California's Governor Newsom Proposes Painful Cuts to Health Care Programs to Close Budget Shortfall

Disaster is coming to some patients on MediCal.   Despite the recent restoration of some MediCal benefits in January 2020, before the Covid-19 pandemic, Governor Newsom now reports a major shortfall in California tax revenues that support many Medi-Cal benefits.  

Unfortunately this reduction in benefits falls most heavily upon those least likely to be able to afford it.

The number of Medi-Cal recipients increased. With so many Californians losing jobs and health insurance because of the pandemic, the state estimates 2 million more people will sign up for Medi-Cal coverage this year, bringing the total caseload in the health care program for low-income Californians to 14.5 million people.

To pay for the increase in enrollment, Gov. Gavin Newsom wants to cut back on some of the benefits patients will receive and the rates doctors will get paid to see them. 

Services like vision care, hearing aids, speech and physical therapy,

podiatry will no longer be covered by Medi-Cal under the Governor's 

revised budget.   

Other items projected are a decrease in senior citizen benefits (another reduction on those who can least afford reductions, since most are on fixed budgets from social security, and are at most risk from the Covid-19 pandemic. 

Doctors groups, which spent millions to help pass the tobacco tax, say this cut to reimbursement rates will create more pressure and uncertainty on physician practices at a time when many are already facing big drops in revenue because of canceled surgeries and appointments. Doctors say this could force them to limit the number of Medi-Cal patients they see. 

There are many items in the California budget, sent to the legislature, which could be eliminated or put on hold to save our low income population from disaster. Our representatives need to do a line by line analysis and make their recommendations, and not blindly stamp an approval on Newsom.s proposals.  Read the link here

 

Governor Proposes Painful Cuts to Health Care Programs to Close Budget Shortfall | KQED

The Hunt for Covid-19 The secret to why some people get so sick from covid could lie in their genes |

23andMe is searching for genetic clues to why some get sick from Covid-19 and others don't even have symptoms.

by Antonio Regalado

GETTY Image

While it is known that older people and those with health conditions such as diabetes are most at risk, there could be hidden genetic reasons why some young, previously healthy people are also dying.  

23andMe operates a large gene database with more than 8 million customers, many of whom have agreed to let their data be used for research. The company has previously used consumer data to power searches for the genetic roots of insomnia, homosexuality, and other traits. 

In April the company, based in Sunnyvale, California, sent covid-19 questionnaires out to a swath of its members. So far, says a company spokesman, about 400,000 have enrolled, including 6,000 who say they have confirmed cases of the pandemic disease.

The 23andMe gene hunt will complement efforts from university researchers to obtain genetic profiles of covid-19 cases and pair them with detailed medical records, says Andrea Ganna, who coordinates the Covid-19 Host Genetic Initiative. The international consortium is sharing genetic data on covid-19 cases from Italy, the UK, and the US and regularly making results public. 23andMe has an enormous database of genomic information at it's command.

Scientists hope to find a gene that strongly influences, or even determines, how badly people are affected by the coronavirus. There are well-known examples of such genetic effects on other diseases: for example, sickle-cell genes confer resistance to malaria, and variants of other genes are known to protect people from HIV or to norovirus, an intestinal germ.

According to Ganna, however, an initial peek at the genes of 900 covid-19 cases turned up no significant genetic hits. His consortium is now preparing an analysis of twice as many cases, which could improve their chance of spotting an association.

Over the counter testing company Ancestry  has recruited 250,000 participants from its own database for the same evaluation.

In the meantime the search for The Vaccine is ongoing.  Click on link below:

SARS-CoV-2: A New Song Recalls an Old Melody.  lin   

The secret to why some people get so sick from covid could lie in their genes | MIT Technology Review

IKONA, the Startup Using VR to Improve Health Literacy, Starting with Dialysis

CEO and founder Tim Fitzpatrick is leveraging the latest in neuroscience research and VR filmmaking to radically improve health education and patient confidence. 

Kidney disease is a large and growing health challenge, in the United States and globally, thanks in part to rising rates of diabetes and high blood pressure. A full 37 million Americans (15% of the adult population) suffer from kidney disease, according to the National Kidney Foundation, and in 2016, more than half a million people had to be put on dialysis at least 3 times a week just to survive. 

This represents a huge cost to Medicare ($114B in 2016) and efforts are now underway to transition dialysis patients to in-home care, a cheaper and more comfortable alternative. This need for this transition to home became even more acute during the COVID-19 pandemic, but how can resource-strapped dialysis clinics — which currently only spend a few minutes on patient education through paper pamphlets — safely and efficiently transition hundreds of thousands of patients to home care?

Levin is a former CEO of Time Warner

It has been said that necessity is the mother of invention. Jerry Levin, ex CEO of Time-Warner shares his own personal experience with dialysis. Following a severe injury from a fall, with multiple injuries he eventually was placed on hemodialysis while rehabilitating in a skilled nursing facility.  The experience was an eye-opener and less than optimal for his condition and many others.

The Centers for Disease Control and Prevention has also provided specific guidelines to address a similar deathtrap: dialysis centers, due to their comparable high volume of older patients (50% of all dialysis patients are over 65) and their history of infections are a very high risk for heightening the spread. More than 725,000 Americans suffer from kidney failure, otherwise known as end-stage renal disease (ESRD). Of these, at least 500,000 individuals are on dialysis.

Receiving home dialysis treatments in a nursing home is not something that is only available to people like me (former CEOs). It could be provided to any patient who needs it. Unfortunately, right now it’s not available to many, which is mainly a function of the red tape and bureaucracy in healthcare. Our current system is characterized by slow decision making, limited willingness to try new and innovative therapies, and stubborn adherence to the status quo of where and how healthcare should be delivered.

But there is a safer way to administer this lifesaving care, and we must urgently make plans to deliver dialysis within nursing home and long-term care facilities, and further to accelerate the provision of dialysis for those able to do it in their home. We must save our elderly and our broader population from this deadly blind spot.

Say Hello to IKONA, the Startup Using VR to Improve Health Literacy, Starting with Dialysis

Covid-19 The Risks - Know Them - Avoid Them

People are hoping and anticipating a return to some form of normalcy.  I have been reading and sourcing many opinions.  I found a well written colloquial article by Professor Erin Bromage. If you are about to venture out into the world with or without the permission of the 'experts' this may give you some guidance. A precautionary Waiver.  I  provide this as information only and not my recommendation to do so.

It seems many people are breathing some relief, and I’m not sure why. An epidemic curve has a relatively predictable upslope and once the peak is reached, the back slope can also be predicted. We have robust data from the outbreaks in China and Italy, that shows the backside of the mortality curve declines slowly, with deaths persisting for months. Assuming we have just crested in deaths at 70k, it is possible that we lose another 70,000 people over the next 6 weeks as we come off that peak. That's what's going to happen with a lockdown. 

 As states reopen, and we give the virus more fuel, all bets are off. I understand the reasons for reopening the economy, but I've said before, if you don't solve the biology, the economy won't recover. 

 There are very few states that have demonstrated a sustained decline in numbers of new infections. Indeed, the majority are still increasing and reopening. As a simple example of the USA trend, when you take out the data from New York and just look at the rest of the USA, daily case numbers are increasing. Bottom line: the only reason the total USA new case numbers look flat right now is because the New York City epidemic was so large and now it is being contained. 

So throughout most of the country we are going to add fuel to the viral fire by reopening. It's going to happen if I like it or not, so my goal here is to try to guide you away from situations of high risk. 

Where are people getting sick?   We know most people get infected in their own home. A household member contracts the virus in the community and brings it into the house where sustained contact between household members leads to infection.   But where are people contracting the infection in the community? I regularly hear people worrying about grocery stores, bike rides, inconsiderate runners who are not wearing masks.... are these places of concern? Well, not really. Let me explain.

In order to get infected you need to get exposed to an infectious dose of the virus; based on infectious dose studies with MERS and SARS, some estimate that as few as 1000 SARS-CoV2 viral particles are needed for an infection to take hold. Please note, this still needs to be determined experimentally, but we can use that number to demonstrate how infection can occur. Infection could occur, through 1000 viral particles you receive in one breath or from one eye-rub, or 100 viral particles inhaled with each breath over 10 breaths, or 10 viral particles with 100 breaths. Each of these situations can lead to an infection.

How much Virus is released into the environment?

 

A Bathroom: Bathrooms have a lot of high touch surfaces, door handles, faucets, stall doors. So fomite transfer risk in this environment can be high. We still do not know whether a person releases infectious material in feces or just fragmented virus, but we do know that toilet flushing does aerosolize many droplets. Treat public bathrooms with extra caution (surface and air), until we know more about the risk. 

 A Cough: A single cough releases about 3,000 droplets and droplets travels at 50 miles per hour. Most droplets are large, and fall quickly (gravity), but many do stay in the air and can travel across a room in a few seconds. 

A cough at 6 meters (18 feet)

A Sneeze: A single sneeze releases about 30,000 droplets, with droplets traveling at up to 200 miles per hour. Most droplets are small and travel great distances (easily across a room).

Speaking: increases the release of respiratory droplets about 10 fold; ~200 copies of virus per minute. Again, assuming every virus is inhaled, it would take ~5 minutes of speaking face-to-face to receive the required dose. 

If a person is infected, the droplets in a single cough or sneeze may contain as many as 200,000,000 (two hundred million) virus particles which can all be dispersed into the environment around them.

 A breath: A single breath releases 50 - 5000 droplets. Most of these droplets are low velocity and fall to the ground quickly. There are even fewer droplets released through nose-breathing. Importantly, due to the lack of exhalation force with a breath, viral particles from the lower respiratory areas are not expelled. 

 Unlike sneezing and coughing which release huge amounts of viral material, the respiratory droplets released from breathing only contain low levels of virus. We don't have a number for SARS-CoV2 yet, but we can use influenza as a guide. We know that a person infected with influenza releases about 3 - 20 virus RNA copies per minute of breathing. 

Remember the formula: Successful Infection = Exposure to Virus x Time. In other words if you have to go somewhere, do not linger.   Have a list for grocery shopping and plan your visit.  Do not  "window shop'.

Air filters may offer additional protection. Hospitals use them all the time, especially in the ER, ICU, and Operating Rooms.  Air Cleaning Technologies An Evidence-Based Analysis

How coronavirus attacks the entire body — damaging the brain, kidneys and more

Modes of transmission of virus causing COVID-19

 

COVID-19 Superspreader Events in 28 Countries: Critical Patterns and Lessons

Understanding Your COVID-19 Test Result

The Risks - Know Them - Avoid Them

Covid Restrictions rescinded in Riverside CA

Good morning, it is 8 AM  Saturday morning on the "Left Coast".  Our restrictions are being loosened, however we are all still wearing masks.  Personally I like it as it gives me a false sense of security, however it reminds me of how close we cam to an even worse disaster with far more deaths that we already have suffered.  It also should remind us it is not over by a long shot.  Numerous predictions about the long term outcome vary greatly from utter destruction of world economics, to it will rebound quickly.  The. stock market seems to have largely ignored the pandemic, after showing an initial decline.  Perhaps no one is working at the NYSE. (Was it determined to be non essential?). It makes a few very rich, and no longer reflects real value of a company.  Social media has more predictive value. The stock market is like a horse race, all bets are off, and chances are the odds are worse in the stock market, and better at the Kentucky Derby where there are less than 20 horses.  You have a far better chance of. picking a winner out of a field of twenty than hundreds of stocks. 

Nothing will be the same? Yes, it will

Where are we this morning?  

Riverside County officials vote to rescind all local coronavirus public health orders.    reported by the LA Times

 Woman wearing a MAGA hat (near exit sign)

With 4,817 COVID-19 cases, Riverside County has the second highest number in the state. A total of 204 people have died from the disease, an increase of 20 since Tuesday. More than 66,000 people have been tested thus far, and nearly 2,500 have recovered.

The Board of Supervisors voted to lift the closure of vocational and higher-education schools, end the restriction on golf courses, eliminate limitations on short-term lodging, and remove the requirements to wear face coverings and engage in social distancing.

Comments from the Supervisors.

Officials also voted for the use of face coverings to be “strongly recommended” by the county, instead of being mandated as Kaiser implemented last month. The use of masks is only a recommendation on the state level.

During the meeting, 5th District Supervisor Jeff Hewitt said that he didn’t feel he needed to wear a mask, citing conflicting evidence of its benefits, but that he would continue to do so if certain businesses require it.

Like his colleagues, 4th District Supervisor V. Manuel Perez, the board chair, called the guidelines unattainable and impossible for Riverside County and any other urban counties with large populations.

When 1st District Supervisor Kevin Jeffries said the county didn’t have the power to revoke Newsom’s orders, Hewitt countered: “The funny part is we do all the enforcement, so his power is powerless if you don’t enforce it.”

Sheriff Chad Bianco had said Tuesday that he would not be enforcing any of the county’s restrictions, which he believed to be unreasonable. During public comment on both days, many protesters voiced their support of him.

Local health experts weren’t given time to speak during Friday’s board meeting, but Vice Chair and 2nd District Supervisor Karen Spiegel said that she’d spoken to Kaiser about potentially amending the mask requirement.

On Tuesday, Kaiser said his position hadn’t changed, and he credited the county’s lower-than-expected COVID-19 cases and deaths to the strict orders. (conflicting statistics from the Los Angeles Times) (see below)

"With 4,817 COVID-19 cases, Riverside County has the second highest number in the state. A total of 204 people have died from the disease, an increase of 20 since Tuesday. More than 66,000 people have been tested thus far, and nearly 2,500 have recovered. He was not available for comment Friday night, and it was not clear if his position had changed, though he apparently plans to sign the recission orders."

Local health experts weren’t given time to speak during Friday’s board meeting, but Vice Chair and 2nd District Supervisor Karen Spiegel said that she’d spoken to Cameron Kaiser M.D., County Chief Public Health Officer, about potentially amending the mask requirement.

Comment from an octogenarian

A 78-year-old man, who spoke in support of rescission, agreed with Hewitt said that he wears a mask only when he’s around people who are afraid. “I’m not afraid.... People get old and they die.”

https://www.domesticpreparedness.com/journals/march-2020/

Scientists Say Llama Antibodies Could Be Key to Defeating COVID

Scientists Say Llama Antibodies Could Be Key to Defeating COVID

"This is one of the first antibodies known to neutralize SARS-CoV-2."

According to a new study by an international team of researchers, antibodies found in the blood of llamas were able to stave off coronavirus infections.

“This is one of the first antibodies known to neutralize SARS-CoV-2,” Jason McLellan, from the University of Texas at Austin and co-author of the study, said in a statement.

The researchers built on previous research from four years ago in which they found that the antibodies from a then 9-month-old llama named Winter were able to neutralize both SARS-CoV-1 and MERS-CoV viruses over six weeks.

Luckily, the antibodies from Winter — who’s now four years old — also staved off SARS-CoV-2, the virus that causes COVID-19. Winter is a 4-year-old chocolate-colored llama with spindly legs, ever-so-slightly askew ears and envy-inducing eyelashes. Some scientists hope she might be an important figure in the fight against the novel coronavirus.  “Vaccines have to be given a month or two before infection to provide protection,” McLellan said in the statement. “With antibody therapies, you’re directly giving somebody the protective antibodies and so, immediately after treatment, they should be protected.”

The Llama and the Nanobody

The molecule the team produced, and for which they obtained a structure, represents only the extracellular portion of the spike protein, but it is enough to elicit an immune response in people, and thus serve as a vaccine.

“The antibodies could also be used to treat somebody who is already sick to lessen the severity of the disease,” McLellan added.She is not a superpowered camelid. Winter was simply the lucky llama chosen by researchers in Belgium, where she lives, to participate in a series of virus studies involving both SARS and MERS. Finding that her antibodies staved off those infections, the scientists posited that those same antibodies could also neutralize the new virus that causes Covid-19. They were right, and published their results Tuesday in the journal Cell.

Surprisingly, this isn’t the first time llamas have been used in antibody research, as The New York Times reports. Llama antibodies have been used in work related to HIV and influenza, where they helped discover promising therapies.

This is a 3D atomic scale map, or molecular structure, of the 2019-nCoV spike protein. The protein takes on two different shapes, called conformations—one before it infects a host cell, and another during infection. This structure represents the protein before it infects a cell, called the prefusion conformation.

Thanks to the llamas’ antibodies’ small size, they can connect with different parts of the virus more easily.  “The antibodies could also be used to treat somebody who is already sick to lessen the severity of the disease,” McLellan added.

“The binding of this antibody to spike is able to prevent attachment and entry, which effectively neutralizes the virus,” Daniel Wrapp, Dartmouth Ph.D. candidate and co-author, explained in the statement.

Scientists are hopeful a treatment plan for the newly infected in the form of antibody therapies is particularly promising.

Scientists Say Llama Antibodies Could Be Key to Defeating COVID:

Emotional Well-Being During the COVID-19 Crisis for Health Care Provider...

Healthcare Personnel and First Responders: How to Cope with Stress and Build Resilience During the COVID-19 Pandemic

Providing care to others during the COVID-19 pandemic can lead to stress, anxiety, fear, and other strong emotions. How you cope with these emotions can affect your well-being, the care you give to others while doing your job, and the well-being of the people you care about outside of work. During this pandemic, it is critical that you recognize what stress looks like, take steps to build your resilience and cope with stress, and know where to go if you need help.

Mechanisms in neurobiology which help physicians and caregivers to deal with covid-19 patients.

Recognize the symptoms of stress you may be experiencing.

1. Feeling irritation, anger, or denial
2. Feeling uncertain, nervous, or anxious
3. Feeling helpless or powerless
4. Lacking motivation
5. Feeling tired, overwhelmed, or burned out
6. Feeling sad or depressed
7. Having trouble sleeping
8. Having trouble concentrating

Tips to cope and enhance your resilience.

Communicate with your coworkers, supervisors, and employees about job stress.
Talk openly about how the pandemic is affecting your work.
Identify factors that cause stress and work together to identify solutions.
Ask about how to access mental health resources in your workplace.
Remind yourself that everyone is in an unusual situation with limited resources.
Identify and accept those things which you do not have control over.
Recognize that you are performing a crucial role in fighting this pandemic and that you are doing the best you can with the resources available.
Increase your sense of control by keeping a consistent daily routine when possible — ideally one that is similar to your schedule before the pandemic.
Try to get adequate sleep.
Make time to eat healthy meals.
Take breaks during your shift to rest, stretch, or check in with supportive colleagues, coworkers, friends and family.
When away from work, get exercise when you can. Spend time outdoors either being physically activity or relaxing. Do things you enjoy during non-work hours.
Take breaks from watching, reading, or listening to news stories, including social media. Hearing about the pandemic repeatedly can be upsetting and mentally exhausting, especially since you work with people directly affected by the virus.
If you feel you may be misusing alcohol or other drugs (including prescriptions), ask for help.
Engage in mindfulness techniques, such as breathing exercises and meditation.
If you are being treated for a mental health condition, continue with your treatment and talk to your provider if you experience new or worsening symptoms.

Stress and Coping

Stress during an infectious disease outbreak can include

• Fear and worry about your own health and the health of your loved ones
• Changes in sleep or eating patterns
• Difficulty sleeping or concentrating
• Worsening of chronic health problems
• Worsening of mental health conditions
• Increased use of alcohol, tobacco, or other drugs

Self assessment and inventory.

People who may respond more strongly to the stress of a crisis include

Older people and people with chronic diseases who are at higher risk for severe illness from COVID-19

Children and teens

People who are helping with the response to COVID-19, like doctors, other health care providers, and first responders

People who have mental health conditions including problems with substance use

Pre-existing conditions

High risk categories...age, chronic illness, emotional wellness

Note: Self assessment can be very difficult. Due to peer pressure, shaming and self esteem issues it is very easy to be in denial.  Ask for help when you feel overwhelmed and/or inadequate.  Others are experiencing these feelings as well. Sharing is caring.

Hopefully this post will help those on the front lines of the covid pandemic.

Please consult with a trusted professional before acting on information in this post.

Stay safe !