanding debate within the Los Angeles Homeless Services Authority over how — or whether — to work with law enforcement.

It’s unclear how large the new response team would be, but in a statement, council members cast the program as part of an effort to reimagine public safety and reduce unnecessary police interactions.

Representatives for the Los Angeles Police Protective League, the union representing rank-and-file officers, have previously pointed to the increased demands placed upon police officers, saying officers now perform the duties of therapists, drug treatment counselors, social workers and EMTs.

Jerretta Sandoz, vice president of the union’s board of directors, said Tuesday that the union agreed that “not every call our city leaders have asked us to respond to should be a police response.”

“We are more than willing to talk about how, or if, we respond to noncriminal and nonemergency calls so we can free up time to respond quickly to 911 calls, crackdown on violent crime, and property crime and expand our community policing efforts,” Sandoz said.

The council members’ motion comes after tens of thousands of people have protested in Los Angeles streets in recent weeks, decrying police brutality and calling for a new approach to long-held strategies over policing, particularly in Black communities.

The City Council on Tuesday also voted to move ahead with studying ways to cut the LAPD’s budget by $100 million to $150 million and put the money into community programs. The council vote was 11-3, with Councilmen Paul Koretz, Joe Buscaino and John Lee dissenting.

A report back to the council on those proposed budget cuts is expected in the coming weeks.

The People’s Budget effectively calls for the dismantling of the LAPD, with the proceeds devoted to housing, healthcare, mental health, parks and many other services.

Buscaino, a former police officer who now serves as a reserve officer, told The Times that his no vote reflected his belief that “real police reform” will come from expanding an existing LAPD program focused on building relationships between police officers and communities.

Separately, the council members’ motion submitted Tuesday also asks for a report back on crisis intervention models, including the “Cahoots” program in Eugene, Ore. The program, short for Crisis Assistance Helping Out on the Streets, sends in teams of medics and mental health counselors if 911 operators determine armed intervention isn’t needed.

The program’s teams handled 18% of the 133,000 calls to 911 last year, requesting police backup only 150 times, Chris Hecht, executive coordinator of White Bird Clinic, which runs the operation, said in an interview.

The program operated on a $2-million budget last year that Hecht said saved the Eugene-Springfield, Ore., area about $14 million in costs of ambulance transport and emergency room care.

Times staff writer Richard Read, in Seattle, contributed to this report.

This content was originally published here.

Motivated by his son Beau, Joe Biden pledges help for veterans with burn pit health issues – CBS News

Throughout his presidential campaign, one of the most striking elements of Joe Biden‘s appeal has been his empathy. The personal tragedies he has suffered inform his interactions with voters who are also experiencing loss. And his sorrow could also guide policy decisions as commander-in-chief, offering assistance to veterans who may be suffering from service-related medical conditions — as he believes his son did. 

With a familiar quiver in his voice, Biden regularly on the campaign trail shares memories of his son Beau, who died in 2015 from glioblastoma brain cancer. A handful of times Biden detailed how he thinks his son’s cancer may have been related in part to the large, military base burn pits during his 2009 service in the Iraq War.

“He volunteered to join the National Guard at age 32 because he thought he had an obligation to go,” Biden told a Service Employees International Union convention in October. “And because of exposure to burn pits — in my view, I can’t prove it yet — he came back with Stage Four glioblastoma.”

Biden’s precise language — “in my view, I can’t prove it yet” — appears to be intentional as he lends his voice to the ongoing and somewhat controversial debate over whether the burn pits caused lasting health issues for American veterans.

“We don’t have 20 years”  

As the Iraq and Afghanistan military operations grew, so did the installations of bigger burn pits on military bases, rather than the smaller burn barrels that had previously been used. The pits were meant to dispose of everything from garbage to sensitive documents and even more hazardous materials. 

“They build as big as this auditorium,” Biden said to a CNN town hall audience in February, “It’s about 8-to-10-feet-deep and they put everything in it they want to dispose of and can’t leave behind, from flammable fuel to plastics to all range of things.”

But in the middle of a war zone, concern about the burn pits was sometimes considered secondary to other safety issues. 

“You’ve got dust storms, you have the enemy, you have all sorts of things going on that some smoke in the air doesn’t really seem like as important of an issue at the moment,” Jim Mowrer, who befriended Beau at Camp Victory in Iraq in 2009, told CBS News. Other times, Mowrer, 34, who now serves as co-chair for the Veterans for Biden committee, said he tried to filter the air by wearing a face covering.

“The concern factor became more of a concern after we came home,” Beau’s overseas boss, Command JAG Kathy Amalfitano, 59, told CBS News. Amalfitano said she remembers discussing the burn pits with Beau a few times, but added “I know our thought process was that this was part of the deployment.”

Biden is not alone in thinking burn pits impacted soldiers’ health.

Since 2014, more than 200,000 Afghanistan and Iraq War veterans have registered in the “Airborne Hazards and Open Burn Pit Registry” run by the Department of Veterans Affairs (VA), detailing exposure to service-related airborne hazards from burn pit smoke and other pollution.

And while these veteran health concerns seem widespread, the VA’s policy only recognizes “temporary” irritation from burn pit exposure. Citing a range of studies, the department states that “research does not show evidence of long-term health problems from exposure to burn pits.”

One ongoing study is by National Jewish Health and funded by the Defense Department, and is examining lung issues and has yielded “a spectrum of diseases that are related to deployment,” the study’s principal investigator Dr. Cecile Rose told CBS News last year. ” [The diseases] weren’t there before, and they are clearly there after people have returned from these arid and extreme environments.” However, Rose cautioned that findings are complicated by other possible culprits, like desert dust and diesel exhaust.

Advocates for veterans say not enough is being done to address veterans’ health claims regarding the burn pits.

From 2007 to 2018, the VA processed 11,581 disability compensation claims that had “at least one condition related to burn pit exposure,” a department spokesman told The New York Times last year. But the department only accepted 2,318 of these claims. The department said the rest did not show evidence connected to military service or the condition in the claim was not “officially diagnosed,” the Times noted. 

The VA did not respond to CBS News’ request this week for updated numbers.

“I always push back on…the VA administration folks who try to use the ‘perfect study’ as a criteria to show proof,” California Representative Raul Ruiz, a doctor and vocal burn pits critic, told CBS News. Ruiz criticized the VA’s reliance on long-term studies to validate clams. 

“We don’t have 20 years because then these veterans are going to be dying without the care they need,” Ruiz said.

A report five years ago by a Defense Department inspector general said it was “indefensible” that military personnel “were put at further risk from the potentially harmful emissions from the use of open-air burn pits.” But the Supreme Court last year rejected a victims’ lawsuit against contractors who oversaw some of the burn pits.

“If these [burn pits] had happened in the United States, the Environmental Protection Agency and Centers for Disease and Control would have this corrected immediately,” said Iraq War veteran Jeremy Daniels, adding he believes burn pits caused him to be wheelchair bound.

Modern-day “Agent Orange”?

Biden on the campaign trail invoked the healthcare struggles of Vietnam veterans exposed to the herbicide Agent Orange to explain the need to address burn pits.

“You were entitled to military compensation if you could prove that Agent Orange caused whatever the immune system damage was to you,” Biden said, accenting the word “prove” during a Veterans Day town hall in Oskaloosa, Iowa. “But you had to prove it and it’s very hard to prove.”

After reading a book on burn pits detailing Beau’s case, Biden has advocated easing this burden of proof for veterans who say the burn pits have harmed them in some way, as he first told PBS.

Biden has a plan that pushes for congressional approval to expand the list of “presumptive conditions”– meaning veterans’ health conditions would be presumed causal to the burn pits making them eligible for greater VA healthcare. He also aims to expand the claim eligibility period for toxic exposure conditions to five years after service instead of one year and increase federal research by $300 million in part to focus on toxic exposure from burn pits.

This push has intensified in recent years on Capitol Hill, and bills funding more research into burn pits have already been signed by President Trump. The recent National Defense Authorization Act also required the Department of Defense to implement a plan to phase out burn pits and disclose the locations of the still-operating pits. Enclosed incinerators are an alternative.

There were nine active military burn pits in the Middle East as of last year, according to the Defense Department’s April 2019 “Open Burn Pit Report to Congress” shared with CBS News, though some advocates think the actual number is higher. 

Some veterans expressed doubt that recent efforts will lead to more aid for veterans exposed to burn pits, given the slow-moving bureaucracy and concern over higher health care costs. And others question whether a Biden administration would act more decisively than the Obama administration, which primarily focused on long-term studies.

But Biden says that his motivation is far greater than his family’s own personal loss, and that the “only sacred” commitment the United States has is to American soldiers.

“It’s not because my son died…[he] went from very, very healthy but he lived in the bloom of those burn pits for a long time. He’s passed—it doesn’t affect him,” Biden said in Oskaloosa. “But the point is that every single veteran shouldn’t have to prove and wait until science demonstrates beyond a doubt…We just have to change the way we think a little bit.”

May 30 will mark the five-year anniversary of Beau Biden’s death.

This content was originally published here.

Ontario’s health minister shopped at Toronto LCBO while awaiting COVID-19 test results | CP24.com

Ontario’s health minister says she was following the advice of medical professionals when she decided to shop at a Toronto LCBO on Wednesday afternoon while awaiting her COVID-19 test results.

Health Minister Christine Elliott and Premier Doug Ford, who have since tested negative for the virus, underwent COVID-19 testing on Wednesday after learning that the province’s education minister, Stephen Lecce, had earlier come in contact with someone who tested positive for the virus.

Ford and Elliott, who had held a joint press conference with Lecce one day earlier, decided to skip their daily briefing at Queen’s Park on Wednesday afternoon out of an abundance of caution.

Elliott also cancelled an appearance at a Brampton mobile testing site that was scheduled for 3 p.m.

Lecce released a statement shortly before 2 p.m. on Wednesday confirming that his test results had come back negative and about an hour-and-a-half later, Elliott was seen shopping at an LCBO near Dupont Street and Spadina Avenue.

A photo sent to CP24 shows Elliott, who is wearing a surgical mask, standing beside a basket and looking at the store’s VQA wine selection.

“Minister Lecce’s results came back negative before I went for testing and so while there was no real need for me to go to be tested, I had made a public commitment to do so and so that’s where I went,” Elliott told reporters at Queen’s Park on Thursday.

“I went and while I was at the assessment centre having the test, I was advised that because I had not directly been in contact with anyone with COVID that I did not need to self-isolate…That was the medical advice I was given and that is what I did and my test results came back negative of course.”

Elliott and Ford returned to Queen’s Park for their daily COVID-19 update on Thursday afternoon.

“To be clear, both Premier Ford and Minister Elliott have had no known contact with anyone who has tested positive for COVID-19, and as a result, there is no need for either of them to self-isolate,” a statement from the premier’s office read.

“They will continue to follow public health guidelines.”

Lecce’s office confirmed Thursday that he will continue to self-isolate.

“Minister Lecce is feeling well and continues to work from home. He is following the advice of his doctor by continuing to monitor for any symptoms,” a statement from the education minister’s office read.

“Out of an abundance of caution, although the exposure risk was extremely low, he will be self-isolating for the remainder of the 14 days since the time of exposure, on June 6. The Minister again would like to offer his sincere thanks to the team at UHN and everyone yesterday who sent positive thoughts and messages.”

Public health experts have cautioned that negative test results are not always an indication that a person isn’t infected with the virus, especially when tests are conducted a short time after exposure.

Those who have tested negative for the virus are still advised to monitor for symptoms as the virus has an incubation period of 14 days.

“As we outlined our testing criteria at the assessment centres… if you have signs and symptoms and you’re suspected of being a COVID case, you will get your test and then you are supposed to stay in self-isolation until you get results,” Dr. David Williams, Ontario’s chief medical officer of health, said at a news conference on Thursday.

“Other criteria, you say, ‘Well, I was in contact with a known positive.’ That is another reason to get tested and you still have to self-isolate until you get that result back, including people who say, ‘Well I’m not sure but I was in a highly risky area, I don’t know.’’”

He noted that the rules are different for people who are not experiencing symptoms of the virus and have not been in contact with a known case.

“Testing asymptomatic people… say 5,000 workers, none of them have symptoms, none of them are cases, we are not going to say all 5,000 wait for five, six days to get results back. They just continue going to work because it is asymptomatic testing,” he added.

“They have no signs and symptoms, they have no contact with a case, no possible contact with a case, and there is no evidence of an outbreak. So it is a different situation altogether.”

This content was originally published here.

Arizona coronavirus: Banner Health reaches capacity on ECMO lung machines

Arizona’s largest health system reaches capacity on ECMO lung machines as COVID-19 cases in the state continue to climb

Stephanie Innes
Arizona Republic
Published 2:24 PM EDT Jun 6, 2020
Coronavirus 2019-nCoV vials
solarseven, Getty Images/iStockphoto

Hospitalizations in Arizona of patients with suspected and confirmed COVID-19 have hit a new record and the state’s largest health system has reached capacity for patients needing external lung machines.

Arizona’s total identified cases rose to 25,451 on Saturday according to the most recent state figures. That’s an increase of 4.4%, since Friday when the state reported 24,332 identified cases and 996 deaths. 

Some experts are saying that Arizona is experiencing a spike in community spread, pointing to indicators that as of Saturday continued to show increases — the number of positive cases, the percent of positive cases and hospitalizations.

Also, ventilator and ICU bed use by patients with suspected and confirmed COVID-19 in Arizona hit record highs on Friday, the latest numbers show.

Statewide hospitalizations as of Friday jumped to 1,278 inpatients in Arizona with suspected and confirmed COVID-19, which was a record high since the state began reporting the data on April 9. It was the fifth consecutive day that hospitalizations statewide have eclipsed 1,000.

On Saturday morning, officials with Banner Health notified the Arizona centralized COVID-19 surge line that  Banner hospitals are unable to take any new patients needing ECMO — extracorporeal membrane oxygenation.

ECMO is an an external lung machine that’s used if a patient’s lungs get so damaged that they don’t work, even with the assistance of a ventilator.

The Arizona surge line is a 24/7 statewide phone line for hospitals and other providers to call when they have a COVID-19 patient who needs a level of care they can’t provide. An electronic system locates available beds and appropriate care, evenly distributing the patients so that no one system or hospital is overwhelmed by patients.

Banner Health, which is the state’s largest health system, is also nearing its usual ICU bed capacity, officials said Friday and if current trends continue is at risk of exceeding capacity. Banner Health typically has about half of Arizona’s suspected and confirmed COVID-19 hospitalized patients.

The state’s death toll on Saturday was 1,042, with 30 new deaths reported. On Friday the tally for the first time reached four figures — 1,012 total deaths —  three weeks after Gov. Doug Ducey’s stay-at-home order expired.

What we know about the known deaths, based on the state data:

Ducey said at a Thursday news conference that “we mourn every death in the state of Arizona.”

“… I’m confident that we’ve made the best and most responsible decisions possible, guided by public health, the entire way,” Ducey said.  

Saturday marked Arizona’s fifth consecutive day of high numbers of new coronavirus cases reported, with 1,119 positives reported Saturday, a record 1,579 reported on Friday, 530 on Thursday, 973 on Wednesday and 1,127 new cases reported on Tuesday.

Dr. Cara Christ, director of the Arizona Department of Health Services, said at a Thursday news conference that the increase in cases was expected given increased testing and reopening. 

“As people come back together, we know that there is going to be transmission of COVID-19,” Christ said. “We are seeing an increase in cases, and so we will continue to monitor at this time. But we have to weigh the impacts of the virus versus the impacts of what a stay-at-home order can have on long-term health as well.”

Before this week, new cases reported daily have typically been in the several hundreds. The state has reported new cases each day, typically in the several hundreds. The daily increase in case numbers also reflects a lag in obtaining results from the time a test was conducted.

Additional deaths are reported each day as well and have varied between single- and double-digit increases. The number of deaths reported each day represents the additional known deaths reported by the Health Department that day, but could have occurred weeks prior and on different days.

The date with the most deaths in a single day so far is April 30 with 26 deaths, followed by May 7 with 25 deaths and April 23 and May 8 with 24 deaths each. Next comes April 20 with 23 deaths and April 19, May 3 and May 5 with 22 deaths on each of those days, according to Friday’s data, which is likely to change in the days ahead as more deaths are identified.

Maricopa County’s confirmed case total was at 12,761 on Saturday according to state numbers. 

“We are seeing some indicators that the number of cases in Maricopa County are starting to rise,” county spokesman Ron Coleman said this week in an email. “This is in addition to an increase from increased testing.”

The number of Arizona cases likely is higher than official numbers because of limits on supplies and available tests, especially in early weeks of the pandemic. 

The percentage of positive tests per week increased from 5% a month ago to 6% three weeks ago to 9% two weeks ago, and 11% last week. The ideal trend is a decrease in percent of positives tests out of all tests. 

In addition to an increase in hospitalizations, ventilator use in Arizona by suspected and positive COVID-19 patients statewide jumped to 292 on Friday, which was the highest number reported since the state data began on April 9.

Also, ICU bed use by patients with positive and suspected COVID-19 on Friday was 391 — a record high and the 11th consecutive day that the number has been higher than 370.

The latest Arizona data

As of Saturday morning, the state reported death totals from these counties: 489 in Maricopa, 205 in Pima, 85 in Coconino, 72 in Navajo, 57 in Mohave, 49 in Apache, 41 in Pinal, 24 in Yuma, six in Yavapai, 4 in Cochise, three in Santa Cruz and three in Gila.

La Paz County officials reported two deaths and Graham County reported one death, although the state site listed them as just having fewer than three deaths. Greenlee County reported no deaths.

Of the statewide identified cases overall, 47% are men and 53% are women. But men made up a higher percentage of deaths, with 54% of the deaths men and 46% women as of Saturday.

Overall, Arizona has 354 cases and 14.49 deaths per 100,000 residents, according to state data.

The scope of the outbreak differs by county, with the highest rates in Apache, Navajo, Santa Cruz, Yuma and Coconino counties.

Of all confirmed cases, 9% are younger than 20, 42% are aged 20 to 44, 16% are aged 45 to 54, 14% are aged 55 to 64 and 17% are over 65. This aligns with the proportions of testing done for each age range.

The state Health Department website said both state and private laboratories have completed a total of  271,646 diagnostic tests for COVID-19, and 109,266 serology, or antibody, tests.

Most COVID-19 diagnostic tests come back negative, the state’s dashboard shows, with 7.2% positive. For serology tests, 3% have come back positive.

Maricopa County’s Department of Public Health provided more detailed information on a total of 12,685 cases Friday (the state reported the county case total at 12,761):

Cases rise in other counties

According to Friday’s state update, Pima County reported 2,950 identified cases. Navajo County reported 2,152 cases, while Yuma County reported 1,850; Apache County 1,692; Coconino County 1,267; Pinal County 1,067; Santa Cruz County 530; Mohave County 485; and Yavapai County 326. 

La Paz County reported 158 cases, Cochise County 122, Gila County 43, Graham County 39 and Greenlee County nine, according to state numbers.

The Navajo Nation reported a total of 5,808 cases and at least 269 confirmed deaths as of Friday. The Navajo Nation includes parts of Arizona, New Mexico and Utah.

237 cases in Arizona prisons

The Arizona Department of Corrections’ online dashboard said 237 inmates had tested positive for COVID-19 as of Friday, up from 198 one day prior. 

The cases were at these eight facilities: 75 in Florence, 97 in Yuma, 28 in Tucson, 12 in Phoenix, nine in Marana, six in Eyman, six in Perryville, two in Kingman and two in Lewis.

Four inmate deaths have been confirmed — two in Florence and two in Tucson, and three deaths are under investigation, the dashboard says.

Ninety-nine staff members have self-reported positive for the virus, and 69 have been certified as recovered, the department said. 

Both legal and nonlegal visitations have been suspended through June 13, at which point the department will reassess. Temporary video visitation will be available to approved visitors and inmates who have visitation privileges, the department announced. Inmates are eligible for one 15-minute video visit per week. CenturyLink also is giving inmates two additional 15-minute calls for free during each week visitation is restricted.

Separately, the Maricopa County Jail system as of Friday was reporting 30 inmates who had tested positive for COVID-19, county officials said. That was up from six positive inmates one week prior.

Arizona Republic reporter Alison Steinbach contributed to this article

Reach the reporter at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes

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This content was originally published here.

44 Black Mental Health Support Resources for Anyone Who Needs Them | SELF

Black lives matter. Black bodies matter. Black mental health matters. This latest string of rampant and wanton brutality against Black people flies in the face of these indisputable truths. As a Black woman myself, I’ve spent years trying to process the violence and racism that are part and parcel of living in this country in this skin. But I’ve never had to do it during a pandemic that, of course, is decimating Black lives, health, and communities the most.

In my years as a mental health reporter and editor, I’ve been heartened to slowly see the collection of mental health resources for Black people start to grow. It’s still not where it needs to be, but there is solidarity and support out there if you need help processing what’s happening (and there’s nothing weak about needing it, either). Here’s a list of resources that may help if you’re looking for mental health support that validates and celebrates your Blackness.

It starts with people to follow on Instagram who regularly drop mental health gems, then goes into groups and organizations that do the same, followed by directories and networks for finding a Black mental health practitioner. Lastly, I’ve added a few tips to keep in mind when seeking out this kind of mental health support, especially right now.

People to follow

Alishia McCullough, L.P.C.: McCullough’s Instagram places an emphasis on Black mental wellness and self-love, along with social justice issues like fat liberation. She also posts about participating in live virtual panels on issues like living with an abuser while social distancing and having to live with toxic family during the new coronavirus crisis, so if you’re craving that kind of content, consider following along.

Bassey Ikpi: Ikpi is a mental health advocate who I first became familiar with when she appeared on The Read podcast, where she talked about her now best-selling debut essay collection, I’m Telling the Truth But I’m Lying, in which she writes about her experiences having bipolar II and anxiety. Ikpi is also the founder of the Siwe Project, a global non-profit that increases awareness around mental health in people of African descent.

Cleo Wade: The best-selling author of Heart Talk and Where to Begin: A Small Book About Your Power to Create Big Change in Our Crazy World, Wade’s poetic Instagram dispatches offer quiet meditations on life, love, spirituality, current events, relationships, and finding inner peace.

Donna Oriowo, Ph.D.: I first heard about Oriowo, a sex and relationship therapist, when a friend told me I had to listen to a recent Therapy for Black Girls podcast episode where Oriowo discussed whether Issa and Molly can repair their friendship on Insecure. Oriowo shared so much insight into Issa and Molly’s psyches that I was having lightbulb moment after lightbulb moment. And as a sex and relationship therapist, her Instagram feed destigmatizes Black sexuality and relationships specifically, which is essential.

Jennifer Mullan, Psy.D.: Mullan’s mission is, as her Instagram handle so succinctly sums up, decolonizing therapy. Check out her feed for ample conversation about how mental health (and access to related services) are impacted by trauma and systemic inequities, along with hope that healing is indeed possible.

Jessica Clemons, M.D.: Dr. Clemons is a board-certified psychiatrist who spotlights Black mental health. Her Instagram encompasses everything from mindfulness to motherhood, and her live Q + As and #askdrjess video posts really make it feel like you’re not only following her, but connecting with her, too.

Joy Haven Bradford, Ph.D.: Bradford is a psychologist who aims to make discussions about mental health more accessible for Black women, particularly by bringing pop culture into the mix. She’s also the founder of Therapy for Black Girls, a much-loved resource that includes a great Instagram feed and podcast.

Mariel Buquè, Ph.D.: Click the follow button if you could use periodic “soul check” posts asking how your soul is holding up, gentle ways to practice self-care, help sorting through your feelings, advice on building resilience, and so much more.

Morgan Harper Nichols: If you don’t already follow Nichols but like stirring art mixed with uplifting messages, you’re in for a treat. Her Instagram feed is a swirly, colorful dream of what she describes as “daily reminders through art”—reminders of how valid it is to still seek joy, and of your worth, and of the fact that “small progress is still progress.”

Nedra Glover Tawwab: In Tawwab’s Instagram bio, the licensed clinical social worker describes herself as a “boundaries expert.” That expertise is critical right now, given that safeguarding our mental health as much as possible pretty much always requires firm boundaries. Tawwab also holds weekly Q+A sessions on Instagram, so stay tuned to her feed if you have a question you’d like to submit.

Thema Bryant-Davis, Ph.D.: A licensed psychologist and ordained minister, some of Bryant-Davis’s clinical background focuses on healing trauma and working at the intersection of gender and race. If you happen to be avoiding Twitter as much as possible for the sake of your mental health, like I am, you might like that her feed is mainly a collection of her great mental health tweets that you would otherwise miss.

Brands, collectives, and organizations to follow

Balanced Black Girl: This gorgeous feed features photos and art of Black people along with summaries of their podcast episode topics, worthwhile tweets you can see without having to scroll through Twitter, and advice about trying to create a balanced life even in spite of everything we’re dealing with. Balanced Black Girl also has a great Google Doc full of more mental health and self-care resources.

Black Female Therapists: On this feed, you’ll find inspirational messages, self-care Sunday reminders, and posts highlighting various Black mental health practitioners across the country. They have also recently launched an initiative to match Black people in need with therapists who will do two to three free virtual sessions.

Black Girls Heal: This feed focuses on Black mental health surrounding self-love, relationships, and unresolved trauma, along with creating a sense of community. (Like by holding “Saturday Night Lives” on Instagram to discuss self-love.) Following along is also an easy way to keep track of the topics on the associated podcast, which shares the same name.

Black Girl in Om: This brand describes their vision as “a world where womxn of color are liberated, empowered & seen.” On their feed, you can find helpful resources like meditations, along with a lot of joyful photos of Black people, which I personally find incredibly restorative at this time.

Black Mental Wellness: Founded by a team of Black psychologists, this organization offers a ton of mental health insight through posts about everything from destigmatizing therapy, to talking about Black men’s mental health, to practicing gratitude, to coping with anxiety.

Brown Girl Self-Care: With a mission described as “Help Black women healing from trauma go from ‘every once in a while’ self-care to EVERY DAY self-care,” this feed features tons of affirmations and self-care reminders that might help you feel a little bit better. Plus, in June, they’re running a free virtual Self-Care x Sisterhood circle every Sunday.

Ethel’s Club: This social and wellness club for people of color, originally based in Brooklyn, has pivoted hard during the pandemic and now offers a digital membership club featuring virtual workouts, book clubs, wellness salons, creative workshops, artist Q+As, and more. Membership is $17 a month, or you can follow their feed for free tidbits if that’s a better option for you.

Heal Haus: This cafe and wellness space in Brooklyn has of course closed temporarily due to the pandemic. In the meantime, they’ve expanded their online offerings. Follow their Instagram to stay up to date with what they’re rolling out, like their free upcoming Circle of Care for Black Womxn on June 5.

The Hey Girl Podcast: This podcast features Alexandra Elle, who I mentioned above, in conversation with various people who inspire her. Its Instagram counterpart is a pretty and calming feed of great takeaways from various episodes, sometimes layered over candy-colored backgrounds, other times over photos of the people Elle has spoken to.

Inclusive Therapists: This community’s feed specializes in regular doses of mental health insight, a lot of which seems especially geared towards therapists. With that said, you don’t have to be a therapist to see the value in posts like this one that notes, “You are whole. The system is broken.”

The Loveland Foundation: Founded by writer, lecturer, and activist Rachel Elizabeth Cargle, The Loveland Foundation works to make mental health care more accessible for Black women and girls. They do this through multiple avenues, such as their Therapy Fund, which partners with various mental health resources to offer financial assistance to Black women and girls across the nation who are trying to access therapy. Their Instagram feed is a great mix of self-care tips and posts highlighting various Black mental health experts, along with information about panels and meditations.

The Nap Ministry: If you ever feel tempted to underestimate the pure power of just giving yourself a break, The Nap Ministry is a great reminder that, as they say, “rest is a form of resistance.” Rest also allows for grieving, which is an unfortunately necessary practice as a Black person in America, especially now. In addition to peaceful and much-needed photos of Black people at rest, there are great takedowns of how harmful grind/hustle culture can be to our health.

OmNoire: Self-described as “a social wellness club for women of color dedicated to living WELL,” this mental health resource actually just pulled off a whole virtual retreat. Follow along for affirmations, self-care tips, and images that are inspirational, grounding, or both. (Full disclosure: I went on a great OmNoire retreat a year ago.)

Saddie Baddies: Gorgeous feed, gorgeous mission. Along with posts exploring topics like respectability politics, obsessive-compulsive disorder, self-harm, and loneliness, this Instagram features beautiful photos of people of color with the goal of making “a virtual safe space for young WoC to destigmatize mental health and initiate collective healing.”

Sad Girls Club: This account is all about creating a mental health community for Gen Z and millennial women who have mental illness, along with reducing stigma and sharing information about mental health services. Scroll through the feed and you’ll see many people of color, including Black women, openly discussing mental health—a welcome sight.

Sista Afya: This Chicago-based organization focuses on supporting Black women’s mental health in a number of ways, like connecting Black women to affordable and accessible mental health practitioners and running mental health workshops. They also offer a Thrive in Therapy program for Illinois-based Black women making less than $1,500 a month. For $75 a month, members receive two therapy sessions, free admission to the monthly support groups, and more.

Transparent Black Girl: Transparent Black Girl aims to redefine the conversation around what wellness means for Black women. Their feed is a mix of relatable memes, hilarious pop culture commentary, beautiful images and art of Black people, and mental health resources for Black people. Transparent Black Guy, the brother resource to Transparent Black Girl, is also very much worth a follow, particularly given the stigma and misconceptions that often surround Black men being vulnerable about their mental health.

Directories and networks for finding a Black (or allied) therapist

Here are various directories and networks that have the goal of helping Black people find therapists who are Black, from other marginalized racial groups, or who describe themselves as inclusive. This list is not exhaustive, and some of these resources will be more expansive than others. They also do different levels of vetting the experts they include. If you find a therapist via one of these sites who seems promising, be sure to do some follow-up searches to learn more about them.

This content was originally published here.

Minn. health officials urge caution after news of ICU beds filling up – StarTribune.com

Metro hospitals are running short on intensive care unit beds due to an increase in patients with COVID-19 and other medical issues, prompting health officials to call for more public adherence to social distancing to slow the spread of the infectious disease.

The Minnesota Department of Health on Friday reported a record 233 patients with COVID-19 in ICU beds, but doctors and nurses said patients with other illnesses resulted in more than 95% of those beds in the Twin Cities to be filled.

Patients with unrelated medical problems needed intensive care, along with patients recovering from surgeries — including elective procedures that resumed May 11 after they had been suspended due to the pandemic.

“We are tight,” said Dr. John Hick, an emergency physician directing Minnesota’s Statewide Healthcare Coordination Center. “Resuming elective surgeries plus an uptick in ICU cases has constricted things pretty quickly.”

At different times, Hennepin County Medical Center and North Memorial Health Hospital were diverting patients to other hospitals. Almost all heart-lung bypass machines were in use for severe COVID-19 patients and others at the University of Minnesota Medical Center and Abbott Northwestern Hospital in Minneapolis.

As planned, Children’s Minnesota took on some young adult patients to take pressure off the general hospitals.

People might think the pandemic is over because public restrictions are being scaled back, but “in the hospitals, it is not over and it is not getting back to normal,” said nurse Emily Sippola, adding that her United Hospital was opening a third COVID-specific unit ahead of schedule. “The pace is picking up.”

The pressure on hospitals comes at a crossroads in Minnesota’s response to the pandemic, which is caused by a novel coronavirus for which there is yet no vaccine. Infections and deaths are rising even as Gov. Tim Walz lifted his statewide stay-at-home order on Monday and faced pressure this week to pull back even more restrictions on businesses and churches.

Despite talks with Walz on Friday, leaders of the Catholic Archdiocese of St. Paul and Minneapolis issued no change in guidance for their churches to defy the governor’s order and hold indoor masses at one-third seating capacity starting Tuesday. President Donald Trump might have altered those talks when he threatened to supersede any state government that tried to keep churches closed any longer, although the White House didn’t cite any law giving him the right to do so.

A single-day record of 33 COVID-19 deaths was reported Friday in Minnesota — with 25 in long-term care and one in a behavioral health group home — raising the death toll to 842. Infections confirmed by diagnostic testing increased by 813 on Friday to 19,005 overall, and Dr. Deborah Birx, the White House’s coronavirus response coordinator, called out Minneapolis for having one of the nation’s highest rates of diagnostic tests being positive for COVID-19.

People can slow the spread of COVID-19 if they continue to wear masks, practice social distancing, wash hands and cover coughs, said Dr. Ruth Lynfield, state epidemiologist.

“There are those among us who will not do well with this virus and will develop severe disease, and I think we need to be very mindful of that,” she said. “It’s not high-tech. We know what to do to prevent transmission of this virus.”

While as many as 80% of people suffer mild to moderate symptoms from infection, the virus spreads so easily that it will still lead to a high number of people needing hospital care. Health officials are particularly concerned about people with underlying health problems — including asthma, diabetes, smoking, and diseases of the heart, lungs, kidneys or immune system.

Individuals with such conditions and long-term care facility residents have made up around 98% of all deaths. The state’s total number of long-term care deaths related to COVID-19 is now 688.

The University of Minnesota’s Center for Infectious Disease Research and Policy estimates that only 5% of Minnesotans have been infected so far and that this rate will increase substantially.

Hospitals working together

Part of the state response strategy is aggressive testing of symptomatic patients to identify the course of the virus and hot spots of infection before they spread further. Widespread testing is being scheduled in long-term care facilities that have confirmed cases, and testing has taken place in eight food processing plants with cases as well.

The state averaged nearly 7,000 diagnostic tests per day this week, and the state should get a boost from a new campaign of testing clinics at six National Guard Armory locations across Minnesota from Saturday through Monday, said Jan Malcolm, state health commissioner.

The state’s pandemic preparedness website as of Friday indicated that 1,045 of 1,257 available ICU beds were occupied by patients with COVID-19 or other unrelated medical conditions — and that another 1,093 beds could be readied within 72 hours.

Several hospitals are already activating those extra beds, though in some cases they are finding it difficult to find the critical care nurses to staff existing ICU beds — much less new ones, said Dr. Rahul Koranne, president of the Minnesota Hospital Association. Staffing difficulties, rather than a lack of physical bed space, caused some of the hospitals to divert patients.

Nurses in the Twin Cities reported being called in for overtime shifts for the Memorial Day weekend, which in typical years also launches a summerlong increase of car accidents and traumatic injuries. North Memorial, HCMC and Regions Hospital in St. Paul are trauma centers.

“This increased trauma volume typically persists throughout the summer season and into fall,” North Memorial said in a statement provided by spokeswoman Katy Sullivan. “To be able to provide the needed level of care for the community and honor our commitments to our healthcare partners throughout Minnesota and western Wisconsin, we need to preserve some capacity for emergency trauma care.”

An increase in surgeries might have contributed to the ICU burden, but Koranne said many didn’t fit the definition of elective. Some patients delayed the removal of tumors due to the pandemic but can no longer afford to do so.

“They are patients who have been waiting for critical time-sensitive procedures that their physician is worried might be getting worse,” Koranne said. “To call those type of procedures elective could not be further from the truth.”

Competing hospitals have long cooperated when others needed to divert patients, but that has increased with the help of the state COVID-19 coordinating center and is showing in how they are managing ICU bed shortages, hospital leaders said.

“We all have surge plans in place,” said Megan Remark, Regions president, “but more than ever before, everyone is working together and with the state to ensure that we can provide care for all patients.”

This content was originally published here.

‘This is not about politics’: GOP governor says wearing masks is public health issue

WASHINGTON — Ohio Republican Gov. Mike DeWine on Sunday dismissed the politicization of wearing masks in public to help contain the spread of the coronavirus, imploring Americans during the Memorial Day Weekend to understand “we are truly all in this together.”

With many states like Ohio beginning to relax stay-at-home restrictions, DeWine underscored the importance of following studies that show masks are beneficial to limiting the spread of the virus in an exclusive interview with “Meet the Press.”

“This is not about politics. This is not about whether you are liberal or conservative, left or right, Republican or Democrat,” DeWine said.

“It’s been very clear what the studies have shown, you wear the mask not to protect yourself so much as to protect others. This is one time where we are truly all in this together. What we do directly impacts others.”

DeWine made the comments in response to an emotional plea from North Dakota Gov. Doug Burgum, who last week denounced the idea that mask-wearing should be a partisan issue.

Public health experts continue to say mask usage can help stunt the spread of the virus and recommend that people wear masks where social distancing is not feasible. But the White House has sent mixed signals on the practice.

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President Trump has repeatedly bucked the practice of wearing a mask in public, reportedly telling advisers he thought doing so would send the wrong message and distract from the push to reopen the economy.

He did not wear one during a visit to an Arizona mask production facility earlier this month. And while he did wear one for part of his trip to a Ford manufacturing plant in Michigan last week, he took it off before speaking to reporters and said “I didn’t want to give the press the pleasure of seeing it.”

Vice President Pence did not wear a mask while touring the Mayo Clinic in Minnesota last month, but donned one during another tour days later in Indiana after criticism.

O’Brien: The president wears masks ‘when necessary’

Robert O’Brien, Trump’s national security adviser, told “Meet the Press” Sunday that he and many other members of White House staff wear masks during work and hope that will set an “example” for Americans looking to return to the office. And he defended the president’s conduct by arguing that if proper social-distancing measures are taken, Trump doesn’t always need to wear a mask.

“I think Gov. DeWine was spot on when he talked about office-workers wearing the masks, and mask usage is going to help us get this economy reopened,” he said.

“And we do need to get the country reopened because we can’t get left behind by China or others with respect to our economy.”

The question of how to safely reopen the American economy is weighing heavy this Memorial Day weekend, as every state across the country is beginning to move toward relaxing coronavirus-related restrictions.

There have been more than 1.6 million coronavirus cases in America including more than 97,700 deaths as of Sunday morning, according to NBC News’ count. And 38 million Americans have filed unemployment claims since March 14.

As governors like DeWine are trying to balance the public health risks of removing restrictions with the economic risks of keeping most of America shut in their homes, the Ohio governor said that he’s confident “we can do two things at once.”

“We want to continue to up that throughout the state because it is really what we need as we open up the economy. This is a risk, but it’s also a risk if we don’t open up the economy, all the downsides of not opening up the economy,” he said.

This content was originally published here.

Wealthiest Hospitals Got Billions in Bailout for Struggling Health Providers – The New York Times

But it is not just another deep-pocketed investor hunting for high returns. It is the Providence Health System, one of the country’s largest and richest hospital chains. It is sitting on nearly $12 billion in cash, which it invests, Wall Street-style, in a good year generating more than $1 billion in profits.

With states restricting hospitals from performing elective surgery and other nonessential services, their revenue has shriveled. The Department of Health and Human Services has disbursed $72 billion in grants since April to hospitals and other health care providers through the bailout program, which was part of the CARES Act economic stimulus package. The department plans to eventually distribute more than $100 billion more.

Those cash piles come from a mix of sources: no-strings-attached private donations, income from investments with hedge funds and private equity firms, and any profits from treating patients. Some chains, like Providence, also run their own venture-capital firms to invest their cash in cutting-edge start-ups. The investment portfolios often generate billions of dollars in annual profits, dwarfing what the hospitals earn from serving patients.

Representatives of the American Hospital Association, a lobbying group for the country’s largest hospitals, communicated with Alex M. Azar II, the department secretary, and Eric Hargan, the deputy secretary overseeing the funds, said Tom Nickels, a lobbyist for the group. Chip Kahn, president of the Federation of American Hospitals, which lobbies on behalf of for-profit hospitals, said he, too, had frequent discussions with the agency.

One formula based allotments on how much money a hospital collected from Medicare last year. Another was based on a hospital’s revenue. While Health and Human Services also created separate pots of funding for rural hospitals and those hit especially hard by the coronavirus, the department did not take into account each hospital’s existing financial resources.

“This simple formula used the data we had on hand at that time to get relief funds to the largest number of health care facilities and providers as quickly as possible,” said Caitlin B. Oakley, a spokeswoman for the department. “While other approaches were considered, these would have taken much longer to implement.”

That pattern is repeating in the hospital rescue program.

For example, HCA Healthcare and Tenet Healthcare — publicly traded chains with billions of dollars in reserves and large credit lines from banks — together received more than $1.5 billion in federal funds.

Angela Kiska, a Cleveland Clinic spokeswoman, said the federal grants had “helped to partially offset the significant losses in operating revenue due to Covid-19, while we continue to provide care to patients in our communities.” The Cleveland Clinic sent caregivers to hospitals in Detroit and New York as they were flooded with coronavirus patients, she added.

Critics argue that hospitals with vast financial resources should not be getting federal funds. “If you accumulated $18 billion and you are a not-for-profit hospital system, what’s it for if other than a reserve for an emergency?” said Dr. Robert Berenson, a physician and a health policy analyst for the Urban Institute, a Washington research group.

Hospitals that serve poorer patients typically have thinner reserves to draw on.

Even before the coronavirus, roughly 400 hospitals in rural America were at risk of closing, said Alan Morgan, the chief executive of the National Rural Hospital Association. On average, the country’s 2,000 rural hospitals had enough cash to keep their doors open for 30 days.

At St. Claire HealthCare, the largest rural hospital system in eastern Kentucky, the number of surgeries dropped 88 percent during the pandemic — depriving the hospital of a crucial revenue source. Looking to stanch the financial damage, it furloughed employees and canceled some vendor contracts. The $3 million the hospital received from the federal government in April will cover two weeks of payroll, said Donald H. Lloyd II, the health system’s chief executive.

This content was originally published here.