A high-ranking federal official in late February warned that the United States needed to plan for not having enough personal protective equipment for medical workers as they began to battle the novel coronavirus, according to internal emails obtained by Kaiser Health News.
The messages provide a sharp contrast to President Donald Trump’s statements at the time that the threat the coronavirus posed to the American public remained “very low.” In fact, concerns were already mounting, the emails show, that medical workers and first responders would not have enough masks, gloves, face shields and other supplies, known as PPE, to protect themselves against infection when treating COVID-19 patients.
The emails, part of a lengthy chain titled “Red Dawn Breaking Bad,” includes senior officials across the Department of Veterans Affairs, the State Department, the Department of Homeland Security and the Department of Health and Human Services, as well as outside academics and some state health officials. KHN obtained the correspondence through a public records request in King County, Washington, where officials struggled as the virus set upon a nursing home in the Seattle area, eventually killing 37 people. It was the scene of the first major outbreak in the nation.
“We should plan assuming we won’t have enough PPE — so need to change the battlefield and how we envision or even define the front lines,” Dr. Carter Mecher, a physician and senior medical adviser at the Department of Veterans Affairs, wrote on Feb. 25. It would be weeks before front-line health workers would take to social media with the hashtag #GetMePPE and before health systems would appeal to the public to donate protective gear.
In the email, Mecher said confirmed-positive patients should be categorized under two groups with different care models for each: those with mild symptoms should be encouraged to stay home under self-isolation, while more serious patients should go to hospital emergency rooms.
“The demand is rising and there is no guarantee that we can continue with the supply since the supply-chain has been disrupted,” Eva Lee, director of the Center for Operations Research in Medicine and HealthCare at Georgia Tech and a former health scientist at the Atlanta VA Medical Center, wrote that same day citing shortages of personal protective equipment and medical supplies. “I do not know if we have enough resources to protect all frontline providers.”
Reached on Saturday, Lee said she isn’t sure who saw the message trail but “what I want is that we take action because at the end of the day we need to save patients and health care workers.”
Mecher, also reached Saturday, said the emails were an “an informal group of us who have known each other for years exchanging information.” He said concerns aired at the time on medical protective gear were top of mind for most people in health care. More than 35 people were on the email chain, many of them high-ranking government officials.
The same day Mecher and others raised the concern in the messages, Trump made remarks to a business roundtable group in New Delhi, India.
“We think we’re in very good shape in the United States,” he said, noting that the U.S. closed the borders to some areas. “Let’s just say we’re fortunate so far. And we think it’s going to remain that way.”
The White House declined to comment. In a statement, VA press secretary Christina Mandreucci said, “All VA facilities are equipped with essential items and supplies to handle additional coronavirus cases, and the department is continually monitoring the status of those items to ensure a robust supply chain.”
Doctors and other front-line medical workers in the weeks since have escalated concerns about shortages of medical gear, voicing alarm about the need to protect themselves, their families and patients against COVID-19, which as of Saturday evening had sickened more than 121,000 in the United States and killed at least 2,000.
As Mecher and others sent emails about growing PPE concerns, HHS Secretary Alex Azar testified to lawmakers that the U.S. had 30 million N95 respirator masks stockpiled but needed 300 million to combat the outbreak. Some senior U.S. government officials were also warning the public to not buy masks for themselves to conserve the supply for health care providers.
U.S. Surgeon General Jerome Adams tweeted on Feb. 29: “Seriously people – STOP BUYING MASKS! They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!”
Still, on Feb. 27, the FDA in a statement said that officials were not aware of widespread shortages of equipment.
“We are aware of reports from CDC and other U.S. partners of increased ordering of a range of human medical products through distributors as some healthcare facilities in the U.S. are preparing for potential needs if the outbreak becomes severe,” the agency said.
Simultaneously, Trump downplayed the risk of the novel coronavirus to the American public even though the Centers for Disease Control and Prevention was warning it was only a matter of time before it would spread across the country. On Feb. 29, the CDC also updated its strategies for health workers to optimize supplies of N95 masks.
An HHS spokesperson said Saturday the department has been in “an all-out effort to mobilize America’s capacity” for personal protective equipment and other supplies, including allowing the use of industrial N95 respirators in health care settings and awarding contracts to several private manufacturers to buy roughly 600 million masks over the next 18 months.
“Health care supply chains are private-sector-driven,” the spokesperson said. “The federal role is to support that work, coordinate information across the industry and with state or local agencies if needed during emergencies, and drive manufacturing demand as best we can.”
The emails from King County officials and others in Washington state also show growing concern about the exposure of health care workers to the virus, as well as a view into local officials’ attempts to get help from the CDC.
In one instance, local medical leaders were alarmed that paramedics and other emergency personnel were possibly exposed after encountering confirmed-positive patients at the Life Care Center of Kirkland, the Seattle-area nursing home where roughly three dozen people have died because of the virus.
“We are having a very serious challenge related to hospital exposures and impact on the health care system,” Dr. Jeff Duchin, the public health officer for Seattle and King County, wrote in a different email to CDC officials March 1. Duchin pleaded for a field team to test exposed health care workers and additional support.
Duchin’s email came hours after a physician at UW Medicine wrote about being “very concerned” about exposed workers at multiple hospitals and their attempts to isolate infected workers.
“I suspect that we will not be able to follow current CDC [recommendations] for exposed HCWs [health care workers] either,” wrote Dr. John Lynch, medical director of employee health for Harborview Medical Center and associate professor of Medicine and Allergy and Infectious Diseases at the University of Washington. “As you migh [sic] imagine, I am very concerned about the hospitals at this point.”
Those concerns have been underscored with an unusual weekend statement from Dr. Patrice Harris, president of the American Medical Association, which represents doctors, calling on Saturday for more coordination of needed medical supplies.
“At this critical moment, a unified effort is urgently needed to identify gaps in the supply of and lack of access to PPE necessary to fight COVID-19,” the statement says. “Physicians stand ready to provide urgent medical care on the front lines in a pandemic crisis. But their need for protective gear is equally urgent and necessary.”
By Rachana Pradhan and Christina Jewett
This story was produced by Kaiser Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
(KHN Illustration; Getty Images)
I was ten or twelve years old when I first heard of the “Bhagavad Gita.” We lived in Bengaluru, and once a week, my spiritually-inclined, civil engineer father would explain its concepts – meditation and other virtues – to my siblings and me. He loved these sessions.
He told us the essence of the Bhagavad Gita was that “Krishna asks everyone to perform their duties to the best of their abilities.” And yet, I still could not make any sense of it. I just felt overwhelmed.
A few years ago, my father passed away and my life came to a standstill. It took days afterwards, filled with sadness, for me to start a transformation that helped me appreciate the Bhagavad Gita’s wisdom and the love and kindness in my surroundings.
The Bhagavad Gita is a profound dialogue between two friends on a battlefield nearly 5000 years ago. When the war begins in the great battle of Kurukshetra, Arjuna declines to fight. Krishna, the mystic, patiently explains a psychological battleplan that navigates a pathway from confusion to knowledge, virtuosity and happiness in the midst of war and chaos.
The mind today is a similar battleground between thoughts and emotions. We face challenges and confusion every day from childhood through adulthood, but there are answers to be found in the Bhagavad Gita.
Swami Chinmayananda calls the Bhagavad Gita “a piece of art of strange beauty and it stands apart from everything else, in a class all by itself.”
Its eighteenth chapter contains a philosophy of living which resonated with me when I moved to the US twenty years ago.
My son was enrolled in the Chinmaya Mission and I became intrigued by their discourses on the Gita. I began reading chapters from a Bhagavad Gita my husband had bought at a temple and which we kept at our prayer altar. The scriptures began to influence me in my daily life.
One idea that I found particularly useful said, “You have the right to perform your prescribed duty, but you are not entitled to the results of your actions. ”
It taught me how to perform my duties to the best of my abilities but not stress about the outcomes.
It was one of many profound lessons the Gita has taught me.
I have learnt from the Gita to adjust and accept situations and people. I have realized that each person is uniquely gifted with different emotions and virtues. And the Gita helps me make better decisions that give me happiness.
A few years ago, tragic life events – death, accidents, illness, would depress me for days. Somehow today I’ve developed a better understanding of Karma, the concept of ‘law of action’ related to fear, life and death.
My reaction now is quite different. While I still feel some sadness for a while, I regain my sense of balance far more quickly.
Individuals who intellectually absorb and assimilate the knowledge the Gita offers, become “liberated from confusion and sorrows, and reach a state of inner tranquility and happiness,” says Swami Chinmayananda. I do believe he’s right.
I’m trying to integrate the principles of Bhakti (Devotional)Yoga, Jnana (Knowledge) Yoga and Karma (Work)Yoga into my own life.
Quite simply, this means channelling my emotions in order to discipline my mind (devotional or Bhakti yoga), discipline my body and its actions to help control my mind (work or Karma yoga), and practice meditation, reflection and detachment to ‘lift the mind to silence’, and reach a place of serenity, peace and calm (knowledge or Jnana yoga).
Every day, I attempt to apply the Divine – positivity – in my work and life . When my mind brims with positivity, I’ve noticed that negative emotions don’t invade my thinking! My mother-in-law is a great example of this practice. She works with utmost care and patience and is mindful in all her tasks, whether drawing a rangoli or chopping vegetables. The motto “Work is Worship” is apt for folks like her who are inclined towards Karma Yoga.
Was Krishna the first psychotherapist? Perhaps!
When I read the Gita it often feels as though I’m being personally guided by a psychotherapist friend to make stress-free decisions. And yet, it contains concepts that transcend religions and borders. These ideas have helped reinforce positivity, love and hope in my own life – but I also believe there are lessons to be found in the old teachings to navigate the crises of our present times. As the world battles the stress and anxiety of the coronavirus pandemic, the Gita can offer peace, hope and answers that humanity seeks to fight an invisible enemy in a different kind of war.
Kumudha Venkatesan is based in Atlanta and loves to read the Bhagavad Gita and often writes about the vegan lifestyle and spirituality.
Edited by Meera Kymal, contributing editor, India Currents.
Image 2: By Mahavir Prasad Mishra – https://archive.org/details/MahabharataTejKumarBookDepotMahavirPrasadMishra, CC0, https://commons.wikimedia.org/w/index.php?curid=66704373
What seemed improbable a month ago is today a shared global reality. The steady unravelling of COVID-19 has forced us all – across generations and geographies, to stay home. Morale is low and stress levels are high as we work from home, grieve for and worry about those afflicted, homeschool our children, and struggle to make ends meet in a crumbling economy.
While challenges of confinement and the lack of routine have pushed me out of my comfort zone, strangely, this period has also been a deeply introspective one. I have had teaching moments that have helped me prioritize and gain perspective to effectively navigate these difficult and fluid times.
LEARNING TO ROLL WITH AMBIGUITY
The steepest learning curve for me has been accepting unpredictability and rolling with it. I find myself:
- Improvising. For example, when I couldn’t find any sanitizers anywhere, I was forced to make my own. My favorite recipe is mixing ¼ tsp of bleach with 4 cups of water.
When getting my daily yoga stretches seemed impossible, I resorted to CosmicKids Yoga. Now, I get a yoga workout with my preschooler in tow since it engages kids through story and movement.
- Getting creative. I buy whatever fresh produce is readily and easily available and turn to the internet for inspiration. I’ve dug out my formally forgotten cookbooks and am trying my hand at new recipes.
- Relaxing standards. With everyone homebound, there’s more mess, less tidiness and meals are often prepared on the fly. But that’s to be expected. Once this realization struck, I recalibrated and lowered standards. This helped me stay calm and centered. Beds don’t always get made, but the sheets are clean. Meals may be prepared on the fly, but they’re healthy. I learned not to sweat it. There’s enough to worry about as is.
I am by no means a planner. But, when I saw the panic around me at our local grocery store, I was jolted into action:
- To create a weekly meal roster to plan grocery runs.
- I stocked up on non-perishables. Fortunately, being accustomed to eating and cooking Indian food, between atta (whole wheat), rice, Sabudana (tapioca), pasta, flour, sooji (semolina), besan (chickpea flour), poha (flattened rice), bread, and a few packs of frozen rotis and naans, I had an array of grain options. My new favorite comfort food now is a simple and wholesome Sabudana khichri.
- To bolster our supply of vitamins, ginger tea, and citrus fruits to keep up our immunity.
At a time when schedules are unpredictable with no school and everyone working from home, things don’t always fall in place as seamlessly as they used to. As a result, I found it vital to effectively communicate household rules and expectations.
- We have a written daily routine and each person is assigned household chores and responsibilities. That way everyone’s on the same page and knows when and how to chip in. This has provided the much-needed predictability in times of uncertainty and has also fostered teamwork.
- I am also making the most of this opportunity to double down on conversing in my native language (Hindi) with my preschooler and second grader. I can already see some promising results.
MAKING TIME FOR LITTLE THINGS
I find myself making more time for family. A relatively slower pace of life is allowing more time to connect with each other as well as with extended family and community members. More than before, I see us using FT, Skype and Zoom to connect with each other. Most importantly, I’m enjoying simple activities like:
- Walking. It is Spring after all! If parks are out of bounds, we take family walks. These aren’t long. Sometimes squeezing in a short walk between meetings or a break is good enough. It’s refreshing to marvel at blooming flowers and seek joy in the many signs of new life and activity around us.
- Playing. We make up silly games, play board games, word games, card games, Simon says, red light-green light, do messy art projects; all of which fuel our creativity and bring us closer as a family.
- Baking. Instead of composting that overripe banana, we make banana bread. We roll dough and cut out shapes when we make atta ladoos and atta cookies respectively.
For some time, I had replaced humor with fear, anxiety and stress. One day, my eight-year-old asked me, “Why do graveyards have a fence around them?” Looking at my confused expression, he promptly replied, “Because people are dying to get in!” With all the dread unfolding, it felt like a scene from a dark comedy movie. It lightened the mood and we all had a good laugh.
I realized that it’s ok to laugh even in the face of adversity. Given our current reality, it’s easy to forget to let some humor into our lives. Besides, doesn’t laughter reduce stress-generated cortisol that kills our immune system? So, why not laugh, boost our immunity and flatten the curve!
To get in some laughs every day:
- I have intentionally added joke books to our children’s daily reading stack. Kids love jokes and rarely miss an opportunity to share something that tickles them.
- In the evening, my husband and I carve out some time to watch something funny. It’s a wonderful way to relax, connect and laugh together as adults.
The COVID-19 pandemic continues to be a trying time, stretching our mental and physical capacity to endure fear and uncertainty. Yet, it’s heartening to see folks reach out to provide services like grocery runs or offer free in-home entertainment materials like family games, books and DVDs. We’re connecting with family, friends and our extended community, to make sure we’re all okay. Our children are virtually interacting with cousins, grandparents and friends. I’m reminded of Gilda Radner, who once wisely said – “Life is about…taking the moment and making the best of it, without knowing what’s going to happen next.”
We’re certainly trying our best!
Nidhi Kirpal Jayadevan’s pre-kids’ life was dedicated to the complex field of Communication Sciences. After choosing to be a fulltime mother, reading and playing with her high energy boys has been a fascinating journey. It has (re)kindled in her a sense of wonder in all things small. She constantly sees the world through little eyes, applying simple learnings to deepen life’s meaning for herself and her family.
Edited by Meera Kymal, contributing editor at India Currents
Nearly 100,000 Physicians of Indian origin in the United States serve every seventh patient across the United States – This powerful statistic shared by Dr. Anupama Gotimukula, Vice president of AAPIUSA at a recent teleconference, underscores the significant numbers of Indian American medical professionals involved in the fight against the novel coronavirus.
“While COVID-19 continues to disrupt life around the globe, AAPI is committed to helping its tens of thousands of members across the US and others across the globe,” said Dr. Suresh Reddy, President of AAPI. “We do acknowledge that these are challenging times, more than ever for us, physicians, who are on the frontline to assess, diagnose and treat people who are affected by this deadly pandemic, COVID-19. Many of our colleagues have sacrificed their lives in order to save those impacted by this pandemic around the world.”
The numbers are grim. Coronavirus deaths in the US are over 3000 (exceeding the initial death toll of September 11), while over 175,000 people have tested positive for the virus – more than double that announced by China.
In response to the pandemic, AAPI has embarked on several initiatives, the most effective being a twice weekly conference call attended by over 2,000 physicians from across the United States, to share expertise and best care practices with other professionals from the healthcare sector.
Nearly 200,000 Indian students in the US are impacted by the pandemic, said Anurag Kumar, Minister of Community Affairs, who outlined efforts to give them assistance.
“We are coordinating with the community and hotels owned by AAHOA members in arranging accommodation for students, “ he said. “Everyone is advised not to travel abroad and back to India, stay where you are until things get better.”
Speakers on the forum highlighted the need for the people to recognize that Covid-19 is an aggressive type of virus. “Everyone needs to take appropriate precautions. Even if symptoms are negative, one is likely they carry symptoms,” advised Dr. Bharat Barai.
Social distancing matters cautioned Dr. Prasad Garimella, a critical care medicine specialist . “Social distancing is not isolating. Keep in touch with loved ones. Stay busy and stay connected. Filter and assess the news, look for credible sources to rely upon. Everyone needs to act like a health care professional and need to have the best attitude in order to defeat this deadly virus.”
Emergency medicine specialist Dr. Arunachalam Einstein endorsed self-quarantine and masks as a way to prevent spreading. “Go out only for essential things,” he advised. “ Everyone coming to ED symptomatic and non-symptomatic and the staff must wear mask, which will prevent droplets from affecting others. Even when going out to grocery shopping use masks.”
Dr. Sudhakar Jonnalagadda, expressed concern about the adverse effect of inadequate testing for at risk seniors, as well as for physicians and healthcare workers fighting infection on the frontlines, stating “It’s essential to create a wholesale expansion of free COVID-19 testing available in order for identifying asymptomatic carries and then isolating them.”
A rising number of people across age groups are affected by the highly infectious virus, said Dr. Usha Rani Karumudii, an infectious disease specialist, reporting that “People of all ages are prone to the disease. Hand hygiene and social distancing will help prevent. Precautions while shopping, reduce trips. wash and decontaminate hands after going out.”
AAPI also has launched a DONATE A MASK PROGRAM – a major initiative to protect the medical fraternity as they combat the “rakshas” virus. Members were requested to donate generously to fight “this ferocious virus which has put basic existence of entire human race at stake.”
A severe shortage of GS masks and other protective gear is impacting “the foot soldiers and front line physicians,” some of whom have succumbed to the deadly virus. A donation box labelled “DONATE A MASK,” has been added to the AAPI website ands a task force established to identify hospitals and direct supplies of Masks/PPE.
Updates on AAPI initiatives can be found at www.appiusa.org
Dr. Madhu Bhatia, a psychiatrist in Washington D.C., finished setting up her home office a few days ago, two weeks after the Metro area began to sit up and take notice of COVID 19.
“I’ve already seen an uptick in anxiety among my patients,” she says, “and now, more than ever, I need to stay in touch. I’m expecting an increase in cases, and more Post Traumatic Stress Disorder (PTSD) type symptoms.”
“This is the first time I’m practicing telepsychiatry on this scale,” she adds wryly. “It’s going to be a new experience for me and many of my colleagues – but it may be the future, for a long time.”
The suddenness and speed of COVID19’s onslaught has sent our health care and our social systems into shock. Equally important, (but in danger of being underplayed as all our attention focuses on the battle with the virus), it has been a massive, invisible shock to our collective psyche.
As we live this in real time, health professionals all over the world are getting more concerned about the long-term emotional fallout from the pandemic. The complete cessation of normal activity in lockdown, a constant ticker tape of rising numbers of those infected and dying on TV, and economic insecurity associated with the shutdown is the perfect formula for creating a sense of suppressed panic and helplessness, which, in turn, is a perfect breeding ground for anxiety disorders and depression.
We can look to China, which was ahead of the curve, for the trajectory of anxiety and anxiety related disorders. Early studies on the effect of the pandemic indicate an enormous, lingering impact on mental health. In the first few weeks of the lock down in China, there was mostly worry about contracting the virus and the safety of loved ones. As more time passed in quarantine, financial strain and more stress with family relations piled onto the general worry for safety.
In an ITV report, Dr. Peng Kaiping, the head of Psychology at Tsinghua University in Hubei province (where the epicenter, Wuhan is located), says they are now increasingly seeing symptoms of PTSD among the population.
“It’s important to remember,” says Dr. Bhatia, “that even something as innocuous as more enforced time at home with the family can become a source of great anxiety, if it isn’t handled correctly. There can be something like too much togetherness. Time has to be managed carefully, especially in families which already have underlying stresses in relationships.”
She advises setting up strict daily routines, especially if there are children at home.
“Children need the security a routine provides. However, they also need social interaction with their peers and a sudden cessation of contact with friends creates anxiety. If they are young, set up facetime playdates for them.”
“For teenagers, try to give each individual enough time on their own and permission to retreat into their own space if they want to, but designate a family time where you come together, especially for meals. Make that a pandemic free space, where things like homework or activities are discussed and optimism about the future is restored.”
“South Asian families are often not very good at expressing their feelings, and there is a sense of shame, specifically in the older generation, in admitting that they are fearful. This is a time when parents should reassure their children (and sometimes their own parents), that it’s important to talk frankly about one’s fears and be supportive of each other.”
Therapists and providers are increasingly adapting their practices to technology to get their message out.
Pallavi Surana, a resident of Herndon, Virginia, and a meditation therapist, has guided a group meditation session every Friday for the past 10 years.
With Virginia’s COVID restrictions, she has now taken it to Facetime (the group dials in from home and meditates together) and increased its frequency to an hour every day.
“Daily Meditation is more important than ever during this crisis,” she says. “We are locked in at home, with our fight or flight responses highly aroused. Calming our minds has an enormous impact on our immune systems, and doing it collectively is even more beneficial. Even a short 20-minute session has an impact.”
Alice Walton in a recent Forbes article suggested important ways to preserve sanity and maintain optimism during these trying times.
Gratitude is a therapeutic emotion. Take time to be grateful for family and friends, and for all the things which are working for you in life. In a Harvard health study, it was found that writing down even 5 things you were grateful for, just once a week, had an enormous positive effect on emotional well-being.
Exercise and meditate daily. Treat these activities as necessary, medicinal doses of stress relief and give them priority. There are several online sites offering free exercise routines and meditation. Mindfulness based stress reduction (MBSR), developed by Jon Kabat Zinnat at UMass, has been shown, through many studies, to be very effective. Several organizations now offer this online. Meditation is a proven stress buster and is especially good for our immune systems.
If you aren’t into meditation, studies have shown that just calming your breathing – taking a few minutes a day to sit quietly and breathe deeply – can greatly reduce daily stress. Simple breathing exercises, like those taught in Yoga, (check out these top rated apps), are also great at soothing the mind and producing a sense of well-being.
Your daily exercise routine should be supplemented by “quality time” outdoors. The Japanese concept of “forest bathing,” which means spending as much time in nature as possible and mentally “bathing” in its beauty, is now backed by science. Being around greenery doesn’t just calm the mind – it has a proven effect on our immune system and lowers the levels of the stress hormone, cortisol. Consider positioning your home office where you have a view of the greenery outside.
And last, but not the least, connect to friends and family daily through whatever means available. Social isolation is like a punishment for our species, because we are wired with a strong need to interact. A recent article in the Washington Post by social scientist, Arthur C. Brooks, emphasizes the importance of social interactions which allow eye contact. Looking directly into a person’s eyes while talking releases oxytocin, the pleasure hormone, and is the most beneficial for our social needs. So, choose a medium like Skype or Zoom or Face Time where you can see your friend or family.
Stay safe, dear reader, and remember to hug your family often! Human touch is a proven therapy for anxiety.
Jyoti Minocha is an DC-based educator and writer who holds a Masters in Creative Writing from Johns Hopkins, and is working on a novel about the Partition.
Edited by Meera Kymal, contributing editor at India Currents.
Close down group meals for seniors. Cancel social gatherings.
The directive, from the Illinois Department on Aging, sent shock waves through senior service organizations late last week.
Overnight, Area Agencies on Aging had to figure out how to help people in their homes instead of at sites where they mingle and get various types of assistance.
This is the new reality as the COVID-19 virus barrels into communities across America. Older adults — the demographic group most at risk of dying if they become ill ― are being warned against going out and risking contagion. And programs that serve this population are struggling to ensure that seniors who live in the community, especially those who are sick and frail, aren’t neglected.
This vulnerable population far outstrips a group that has received more attention: older adults in nursing homes. In the U.S., only 1.4 million seniors reside in these institutions; by contrast, about 47 million older adults are aging in place. An additional 812,000 seniors make their homes at assisted living facilities.
While some of these seniors are relatively healthy, a significant portion of them are not. Outside of nursing homes, 15% of America’s 65-and-older population (more than 7 million seniors) is frail, a condition that greatly reduces their ability to cope with even minor medical setbacks. Sixty percent have at least two chronic conditions, such as heart disease, lung disease or diabetes, that raise the chance that the coronavirus could kill them.
But the virus is far from the only threat older adults face. The specter of hunger and malnutrition looms, as sites serving group meals shut down and seniors are unable or afraid to go out and shop for groceries. An estimated 5.5 million older adults were considered “food insecure” — without consistent access to sufficient healthy food ― even before this crisis.
As the health care system becomes preoccupied with the new coronavirus, non-urgent doctors’ visits are being canceled. Older adults who otherwise might have had chronic illness checkups may now deteriorate at home, unnoticed. If they don’t go out, their mobility could become compromised — a risk for decline.
Furthermore, if older adults stop seeing people regularly, isolation and loneliness could set in, generating stress and undermining their ability to cope. And if paid companions and home health aides become ill, quarantined or unable to work because they need to care for children whose schools have closed, older adults could be left without needed care.
Yet government agencies have not issued detailed guidance about how to protect these at-risk seniors amid the threat of the COVID-19 virus.
“I’m very disappointed and surprised at the lack of focus by the CDC in specifically addressing the needs of these high-risk patients,” said Dr. Carla Perissinotto, associate chief for geriatrics clinical programs at the University of California-San Francisco, referring to the Centers for Disease Control and Protection.
In this vacuum, programs that serve vulnerable seniors are scrambling to adjust and minimize potential damage.
Meals on Wheels America CEO Ellie Hollander said “we have grave concerns” as senior centers and group dining sites serving hot meals to millions of at-risk older adults close. “The demand for home-delivered meals is going to increase exponentially,” she predicted.
That presents a host of challenges. How will transportation be arranged, and who will deliver the meals? About two-thirds of the volunteers that Meals on Wheels depends on are age 60 or older ― the age group now being told to limit contact with other people as much as possible.
In suburban Cook County just outside Chicago, AgeOptions, an Area Agency on Aging that serves 172,000 older adults, on Thursday shuttered 36 dining sites, 21 memory cafes for people with dementia and their caregivers, and programs at 30 libraries after the Illinois Department on Aging recommended that all such gatherings be suspended.
Older adults who depend on a hot breakfast, lunch or dinner “were met at their cars with packaged meals” and sent home instead of having a chance to sit with friends and socialize, said Diane Slezak, AgeOptions president. The agency is scrambling to figure out how to provide meals for pickup or bring them to people’s homes.
With Mather, another Illinois organization focused on seniors, AgeOptions plans to expand “Telephone Topics” — a call-in program featuring group discussions, lectures, meditation classes and live performances — for seniors now confined at home and at risk of social isolation.
In New York City, Mount Sinai at Home every day serves about 1,200 older adults who are homebound with serious illnesses and disabilities — an extraordinarily vulnerable group. A major concern is what will happen to clients if home care workers become sick with the coronavirus, are quarantined or are unable to show up for work because they have to care for family members, said Dr. Linda DeCherrie, Mount Sinai at Home’s clinical director and a professor of geriatrics at Mount Sinai Health System.
With that in mind, DeCherrie and her colleagues are checking with every patient on the program’s roster, evaluating how much help the person is getting and asking whether they know someone ― a son or daughter, a friend, a neighbor — who could step in if aides become unavailable. “We want to have those names and contact information ready,” she said.
If caregivers aren’t available, these frail, homebound patients could deteriorate rapidly. “We don’t want to take them to the hospital, if at all possible,” DeCherrie said. “The hospitals are going to be full and we don’t want to expose them to that environment.”
In San Francisco, UCSF’s Care at Home program serves about 400 similarly vulnerable older adults. “Testing [for the coronavirus] is even more of a problem for people who are homebound,” said Perissinotto, who oversees the program. And adequate protective equipment ― gloves, gowns, masks, eye shields — is extremely difficult to find for home-based providers, Perissinotto said, a concern voiced by other experts as well.
To the extent possible, UCSF program staff are trying to do video visits so they can assess whether patients are symptomatic ― feverish or coughing — before going out to their homes. But some patients don’t have the technology that makes that possible or aren’t comfortable using it. And others, with cognitive impairments who don’t have family at home, may not be able to respond appropriately.
At UCSF’s general medicine clinic, nonessential medical visits have been canceled. “I have a lot of older patients with chronic pain or diabetes who otherwise would come in for three-month visits,” said Dr. Anna Chodos, a geriatrician and assistant professor of medicine who practices in the clinic. “Now, I’m talking to them over the phone.”
“I’m less worried about people who can answer the phone and report on what they’re doing,” she said. “But I have a lot of older patients who are living alone with mild dementia, serious hearing issues and mobility impairments who can’t work their phones.”
Plans to and from India get made a year in advance and are being affected by the COVID-19 pandemic. The Embassy of India in D.C. has released information on Visa restrictions for those traveling to and from India during the travels ban, along with phone numbers that can be called for more detailed information. Ensure that you are prepared for your next steps as the travel ban is enforced!
For those trying to travel to and from India, read closely about your visa status.faq-covid-19
Upon arrival to India, you will have to provide a self declaration form that may or may not be provided to you. You should print out this form before flying to India.SELF DECLARATION FORM FOR TRAVELLERS- - .pdf.pdf
If you have further questions and would like to speak to a representative, there are 24 hour helplines available.
For more information about India closing its borders, check out our previous article here.
Srishti Prabha is the current Assistant Editor at India Currents and has worked in low income/affordable housing as an advocate for women and people of color. She is passionate about diversifying spaces, preserving culture, and removing barriers to equity.
The recommendations of the Committee of Secretaries chaired by Chairpersonship of Dr. Harsh Vardhan, Union Minister of Health &Family Welfare. Sh. Hardeep S. Puri, Minister of Civil Aviation, Dr. S. Jaishankar, Minister of External Affairs, Sh. Nityananda Rai, Minister of State for Home, Shri Mansukh Mandaviya, Minister of State (I/c), Ministry of Shipping, Chemicals and Fertilisers and Sh. Ashwini Kumar Choubey, Minister of State, Health &Family Welfare were placed before Group of Ministers. After detailed deliberations on preventive measures, actions taken and preparedness for Novel Coronavirus Disease (COVID-19), the GoM took the following decisions:
- All existing visas, except diplomatic, official, UN/International Organizations, employment, project
visas, stand suspended till 15th April 2020. This will come into effect from 1200 GMT on 13th March 2020 at the port of departure.
- Visa free travel facility granted to OCI card holders is kept in abeyance till April 15th 2020. This will come into effect from 1200 GMT on 13th March 2020 at the port of departure.
- Any foreign national who intends to travel to India for compelling reason may contact the nearest Indian Mission.
- All incoming travellers, including Indian nationals, arriving from or having visited China, Italy, Iran, Republic of Korea, France, Spain and Germany after 15th February, 2020 shall be quarantined for a minimum period of 14 days. This will come into effect from 1200 GMT on 13th March 2020 at the port of departure.
- Incoming travellers, including Indian nationals, are advised to avoid non-essential travel and are informed that they can be quarantined for a minimum of 14 days on their arrival in India.
- Indian nationals are strongly advised to avoid all non-essential travel abroad. On their return, they can be subjected to quarantine for a minimum of 14 days.
- International traffic through land borders will be restricted to Designated check posts with robust screening facilities. These will be notified separately by M/o Home Affairs.
- Provision for testing primarily for students/compassionate cases in Italy to be made and collection for samples to be organized accordingly. Those tested negative will be allowed to travel and will be quarantined on arrival in India for 14 days.
Originally Posted On: 11 MAR 2020 10:18PM by PIB Delhi
Image can be found here.
Long before the novel coronavirus made its surprise appearance, the nation’s nursing homes were struggling to obey basic infection prevention protocols designed to halt the spread of viruses and bacteria they battle daily.
Since the beginning of 2017, government health inspectors have cited more nursing homes for failing to ensure that all workers follow those prevention and control rules than for any other type of violation, according to a Kaiser Health News analysis of federal records.
In all, 9,372 nursing homes, or 61%, were cited for one or more infection-control deficiencies, the analysis showed. It also found violations were more common at homes with fewer nurses and aides than at facilities with higher staffing levels.
Even among nursing homes crowned with the maximum government rating of five stars for overall quality, 4 in 10 have been cited for an infection-control lapse. Those include the Life Care Center of Kirkland, Washington, a Seattle suburb, where five people who had lived at the facility have died.
Inspection reports from around the country show many errors are rudimentary, such as workers not washing their hands as they moved to the next patient, or failing to don masks, gloves and gowns when in the rooms of contagious patients in isolation.
“It’s all these little things that are part of infection-control practices that when they are added up can create an environment for an infection outbreak,” said Patricia Hunter, the Washington State Long-Term Care Ombuds, who addresses complaints from residents and families and pushes for improvements in facilities.
In recent years, the federal government has been ramping up the standards for nursing homes, but inspectors remain frustrated by the prevalence of sloppy or nonexistent handwashing. “We have got to do better on handwashing,” Evan Shulman, the director for the nursing home division of the Centers for Medicare & Medicaid Services, told an association of nursing home directors in 2018.
While citations are rampant across the industry, health inspectors have classified all but 1% of violations as minor and not warranting fines, the KHN analysis found. A single low-level citation usually has limited impact on the overall star rating, the only metric most consumers examine.
The coronavirus has demonstrated its potential lethality among the old and frail in Kirkland, but the infections that nursing homes already battle with mixed success — influenza and antibiotic-resistant bacteria like methicillin-resistant Staphylococcus aureus (MRSA) — can be equally fatal. As many as 3.8 million infections occur in nursing homes each year, killing nearly 388,000 residents.
Dr. David Gifford, the chief medical officer for the American Health Care Association, the primary nursing home trade group, told reporters Monday that these facilities were ready to deal with coronavirus infections through the prevention plans they have in place. “We prepare for seasonal influenza every year — it’s very similar to that,” he said.
“We are reinforcing the information for basic procedures for how to prevent the spread,” he added, such as keeping infected residents away from others and having sick employees stay home.
Yet the same industry deficits that have hampered past infection-control efforts are in play with the coronavirus. Nursing homes experience frequent staff turnover, and new or temporary workers are less likely to be familiar with a facility’s protocols. Also, inspectors have found that these homes have had difficulty making sure that potentially infected workers stay home, a problem compounded by the low pay and limited time-off benefits many receive.
During a norovirus outbreak in 2017 at another Washington state nursing home, for instance, at least six infected employees returned to work earlier than they were supposed to. Inspectors discovered the virus ultimately spread to 32 employees and 43 residents — more than 40% of those living in the home, according to an inspection report.
Even if nursing homes are successful in getting infected workers to take days off, they may run into trouble finding replacements. Dr. David Nace, director of long-term care and flu programs at the University of Pittsburgh Department of Medicine, said staffing issues are compounded by a national shortage of healthcare workers. “Facilities may be faced with the issue of closure if they don’t have the staffing,” he said.
KHN’s analysis found that 53% of homes with the most nurses and aides — which CMS awards five stars for staffing on its Nursing Home Compare website — had been cited for infection-control violations in the past three years, while 65% of homes with the fewest staff — garnering only one star — were cited for the same type of failing. The staffing stars make up one component of the overall rating.
“So many times, when there aren’t enough staff, the aides and nurses are literally trying to do 50 things at once, running from person to person,” said Lori Smetanka, executive director of the National Consumer Voice for Quality Long-Term Care, a nonprofit based in Washington, D.C. “That’s when things fall through the cracks, like handwashing, which is the most useful thing to do to prevent infections.”
More sparsely staffed nursing homes were also cited more often: one-star facilities averaged 1.5 deficiencies while five-star facilities averaged 1.3 deficiencies. But out of more than 13,000 citations for infection-control lapses, regulators classified only 109 as serious harms or threats to patients. That finding echoed the results of a similar investigation KHN conducted in 2017. “It shows how ineffectual the enforcement situation is,” said Toby Edelman, a senior policy attorney at the Center for Medicare Advocacy.
One such violation was cited last April at the Kirkland nursing home after inspectors there observed a registered nurse treating a patient whose feet were touching the floor, even though one heel had a pressure sore that the resident’s daughter said she feared was infected. “It was unhygienic,” the daughter told inspectors.
Inspectors also watched another nursing home employee work in the room of a patient with pneumonia without wearing a mask, gown and gloves as required by a sign outside the room. They noted in their report that the facility had experienced two outbreaks of influenza that year, affecting at least 17 residents and seven staff members all told. Inspectors labeled the violations they observed as low level because they caused “minimal harm or potential for actual harm.” The nursing home pledged to reeducate staff on procedures and investigators found no problems when they revisited two months later.
Life Care Center, in an upscale, wooded neighborhood less than a mile from Lake Washington’s popular Juanita Beach Park, said in a statement released Monday that it is screening workers before they start work and after and has suspended visits and new admissions.
“We are also following infection control recommendations, including proper hand-washing techniques and wearing masks, gowns and gloves when caring for any symptomatic patients,” the statement said. The facility declined to discuss its previous citation.
Seema Verma, the CMS administrator, said during a press briefing at the White House Tuesday night that her agency is sending inspectors to the nursing home, as well as a hospital and dialysis center that treated coronavirus patients, to see if federal health and safety regulations were followed.
Hunter, the Washington state ombud, said that during her recent visits to 14 nursing homes in three Northwestern states, she observed that aides were generally good about using hand sanitizer but rarely washed residents’ hands. Not every resident room had a sink, she said. “I haven’t seen one resident have their hands washed during lunchtime or dinnertime,” she said.
While some nursing homes are making concerted efforts, “there are nursing homes that are really dirty and there are concerns that they’re not getting the job done,” Hunter added.” The trouble is when you don’t have enough workers, or you don’t have a stable workforce that’s trained to follow your protocol, that’s a weakness in the system.”
In 2016, CMS updated and expanded its infection-control rules, requiring among other things that each facility appoint one person to be in charge of infection control. CMS required the employee in that position, known as an infection preventionist, to complete specialized training and work at the facility either part time or full time. The Trump administration has proposed eliminating the on-site requirement.
Instead, CMS proposed the preventionist be someone who has spent “sufficient time” at the facility to oversee its infection-control efforts. It has asked the public for advice on how to define sufficient.
“We believe this is an appropriate standard,” the agency wrote in its proposed rule, issued last July. “However, we are also concerned that there could be a substantial variance in how LTC [long-term care] facilities interpret this requirement.”
KHN senior correspondent JoNel Aleccia contributed to this report.
The first death in the US from Corona Virus was confirmed by the Washington Dept. of Health, when a man in his 50s, with no travel history, succumbed to the infection; since then five more people have died, bringing the total number of coronavirus victims in the US to six. Kirkland WA, is now being called the epicenter of the coronavirus response as the outbreak worsens.
The Washington Post has reported that the outbreak has probably been spreading undetected in Washington state for over 6 weeks with hundreds of infections predicted throughout the state. According to a public health official, the outbreak is spreading through ‘community transmission’ in the Seattle area. Santa Clara County officials recently confirmed three new cases and New York state announced its first coronavirus case in a press conference.
The global death toll has exceeded 3000 as COVID-19 spreads in other countries, and the White House has announced a travel advisory for Italy, Iran and South Korea, in response to the likely global pandemic.
It’s only a matter of time before Americans “see community spread in this country,” warns the CDC, urging US businesses, hospitals, and communities to begin preparing for the advent of COVID19, as the window of opportunity to stop its spread is shrinking.
Common-Sense Precautions Against Viruses
Dr.James Robb, one of the first molecular virologists in the world to work on coronaviruses, cautioned that current projections for the COVID19 expansion in the US are only probable due to continued insufficient worldwide data, but, it is most likely to be widespread in the US by mid to late March and April.
He suggests common-sense precautions (listed below) which are currently in use during the influenza season and urges Americans to protect themselves by adding to their anti-virus arsenal by stocking up on masks, gloves and a few other items, in preparation for the pandemic spread to the US.
- NO HANDSHAKING! Use a fist bump, slight bow, or elbow bump or simply a nod when greeting people.
- Use ONLY your knuckles to touch light switches. elevator buttons, etc..
- Keep a bottle of sanitizer available at home AND in your car for use after getting gas or touching other contaminated objects when you can’t immediately wash your hands. Hand sanitizers must be alcohol-based and greater than 60% alcohol to be effective.
NOTE: This virus only infects your lungs because it is lung-specific and only has cell receptors for lung cells. This is the only way this virus can infect you.The corona 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.
In a story reported by the New York Times, Thongsuk Thongrat, a Thai cab driver, caught the coronavirus from an infected passenger who sneezed into his face.
So, the only way for the virus to infect you is by an infected cough or sneeze onto or into your nose or mouth, or through your nose or mouth via your hands.
Will Masks and Gloves Help?
We touch our nose and mouth at least 90 times a day without knowing it!
The mask will not prevent the virus in a direct sneeze from getting into your nose or mouth – it is only to keep YOU from touching your nose or mouth.
So, stock up on disposable, surgical masks and hand sanitizers, and use them to protect yourself when touching your nose and/or mouth.
- Use latex or nitrile latex disposable gloves when going shopping, using the gasoline pump, and all other outside activity when you come in contact with contaminated areas.
- 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.
- 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 viruses that can be passed on for up to a week or more!
- Stock up now with zinc lozenges. Studies show that these lozenges have proven to be effective in reducing the duration of the common cold (and most other viruses) from multiplying in your throat and nasopharynx and could give you an extra boost of inhibitory prevention against the corona virus while traveling, but it’s important to consult with your physician first.
Tremendous worldwide efforts are being made to understand the molecular and clinical virology of this virus, says Dr. Robb, . “BUT, there will be NO drugs or vaccines available this year to protect us or limit the infection within us. Only symptomatic support is available.”
James Robb, MD FCAP, was a professor of pathology at the University of California San Diego and one of the first molecular virologists in the world to work on coronaviruses (the 1970s). He was the first to demonstrate the number of genes the virus contained. Since then, he has kept up with the coronavirus field and its multiple clinical transfers into the human population (e.g., SARS, MERS), from different animal sources.
The information presented in this article is offered for educational and informational purposes only and should not be construed as personal medical advice. You should consult with your personal physician/care giver regarding your own medical care.
Meera Kymal is a contributing editor at India Currents.