วันที่ 06 ก.ย. 2563 เวลา 08:09 น.ปั้นซิกแพคไม่ไกลเกินฝัน เมื่อเทรนด์โชว์กล้ามท้องยุค New Normal มาแรง! STAGE Find The Real U ฟิตเนสหรูชื่อดังแห่งยุค New Normal เอาใจสาวๆ ด้วยการแนะนำ 4 ท่าง่ายๆ ปั้นกล้ามท้องสวยๆ
เอว S กับกล้ามหน้าท้องไม่ได้มีประโยชน์เพียงเพื่อความสวยงามอย่างเดียวเท่านั้น แต่รอบเอวที่เกินขนาดมาตรฐานยังบ่งบอกถึงความเสี่ยงที่เพิ่มขึ้นของหลายๆ โรค ไม่ว่าจะเป็นโรคอ้วน โรคหัวใจ หรือไขมันในเลือดสูง ดังนั้นการลดไขมันหน้าท้องจึงเป็นเรื่องที่ควรให้ความสำคัญ วันนี้ STAGE Find The Real U ฟิตเนสหรูชื่อดัง แห่งยุค New Normal ขอเอาใจสาวๆ ด้วยการแนะนำ 4 ท่าง่ายๆ แต่โดน และเห็นผล เพื่อปั้นกล้ามท้องสวยๆ ที่ปังปุริเย่! อย่างไม่ไกลเกินฝัน..
By The Washington Post · Amy Goldstein, Sean Sullivan · NATIONAL, HEALTH, HEALTH-NEWS
WASHINGTON – The director of the Centers for Disease Control and Prevention predicted Wednesday that most of the American public will not have access to a vaccine against the novel coronavirus until late spring or summer of next year – prompting a public rebuke from President Donald Trump, who declared the CDC chief was wrong.
At a Senate hearing on the government’s response to the pandemic, CDC director Robert Redfield adhered to Trump’s oft-stated contention that a safe and effective vaccine will become available in November or December – perhaps just before the presidential election seven weeks away.
But Redfield said the vaccine will be provided first to people most vulnerable to covid-19, the disease caused by the virus, and supplies will increase over time, with Americans who are lower priority for the protection offered the shot more gradually. For it to be “fully available to the American public, so we begin to take advantage of vaccine to get back to our regular life,” he said, “I think we are probably looking at late second quarter, third quarter 2021.”
Hours later, Trump sought to knock down Redfield’s predicted timeline from the White House press briefing room, saying at a news conference, “I think he made a mistake when he said that. . . . We’re ready to distribute immediately to a vast section of the country.”
The president said that, when he heard what the CDC director had told senators, he called him directly. Trump said Redfield “didn’t tell me that,” though the president declined to disclose how Redfield replied.
“It was an incorrect statement. . . . We are ready at a much faster level than he said,” Trump said, reiterating a recent talking point that a vaccine could be ready to begin administering as early as mid-October.
Multiple experts – including top scientists leading the vaccine effort – have said it is very unlikely a vaccine will be available by then.
Speaking alongside the president, Scott Atlas, a recent addition to the White House’s coronavirus advisers, noted that the administration Wednesday circulated a vaccine distribution strategy to states and others. Atlas said the plan anticipates that “no later than January, all the top-priority people will be able to receive the vaccine,” with other Americans receiving it starting soon after.
The CDC director issued his prediction and received the presidential drubbing the same day that Democratic presidential nominee Joe Biden raised questions about the safety of a coronavirus vaccine approved during Trump’s tenure, warning something so complex and vital to the public’s well-being takes time.
“Scientific breakthroughs don’t care about calendars any more than the virus does,” the former vice president said.
Redfield said that though any individual vaccinated should benefit from a vaccine, the progressive widening of its availability means there will be a time lag between when a vaccine is approved and when it could have a measurable effect in controlling the pandemic. That might be six to nine months after the day it is approved by federal drug regulators, Redfield predicted.
Redfield said that lag between when a vaccine is approved and when the public can get it reinforces the importance of safety measures, such as keeping a proper distance, washing hands and wearing masks.
“I might even go so far as to say that this face mask is more guaranteed to protect me against covid than when I take a covid vaccine,” Redfield said, because the vaccine is unlikely to produce the desired immune response in everyone who gets it.
But Trump at his briefing continued to cast doubt on the value of masks, saying, “The mask is a mixed bag.”
Redfield’s comments were the most detailed time frame outlined so far by the leader of the government’s main public health agency. They are consistent with the perspective of Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, who said in a recent interview with CNN that relatively small amounts of vaccine will be available at first.
“It won’t be until we get into 2021 that you’ll have hundreds of millions of doses, and just the logistics, constraints in vaccinating large numbers of people,” Fauci said. “It’s going to take months to get enough people vaccinated to have an umbrella of immunity over the community so that you don’t have to worry about easy transmission.”
Redfield’s forecast came as Trump has latched onto the prospect of a vaccine as crucial to his prospects for a second term, with low approval ratings among voters for his handling of the worst public health crisis that the country and world have confronted in a century.
A vaccine also is widely regarded as a pivot point for Americans to be unfettered from the constraints the pandemic has imposed on daily life – from recreation such as concerts and movie theaters to workplaces that remain shuttered.
A race is underway internationally among pharmaceutical makers to develop vaccines that are safe and effective against the virus, which has infected nearly 6.6 million people in the United States and killed almost 200,000. Developing a vaccine typically takes years, but researchers are working with unprecedented speed. U.S. researchers in January established the goal of a world-record pace of developing an inoculation against the coronavirus within a year to 18 months.
Now, three experimental vaccines have entered the final stage of testing in the United States – giving each one to thousands of people to check effectiveness and safety – before submission for federal approval. A debate is raging over whether the Food and Drug Administration should hasten a vaccine’s availability by employing emergency authority it has before going through the process of a formal approval.
The CDC told states this month they should be ready to receive a coronavirus vaccine as early as Nov. 1 – two days before the election – prompting allegations from critics that the date was politically motivated. Sen. Patty Murray, D-Wash., the subcommittee’s senior Democrat, accused the administration of “rampant political interference in scientific decision-making.”
Redfield pressed back against such suggestions during an appearance Wednesday before a Senate subcommittee with jurisdiction over the Department of Health and Human Services, of which the CDC is a part. He said the advice to states was based on the pace of the science, not any electoral considerations. And he said his agency was eager to avoid a repetition of a problem that emerged during a pandemic of the H1N1 virus in 2009, when a vaccine became available and states were not ready to receive and distribute it.
“We don’t want to repeat that hiccup,” Redfield told senators.
He also said the government does not have an estimated $6 billion it needs for the distribution of a coronavirus vaccine. Such funds were proposed in pandemic relief legislation that Congress has not adopted, among partisan disputes over how much more aide the government should provide for laid-off workers and a variety of other purposes.
Providing that money, Redfield said, “is as urgent as getting these manufacturing facilities up.”
Biden’s remarks Wednesday show how the pandemic has increasingly become a focal point for both candidates in the final weeks of the race. Biden campaign advisers have regarded the election as a referendum on Trump and his handling of the pandemic. The campaign continues to hold events and run advertisements squarely on this theme.
The former vice president’s comments, extending suspicions Biden has expressed in recent weeks, highlight the extraordinary roughness of this presidential contest. In past election cycles, calling into question whether an incumbent might risk deliberate harm to Americans to forward his political ambitions was not the norm.
But speaking in Wilmington, Del., Biden expressed reservations about whether a covid-19 vaccine approved by the Trump administration would be safe, casting doubt on the incumbent’s willingness to put the health of Americans before politics.
“I trust vaccines. I trust scientists. But I don’t trust Donald Trump,” Biden said. “And at this point, the American people can’t, either.”
Biden raised the possibility of Trump pressuring his administration’s health officials to sign off on a vaccine in which scientists do not yet have full confidence in order to gain an election advantage. The Democratic nominee expressed skepticism about the CDC and FDA, as well as the president.
The former vice president essentially echoed Redfield’s point that vaccinating the nation will happen gradually. “It’s not going to happen overnight,” Biden said. “Once we have it, it’s going to take months to distribute.”
If a vaccine is swiftly approved, it could upend the campaign, and both sides are increasingly bracing for how to deal with the political uncertainty of the coming weeks. Still, experts have questioned whether it is realistic for one to become available before the election.
Biden made his remarks after receiving a briefing Wednesday about the quest for a vaccine from scientific, public health and health policy experts. Creating the drug is only “part of the battle,” said Biden, who likened effective distribution to a complex military operation. He said a vaccine should be free and that priority should go to those who need it most – and that includes Black and Hispanic communities.
The Democrat’s view about the possibility of a vaccine has become a point of contention in the campaign, with Trump accusing Biden and his running mate, Sen. Kamala Harris, D-Calif., of spreading “anti-vaccine rhetoric.”
Biden said he would have no problems endorsing a vaccine – provided it met certain criteria. If the current administration allows a vaccine to be distributed, Biden said, “who will validate it was driven by science? What groups of scientists?”
He added that Americans must be confident “distribution will be safe and cost-free” with a plan for doing so “without a hint of favoritism.”
Biden also lambasted Trump for not aggressively encouraging mask-wearing and alleging that waiters do not like to wear them. The Democrat defended his own calls for a national mask mandate, saying he would seek to implement one by working with governors but that he was not yet completely sure what legal authority he would have to deploy such a rule.
By The Washington Post · Sean Sullivan · NATIONAL, HEALTH, POLITICS, SCIENCE-ENVIRONMENT, HEALTH-NEWS WILMINGTON, Del. – Joe Biden on Wednesday expressed reservations about whether a coronavirus vaccine approved by the Trump administration would be safe, raising doubts about the president’s ability to put the health of Americans before politics.
Biden said Americans should trust a coronavirus vaccine developed under the Trump administration only if the president gives “honest answers” to questions about its safety, effectiveness and equitable distribution. “I trust vaccines. I trust scientists. But I don’t trust Donald Trump,” Biden said. “And at this point, the American people can’t, either.”
Biden also raised the possibility of President Trump pressuring agency officials to sign off on a vaccine that scientists are not yet confident in, to gain an electoral advantage.
The comments, which echo suspicions Biden has expressed in recent weeks, highlight the extraordinary division between the two candidates. Biden’s remarks also show how the pandemic has become a focal point in the final weeks of the race.
Biden campaign advisers have long felt that the election will be a referendum on Trump and his handling of the pandemic, which has stoked widespread anger and received low marks in public polls. They continue to hold events and run advertisements focused on this theme.
Trump has pressed health officials to accelerate the vaccine timeline and deliver one by the end of the year. At a news conference Wednesday, the president said that the vaccine “could be announced in October” and that as soon as it is available it can be distributed “immediately” to the general public. “To the general public immediately – when we go, we go,” he said.
If a vaccine is swiftly approved, it could upend the campaign. However, experts have said it is unlikely that a vaccine could be approved and come into full circulation before the Nov. 3 election.
Centers for Disease Control and Prevention Director Robert Redfield told senators Wednesday that after a safe and effective vaccine becomes available, it probably will take six to nine months for enough Americans to get vaccinated to significantly affect the pandemic.
Redfield said he expected a vaccine to start being available in November or December, with the first people to receive it being those with health problems that make them most vulnerable to a severe case or death if they are infected.
Biden spoke here in his hometown after receiving a briefing from experts about developing and distributing a vaccine. Creating the drug is only “part of the battle,” said Biden, who likened effective distribution to a complex military operation.
The former vice president said that a vaccine should be free and that priority should go to those who need it most – and that includes Black and Brown communities.
Biden received his briefing virtually from experts who appeared on a large screen that was set up inside the downtown theater where he spoke. He sat at a desk and listened to his briefers, which included some boldface names from the Obama administration.
Among the participants were former surgeon general Vivek Murthy; Zeke Emanuel, chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania; former Chicago health commissioner Julie Morita; and former Food and Drug Administration commissioner Peggy Hamburg.
Biden cast doubt not only on Trump but also on those around him. Asked whether he trusted the CDC and FDA, Biden said he did not trust “people like the fellow that just took a leave of absence.” He appeared to be referring to Michael Caputo, assistant secretary for public affairs at the Department of Health and Human Services, who urged Trump’s supporters to prepare for an armed insurrection and accused scientists in his agency of “sedition.”
As Biden addressed reporters, he attacked Trump’s handling of the pandemic and comments in an ABC town hall defending his administration’s response, despite widely documented problems with it. Biden urged Americans to ask themselves how it made them feel to hear Trump say he would not have done things differently.
Biden said people should not expect results just because the president is talking up the possibility of a vaccine. “Scientific breakthroughs don’t care about calendars any more than the virus does,” he said. He warned that politics should have no place in the production of a vaccine.
The Democrat’s position has become a point of contention in the campaign, with Trump accusing Biden and his running mate, Sen. Kamala Harris, D-Calif., of spreading “anti-vaccine rhetoric.”
At a Wednesday news conference, Trump said Biden’s comments were “anti-vaccine” and “hurting the importance of what we’re doing.” He added, “I know that if they were in this position, they’d be saying how wonderful it is.”
Biden said he would have no problems endorsing a vaccine – provided it met certain criteria. If the administration greenlights a vaccine, Biden said, “who will validate it was driven by science? What groups of scientists?”
He added that Americans must be confident “distribution will be safe and cost-free,” with a plan that is “without a hint of favoritism.”
Polls show Biden leading Trump nationally and in key battleground states. But one area where Trump’s standing has shown strength is his handling of the economy. Asked Wednesday why that is the case, Biden replied, “I’ve been out of office for four years,” arguing that voters do not have an immediate sense of the progress the Obama administration made.
Biden also lambasted Trump for not aggressively encouraging mask-wearing and alleging that waiters do not like to wear them. The Democrat defended his own calls for a national mask mandate, saying he would seek to implement one by working with governors but was not completely sure yet what legal authorities he would have to deploy such a rule. (He said his advisers think they can create a mandate.)
He also sought to rebut attacks Trump has lobbed at him for unrest across the country. “I’m not the president. He’s the president,” Biden said, arguing that his opponent should be held to account for the country’s woes.
Lilly says antibody therapy may lower covid hospitalizations
Health & BeautySep 17. 2020Lab technicians produce covid-19 diagnostic kits in a laboratory at the Newtech Medical Devices facility in Faridabad, Haryana, India, on July 15, 2020. MUST CREDIT: Bloomberg photo by T. Narayan.
By Syndication Washington Post, Bloomberg · Riley Griffin, Cristin Flanagan · BUSINESS, HEALTH, HEALTH-NEWS Eli Lilly and Co.’s experimental antibody treatment for covid-19 reduced the rate at which symptomatic patients were hospitalized compared to a placebo, according to preliminary study results released by the company and its partner.
Indianapolis-based Lilly and AbCellera Biologics Inc., a closely held Canadian biotechnology company, are co-developing neutralizing antibodies derived from one of the earliest patients in the U.S. to contract covid-19. They are among a handful of companies, including Regeneron Pharmaceuticals Inc., AstraZeneca Plc., GlaxoSmithKline Plc and its partner Vir Biotechnology Inc. pursuing antibody therapies to combat the pandemic.
Interim results from a mid-stage trial that evaluated multiple dosages found that Lilly and AbCellera’s treatment, known as LY-Cov555, was associated with a 1.7% rate in hospitalizations and ER visits among those who took the treatment compared with a 6% rate among people on a placebo, a 72% reduction in risk. No patients in the study progressed to mechanical ventilation or died.
Lilly’s shares rose 0.9% to $151.48 at 10:29 a.m. in New York trading on Wednesday. The lack of a response at the highest dose and scant detail on the lower hospitalization rates drew Wall Street analyst scrutiny.
The results were “odd,” Bloomberg Intelligence’s Sam Fazeli wrote in a note, adding “It’s not clear which dose drove the 72% reduction in hospitalizations. Very few patients were hospitalized, raising a risk that the effect is by chance. We need to see more data.”
The early results also showed that one of three doses of the antibody drug tested against covid-19 lowered the amount of virus present 11 days after patients received the treatment compared to the placebo. A 2,800 milligram dose version of the drug reduced the viral load, though the 700 mg and 7,000 mg doses did not achieve that end point. Most patients, including those receiving the placebo, demonstrated near complete viral clearance by the eleventh day.
Lilly said it will soon publish the results of this interim analysis in a peer-reviewed journal and discuss appropriate next steps with regulators.
Regeneron is expected to report results of its own at the end of this month. Jefferies analyst Biren Amin was confident the biotech company’s antibody cocktail approach could prove more effective than Lilly’s, which relies on a single antibody..
On Tuesday, top officials at Operation Warp Speed, the Trump administration’s effort to expedite the development of an inoculation and treatment, identified antibody therapies as one of its foremost R&D priorities to counter covid.
Moncef Slaoui, who is leading the Trump Administration’s Warp Speed initiative, wrote in The New England Journal of Medicine that the U.S. government plans to support manufacturing of the “most potent” monoclonal antibody products “so that hundreds of thousands of doses could be deployed this fall and winter.”
Slaoui touted the potential for monoclonal antibodies not just to serve as treatments for sick patients who’ve become infected, but as a preventive drug for those at high-risk.
In August, Lilly and AbCellera kick-started a trial of its antibody drug in nursing homes, suggesting it may have the potential protect vulnerable groups that vaccines may not cover. Slaoui said it will continued to be tested in nursing homes, as well as “meat-packing plants, and other settings” beginning in October.
The “true utility” of neutralizing antibody treatments will be in the preventing infections in unexposed people — not as a treatment of the virus, as seen in Wednesday’s results, Evercore ISI analyst Umer Raffat said in an email.
Medicaid rolls swell amid the pandemic’s historic job losses, straining state budgets
Health & BeautySep 15. 2020“We are going to have to make some difficult decisions,” said Howard Baron, a pediatric gastroenterologist, about his medical practice in Las Vegas. MUST CREDIT: Photo by Bridget Bennett for The Washington Post.
By The Washington Post · Amy Goldstein · NATIONAL, HEALTH, HEALTH-NEWS
The unlikely portrait of Medicaid in the time of coronavirus looks like Jonathan Chapin, living with his wife and 11-year-old daughter in a gated community in the Sierra Nevada foothills.
Chapin had a thriving Reno, Nev., production company, We Ain’t Saints, booking bands, managing weddings, hosting 600-strong karaoke nights at the Tahoe Biltmore Lodge & Casino. When the novel coronavirus came, forcing northern Nevada’s entertainment industry to go dark, he said, “everything I knew all disappeared.”
The family’s health insurance gone along with their income, Chapin applied online for Medicaid on April 1, the day after his wife’s job ended and three days before he needed a molar pulled. By the time his mouth was throbbing, Chapin and his family had become early additions to Nevada’s Medicaid rolls – rolls swollen now to record levels while pandemic-inflicted fiscal wounds have damaged the state’s ability to afford the safety-net health coverage.
By the most recent count, the roster of Nevadans on Medicaid has climbed from fewer than 644,000 in February, the month before the state reported its first case of covid-19, the disease caused by the virus, to about 731,000 through August.
That 13.5% increase places Nevada among at least three states, along with Kentucky and Minnesota, where the cadre of people on Medicaid has spiked that much, including families, like the Chapins, who have never before asked for government help. But increases are widespread: Caseloads had risen on average 8.4% through July in 30 states for which researchers have enrollment information. And in 14 states with enrollment data through August, the average is 10%.
If the past is a guide, this is merely the beginning.
During the Great Recession from late 2007 to mid-2009 and previous bad economic spells in the history of Medicaid, Americans have turned to the program more gradually than to unemployment benefits, food stamps and other aid for people sliding out of comfortable lives. Medicaid is insurance for the poor that is a shared responsibility of the federal government and states, begun as a pillar of President Lyndon B. Johnson’s Great Society expansion of government help of the 1960s.
“We believe Nevada has not yet seen the full impact as a result of the covid pandemic,” said the state’s Medicaid director, Suzanne Bierman, echoing expectations elsewhere of experts on the social safety net.
With Nevada’s tourism-fueled economy stalled, the unemployment rate soared to 30.1% in April, the highest ever recorded for any state in any month.
“You can pick just about any adjective you like to describe just how unprecedented the numbers are, and you wouldn’t be exaggerating,” said David Schmidt, chief economist for the Nevada Department of Employment, Training and Rehabilitation.
“When all the casinos had to close all at once by the end of March, 95% of our members were off work, so it was a complete wipeout,” said Bobbette Bond, director of public policy for the Culinary Health Fund, which provides insurance to about half the cooks and dishwashers, porters and housekeepers and other unionized casino workers. The fund is covering unemployed members for another month.
Some casinos’ lights are back on, but fewer than one-third of workers have returned to their jobs, Bond said, and some have too few hours to qualify for their old health benefits. Even Nevada’s most recent reported unemployment rate – 14% for July – is higher than the nationwide rate at the Great Recession’s worst.
With most Americans’ private health insurance tethered to their jobs, this enormous disappearance of work is a central reason Medicaid programs are swelling and strained.
Another reason: Under the Cares Act, a broad set of pandemic relief measures Congress adopted in the spring, states may not remove anyone from their rolls if they accept extra federal Medicaid aid provided by the law. But in Nevada, most of the growth is fueled by people joining, with about two-thirds of the enrollment boom most months attributed to new applicants, according to state estimates.
The spiraling demand for Medicaid is colliding with a diminished ability by the state to pay for it. With Nevada confronting a $1.2 billion deficit and a requirement to balance its budget, the legislature has taken steps to slow the program’s spending – notably, curbing payments to doctors, hospitals and others who care for Medicaid patients to save $53 million through next summer. That 6% rate cut is the largest so far in the nation.
“Nevada is the extreme of what’s happening around the country,” said Aviva Aron-Dine, vice president for health policy at the Center on Budget and Policy Priorities, who has been tracking Medicaid in the pandemic. “The fear is that it’s the leading edge.”
Chapin finally posted on his personal Facebook page July 1 what had been true for months: “It’s with a heavy heart and a lot of fantastic memories, I regret to announce the closing of my business of 19 1/2 years. . . . With covid spiking again. Wedding season cancelled, no bars to do Karaoke, no venues to book bands, and no real return for the music and entertainment industry in sight.”
It had been 2001, months into his sobriety, when he launched We Ain’t Saints, with its logo of a devil holding a beer and its motto straight from Alcoholics Anonymous. Over the years, the weddings he hosted twice made Brides magazine. He counted Google, Instagram and Squaw Valley Ski Resort among his clients for events.
The business earned him $80,000 to $140,000, depending on the year. “My company allowed me to raise a family nicely,” Chapin, 49, said. “This is what we do seriously for years and years and years. Bringing live music for people. . . . Making sure your bar is filled on Friday night. Not only is it something financially but emotionally you have all these ties with all these people.”
His wife’s final day as an administrative assistant for an organization working with children who have autism was March 31. Her health benefits ended at once. He already had stopped paying into Access to Healthcare Network, a nonprofit medical discount program that covered him and their daughter for a monthly fee. Chapin was approved for Medicaid hours after he typed up an application – a contrast to delays often vexing people as they try to get unemployment checks flowing.
For the emergency molar extraction, he had to find a dentist open in the pandemic and willing to accept SilverSummit, a Medicaid managed-care plan. Discovering none in Reno, he drove to Carson City, about 30 miles south. But he could still go to Northern Nevada HOPES, a community health center where he gets some of his care, when he awoke in April with a blood clot in his left calf. Medicaid paid for him to have it removed and is paying for a blood-thinning drug. His daughter, who has entered sixth grade online, has just been approved for braces.
If not for Medicaid, “we would have sold things, or we would have gone into debt,” Chapin said. “I think about it all the time.”
As it is, they are scraping by, using savings for house payments. Even without a job, he is finding a way to give back. Before starting his production company, he was a chef. Now, he is raising money, making beef stroganoff and peach and avocado salad, pork loin with mushroom sauce and grilled asparagus, and giving the meals to families in need. A lot of the people picking up his meals are recent exiles from the middle class.
Looking over his own rise and pandemic fall, Chapin said, “It’s part of being American. I started this business, and I was living the dream.” And now, to get health insurance, “I have to ask” the state.
– – –
Nevada Democratic Gov. Steve Sisolak issued a report just after July 4, laying out the depth of the economic wreckage wrought by the coronavirus. In nearly three years during and after the Great Recession, the governor noted, Nevada lost 180,000 jobs; in the previous three months, the state had hemorrhaged more than 250,000.
The governor said he wanted to go easy on cuts to health services. But with the Nevada Department of Health and Human Services accounting for one-third of the state’s budget through next summer, and Medicaid the department’s biggest expense, the program was a target.
To help carve $233 million from the department, Sisolak urged lawmakers to eliminate a raft of services that Nevada has offered Medicaid patients, beyond what the federal government requires.
A $3.2 million savings by getting rid of optometry for adults. Another $2.1 million by no longer covering adults’ prostheses. Other services would be restricted. No more than a dozen physical therapy sessions. Limited dental care, except for pregnant women and children.
By the time state legislators finished their special session in late July, they had set aside the idea of reducing benefits – for as long as the nationwide public health emergency continues, at least through the end of the year. Other cuts were approved and, if federal health officials accept them, will be retroactive to mid-August.
Beyond lowering doctors’ pay, the state reversed a 2.5% increase that had begun in January in the daily rate for hospitals’ inpatients. It delayed certain payments to HMOs. It reduced payments for treating the sickest newborns. More than $130 million worth of Medicaid cuts in all.
The health-care industry and some consumers are fuming.
“We have real concerns about our ability to continue to provide for Nevada Medicaid patients,” William Ziesmer, chief financial officer for Sunrise Hospital & Medical Center, the state’s largest, said at a public hearing last month on the changes.
Sunrise officials are examining services “to determine which can be saved and which we’ll be forced to reduce,” Ziesmer said. “This is an incredibly difficult position to put hospitals in, when there is so much need in the community.”
Pam Berek, whose 18-year-old son, Carson, has cerebral palsy, epilepsy and autism, implored officials at the hearing to rethink the cuts. “We don’t want to put our children away in an institution,” Berek said, predicting that an undersupply of home therapists and nurses will worsen, costing the state more in the long run. “We are not just numbers on a paper. We are actually families struggling to keep our children at home.”
On the third floor of a medical office building three miles east of the Las Vegas Strip, Howard Baron has been in practice for 27 years. Nevada’s first pediatric gastroenterologist recruited him in 1993. Baron was the second.
He and three partners treat children with growth failure, nutritional deficits, malfunctioning gastrointestinal tracts, liver disease, a need for feeding tubes. Their patients’ families vary from well-off to undocumented, but many live in the poor neighborhoods nearby. Nearly 6 in 10 of the children the practice cares for are on Medicaid.
To avoid the virus, Baron and his partners stopped performing elective procedures for two months. Other patients simply stayed away. He applied for a federal Paycheck Protection Program loan for small businesses, was turned down on the first round, then received nearly $150,000 on the second. It allowed his practice to pay two months’ salaries and health benefits for the nurse practitioner and dietitian who work with the doctors.
The immediate past president of the Nevada State Medical Association, Baron was in his office around the time the loan ran out in early July, before a special session of the legislature began, when he got an email from Jaron Hildebrand, the association’s executive director. The governor, Hildebrand was hearing, wanted to cut doctors’ Medicaid payments by 6%.
Baron’s first thought: “Wow, how are we going to continue to do what we do?”
He does not yet know how he and his partners will cope. But he knows that, even before these cuts, Medicaid reimbursement for their patient visits are slightly less than they usually cost. “We are going to have to make some difficult decisions,” he said. Perhaps letting staff go. Perhaps limiting patients on Medicaid.
And he knows the costs to Nevada’s low-income children and their parents if his practice was to shut its door to Medicaid – and if other doctors reeling from the fresh cuts did the same.
In a state with a scarcity of medical professionals, Hildebrand said, “It’s only going to exacerbate the shortage and lack of access to care,” coinciding with more and more Nevadans depending on Medicaid.
At Nevada HOPES, the Reno community health center where Chapin gets care, executive director Sharon Chamberlain steels for the strain on clinics such as hers as more doctors with private practices may become less welcoming of Medicaid patients.
“We’re bracing for it,” said Chamberlain, who founded Nevada HOPES as a pioneering HIV clinic 23 years ago, eventually turning it into a full-service health center.
The clinic has always helped patients apply for Medicaid. Before the pandemic, it was helping an average of eight households a month get on the program. Since mid-March, the monthly average has been 24. Of the 136 households HOPES has led onto Medicaid during the pandemic, almost half are new to it.
“I just think we are headed into a dark time,” Chamberlain said, with private doctors likely to back away.
Baron broached the subject a couple of weeks ago, at the monthly lunch when he and his partners gather in their small conference room, usually ordering in Thai. The cuts are significant, he said. If Medicaid patients could return more often to their main pediatricians for follow-up care, that might be something to consider.
He hates the idea of treating sick children differently, depending on who is paying the bill. Still, Baron said, “the fact is, we won’t be here for any patient if we continue to absorb the cost of providing the care.”
– – –
In this time of covid, Medicaid offers a broader tent than it did during the Great Recession. The Affordable Care Act, the sprawling health-care law, did not exist then. Now, 38 states and the District have expanded Medicaid as the law allows, enabling people with somewhat more money to sign up.
In Nevada, 4 in 10 of the state’s new enrollees are in that group, according to state estimates.
That does not mean Medicaid is rescuing everyone who needs it. Rechica Ledesma, 48, was an administrative assistant in the conventions and catering department at Caesars’s Rio Hotel and Casino. Her last day in the office was March 18. After working from home, she was furloughed a month later, then laid off in August. Conventions were not viable once the governor banned public gatherings of more than 50 people.
Her husband, Arnulfo Ledesma, lost his commercial roofing job in May, the month he was diagnosed at age 44 with colon cancer. With unemployment checks of about $700 between them and her health insurance ending, she realized last month the price of Cobra coverage – insurance laid-off workers can buy – that the hotel offered was out of reach. She began exploring Nevada’s ACA insurance marketplace, soon turning off her phone, pummeled with marketing calls for health plans she could not afford.
Finally, with a medical appointment looming to decide on treatment for her husband’s Stage 2 cancer, she applied to Medicaid. When she checked the online app Aug. 31 – the last day of her coverage from Caesars – she found a ruling that they are ineligible because they have too much money.
She does not understand the denial. After months of looking for work, she finally had a job interview this month. She does not know how many other out-of-work Nevadans are being interviewed, or how she and her husband will pay for his cancer treatment if she is not hired.
If Nevada’s Medicaid is not rescuing everyone, it is helping many. It is helping Rich Cox, who takes 14 medications, nine of them psychiatric drugs for the chronic PTSD he came home with after Army stints in Somalia, Bosnia, North Africa and Iraq.
Cox, 47, lost his Aetna health plan when he got an email in mid-April, abruptly ending the job he’d held for 15 years with an auto-repair retailer, working his way up to running a store and being sent into stores around the country to train other managers.
He’d been earning $150,000 to $180,000 a year, mostly in commissions and bonuses, said Cox, whose two daughters live with him half the time.
“I was not exactly careful with my money,” he said. “So losing my job meant losing everything – home, car, of course the insurance.”
He gave up a five-bedroom house on a lake in Summerlin, on Las Vegas’s west side, his bedroom the size of the entire first floor of the two-bedroom he found for a cheap rent. He traded his high-horsepower truck for a small car.
Medicaid approved him before his one month of Cobra insurance ran out in May. He discovered that his psychiatrist, primary care doctor and the orthopedic surgeon – for his bad knees and tendon trouble in his arms – he’d been seeing through Aetna do not accept Medicaid. He has found doctors who do.
Still, he said, Medicaid is “the only good thing to come about with this whole lifestyle change that covid forced me into. . . . Instead of feeling like I was thrown off a cliff, I feel like I was thrown off a boat.”
Oregon residents struggle to live with relentless smoke
Health & BeautySep 15. 2020Smoke blankets the tree line Sunday in Troutdale, Ore., east of Portland. MUST CREDIT: Photo by Mason Trinca for The Washington Post.
By The Washington Post · Samantha Schmidt · NATIONAL, HEALTH, HEALTH-NEWS HAPPY VALLEY, Ore. – It’s been a week since Deborah Stratton breathed clean air.
The 54-year-old and her friend evacuated their homes in Estacada, Ore., last week as flames approached. They spent days sleeping in their cars in a Walmart parking lot, using their last $12 on showers at a truck stop. Finally, they found their way here, to a shopping mall about 20 miles away from their town, in a parking lot where a Red Cross volunteer began pitching them a tent.
Portland, Ore., on Sunday. MUST CREDIT: Photo by Mason Trinca for The Washington Post.
But the smoke followed them, hanging heavy in the air, sticking to the back of Stratton’s throat.
“It burns your chest,” Stratton said, eating nachos in the Clackamas Town Center parking lot Sunday afternoon. “It’s gotten thicker and thicker.”
A week after wildfires began ravaging the state and displacing thousands of people, the air quality in many parts of Oregon ranks among the world’s worst, as bad as the pollution “airpocalypse” in Beijing in 2013. As white, thick clouds hover over buildings and highways, a miserable reality is setting in for Oregonians: They can flee from the fires, but they can’t escape the smoke.
Nauseating and suffocating, it lingers – in clothes, on hair, in bedsheets. No shower seems capable of getting rid of it, no air freshener can mask the scent. It seeps inside, even with windows and doors closed. Crack a car door open and it finds its way in. Turn on the air conditioning and the vents spit out even more. Put on your mask and it smothers you in the smell of ash.
“It’s like sticking yourself in a little room with 12 people all around you, smoking cigarettes,” said Lisa Jones, Stratton’s friend. It’s a terrifying reminder that somewhere, nearby, a fire is still burning. “It makes me feel like it’s not over, like it’s still coming.”
The wildfires ripping through Oregon have claimed at least 10 lives and at least 22 people have been reported missing, state officials said Monday. Lower temperatures and higher humidity have allowed firefighters to make progress on the blazes, but many of the state’s fires continue to rage with little containment. A long-awaited rain, originally forecast for Monday, is not expected until Wednesday or Thursday, said Doug Grafe, chief of fire protection at the Oregon Department of Forestry. And with it, the rain could bring thunderstorms and lightning, which could ignite more fires, he said.
“Without question, our state has been pushed to its limits,” said Democractic Gov. Kate Brown. “The smoke blanketing the state is a constant reminder that this tragedy has not yet come to an end.”
In hospitals across the state, health officials already are seeing the impact of the hazardous air. Ten percent of all emergency-room visits in Oregon are for asthma-like symptoms, said Gabriela Goldfarb, a manager in the environmental public health section of the Oregon Health Authority. State officials said they plan to send 250,000 N95 respirator masks to agricultural workers and Native American tribes to protect them from the smoke. And they do not expect to see somewhat clearer skies until late in the week.
“Even in some places where there may be limited improvement at times,” Goldfarb said, “that just means dropping from one bad air category to the next.”
In Portland, the smoke and fog Sunday and Monday covered everything in sight. The waterfront, usually filled with runners and dog-walkers, was empty. On bridges above the Willamette River, nothing but white clouds could be seen on either side.
In the city’s Hawthorne district, known for its boutiques and restaurants, many businesses were dark Sunday. Coffee shops and storefronts that had recently hung up signs with the words “Welcome back!” and “We’re now open” now displayed scrawled-out words on sheets of paper taped to their doors: “Closed due to air.”
Across town, Mark Rohner sat waiting at a bus stop, wearing a neck gaiter over an N95 mask, dampened with water and eucalyptus to help him breathe. He had stayed home for the past three days, hiding from the smoke that had been giving him headaches and making him dizzy. Even a half-hour trip to the grocery store left him feeling nauseated.
He wished he did not need to go out, but he had rent to pay, and he needed to go to his job in property leasing. It felt like the beginning of the pandemic all over again, each trip out of the house bringing risks of exposure.
“It’s like, OK, what next?” he said. “When is it too much? When do you stop?”
Not owning a car, Rohner had no way to escape the city. And even if he could, where would he go? He could take a train to the outskirts of Portland, but “what do you do when you get to the edge of town?”
The smoke was even worse in other parts of the state. He envied one of his friends, who fled to Boise, Idaho.
“It just feels claustrophobic,” he said. Even after being stuck in quarantine in the pandemic, “I feel more trapped than usual.”
In northeast Portland, DeShawn Brown pulled his FedEx truck to the side of the road, its doors and windows open as always. A delivery driver for a private contractor, Brown rolled a cart up to an apartment building and unloaded cardboard boxes.
“It slows me down,” Brown, 45, said of the smoke. “The other guys, too, trying to figure out how to breathe. Because this is how we roll, with the door open.”
Across town, standing outside a church, 60-year-old Teberih Medhanie wore a blue mask and a headscarf as she waited for her son to pick her up from a funeral for a relative. She had been trying to avoid the outside at all costs and was too scared to drive in the heavy smoke.
Her son, Jordan Taylor, worried about how the smoke could affect his mother’s health, and his own. The outdoors had been his way of coping with quarantine. He missed the sunlight, the vitamin D, the long walks outside.
“We can’t be inside with people. Now we’ve got this smoke and we can’t be outside,” Taylor said. “You can’t get a breath of fresh air.”
As darkness fell Sunday over the Clackamas Town Center parking lot, about 10 miles from Portland, Karol Parham’s eyes were swollen and her voice raspy from the smoke. She sat on a lawn chair drinking a beer next to her new friend, Ryan Brault, using an upside-down cardboard box as a makeshift table. After spending days parked next to each other, each living out of a car, they had become neighbors in their community of fire evacuees.
A Red Cross volunteer had given them a tent, but neither wanted to sleep in it. They felt more comfortable in their cars, where they could circulate the air to keep from breathing in the smoke. Brault had figured out a nightly routine: He runs the air in his car for half an hour, turns it off, and turns it back on a few hours later. He knows it is time for more air when he feels his eyes start to burn, he said.
“Every couple of hours you can just feel it,” he said. “It wakes you up.”
The headaches and pain in Parham’s chest always feel worse at night, when the smoke feels thicker, she said.
“Your lips get dry,” Parham said. “You drink water like crazy.”
Yards away, Stratton held her inhaler to her mouth and breathed in. Before, she used the inhaler rarely, only about once a week. Since the smoke arrived, she has used it nearly five times a day, she said.
With a toothbrush, shampoo and towel in her hands, she walked to the Red Cross showers, hoping to finally feel clean after another day smothered in smoke. It made her anxious to always smell like this, she said: “I just feel dirty, all the time.”
Minutes later, she returned with wet hair and clean pajamas, ready to crawl into her tent and watch TV on her phone. She opened up the driver’s door to her Ford Explorer and spritzed some of her favorite body wash, a “Twilight” scent she hoped would mask the smoke.
Pandemic limits on alcohol, indoor dining fuel a restaurant rebellion in Pennsylvania
Health & BeautySep 13. 2020Kristen and Rush Burpee of Michigan relax with drinks outside Pittsburgh’s Wigle Whiskey. Owner Meredith Meyer Grelli doesn’t blame the state, but says, “We are bleeding money like anyone else.” MUST CREDIT: Photo by Jeff Swensen for The Washington Post
By Special to The Washington Post · Christine Spolar · NATIONAL, BUSINESS, FEATURES, HEALTH, POLITICS, FOOD PITTSBURGH – Since 1959, Al’s Cafe has been known for cold beer, hearty hoagies and the occasional coconut shrimp platter. But since the coronavirus outbreak, the Bethel Park eatery has become the staging ground for an unlikely anti-government rebellion.
First came complaints that owner Rod Ambrogi and his patrons were failing to abide by a statewide mask mandate imposed in July by Pennsylvania Gov. Tom Wolf, a Democrat. Ambrogi has since put on a mask, but he refuses to prevent customers from bellying up to the bar in defiance of state rules strictly limiting indoor dining.
Rpd Ambrogi greets patrons at the restaurant his family has run since 1959. CREDIT: Photo by Jeff Swensen for The Washington Post
“I can see [wearing] the mask now. But the rest of it is stupid,” said Ambrogi, 74, who has rallied local tavern owners to defy the rules. “There are people going out of business every day around here.”
Six months into the coronavirus pandemic, restrictions on dining have left restaurants and taverns across the nation struggling to stay afloat. Democratic presidential candidate Joe Biden has blamed President Donald Trump for a bungled pandemic response that has left at least 190,000 dead and millions unemployed. But in Pennsylvania, a crucial swing state Trump carried by just 44,000 votes in 2016, a debate is raging over whether the Republicans in Washington or the Democrats in Harrisburg bear more responsibility for the industry’s economic pain.
Nationally, jobs in food service and drinking places fell 49 percent from February to April, according to Gus Faucher, chief economist for Pittsburgh’s PNC Financial Services Group. In Pennsylvania, the job loss was steeper, at 59 percent. And in the Pittsburgh metropolitan statistical area, which includes seven counties in the state’s southwest corner, those jobs plummeted by 62 percent.
While some have bounced back, July figures show that Pennsylvania bars and restaurants are still hurting. In Pittsburgh, only about a third of lost food and drink jobs have returned, leaving about 33,000 people still unemployed.
“Who are those 33,000 people out of work?” Faucher said. “And who are they going to hold responsible?”
For some, the answer is the governor. After closing restaurants and bars along with other nonessential businesses when the pandemic struck in mid-March, Wolf began permitting them to reopen this spring. But when the number of new infections began rising, the state health commissioner cranked up restrictions on indoor dining, a key vector of infection.
Under the new rules, alcohol could be sold only if customers also ordered food. Sidling up to a bar for a brew was forbidden.
Most infuriating to owners: Eateries that had been preparing to reopen at 50 percent capacity were suddenly told they would have to operate at 25 percent capacity. Pennsylvania is one of just three states to impose such severe limits, according to a database compiled by the National Restaurant Association, though some local jurisdictions have done so.
Many bar and restaurant owners say the state is denying them the right to earn a living. Rui Lucas, 45, who owns three restaurants in suburban Philadelphia, formed a trade association this summer to push for counties, rather than the state, to set coronavirus standards for bars and restaurants.
“Of course, we’re all scared. On many levels,” Lucas said. “We know we are at the fate of the virus. But we are also at the fate of Governor Wolf.”
State health officials defend the decision to keep a tight rein on bars and restaurants, saying it is based on data, including information from people who tested positive after dining out. The number of new cases has fallen, and White House coronavirus response coordinator Deborah Birx praised the state earlier this month, saying only five others have a lower case count.
Still, Sarah Boateng, executive deputy secretary at the Pennsylvania Department of Health, said she understands the blowback. “I hear the frustration of the restaurant owners. I appreciate it,” she said. “We know it’s not been easy.”
In general, state residents give Wolf good marks for his handling of the crisis. According to an August Monmouth University poll, 62 percent of Pennsylvania voters said the governor has done a good job, while more than half the state’s voters – 53 percent – said they disapproved of Trump’s handling of the virus.
But approval for Wolf’s performance slipped from 67 percent in July. And the same survey showed Biden leading Trump by just four points – 49 percent to 45 percent – down from a 13-point advantage a month earlier.
Lara Putnam, a history professor at the University of Pittsburgh who monitors political activity on Facebook and other social media sites, said she sees “an intensity of agitation online, especially farther outside of metropolitan areas, to blame Tom Wolf” for the grim economic situation. The state’s overall unemployment rate was 13.7 percent in July, the most recent available, significantly above the national July average of 10.2 percent.
“If you’re a waitress who has lost all your hours,” Putnam said, “who are you going to blame?”
Ambrogi, who so far has called back only 40 of 60 employees at Al’s Cafe, knows precisely whom he blames. He blasts Wolf’s restrictions on dining as “unconstitutional.”
“Look, I know it’s a bad virus. And no one wants to see anyone get sick,” Ambrogi said. “But it comes to a point: The general public has had enough of this.”
On Tuesday, with new infections down, Wolf granted restaurateurs a reprieve: Starting Sept. 21, they can operate at 50 percent capacity. But they will also have to stop serving alcohol at 10 p.m., an hour earlier.
“We wanted a ham and he gave us a hot dog,” complained Ambrogi, a stalwart Trump supporter. Of the new time for last call, he said, “I don’t know what that will mean” for business.
Since leading a local revolt against the restrictions, Ambrogi has corresponded with restaurant owners across the state. He said he has also written to Wolf and reached out to state lawmakers from both parties. Only Republicans responded, he said.
“Where are the Democrats? Are they waiting to make Trump look bad?” said Phil Catagnus, one of Ambrogi’s brothers in arms and the owner of the Double Visions go-go bar outside Philadelphia. “We are the people stuck in the middle of this.”
Because people can no longer drink without ordering food, Catagnus, 64, joked that he now sells “virus-killing hot dogs.” Still, the restrictions on indoor dining are killing business, he said.
“I’m very grateful for being open. But the margins are so small,” said Catagnus, who plans to vote for Biden despite feeling neglected by Democrats in Harrisburg.
Meredith Meyer Grelli grew up in Pittsburgh’s North Hills, teaches entrepreneurship at Carnegie Mellon University and runs Wigle Whiskey, the first distillery in Pittsburgh since Prohibition. Before the pandemic, nearly 150 customers showed up for Saturday tours. These days, Grelli relies heavily on bottle sales to stay afloat.
“What’s frustrating for bars and restaurants is they have been singled out, but there has been no effort to provide specific support,” said Grelli, 35. “We are fortunate that we have bottle sales. But this capacity issue? No one builds a business to operate at 25 percent or 50 percent.”
Grelli said that she doesn’t blame the state for her problems but that she understands why many bar owners are angry.
The distillery “gave up on profitability a long time ago,” she said. “We are bleeding money like anyone else.”
Lawyer-cum-brewer Peter Kurzweg co-owns the Independent Brewing Company and two other craft beer halls in Pittsburgh. He used to pack 120 people into his hipster beer room in the city’s Squirrel Hill neighborhood on Friday nights. Today, he has no indoor seating because he thinks ventilation is key to controlling the virus.
Kurzweg, too, is unhappy with the statewide restrictions. “I have lost count of the number of good restaurants that have closed,” he said.
But Kurzweg, 38, said he places greater blame on Trump. While countries like Germany kept the virus at bay and largely have returned to normal life, he said, the White House failed to gain control of the outbreak, allowing it to become a national calamity.
“I have mixed feelings about what the state did. They needed to find a happy balance,” Kurzweg said. But “fundamentally, I attribute what we have now to a lack of a strong federal response and strong federal guidance.”
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CDC director Robert Redfield 
Joe Biden 
Lab technicians produce covid-19 diagnostic kits in a laboratory at the Newtech Medical Devices facility in Faridabad, Haryana, India, on July 15, 2020. MUST CREDIT: Bloomberg photo by T. Narayan. 
“We are going to have to make some difficult decisions,” said Howard Baron, a pediatric gastroenterologist, about his medical practice in Las Vegas. MUST CREDIT: Photo by Bridget Bennett for The Washington Post. 
Smoke blankets the tree line Sunday in Troutdale, Ore., east of Portland. MUST CREDIT: Photo by Mason Trinca for The Washington Post. 
Kristen and Rush Burpee of Michigan relax with drinks outside Pittsburgh’s Wigle Whiskey. Owner Meredith Meyer Grelli doesn’t blame the state, but says, “We are bleeding money like anyone else.” MUST CREDIT: Photo by Jeff Swensen for The Washington Post 
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