Monthly Archives: April 2020

    BERLIN (Reuters) – When he was diagnosed with COVID-19, Andre Bergmann knew exactly where he wanted to be treated: the Bethanien hospital lung clinic in Moers, near his home in northwestern Germany

    The clinic is known for its reluctance to put patients with breathing difficulties on mechanical ventilators – the kind that involve tubes down the throat.

    The 48-year-old physician, father of two and aspiring triathlete worried that an invasive ventilator would be harmful. But soon after entering the clinic, Bergmann said, he struggled to breathe even with an oxygen mask, and felt so sick the ventilator seemed inevitable.

    Even so, his doctors never put him on a machine that would breathe for him. A week later, he was well enough to go home.

    Bergmann’s case illustrates a shift on the front lines of the COVID-19 pandemic, as doctors rethink when and how to use mechanical ventilators to treat severe sufferers of the disease – and in some cases whether to use them at all. While initially doctors packed intensive care units with intubated patients, now many are exploring other options.

    Machines to help people breathe have become the major weapon for medics fighting COVID-19, which has so far killed more than 183,000 people. Within weeks of the disease’s global emergence in February, governments around the world raced to build or buy ventilators as most hospitals said they were in critically short supply.

    Germany has ordered 10,000 of them. Engineers from Britain to Uruguay are developing versions based on autos, vacuum cleaners or even windshield-wiper motors. U.S. President Donald Trump’s administration is spending $2.9 billion for nearly 190,000 ventilators. The U.S. government has contracted with automakers such as General Motors Co and Ford Motor Co as well as medical device manufacturers, and full delivery is expected by the end of the year. Trump declared this week that the U.S. was now “the king of ventilators.”

    However, as doctors get a better understanding of what COVID-19 does to the body, many say they have become more sparing with the equipment.

    Reuters interviewed 30 doctors and medical professionals in countries including China, Italy, Spain, Germany and the United States, who have experience of dealing with COVID-19 patients. Nearly all agreed that ventilators are vitally important and have helped save lives. At the same time, many highlighted the risks from using the most invasive types of them – mechanical ventilators – too early or too frequently, or from non-specialists using them without proper training in overwhelmed hospitals.

    Medical procedures have evolved in the pandemic as doctors better understand the disease, including the types of drugs used in treatments. The shift around ventilators has potentially far-reaching implications as countries and companies ramp up production of the devices.

    “BETTER RESULTS”

    Many forms of ventilation use masks to help get oxygen into the lungs. Doctors’ main concern is around mechanical ventilation, which involves putting tubes into patients’ airways to pump air in, a process known as intubation. Patients are heavily sedated, to stop their respiratory muscles from fighting the machine.

    Those with severe oxygen shortages, or hypoxia, have generally been intubated and hooked up to a ventilator for up to two to three weeks, with at best a fifty-fifty chance of surviving, according to doctors interviewed by Reuters and recent medical research. The picture is partial and evolving, but it suggests people with COVID-19 who have been intubated have had, at least in the early stages of the pandemic, a higher rate of death than other patients on ventilators who have conditions such as bacterial pneumonia or collapsed lungs.

    This is not proof that ventilators have hastened death: The link between intubation and death rates needs further study, doctors say.

    In China, 86% of 22 COVID-19 patients didn’t survive invasive ventilation at an intensive care unit in Wuhan, the city where the pandemic began, according to a study published in The Lancet in February. Normally, the paper said, patients with severe breathing problems have a 50% chance of survival. A recent British study found two-thirds of COVID-19 patients put on mechanical ventilators ended up dying anyway, and a New York study found 88% of 320 mechanically ventilated COVID-19 patients had died.

    More recently, none of the eight patients who went on ventilators at the Abu Dhabi hospital had died as of April 9, a doctor there told Reuters. And one ICU doctor at Emory University Hospital in Atlanta said he had had a “good” week when almost half the COVID-19 patients were successfully taken off the ventilator, when he had expected more to die.

    The experiences can vary dramatically. The average time a COVID-19 patient spent on a ventilator at Scripps Health’s five hospitals in California’s San Diego County was just over a week, compared with two weeks at the Hadassah Ein Kerem Medical Center in Jerusalem and three at the Universiti Malaya Medical Centre in the Malaysian capital Kuala Lumpur, medics at the hospitals said.

    In Germany, as patient Bergmann struggled to breathe, he said he was getting too desperate to care.

    “There came a moment when it simply no longer mattered,” he told Reuters. “At one point I was so exhausted that I asked my doctor if I was going to get better. I was saying, if I had no children or partner then it would be easier just to be left in peace.”

    Instead of putting Bergmann on a mechanical ventilator, the clinic gave him morphine and kept him on the oxygen mask. He’s since tested free of the infection, but not fully recovered. The head of the clinic, Thomas Voshaar, a German pulmonologist, has argued strongly against early intubation of COVID-19 patients. Doctors including Voshaar worry about the risk that ventilators will damage patients’ lungs.

    The doctors interviewed by Reuters agreed that mechanical ventilators are crucial life-saving devices, especially in severe cases when patients suddenly deteriorate. This happens to some when their immune systems go into overdrive in what is known as a “cytokine storm” of inflammation that can cause dangerously high blood pressure, lung damage and eventual organ failure.

    The new coronavirus and COVID-19, the disease the virus causes, have been compared to the Spanish flu pandemic of 1918-19, which killed 50 million people worldwide. Now as then, the disease is novel, severe and spreading rapidly, pushing the limits of the public health and medical knowledge required to tackle it.

    When coronavirus cases started surging in Louisiana, doctors at the state’s largest hospital system, Ochsner Health, saw an influx of people with signs of acute respiratory distress syndrome, or ARDS. Patients with ARDS have inflammation in the lungs which can cause them to struggle to breathe and take rapid short breaths.

    “Initially we were intubating fairly quickly on these patients as they began to have more respiratory distress,” said Robert Hart, the hospital system’s chief medical officer. “Over time what we learned is trying not to do that.”

    Instead, Hart’s hospital tried other forms of ventilation using masks or thin nasal tubes, as Voshaar did with his German patient. “We seem to be seeing better results,” Hart said.

    CHANGED LUNGS

    Other doctors painted a similar picture.

    In Wuhan, where the novel coronavirus emerged, doctors at Tongji Hospital at the Huazhong University of Science and Technology said they initially turned quickly to intubation. Li Shusheng, head of the hospital’s intensive care department, said a number of patients did not improve after ventilator treatment.

    “The disease,” he explained, “had changed their lungs beyond our imagination.” His colleague Xu Shuyun, a doctor of respiratory medicine, said the hospital adapted by cutting back on intubation.

    Luciano Gattinoni, a guest professor at the Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen in Germany, and a renowned expert in ventilators, was one of the first to raise questions about how they should be used to treat COVID-19.

    “I realised as soon as I saw the first CT scan … that this had nothing to do with what we had seen and done for the past 40 years,” he told Reuters.

    In a paper published by the American Thoracic Society on March 30, Gattinoni and other Italian doctors wrote that COVID-19 does not lead to “typical” respiratory problems. Patients’ lungs were working better than they would expect for ARDS, they wrote – they were more elastic. So, he said, mechanical ventilation should be given “with a lower pressure than the one we are used to.”

    Ventilating some COVID-19 sufferers as if they were standard patients with ARDS is not appropriate, he told Reuters. “It’s like using a Ferrari to go to the shop next door, you press on the accelerator and you smash the window.”

    The Italians were swiftly followed by Cameron Kyle-Sidell, a New York physician who put out a talk on YouTube saying that by preparing to put patients on ventilators, hospitals in America were treating “the wrong disease.” Ventilation, he feared, would lead to “a tremendous amount of harm to a great number of people in a very short time.” This remains his view, he told Reuters this week.

    When Spain’s outbreak erupted in mid-March, many patients went straight onto ventilators because lung X-rays and other test results “scared us,” said Delia Torres, a physician at the Hospital General Universitario de Alicante. They now focus more on breathing and a patient’s overall condition than just X-rays and tests. And they intubate less. “If the patient can get better without it, then there’s no need,” she said.

    In Germany, lung specialist Voshaar was also concerned. A mechanical ventilator itself can damage the lungs, he says. This means patients stay in intensive care longer, blocking specialist beds and creating a vicious circle in which ever more ventilators are needed.

    Of the 36 acute COVID-19 patients on his ward in mid-April, Voshaar said, one had been intubated – a man with a serious neuro-muscular disorder – and he was the only patient to die. Another 31 had recovered.

    “IRON LUNGS”

    Some doctors cautioned that the impression that the rush to ventilate is harmful may be partly due to the sheer numbers of patients in today’s pandemic.

    People working in intensive care units know that the mortality rate of ARDS patients who are intubated is around 40%, said Thierry Fumeaux, head of an ICU in Nyon, Switzerland, and president of the Swiss Intensive Care Medicine Society. That is high, but may be acceptable in normal times, when there are three or four patients in a unit and one of them doesn’t make it.

    “When you have 20 patients or more, this becomes very evident,” said Fumeaux. “So you have this feeling – and I’ve heard this a lot – that ventilation kills the patient.” That’s not the case, he said. “No, it’s not the ventilation that kills the patient, it’s the lung disease.”

    Mario Riccio, head of anaesthesiology and resuscitation at the Oglio Po hospital near Cremona in Lombardy, Italy’s worst-hit region, says the machines are the only treatment to save a COVID-19 patient in serious condition. “The fact that people who were placed under mechanical ventilation in some cases die does not undermine this statement.”

    Originally nicknamed “iron lungs” when introduced in the 1920s and 1930s, mechanical ventilators are sometimes also called respirators. They use pressure to blow air – or a mixture of gases such as oxygen and air – into the lungs.

    They can be set to exhale it, too, effectively taking over a patient’s entire breathing process when their lungs fail. The aim is to give the body enough time to fight off an infection to be able to breathe independently and recover.

    Some patients need them because they’re losing the strength to breathe, said Yoram Weiss, director of Hadassah Ein Kerem Medical Center in Jerusalem. “It is very important to ventilate them before they collapse.” At his hospital, 24 of 223 people with COVID-19 had been put on ventilators by April 13. Of those, four had died and three had come off the machines.

    AEROSOLS

    Simpler forms of ventilation – face masks for example – are easier to administer. But respirator masks can release micro-droplets known as aerosols which may spread infection. Some doctors said they avoided the masks, at least at first, because of that risk.

    While mechanical ventilators do not produce aerosols, they carry other risks. Intubation requires patients to be heavily sedated so their respiratory muscles fully surrender. The recovery can be lengthy, with a risk of permanent lung damage.

    Now that the initial wave of COVID-19 cases has peaked in many countries, doctors have time to examine other ways of managing the disease and are fine-tuning their approach.

    Voshaar, the German lung specialist, said some doctors were approaching COVID-19 lung problems as they would other forms of pneumonia. In a healthy patient, oxygen saturation – a measure of how much oxygen the haemoglobin in the blood contains – is around 96% of the maximum amount the blood can hold. When doctors check patients and see lower levels, indicating hypoxia, Voshaar said, they can overreact and race to intubate.

    “We lung doctors see this all the time,” Voshaar told Reuters. “We see 80% and still do nothing and let them breathe spontaneously. The patient doesn’t feel great, but he can eat and drink and sit on the side of his bed.”

    He and other doctors think other tests can help before intubation. Voshaar looks at a combination of measures including how fast the patient is breathing and their heart rate. His team are also guided by lung scans.

    “HAPPY HYPOXICS”

    Several doctors in New York said they too had started to consider how to treat patients, known as “happy hypoxics,” who can talk and laugh with no signs of mental cloudiness even though their oxygen might be critically low.

    Rather than rushing to intubate, doctors say they now look for other ways to boost the patients’ oxygen. One method, known as “proning,” is telling or helping patients to roll over and lie on their fronts, said Scott Weingart, head of emergency critical care at Stony Brook University Medical Center on Long Island.

    “If patients are left in one position in bed, they tend to desaturate, they lose the oxygen in their blood,” Weingart said. Lying on the front shifts any fluid in the lungs to the front and frees up the back of the lungs to expand better. “The position changes have radically impressive effects on the patient’s oxygen saturations.”

    Weingart does recommend intubating a communicative patient with low oxygen levels if they start to lose mental clarity, if they experience a cytokine storm or if they start to really struggle to breathe. He feels there are enough ventilators for such patients at his hospital.

    But for happy hypoxics, “I still don’t want these patients on ventilators, because I think it’s hurting them, not helping them.”

    QUALITY, SKILL

    As governments in the United States and elsewhere are scrambling to raise output of ventilators, some doctors worry the fast-built machines may not be up to snuff.

    Doctors in Spain wrote to their local government to complain that ventilators it had bought were designed for use in ambulances, not intensive care units, and some were of poor quality. In the UK, the government has cancelled an order for thousands of units of a simple model because more sophisticated devices are needed.

    More important, many doctors say, is that the additional machines will need highly trained and experienced operators.

    “It’s not just about running out of ventilators, it’s running out of expertise,” said David Hill, a pulmonology and critical care physician in Waterbury, Connecticut, who attends at Waterbury Hospital.

    Long-term ventilation management is complex, but Hill said some U.S. hospitals were trying to bring non-critical care physicians up to speed fast with webinars or even tip sheets. “That is a recipe for bad outcomes.”

    “We intensivists don’t ventilate by protocol,” said Hill. “We may choose initial settings,” he said, “but we adjust those settings. It’s complicated.”

    Escritt reported from Berlin, Aloisi from Milan, Beasley from Los Angeles, Borter from New York and Kelland from London. Additional reporting: Alexander Cornwell in Abu Dhabi, Panu Wongcha-um in Bangkok, Maayan Lubell in Jerusalem, A. Ananthalakshmi and Rozanna Latif in Kuala Lumpur, Kristina Cooke in Los Angeles, Sonya Dowsett in Madrid, Jonathan Allen and Nicholas Brown in New York, John Mair in Sydney, Costas Pitas in London, David Shepardson in Washington DC, Brenda Goh in Wuhan and John Miller in; Zurich. Writing by Andrew RC Marshall and Kate Kelland; Edited by Sara Ledwith and Jason Szep

     

      El gobierno podrá asistir a los pequeños empresarios y auxiliar a los municipios con los fondos que recibió esta seman
      San Juan, PR - Las guías del Departamento del Tesoro federal sobre el uso de los $2,200 millones que el gobierno de Puerto Rico recibió el miércoles para asistir con los gastos de la emergencia que genera el coronavirus permiten que se otorgue asistencia adicional a las pequeñas empresas y se auxilie a los municipios

      Así mismo, autorizan financiar con ese dinero -que es parte de la ley de estímulo económico federal Cares-, los gastos de la enseñanza a distancia debido al cierre de escuelas, y la entrega de alimentos a adultos mayores u otros sectores vulnerables de la población, como los desamparados.

      Aunque la gobernadora Wanda Vázquez Garced dijo que todavía no se habían notificados las normas referentes a esos fondos, el Departamento del Tesoro las publicó el mismo miércoles que desembolsó el dinero.

      Según las normas del Tesoro, los gobiernos estatales, territoriales y locales que reciben esa asignación, solo podrán utilizarla para “responder a la emergencia pública de salud”. Los gastos no pueden haber estado presupuestados antes de la emergencia y el dinero debe utilizarse entre el 1 de marzo y el 30 de diciembre de 2020.

      Como era de esperarse, las guías permiten que el dinero se destine a gastos relacionados con el fortalecimiento de los hospitales públicos, clínicas y otros centros de salud, incluso para habilitar instalaciones temporales, sus costos de construcción y el transporte médico de emergencia.

      También podrán financiarse la compra y suministro de pruebas de detección del COVID-19, incluidas las pruebas serológicas, los costos de establecer medicina pública, la desinfección de áreas públicas, la adquisición de suministros médicos, desinfectantes, y equipos de protección de personal (PPE).

      Las guías federales autorizan además asignar fondos para gastos por asistencia técnica a los gobiernos municipales, medidas de seguridad públicas, el costo de colocar a personas en cuarentena, gastos de nómina para seguridad pública, salud pública, y cuidado médico, y de asegurar la salud en las prisiones

      Para poder cumplir con las medidas de salud pública, las normas el Tesoro aprueban que los $2,200 millones puedan financiar las capacidades de los gobiernos para que sus empleados desempeñen trabajo remoto.

      El gobierno de Puerto Rico, además, podrá costear con ese dinero las licencias por enfermedad y familiares que sean necesarias para mantener las medidas que buscan evitar la propagación del virus.

      Con respecto a medidas económicas, el Tesoro autorizó que el dinero se utilice para proveer subsidios a pequeños empresarios que reembolsen el costo de la interrupción de la economía, el costo de los seguros de desempleo – si no han sido reembolsados por el gobierno federal-, y gastos de apoyo a la nómina gubernamental.

      La ayuda a los pequeños empresarios sería independiente a los programas establecidos por la ley Cares a través de la Administración de Pequeños Negocios (SBA).

      Como ejemplo de iniciativas prohibidas por estas guías, el Tesoro mencionó el pareo de fondos para los servicios médicos asociados a Medicaid, daños que son cubiertos por seguros y gastos de nómina de los gobiernos de personal cuyas tareas no están relacionadas a la mitigación o respuesta a esta emergencia de salud pública.

       

      (Reuters) – The U.S. Supreme Court on Thursday made it easier for federal authorities to deport certain immigrants who have committed crimes in a victory for President Donald Trump’s administration.

      The court ruled 5-4, with the conservative justices in the majority, to uphold a lower court decision that found a legal permanent resident from Jamaica named Andre Martello Barton ineligible to have his deportation canceled under a U.S. law that lets some longtime legal residents avoid expulsion.

      Barton was targeted for deportation after criminal convictions in Georgia for drug and gun crimes.

      The decision could affect thousands of immigrants with criminal convictions – many for minor offenses – who reside legally in the United States

      The Trump administration argued against Barton’s bid to avoid removal. Trump’s hardline stance on both legal and illegal immigration has been a key feature of his presidency and his 2020 re-election campaign. He has justified his immigration crackdown in part by citing crimes committed by immigrants.

      Permanent residents selected for deportation may apply to have their removal canceled if they have been living continuously in the United States for at least seven years, except if they have committed certain serious felonies.

      Reporting by Andrew Chung in New York; Editing by Will Dunham

       

        Washington – El presidente del Comité de Finanzas del Senado de Estados Unidos, el republicano Charles Grassley, ha pedido cuentas a la gobernadora Wanda Vázquez Garced sobre el escándalo de los contratos para la compra de pruebas rápidas de detección del coronavirus y las razones para la renuncia reciente de altas funcionarias del Departamento de Salud.

        En una carta enviada hoy con reclamos abarcadores de información, Grassley también ha solicitado un listado de investigaciones iniciadas este cuatrienio por el gobierno de Puerto Rico sobre posibles actos de malversación.

        El senador Grassley hizo referencia no solo a las pruebas rápidas de detección del virus, sino a los escándalos sobre el almacén con suministros en Ponce, en torno al contrato con la empresa Whitefish Energy, el vehículo blindado de $245,000 adquirido por el gobierno de Ricardo Rosselló Nevares, la politización del Instituto de Estadísticas y la demanda a que se enfrentó el gobierno de la Isla por la falta de información pública en torno a las fatalidades ocurridas a causa del huracán María.

        La mayor parte de sus peticiones se centran en las denuncias sobre los contratos por más de $40 millones para comprar pruebas rápidas para detectar el coronavirus a empresas sin ninguna experiencia en el manejo de productos médicos, a costos al parecer muy por encima de su valor en el mercado internacional y sin garantía de que el gobierno de Estados Unidos autorizaría su uso en Puerto Rico.

        La más grande de esas transacciones – la compra de un millón de pruebas rápidas de coronavirus por $38 millones a la empresa de construcción Apex General Contractors, con conexiones políticas con el Partido Nuevo Progresista (PNP)-, fue cancelada cuando la compañía no pudo cumplir con la fecha de entrega, prevista para el 31 de marzo.

        “Parece que las adquisiciones y contrataciones en Puerto Rico a menudo pasan por un filtro de conexiones políticas antes de que los recursos destinados al pueblo de Puerto Rico realmente los alcancen y logren el uso previsto, privando al pueblo de Puerto Rico de la primacía que se merecen”, indicó Grassley en la carta a la gobernadora.

        En su misiva, Grassley también pidió explicaciones sobre el escándalo del almacén de suministros de Ponce, ocurrido durante la emergencia de los recientes terremotos, y el descubrimiento reciente de medicamentos expirados que estaban bajo el control del Departamento de Salud de Puerto Rico.

        Grassley, como presidente del Comité de Finanzas, tiene bajo su supervisión programas como Medicaid y temas tributarios de importancia para la Isla. Quiere las respuestas en una semana, para el lunes 27 de abril.

        El senador republicano hizo referencia a que los escándalos en el gobierno de Puerto Rico se desatan en momentos en que el pueblo de Puerto Rico “ha sufrido graves dificultades debido a una secuencia de desastres naturales y la emergencia de salud pública asociada con el novel coronavirus, COVID-19”.

        Grassley recordó que el Congreso “ha aumentado significativamente los fondos para el sistema de salud de Puerto Rico, incluidos los fondos de Medicare y Medicaid, así como fondos para medidas para enfrentar COVID-19”.

        Grassley destacó que El Nuevo Día reportó que las transacciones para la compra de pruebas rápidas del COVID-19 están ya bajo investigación del FBI.

        Entre las preguntas que le hace el senador republicano a la gobernadora se encuentran las razones para las renuncias de la ex secretaria interina de Salud Concepción Quiñones de Longo, la anterior jefa de Epidemióloga Carmen Deseda y Adil Rosa.

        Requirió que se le precise quien en el gobierno de Puerto Rico tomó la decisión de comprar las pruebas rápidas o entrar en los contratos con las empresas Apex y 313 LLC, la cadena de decisiones que tuvo ese proceso y si hubo consideraciones político-partidistas.

         

         

        19 de enero de 2017 - Fotos genéricas en Washington D.C. En la Foto: Corte Suprema de los Estados Unidos de América; Supreme Court of the United States; SCOTUS.

        Hasta hoy, no se requería que el veredicto de culpabilidad fuera unánime, sino que fuera, por lo menos, de 9 a 3

        El Tribunal Supremo de los Estados Unidos emitió una decisión hoy que cambia directamente una disposición sobre juicios criminales que contiene la Constitución del Estado Libre Asociado y los Estados Unidos

        Se trata de la decisión en el caso Ramos v. Loiusiana, en la cual el Supremo federal sostuvo que los derechos de un acusado por delito grave en juicio por jurado incluyen que el veredicto en su contra tiene que ser unánime, tal y como lo es en la esfera federal.

        En Puerto Rico, la Constitución indica en la Sección 11 del Artículo II (Carta de Derechos) que los acusados por delito grave tienen derecho a que el veredicto en su contra sea “por mayoría de votos en el cual deberán concurrir no menos de nueve”.

        Por tanto, en Puerto Rico, hasta hoy, no se requería que el veredicto de culpabilidad fuera unánime, sino que fuera, por lo menos, de 9 a 3.

        En los casos que se dilucidan en el Tribunal de los Estados Unidos para el Distrito de Puerto Rico, el requerimiento sí ha sido que el veredicto sea unánime y eso no cambia con esta decisión.

         

        It’s been well over a month since COVID-19 sent plenty of shoppers panic buying and some stores to price gauge. One local lawmakers says that price gauging is still happening here in Western New York.

        Erie County Legislator Howard Johnson said some corner stores in his district are charging ridiculous prices for essential products. Johnson said at least one store in Buffalo is charging $75 for a box of masks. The same box would cost $10 at a big box hardware store. He said, he understands there are supply issues, but that shouldn’t mean prices are inflate to this amount.

        He’s proposing the Erie County Office of Public Advocacy take a closer look.

        The City of Buffalo and the State of New York have already been looking into price gouging. If you suspect a store is price gouging, the NYS Attorney General’s office has a website to file a complaint.

          Nurses are facing unprecedented challenges right now—supply shortages, shifting protocols, and uncertainty about their own health status in the absence of readily available tests for COVID-19. With these realities in mind, we’ve gathered some stories that showcase nurses’ responses to the pandemic, their needs at this difficult time, and actions taken by their leaders and government, which directly impact those providing care. In this post, we hear from nurses on the frontline. In a separate post, we look at what government and nurse leaders are doing to ensure the nursing workforce is adequate and protected during the COVID-19 pandemic.

          Preparedness varies

          At Buffalo General Hospital, which treated some of the first U.S. patients diagnosed with COVID-19, intensive care unit nurse Stephanie Bandyk, RN, painted a reassuring picture last week. She reported that she and her colleagues had adequate personal protective equipment (PPE) to do their jobs safely and that educators were readily available to staff, making sure everyone was using their PPE properly.

          In contrast, Puerto Rico-based travel nurse Carmen Rios, RN, told STAT News, “This is unlike any other outbreak I’ve been involved with.” Rios worked during the H1N1 epidemic and has spoken with other health workers in her region. “There’s absolutely no training and information to the staff that will be involved. And no message to the community that would lower cases, thereby allowing better care in our facilities.”

          STAT also quoted other hospital employees frustrated by their inability to get tested for COVID-19 despite having recently been ill. A certified nurse assistant (CNA) in New York described the situation as confusing, arbitrary, and chaotic. “No one among the CNA staff is talking about this in any meaningful way,” she said. “If the nurses are, I don’t know about it.”

          “Nurses often face what is called moral distress—defined as knowing what should be done for a patient while at the same time being unable to provide the appropriate care, often because of constraints imposed by organizations or practice settings,” wrote University of Pennsylvania nursing and bioethics professor Connie Ulrich, PhD, RN, FAAN, in a March 10 op-ed in The Boston Globe. She cited a national survey, which had 8,200 respondents as of March 16. Most of those nurses reported their employers had inadequate protective equipment on hand and had not sufficiently informed them about how to recognize and respond to cases of COVID-19.

          Many of these concerns center on the risk health workers face of contracting the virus given insufficient stocks of PPE, insufficient training in how to use it properly, and shifting guidance. The Centers for Disease Control and Prevention (CDC) revised its interim infection prevention and control recommendations for COVID-19 in light of increased demand for PPE and supply-chain disruptions. “Many of us were taken aback to read the new document,” wrote Betsy Todd, MPH, RN, in the American Journal of Nursing’s Off the Charts blog. She explained the CDC rationale for recommending the use of regular surgical face masks instead of N95s and reminded readers that PPE is not the only line of defense against the virus. “Engineering and administrative controls are considered the most effective infection prevention measures, because they are ‘built into’ physical systems and protocols,” she said.

          Self-care

          As rewarding as it is, nursing is a challenging profession under the best of circumstances. Under current conditions, nurses need all the support they can get to stay healthy and well. For some, free access to the Headspace meditation and mindfulness app may help. For others, the knowledge they acquire from Nurse.com’s free course on COVID-19 may give them a greater sense of control. For those not engaged in direct care, such as the Berkeley, Calif., nurse-midwife student Britt Urban, RN, who is organizing volunteers in her community, finding a purpose and serving others may provide a path through this crisis.

          Last week, one nurse at a major New York hospital shared her fears and the source of her strength—from first hearing about the virus in January until last week, when she volunteered to fill in on a unit that had placed many of her colleagues in quarantine. “I’m staying calm by thinking about how I’ve handled really tough days in the past before—and I got through it,” she said. “I have a really great team of nurses that I’ve worked with and I’m not alone in this. This is going to be something that we will get through.”

            Puerto Rico and Most States highly affected by COVID 19 unable to keep up with unemployment  claims.

            Gov. Andrew M. Cuomo has repeatedly promised to fix New York’s archaic unemployment-insurance system, which has been overwhelmed by an unprecedented wave of claims.

            The state has partnered with Google to overhaul the online application, staffed call centers with thousands of additional workers and expanded their call-volume capacity, and vowed to address outstanding unemployment claims within 72 hours.

            Carly Keohane has yet to benefit from any of those improvements.

            Ms. Keohane, who lost her waitressing job in Rochester, N.Y., has been waiting a month to receive $2,124 in unemployment payments as a direct deposit into her bank account.

            But the state instead told her that the money had been deposited on a state-issued debit card, which she never received. She cannot get anyone on the phone to find out where it is.

            “I call the Department of Labor every single day, and I know the options by heart now,” said Ms. Keohane, 31, whose checking account was down to $10.35. “It would be OK if I just knew where the money was.”

            As the coronavirus pandemic and near-nationwide stay-at-home orders exact an astonishing toll on the American economy, states’ unemployment systems have cratered under a never-before-seen deluge of jobless claims. Over the past four weeks, about 22 million workers filed jobless claims, including about 1.2 million New Yorkers.

            Unemployment systems, some of which rely on an antiquated computer programming language that has largely gone the way of dinosaurs, were not built for such a rush of claimants.

            They also were not built for a new class of workers — independent contractors and the self-employed — now eligible for assistance during the pandemic.

            The results have been disastrous and maddening. Many people have had their online applications crash before they could hit submit, requiring them to start again from scratch. They have endured hourslong wait times over several days only to get randomly disconnected, or connected with representatives who say they cannot fix their issues.

            In other states and Territories , including Kansas and Missouri, and Puerto Rico applicants say that they are still waiting for their unemployment payments to arrive, and that they have experienced long wait times on the phone, as well as busy signals, disconnections and error-prone online applications.

            Without unemployment assistance, they have relied on friends, family and savings, if they have one, to survive.

            For applicants in New York lucky enough to get through and submit a claim, some have been jolted awake at 2 a.m. by calls from the state’s Department of Labor seeking to confirm their identity.

            Speaking in Albany on Thursday, the secretary to the governor, Melissa DeRosa, said the state had been staggering under the weight of more than one million claims for unemployment insurance, about four times the number of people who had lost jobs after the 2008 economic meltdown.

            “We are going to continue doing everything we can to bring the system up to deal with this scale,” she said.

            Ms. Keohane was saving for a down payment on house. Instead, she has withdrawn all of her money to pay for groceries, as well as diapers and wipes for her 2-year-old son.

            She has debated getting groceries from a food pantry but cannot bring herself to do it.

            “It’s not right for me to have to go there,” she said. “There are people who are more needy than me.”

            Amy Berryman, a playwright who was let go from a wine bar in Manhattan last month, has not received the debit card that the state said it sent her weeks ago. Every week when she has to certify her unemployment claim, she asks that her payment be deposited into her bank account. It never has.

            “I’m trying to spend $50 a week or less,” said Ms. Berryman, 31, as she stood in line at a grocery store to buy fresh produce, which she has been using to make lots of soup.

            The $2.2 trillion federal stimulus passed last month sets aside especially generous benefits for the recently unemployed. It provides $600 a week on top of what states offer for unemployment. (The maximum weekly unemployment in New York is $504.)

            But the stimulus has exacerbated the problem for states, which are now responsible for administering an enormous expansion of unemployment benefits for previously ineligible workers. For the first time, independent contractors and self-employed workers qualify for unemployment relief.

            But in New York and other states, those workers are facing an extra set of head-scratching bureaucratic obstacles.

            Self-employed New Yorkers, for instance, must first apply for traditional unemployment benefits even though they are not eligible. Once the state denies their claim, they then can pursue the new pandemic benefits available to them.

            Jennifer Walsh, a self-employed hair stylist in upstate New York who stopped working on March 14, submitted her application more than two weeks ago. She is still waiting to be denied.

            “Why is this even a step?” said Ms. Walsh, who added that many of her friends in the hair business were in the same situation. “I understand this is a new process for everyone, but in the meantime we are broke and we have no answers.”

            While she waits, Ms. Walsh has been using credit cards and her savings to buy food and pay bills. “That will only go so far,” she said.

            Ms. DeRosa said on Thursday that roughly 275,000 New Yorkers still had outstanding unemployment claims, most of which involve people who were self-employed, which requires additional paperwork and confirmation.

            A state official on Friday said that the federal government was requiring New York State to confirm that those workers are not eligible for traditional unemployment before processing their claims for pandemic assistance. The state is working to create a single unemployment application for those workers.

            But challenges with the New York’s unemployment system are just the start of problems for many people out of work. More than a half-dozen New Yorkers who recently lost their jobs told The New York Times that they requested unemployment payments to be deposited into their checking accounts, but instead received debit cards.

            James Colón, who was let go from the Strand bookstore in Manhattan last month, received one of the cards, issued by Key Bank, a regional bank based in Cleveland. Its online banking system worked the first day, but now shows an error message when he tries to log on.

            Without access to Key Bank’s site, he cannot transfer the money into his checking account to pay May rent. No one at Key Bank has been able to resolve the problem, he said.

            A representative for Key Bank did not immediately respond to questions about its unemployment benefits card. Other states, including Washington and Indiana, also disperse unemployment assistance onto the bank’s cards.

            The state official said on Friday that the New York Department of Labor had temporarily suspended direct deposit payments because of back-end problems. During that period, the state issued the debit cards to ensure claimants received payments, the official said.

            “We are contacting Key Bank today to get to the bottom of this,” said the official, who asked not to be identified because he was not authorized to speak with the media.

            Bobbie de Matos, who lost her server job at a table-tennis themed bar in Manhattan, received a Key Bank card, which she did not request. It also does not work.

            After calling the bank over many days, including a four-hour-hold on one call, Ms. de Matos said she finally reached a representative who told her that the card had not been assigned to her or anyone.

            She needed to ask the state’s Labor Department to fix the issue, the person told her. But the state said it was an error with the bank. A new card is supposed to arrive in the mail soon.

            She is hoping everything will be cleared up by next Friday, when she is scheduled to move from Manhattan to Brooklyn and will need to pay the movers.

            “It’s a complete mess,” said Ms. de Matos, 23.

            Long before the stay-at-home orders, Melvin Taylor II was let go from a production position in New York City. He received a Key Bank card in the mail late last year for his unemployment benefits.

            Right as mass layoffs and furloughs began about a month ago, Key Bank alerted him that it had detected potential fraud on his card and automatically canceled it.

            Mr. Taylor said he had not been able to reach a bank representative to order a replacement card.

            “You’d be on the phone three hours, 59 minutes and 27 seconds, and then the phone would cut off,” Mr. Taylor said.

            He has resorted to searching through coats and pants for loose change — he found about $20 — and has experimented with cheap and filling rice and pasta recipes.

            “There are a lot of different spices that you can put in rice,” he said.

            By: Matthew Haag

             

             

            Assistant Athletic Trainer

            Buffalo State, State University of New York, seeks candidates for the position of Assistant Athletic Trainer.

            For a full job description and to apply: https://jobs.buffalostate.edu.

            Buffalo State is an affirmative action/equal opportunity employer and committed to respect for diversity and individual differences.

             

             

            Financial Analyst

            Buffalo State, State University of New York, seeks candidates for the position of Financial Analyst. For a full job description and to apply: https://jobs.buffalostate.edu.

            Buffalo State is an affirmative action/equal opportunity employer and committed to respect for diversity and individual differences.

              (Reuters) – U.S. restaurants are on track to lose $50 billion in April, with losses mounting to an estimated $240 billion by the end of 2020, as the coronvirus crisis ravages the industry, according to a National Restaurant Association survey released on Monday.

              Two thirds of U.S. restaurant workers – or 8 million people – have been laid off or furloughed as 4 in 10 restaurants are closed, but at least 60% of operators say existing federal relief programs will not help them prevent more layoffs, the survey found.

              Reporting by Hilary Russ; Editing by Chizu Nomiyama

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