WHY?

A new and dangerous public health threat has emerged in North America. As yet it is not known how the disease spreads.  Outbreaks have been rare, but in the more recent two decades it has taken close to 100 lives in the U.S alone.

It kills swiftly but is not uniformly fatal. It leaves a trail of heartbreak and never-ending questions? Those not killed by its outbreak ask could we have been immunized against it?  How can we find a cure or treatment?

What are we writing about here?  Mass murders in schools, and public places.

Among the questions asked are;

Can it be predicted and/or prevented?

Why has it become more prevalent?

What are the risk factors?

Is there something wrong with our mental health system?

Prediction of these events has been a total failure. Forensic psychologists and psychiatrists have elaborated on several personality traits in persons who commit these crimes.  They caution however that these traits do not necessarily point to violent behavior.

There may be an explanation (or several) for it's increase in prevalence.  

Questions 2 and 4 may be related.

The development of effective anti-psychotic and other psychotropic drugs to control unacceptable behavior, psychosis, anxiety and depression initiated a paradigm shift in the treatment of mental illness. Prior to 1980 severely and chronically emotionally disturbed people were admitted to either short term or long term psychiatric institutions.  Most hospitals had a mental health ward that was secure and locked down. Some were smaller private residential facilities, but the vast majority were large state and/or federally administered facilities.

The institutions were expensive to maintain, and in the new era of 'effective' drugs to control aberrant behavior, it was deemed possible to treat more emotionally disturbed people as outpatients once their acute symptoms were controlled.  The number of patients needing to be admitted both for short term or long term hospitalization decreased dramatically and gradually most of these in patient facilities closed or were downsized significantly. The ability to admit patients became more difficult.

The stigma of mental illness remains high. People are fearful of what they do not understand. While it is now better understood what causes emotional disturbance now neuroscience is able to study the metabolic activity of the brain using metabolic scans coupled with MRI imaging. 

Above: The evolution of police uniforms

The image of the policeman on the right does not engender a warm and fuzzy feeling.

The cover of a book is designed to give the reader a sense of what lies inside the covers. Redesigning the uniform of negotiators or mental health personnel would be a significant change.

Social Workers Co-responders

As a result of increasing violence, and criminals obtaining military-grade weapons police have resorted to increasing their own protective equipment and support equipment. Swat teams have evolved to heavily armored transportation devices coupled with entry battering rams. Police have developed an on, off response at one level. Swat teams are called in regularly when an armed criminal event takes place. It often occurs for a 'domestic violence' event. Common sense has devolved into brute force for relatively minor events. This markedly elevates the 'threat' component of an event.

Gun violence under the microscope

Recently a national reaction to episodes of police violence a movement has called police reform mandatory to detach racial profiling from enforcement. Several propositions proposed to 'defund the police' include disbanding present police departments and replace them with new entities. Others suggest integrating more mental health diagnosis and treatment integrated into the police force. Police have recently become much more 'enforcement' entities over 'protect and serve'. The gradual shift has taken place over several decades. It is apparent the current situation is non-sustainable.

Certainly swat teams are indicated for mass shootings at public or school events. The events initiate a heightened sense of awareness and anxiety.

Why is this appearing on a health blog? Statistics reveal this is a public health problem, just as Covid-19 has become. Public health experts who study the situation can make recommendations, but will officials and/or authorities follow their guidance. If Covid-19 sets precedence, it is doubtful. Economic concerns and 'reality' often override science as we observe the current Covid-19 return to normal.

WHY ?

The Patients that need mHealth the Most can't or won't. use It

The Problem

People over 65 stand in front of screens for an average of 10 hours per day. Half of them own smartphones. One would think that this would make them willing to try out mHealth interventions. Well, it’s more complicated than that, according to a new study.

The harsh reality of mHealth use

Let’s face it – the concept of smartphones becoming central to managing diseases is very new. For older people used to good doctor visits and physicals, it might seem downright silly. Even those who engage with mHealth often do so in a lighthearted way and quickly give up.

The study

Scientists in Europe tried to investigate this difficult relationship between elderly patients and mHealth. In order to do so, they looked at the recruitment stats of a previous study, HF-Wii. In that study, researchers wanted to see whether giving heart failure patients a Nintendo Wii would increase their activity levels. What they reported is revealing; out of 1632 patients considered for participation, 71% didn’t make it in the study (44% didn’t want to participate while 27% were rejected by researchers, mainly for balance problems). Patients over 80 years old and those with more severe heart failure were least likely to secure a spot in the study. This finding suggests that indeed, the patients in biggest need of help are the least likely to get it from mHealth solutions.

The consequences

Does this mean that digital health studies are cherry-picking their patients, leading to better results? Maybe, but this happens in all fields, not just mHealth. Bad science is sadly common; patients and doctors need to keep an eye out. That said, mHealth interventions often require hand-eye coordination and finesse that frail patients lack. Instead of excluding patients that can’t handle apps in their current form from the studies, we believe that mHealth innovators should view this as a challenge they should overcome.

10 Products You’ve Never Heard Of (That Will Make Your Life Easier)

On the cutting edge of senior care products are wireless gadgets and wearable devices that help keep loved ones safe and healthy. In our increasingly tech-savvy society, it’s no surprise that the most useful products to aid seniors and caregivers are innovative technologies that promise to make day-to-day life easier and make health monitoring a snap.

The buzzword of the day is “wearable technology.” We saw a lot of breakthroughs over the past year in devices like fitness monitors, GPS trackers, remote patient monitors, and other wearables.

APEX Multifunction Coordinator

Apex has multiple advanced and powerful features such as a built-in temperature sensor and voice prompts. Yet, all of these attributes can be accessed by 2 simple buttons to reduce clutter and confusion. Apex Medical Alert System is a powerful device wrapped in a compact and smartly designed package.

The patients that need mHealth the most won't use it - FantAstrial

The current COVID‐19 pandemic has been identified as a possible trigger for increases in loneliness and social isolation among older people due to the restrictions on movement that many countries have put in place. Loneliness and social isolation are consistently identified as risk factors for poor mental and physical health in older people. Video calls may help older people stay connected during the current crisis by widening the participant’s social circle or by increasing the frequency of contact with existing acquaintances.

The primary objective of this rapid review is to assess the effectiveness of video calls for reducing social isolation and loneliness in older adults. The review also sought to address the effectiveness of video calls on reducing symptoms of depression and improving quality of life.

Video conferencing in general has altered communication in most industries. Ranging from social media (facetime, facebook live, hangouts) to telehealth, and webinars it has allowed for remote learning in a time where social distancing is mandatory due to the novel corona virus. It will assist in school closures and allow for continuing education for K-12 and higher education.

Based on this review there is currently very uncertain evidence on the effectiveness of video call interventions to reduce loneliness in older adults. The review did not include any studies that reported evidence on the effectiveness of video call interventions to address social isolation in older adults. The evidence regarding the effectiveness of video calls for outcomes of symptoms of depression and quality of life were imprecise and at high risk of bias due to study limitations.

Implications for research

Given the very small number of studies included in this review (and considering the current pandemic and associated physical distancing measures) further studies testing the effectiveness of video calls for loneliness or isolation in older adults are needed. Beyond the limited number of studies to date, attention is also needed towards the rigour within studies given the current low participant numbers observed and lack of pre‐registered designs and analysis plans. Finally, more diverse stakeholder groups and settings are needed in future studies, given the current homogeneity of populations with a strong focus on nursing home residents observed. Specifically, future studies should target older adults across a range of settings who are demonstrably lonely or socially isolated, or both, to determine whether video call interventions are effective in a population in which these outcomes are in need of improvement

Limitations of the study include its focus on nursing home patients, who have other confounding conditions such as stroke, respiratory disease, vision deficits, and other comorbidity.  It ignores other aged populations, assisted living, aging at home, and other activities.

Video calls for reducing social isolation and loneliness in older people: a rapid review

Cochrane Systematic Review - Prototype Version published: 21 May 2020

https://doi.org/10.1002/14651858.CD013632

 

The Dual Epidemics of COVID-19 and Influenza: Vaccine Acceptance

COVID-19, a Pandemic or is it now Endemic ?

JHU GLOBAL MAP (interactive)

Day by day over six months have passed since the novel corona virus emerged in Wuhan China. Our modern technological society has been a dual edged sword.  On the one hand we have treatments and vaccinations for most infectious diseases, on the other hand modern technology, airline flights and international global economies allow novel diseases to travel at blazing speeds.  At the same time modern communications such as the internet allow for rapid dissemination of outbreaks.

Data analytics, computation, artificial intelligence developed for the  World Health Organization and Johns Hopkins University allow for daily analysis and demographics of the world, country down to individual counties or jurisdictions.

The health system, and wider society, must prepare for the likelihood of co-epidemics of COVID-19 and influenza. What are the most effective strategies for increasing influenza vaccine coverage across the population and particularly in schools, businesses, and hospitals? Should states or businesses require vaccinations? Influenza vaccination, moreover, could offer valuable lessons for ensuring vaccine acceptance and uptake when COVID-19 vaccines become available.

The nation’s goal should be to attain high influenza vaccine coverage, including near-universal coverage among health care personnel and other high-risk groups for COVID-19. Expanding vaccine coverage requires multiple strategies.

While the initial impact has occured in densely populated areas of the developed nations, the continuing outbreaks in rural and more isolated populations will occur over the next several years.  At the same time continuing resurgences will occur globally.

No one preventative measure will suceed alone.  A multi pronged attack is necessary, including vaccination, physical distancing, sanitation and respiratory filtering.  At the same time biological herd immunity will evolve.  Once a 50-60% saturation occurs herd immunity will equal vaccination effectiveness.

References

1.

Estimated influenza illnesses, medical visits, hospitalizations, and deaths in the United States—2018-2019 influenza season. Published January 8, 2020. Accessed May 22, 2020. https://www.cdc.gov/flu/about/burden/2018-2019.html

2.

Flu vaccine coverage, United States 2018-19 influenza season. Published September 26, 2019. Accessed May 22, 2020. https://www.cdc.gov/flu/fluvaxview/coverage-1819estimates.htm

3.

2018-19 Influenza illnesses, medical visits, hospitalizations, and deaths averted by vaccination. Published January 16, 2020. Accessed May 28, 2020. https://www.cdc.gov/flu/about/burden-averted/2018-2019.htm

4.

Vaccine effectiveness: how well do the flu vaccines work. Published January 3, 2020. Accessed May 28, 2020. https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm

5.

Bramer  CA, Kimmins  LM, Swanson  R,  et al.  Decline in child vaccination coverage during the COVID-19 pandemic—Michigan Care Improvement Registry, May 2016–May 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(20):630-631.PubMedGoogle ScholarCrossref

6.

Influenza vaccination information for health care workers. Published December 18, 2019. Accessed May 22, 2020. https://www.cdc.gov/flu/professionals/healthcareworkers.htm

7.

State healthcare worker and patient vaccination laws. Published February 28, 2018. Accessed May 22, 2020. https://www.cdc.gov/phlp/publications/topic/vaccinationlaws.html

8.

COVID-19 cases in the U.S. Accessed June 3, 2020. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html

9.

Schaffer DeRoo  S, Pudalov  NJ, Fu  LY.  Planning for a COVID-19 vaccination program.   JAMA. Published online May 18, 2020. doi:10.1001/jama.2020.8711
ArticlePubMedGoogle Scholar

The Dual Epidemics of COVID-19 and Influenza: Vaccine Acceptance, Coverage, and Mandates | Geriatrics | JAMA | JAMA Network

The Idiot's Guide to Face Masks for Covid

The novel corona virus has changed our daily patterns of life and fashion. Despite the loosening of restrictions we will all be wearing PPE in the form of face masks, ranging from scarves, DIY, and commercial masks designated as N95.  This booklet details how, what, and where to find a suitable PPE for yourself.

This POST will be available on Amazon Kindle Books for  $ 2.00 USD. It will only be available as a digital edition.

Be safe !

Digital Edition of The Idiot's Guide to Face Masks for Covid

Release Date:  July 1, 2020

Three COVID-19 Vaccines Are Ready For Final Stage of Testing

THREE COVID-19 VACCINES ARE READY FOR FINAL STAGE OF TESTING

 Over the course of the summer, the federal government plans to fund three phase III clinical trials for experimental coronavirus vaccines.

Each of the three vaccines will undergo this final phase of testing on about 30,000 human participants, The Wall Street Journal reports, half of whom will receive a vaccine injection and the other half an inert placebo.

The vaccine developed by Moderna Inc will begin its phase III trial in July, followed soon after by those developed by AstraZeneca and Johnson & Johnson. Normally, reaching this point can take years, but coronavirus vaccines have been developed and tested on a vastly-accelerated timeline.

There are multiple phases of clinical research necessary before a medication or vaccine is granted regulatory approval. 

Phase 0 studies how the human body processes a drug. 

Phase I identifies dangerous side effects and other safety concerns,  

Phase II trials measure whether the drug actually treats the condition it’s supposed to.

Phase III: large-scale tests that compare the drug or vaccine against a placebo. Many drugs don’t ever reach this final stage of the process, so the fact that three COVID-19 vaccines are already there is a promising sign for the fight to end this pandemic.

At this date in early June 2020 there are twenty-three vaccine candidates, proposed by pharmaceutical manufacturers.  Vaccines are a category of drugs developed by specialized companies.  

These 23 companies are working on coronavirus treatments or vaccines. If you want the details, click here.

A mix of legacy drug makers and small startups have stepped forward with plans to develop vaccines or treatments that target the infection caused by the novel coronavirus.It is a team effort to develop a vaccine pipeline.  The pipeline has been in existence for decades, ready at a moment's notice to manufacture this year's model on the assembly line. The design goes all the way back to Henry Ford's idea of automobile assembly.

In the U.S., many of the publicly traded companies that are initiating development have received funding from two organizations: the Biomedical Advanced Research and Development Authority, or BARDA, which is a division of the Department of Health and Human Services, and the National Institute of Allergy and Infectious Diseases, or NIAID, a division of the National Institutes of Health. Some companies have also received funding from Coalition for Epidemic Preparedness Innovations, or CEPI, a global organization based in Oslo that has provided millions of dollars in funding to vaccine makers. Other companies are funding trials by themselves or through life-sciences-company partnerships.

Three COVID-19 Vaccines Are Ready For Final Stage of Testing

COVID-19's financial impact & how digital health advancements will help patients

COVID-19 has had a worldwide impact on health systems. It has impacted healthcare assesibility, supply chain delivery of food, medical supplies, sanitation, masks, and the ability to travel locally and internationally. It  effects the daily mental health, and financial stability of companies and families.  In the United States it accelerated changes already available, such as telehealth. 

The COVID-19 pandemic will have a long-lasting effect on the healthcare industry, with new potential for digital health initiatives and data-sharing to help patients and public health surveillance, according to Judy Faulkner, founder and CEO of Epic.

The economic stress of the pandemic may accelerate mergers of health care providers, hospitals, and other entities such as imaging, physical therapy, laboratories, and perhaps even  payors. 

1. There is a strong possibility for future mergers, acquisitions and layoffs as hospitals and health systems have been forced to spend more money on COVID-19 care while canceling many surgeries and other appointments. Ms. Faulkner said many of Epic's customers have experienced revenue declines between 35 percent and 55 percent.

2. Hospitals will continue to push patient remote monitoring and telehealth programs; she said Epic calculated there have been between 50 and 100 times more video visits being done by clients compared to months before the pandemic.

3. Hospitals and health systems will standardize data definitions so regulators such as the CDC can more quickly access data needed for monitoring public health emergencies.

"If people define the data differently, then you can't aggregate it. So that's a big problem that there isn't enough standardization. And just collecting the data when it isn't standardized doesn't get you very far," Ms. Faulkner said. 

4. There will be a greater focus on public health surveillance, and Epic may help governments by sharing patient data that can derive insights for social distancing guidelines.

5. Did the the pandemic expose any critical flaws in the healthcare system, adding: "This happened so quickly. There was a shortage of [intensive care unit] beds, a shortage of ventilators. So I don't want to say that anything was a flaw. Because when something so out of the ordinary happens, is that a flaw or is it just we've learned something and next time, if this happens again, we'll be better prepared?"

Judy Faulkner on COVID-19's financial impact & how digital health advancements will help patients: 

Minneapolis Clinic Looted During Protests |

It has been a long and momentous week.  As I sat mesmerized by the events as I channel surfed the internet, television, Twitter, Facebook and other news (fake, or otherwise) I realized that although many bad things happened to people, by people it brought the chronic problems of black Americans and black people around the world to an everyday event. This does not apply to only black people, but those refugees forced to migrate due to wars in the middle east causing muslims to migrate to Western Europe. I saw protests occuring in many worldwide cities. 

One story stood out.

"Minneapolis Clinic Looted During Protests"

— But docs support protesters' goal: "Property is property and that can be sacrificed for justice"

When Andrea Westby, MD, arrived at Broadway Family Medicine Clinic in northern Minneapolis on Saturday morning, she was aghast at what she saw. It was boarded up -- as were neighboring store fronts in the strip mall -- and one of the clinic's windows was broken in. Westby walked inside and saw a water-damaged carpet and empty spaces where a lobby television and several computers had been.

When I first saw the above photo my thought was 'drugs'. I was sadly mistaken and realized I am a part of the 'systemic racial problems' in America.  There were no drugs involved, just consumer products such as computers, and televisions, to be used for personal consumption or for sale   probably to purchase food and necessities for life.

Dr Westby said, "It is really hard to have our clinical space damaged," said Westby, a professor of family medicine and community health at the University of Minnesota.

Still, she believes in the larger message of the protests: "We want to see real actionable change come out of this. We are doing what we can in a crisis right now. It's really important that our community gets our voices heard."  

Broadway Medical Clinic is an affiliate of the University of Minnesota School of Medicine, and many of their familly practice residents see patients at the clinic.  This clinic is a store front office along a major street, and does  not stand out from other retail stores. As looters travel down Yonge Street it is an easy target to snatch and grab items. Looters would not stand out in a crowd of hundreds marching and protesting.

Social Determinants of Health. 

The looters gave little thought to the personel and capital invested by the University of Minnesota.  Physicians as a whole give little thought to the color of their patients, No doubt the area is underserved and health conditions  such as hypertension, diabetes and chronic medical illnesses. are more aware of the   The people  are more likely to contract and have more serious illnesses such as COVID-19.

Minneapolis Clinic Looted During Protests | MedPage Today: But docs support protesters' goal: 'Property is property and that can be sacrificed for justice'

Patient Beware of the New Primary Care Workforce

Once again a most important area of primary care is being ignored. The primary care workforce has moved from the most experienced workforce to the least experienced - without so much as a warning.

The focus for primary care has been elsewhere other than significant changes in the workforce in areas such as consumer focus, convenience, quality, metrics, or lower costs.

But there has not been much about changes in the primary care workforce itself.

No, this is not about the movement from physicians to non-physicians, although this change is a big factor in the changing of primary care experience. All of the primary care workforce is impacted - MD DO NP and PA. Fewer enter and even fewer remain. Because they depart and take their primary care experience with them, the remaining workforce is more and more likely to be inexperienced.

Not even researchers are asking many of the important questions with regard to primary care. 

• How is the primary care workforce changing and what does that mean? 
• What does the practitioner or physician bring to the table?
• Is there a depth, breadth, intensity, and volume of previous experiences that matters to care?
• What if the provider has little experience and you have a complex health care need?

You are within your rights to ask to see a specialist if you have an unusual condition, even if you are in a PPO or  HMO. Insist on it. Your provider has a duty to refer. Some providers have been sued for "falure to refer" and have lost.

What Has Happened in the Past 50 Years?

The primary care workforce built by the 1970s and 1980s class years of physician graduates was rich in experience. The health policy of the time supported 30 year careers in primary care with higher volume, intensity, scope, and engagement. The options for them other than primary care were few. The expectation was a career in primary care and this was the result. Options to specialize were few. There were some who left for emergency room careers, but fewer compared to now. There was no hospitalist or urgent care or retail care. There were fewer administrative options.

The primary care workforce based on the graduates of the 2000s and 2010s will be the opposite. This is not just due to the massive increases in graduates. The nurse practitioner and physician assistant higher turnover/transitional role has also been the case for primary care trained physicians.

Physicians go back and specialize. Primary care physicians depart primary care for hospital, urgent, emergent, and other jobs outside of primary care taking their primary care experience out of the primary care pool.

Appeal to Common Sense

Since there is no research on the importance of primary care experience, perhaps we should appeal to common sense.

Ask yourself what would you like in your physician or practitioner as you approach a health care visit for primary care, mental health, women’s health, urgent care, or retail care?

These are the changes seen

Most years of experience – 10 to 15 on average	Least years at 3 to 6 years
3000 – 4000 experiences or encounters a year	2000 – 2500 experiences or encounters a year
40,000 to 60,000 experiences on average previous to the current visit	8000 to 12000 experiences previous to the current visit
High intensity, broad scope experiences, many patients who were very ill	Low intensity, narrow scope, few patients who were very ill
Supervisory role across career, must deal with the issues, less referral	Less autonomous role, can defer to others, more referral
Engagement level high with each patient encounter as this is your career, it is all that you expect and plan for and prepare for	Less engaged as this job is likely temporary and you will be going to another primary care job or leaving for a specialist job
High levels of continuity and contact with patients and family after a visit to see outcomes	Low levels of continuity and contact due to constant changes in insurance, practices, etc.

In summary, most plans require a primary care physician to see you first. Not all PCPs are the same. Some are internal medicine, Ob/Gyn, Pediatrics or Family Practice. Most family practice physicians who have graduated in the past ten years are board certitifed by the American Board of Family Medicine. 





For more details, refer to this link:





Patient Beware of the New Primary Care Workforce

600 Physicians Say Lockdowns Are A ‘Mass Casualty Incident’

by Grace Marie Turner,  Forbes contributor

More than 600 of the nation’s physicians sent a letter to President Trump this week calling the coronavirus shutdowns a “mass casualty incident” with “exponentially growing negative health consequences” to millions of non COVID patients. 

“The downstream health effects...are being massively under-estimated and under-reported. This is an order of magnitude error," according to the letter initiated by Simone Gold, M.D., an emergency medicine specialist in Los Angeles. 

“Suicide hotline phone calls have increased 600%,” the letter said. Other silent casualties:  “150,000 Americans per month who would have had new cancer detected through routine screening.”

From missed cancer diagnoses to untreated heart attacks and strokes to increased risks of suicides, “We are alarmed at what appears to be a lack of consideration for the future health of our patients.”  

Patients fearful of visiting hospitals and doctors’ offices are dying because COVID-phobia is keeping them from seeking care. One patient died at home of a heart attack rather than go to an emergency room. The number of severe heart attacks being treated in nine U.S hospitals surveyed dropped by nearly 40% since March. Cardiologists are worried “a second wave of deaths” indirectly caused by the virus is likely.

The physicians’ letter focuses on the impact on Americans’ physical and mental health.  “The millions of casualties of a continued shutdown will be hiding in plain sight, but they will be called alcoholism, homelessness, suicide, heart attack, stroke, or kidney failure. In youths it will be called financial instability, unemployment, despair, drug addiction, unplanned pregnancies, poverty, and abuse.

“It is impossible to overstate the short, medium, and long-term harm to people’s health with a continued shutdown,” the letter says. “Losing a job is one of life’s most stressful events, and the effect on a person’s health is not lessened because it also has happened to 30 million [now 38 million] other people.  Keeping schools and universities closed is incalculably detrimental for children, teenagers, and young adults for decades to come.” 

While all 50 states are relaxing lockdowns to some extent, some local officials are threatening to keep stay-at-home orders in place until August.  Many schools and universities say they may remain closed for the remainder of 2020.

“Ending the lockdowns are not about Wall Street or disregard for people’s lives; it about saving lives,” said Dr. Marilyn Singleton, a California anesthesiologist and one of the signers of the letter. “We cannot let this disease change the U.S. from a free, energetic society to a society of broken souls dependent on government handouts.” She blogs about the huge damage the virus reaction is doing to the fabric of society. 

“Even patients who do get admitted to hospital, say for a heart problem, are prisoners. No one can be with them. Visitation at a rare single-story hospital was through closed outside window, talking via telephone,” she wrote us.  “To get permission to go to the window you have to make an appointment (only one group of two per day!), put on a mask, get your temperature taken, and get a visitor's badge of the proper color of the day.”

How many cases of COVID-19 are prevented by these practices? “Zero,” Dr. Orient says.  But the “ loss of patient morale, loss of oversight of care, especially at night are incalculable.”

Virtually all hospitals halted “elective” procedures to make beds available for what was expected to be a flood of COVID-19 patients.  Beds stayed empty, causing harm to patients and resulting in enormous financial distress to hospitals, especially those with limited reserves. 

Even states like New York that have had tough lockdowns are starting to allow elective hospital procedures in some regions.  But it’s more like turning up a dimmer switch. In Pennsylvania, the chair of the Geisinger Heart Institute, Dr. Alfred Casale, said the opening will be slow while the facility is reconfigured for COVID-19 social distancing and enhanced hygiene.  

Will patients come back?  COVID-phobia is deathly real.