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Many fear 10 p.m. last call could be last straw for some bars & restaurants Dayton 24/7 Now
Consider yourself warned, Champaign County. The Illinois Department of Public Health on Friday put C-U’s home on a list of 13 counties in danger of having to reimpose social and economic restrictions as COVID-19 cases rise.
Champaign County joined Gallatin, Jackson, Jo Daviess, Johnson, Perry, Randolph, Saline, Sangamon, St. Clair, White and Whiteside on the watch list. All have experienced an increase in two or more risk indicators.
The 13 counties have all had outbreaks linked with business operations and activities such as parties, graduation ceremonies and sports events posing higher risk for disease spread, according to the state health department.
Health officials reported another 16 COVID-19 cases in Champaign County on Friday, upping the total in the county to date to 1,448.
Of those, 1,206 are considered to be recovered, 223 are active cases and 14 people were hospitalized ,according to the Champaign-Urbana Public Health District.
ZIP code areas 61821 and 61802 topped the county in active cases, each with 40, followed by 61820 with 38 active cases.
The health district is currently advising all those who travel outside Illinois, especially to COVID hot spots, to be tested on the day they return and again four days later.
Also:
— The state set a 24-hour pandemic high for most tests processed — 49,782. But it also reported its most new cases in a single day since May 24, with 1,941.
Both the single- and seven-day positivity rates were 3.9%.
— The Vermilion County Health Department reported nine more cases Friday, bringing the total in that county to 185.
Among Vermilion's newest cases were two people who work together and two who traveled to Alabama with a person recently confirmed positive, according to health department Administrator Doug Toole.
Stem cells hold the promise of helping us repair tissues damaged by disease or injury. But outside of bone marrow stem cells, the practice remains largely a promise, as we're just starting clinical trials to determine if we can use these cells effectively. But that hasn't stopped people from offering stem cell "treatments" with no basis in evidence. Many of the clinics that offer these services are based overseas, leading to what's been termed "stem cell tourism." But a number take advantage of ambiguities in Food and Drug Agency regulations to operate in the United States.
A new survey of doctors suggests that a surprising number of their patients are using these services—sometimes with severe consequences. And many doctors don't feel like they're prepared to deal with the fallout.
The work focuses on neurologists, who specialize in treating diseases of the nervous system. These include diseases like Parkinson's and multiple sclerosis, for which there are few effective treatments—although stem cells have undergone some preliminary tests in the case of Parkinson's. Given the lack of established options, it wouldn't be surprising if these patients turned to therapies that haven't been established, like those involving stem cells.
But are patients turning to stem cells? To find out, a team of researchers surveyed neurologists who are likely to care for these patients, leveraging the American Academy of Neurology, which has over 20,000 members. Only a tiny fraction of members responded, with a bit over 200 neurologists taking the survey. But if the numbers that came out of it are at all representative, the survey paints a disturbing picture of stem cell tourism.
Nearly 90 percent of the doctors were treating patients with diseases that were currently incurable, and a similar percentage had been asked about stem cell therapies. About half the neurologists said that they had 15 or more patients ask them just within the past year. While the vast majority of patients were simply looking for additional information about the supposed therapies, a third were looking for the doctor to grant them permission to try one, emphasizing the importance of physicians limiting access to untested treatments.
Fortunately, two-thirds of the doctors warned their patients against trying one of these unproven therapies. Yet nearly two-thirds had one of their patients try an untested stem cell therapy—and another 20 percent of them had patients approach them only after the patients had already tried one. And those procedures weren't without complications. About a quarter of the doctors reported having a patient with complications from a procedure, ranging from stroke to hepatitis. There was no apparent pattern to the reports that suggest that any complications are more common than others, though.
Given that stem cell tourism is becoming increasingly common, you might expect that neurologists have been arming themselves with information to better serve their patients. But only a quarter felt that they were fully prepared for discussing matters with patients, and 10 percent felt completely unprepared (most were somewhere in between). The participants also said that they could benefit from literature that discusses the status of stem cell treatments that could be shared with their patients.
Again, no stem cell therapies for neurological diseases have been demonstrated to be effective. Clinics that offer them to patients are at best preying on these patients' desire for something that addresses a currently incurable illness. At worst, they're simply scams. There have been clinical trials started for some diseases, and more are likely to come. Directing patients to an appropriate study and away from the unregulated stem cell clinics should be part of effective patient care.
This survey is clearly preliminary, given the small subset of the neurology community who responded. Nevertheless, it paints a troubling picture of widespread patient interest in untested treatments and a medical community that isn't always ready or willing to direct them away from potentially harmful "therapies." The survey certainly justifies a broader follow-up to determine the full extent of the risk as well as a more robust outreach effort to make sure the neurology community is prepared to work with patients to direct them away from these clinics and into trials.
Annals of Neurology, 2020. DOI: 10.1002/ana.25842 (About DOIs).
Melissa Hickson says no one asked her husband Michael, shown here with stepdaughter Mia, if he wanted to keep getting treatment. "He would say: 'I want to live. I love my family and my children ... that's the reason for the three years I have fought to survive,'" she says. Melissa Hickson hide caption
What Melissa Hickson says happened to her husband — and what the hospital says — are in conflict.
But this much is for sure: Michael Hickson, a 46-year old quadriplegic who'd contracted COVID-19, died at St. David's South Austin Medical Center in Austin, Texas, on June 11, after the hospital ended treatment for him and moved him from the ICU to hospice care.
Melissa Hickson says her husband was denied potentially life-saving treatment because doctors at the hospital made a decision based on their biases that, because of his disabilities, Michael Hickson had a low quality of life.
The hospital says it acted based on the man's dire medical prognosis and that it would have been pointless and cruel to give him invasive treatment.
Michael Hickson's death has become a cause among many with disabilities, an emblem of a medical system that they believe views their lives as having less value, even before a pandemic put doctors and hospitals under stress.
And now Hickson's death may get the scrutiny of a federal civil rights office.
ADAPT of Texas, a disability rights group in Austin, sent a complaint on July 24 to the federal Office for Civil Rights (OCR) at the Department of Health and Human Services. And on Friday, the National Council on Independent Living filed a similar complaint to ask OCR to open an investigation into Hickson's death.
"In Mr. Hickson's case, the issue is not abstract," the complaint says. "The treating professional for Mr. Hickson made a discriminatory determination that, due to his disabilities, Mr. Hickson's life would not be supported."
In addition to those formal complaints, two members of the U.S. House of Representatives from Texas expressed alarm. Rep. Chip Roy, a Republican, called the circumstances around Hickson's death "highly troubling." And Rep. Joaquin Castro, a Democrat, said Hickson's death "should be immediately investigated."
Since the start of the pandemic, the federal civil rights office has kept an eye on health care rationing. Specifically, it has warned states, doctors and hospitals that they can't place elderly people and disabled people at the back of the line for care for COVID-19.
"We're concerned that stereotypes about what life is like living with a disability can be improperly used to exclude people from needed care," said Roger Severino, the OCR director, on March 28 as he announced guidelines for states and medical providers.
To do so, he warned, would violate laws — including the Americans with Disabilities Act and the Affordable Care Act — that guarantee the disabled and the elderly will not face discrimination when they need medical care.
Since then, Severino's office has investigated multiple states that put out plans for limiting care and has announced settlements with four of those states.
But those plans were simply guidelines, telling medical providers what, theoretically, they could do in case they faced the need to triage care.
Much harder to determine is what actually takes place on the front lines of medical care, especially when hospitals are overwhelmed and doctors are forced to make quick decisions.
Melissa Hickson believes she saw proof that her husband was denied care because of his disability. (Hickson thinks her husband may have been dismissed as a Black man, too, but "the main reason was because of his disabilities.")
On June 5, Hickson went to see her husband in the ICU at St. David's South Austin Medical Center.
Michael Hickson was a quadriplegic who'd been diagnosed with COVID-19. Now he had pneumonia. A BiPap machine, a kind of ventilator that people often use in their own homes, was pushing air into his lungs to help him breathe.
Through the mask, he answered her questions with short answers. Would you like me to get you a Long Island Iced Tea, she joked. Yes, he said with a smile. Will you pray with me? Yes.
She asked him "to keep it in your mind: You will live and not die. You will live." She asked him to repeat the words with her and she saw, under the mask of the breathing device, his lips move as he repeated it with her.
She called the kids on the phone — their five teenage children — for a FaceTime conversation. They told their Dad what they were up to. The 16-year-old was excited she was going to get her driver's license.
Michael Hickson with his five children. Melissa Hickson hide caption
"They chattered. Very chattery," she recalls with a laugh. "And so I could see him just kind of shaking his head" and smiling.
That was June 5. One morning, three years before, Michael Hickson, a Morehouse College graduate who worked as an auto insurance claims estimator, went into sudden cardiac arrest, as he was driving his wife to work. Blood stopped flowing to his brain and other organs. Sudden cardiac arrest is often fatal, but paramedics arrived and performed extensive Cardiopulmonary Resuscitation. He survived. But the temporary loss of oxygen to his brain left him with significant disabilities — an anoxic brain injury, blindness and quadriplegia.
He could no longer walk. He had trouble talking.
Melissa Hickson posted YouTube videos of him in the years after his injuries: Singing Happy Birthday to his daughter from his hospital bed, joking with his kids, getting physical therapy, bobbing his head as he listens to music. He seems to have difficulty speaking and moving but he is aware and involved.
Still, Melissa Hickson says, the years since the accident were difficult for her husband. He'd moved from hospital to nursing home to back home — and then back to more hospitals and nursing homes.
That day at St. David's hospital, this past June 5, the medical staff had something to tell Melissa Hickson. They were going to stop treating her husband. And move him from the ICU to hospice care.
In the hallway, Hickson found the doctor. She asked why. And she recorded their conversation.
The recording is hard to hear, the doctor's voice a bit distant. But he tells Hickson: "The decision is: Do we want to be extremely aggressive with his care or do we feel like this would be futile?"
And then he adds: "As of right now, his quality of life — he doesn't have much of one."
Hickson challenges the doctor. "What do you mean?" she asks. "Because he's paralyzed with a brain injury, he doesn't have quality of life?"
"Correct," the doctor replies.
After a while, the doctor gives a different explanation: If we have to intubate him — put him on a more powerful ventilator — in his weakened condition, he's not going to survive.
Michael Hickson was driving his wife to work three years ago when he had a sudden cardiac arrest. It resulted in an anoxic brain injury, blindness and quadriplegia. Melissa Hickson hide caption
That didn't make sense to Melissa Hickson. The hospital wasn't overwhelmed with COVID-19 patients. It didn't need to ration care. Her husband had dealt with pneumonia before, and other hospitals had successfully treated it.
"This decision was not made based on a disability in any way," says Dr. DeVry Anderson, the chief medical officer at St. David's. He adds that it was not an issue of the hospital being short on its ability to treat COVID-19 patients.
Anderson says Michael Hickson was much sicker than his wife may have realized: He had sepsis, pneumonia in both lungs and that his organs were shutting down.
Anderson says a medical team — of doctors, palliative care specialists, a chaplain — made the decision that Hickson could not survive further treatment. The team then got sign-off from Michael Hickson's medical guardian.
A Texas probate court earlier this year had stepped in and appointed an elder care agency to make medical decisions for Michael Hickson. That happened after Melissa Hickson disagreed with a previous hospital. She says it wanted to discharge her husband to a nursing home. She insisted he needed more specialized care at a brain and spinal cord injury center.
It's not unusual for caregivers and medical staff to fight. It's unusual, though, that a probate court would step in.
Anderson says that tape recording Melissa Hickson made — of the doctor at the hospital saying her husband had no quality of life — was just a miscommunication. He says the doctor misused the term "quality of life" and that he wasn't saying the hospital was ending care because her husband was disabled.
Says Anderson: "But rather he was trying to help Mrs. Hickson understand compassion based on understanding what quality of life is — how someone might suffer more based on doing things that we consider treatments or interventions that are actually not helping them be better or feel better."
NPR listened to the five-minute recording Melissa Hickson made of her conversation with the unnamed doctor. The doctor speaks of Michael Hickson's quality of life, of wanting to make a "humane" decision. He says he's seen only three people with COVID-19 on ventilators in the ICU — all young and previously in good health — recover.
The difference between them and her husband, he says: "They're walking and talking." Her husband, he says, has "a number of medical problems."
Melissa Hickson agrees that she doesn't want her husband intubated. She asks if he could get Remdesivir, a drug in short supply that, studies suggest, can reduce the hospital stay of someone seriously ill from COVID-19. She wants the hospital to try some treatment to save her husband. "It doesn't make any sense to me to not try," she tells the doctor.
The doctor, on the tape, never mentions the issues that Dr. Anderson says led to the decision to end treatment — the sepsis and organ failure.
Hospitals call in Devan Stahl on cases just like this. Stahl is an associate professor of ethics at Baylor University in Waco, Texas.
She wasn't consulted on this case. She doesn't know all the details of Michael Hickson's medical condition.
But she's listened to the tape.
"It was very troubling. Kind of a gut punch," she says.
"Because a treatment working or not working has nothing to do with a patient's quality of life, however it's deemed by this physician," she says. "And by all accounts — by his wife — that he had a quality of life."
Stahl says there's research that we — all of us, and especially doctors — see someone like Michael Hickson with a significant disability and say, I wouldn't want to live like that. And we have a bias to underestimate that person's quality of life.
Stahl says doctors need to protect against doing that with disabled patients. "That doesn't mean they should be triaged out of medical treatment," she says.
Melissa Hickson says no one asked Michael Hickson if he wanted treatment. "He would say, 'I want to live. I love my family and my children and they're the most important things to me,'" she says. "He would probably say that's the reason for the past three years I have fought to survive."
On Thursday, June 11, Hickson tried to make a FaceTime call to her husband. The hospital said that she needed permission from that guardianship agency. The guardian said she needed it from the hospital.
The next morning she got up early and tried again.
Michael participates in physical therapy after his accident. Melissa Hickson hide caption
Later that morning she got a phone call — this time from the hospice agency. The message said: Michael Hickson had died the night before. It took 12 hours before anyone called to tell Melissa Hickson.
"Michael Hickson's life mattered — to his wife, to his children, and to his community," says a statement released by the National Council on Independent Living. "It should have mattered to the medical professionals charged to care for him."
On Friday, the council, along with seven other disability groups, asked the Office for Civil Rights to investigate his death. The complaint named the hospital, its parent company and Family Eldercare, the guardianship agency. The council represents a national network of 400 centers run by disabled people to advise and advocate for other disabled people.
A spokeswoman for OCR would not say if the office would open an investigation. But sources told NPR that the office has been interested in pursuing a complaint if it thought a decision to triage care was based improperly on a person's disability.
OCR "can't discuss open or potential investigations," says spokesperson Arina Grossu. If it does open an investigation, and finds that the hospital violated civil rights laws, it could then work on an agreement with the hospital to put systems in place to prevent that kind of decision on treatment from happening again. Or if a hospital fails to address a problem, the office can seek to get back or end federal funds to the hospital.
Disability groups have seen OCR as an agency that will protect access to medical care during the pandemic. Groups in multiple states have filed complaints about state triage policies — often called "crisis standards of care plans" — that they feel allow medical providers to give lesser care to the elderly and people with disabilities.
One of the most recent complaints, filed July 22, comes from national and Texas disability groups, led by Disability Rights Texas. It asks OCR to tell Texas to modify guidelines that allow hospitals to use a point scale to determine who is most likely to benefit from care when it is scarce. But the point system, the complaint says, discriminates against people with disabilities because they lose points for their disabilities and underlying medical conditions.
OCR has investigated complaints in other states and forced changes. Pennsylvania modified a system similar to the one now challenged in Texas, Alabama and Tennessee rewrote their rules to ensure that people with dementia, intellectual disabilities, traumatic brain injuries, advanced neuromuscular disease and other disabilities would not be denied ventilator and other care simply because of those conditions.
Now, the death of Michael Hickson, at that hospital in Austin, could be the next test of how doctors and hospitals, stressed by the coronavirus pandemic, provide medical care and whether they do it in a way that values the lives of people with disabilities.
This big lug of a planet (Jupiter) may be why we don't have more life in our own solar system.
NASA/JPL-Caltech/SwRI/MSSS/Image processing by Kevin M. GillScientists love to debate and investigate the possibility of life on exoplanets, planets that are located outside our solar system. Maybe intelligent alien civilizations are incredibly rare. Maybe one of those potentially habitable exoplanets we've spotted will have some small spark of life.
We have a new number to think about when it comes to exciting exoplanets: seven. A research team led by University of California, Riverside astrobiologist Stephen Kane crunched the data and found that some stars could potentially host as many as seven Earth-like planets, so long as they don't have a Jupiter to screw things up.
Kane -- who previously investigated the possibility of habitable exomoons -- has been studying the intriguing Trappist-1 system, home to several Earth-like planets located in the star's habitable zone where liquid water could exist.
"This made me wonder about the maximum number of habitable planets it's possible for a star to have, and why our star only has one," said Kane in a UC Riverside release on Friday.
This illustration compares the Trappist-1 system and the three planets in its habitable zone (in green) with our own solar system.
NASA/JPL-CaltechThe researchers created a solar system computer model and ran simulations on planet interactions over great spans of time. The data revealed that a sun-like star could support up to six planets with liquid water, while some other stars could conceivably handle up to seven.
"More than seven, and the planets become too close to each other and destabilize each other's orbits," said Kane.
While the data suggests life-packed systems could exist, we have so far spotted very few stars that appear to have multiple planets within their habitable zones. These other stars are so far away, we can't just pop over and check for signs of life.
The team published its findings in The Astronomical Journal this week. The study could help guide astronomers in the search for habitable-zone exoplanets. Kane is particularly interested in stars with collections of smaller planets.
Kane pointed a finger at massive Jupiter as the likely culprit in our own solar system's lack of life-friendly planets. He called out Jupiter's size and its impact on the orbits of the other planets in our system for why our habitable zone is so lonely. Thanks a lot, Jupiter.
Watch this: How NASA's Mars helicopter could change the future of...
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Florida Tech listed in report of colleges in danger of perishing - Orlando Orlando Business Journal
INDUSTRY INSIGHT
Amid the current national discourse about the proper use of police force, social media has become a powerful tool for law enforcement agencies. Texts, posts and tweets offer direct ways to engage with communities by sharing critical updates and receiving candid feedback about local concerns.
Social media can help spread information rapidly to community members, which can be useful during public safety emergencies and natural disasters. It can also reduce the time it takes for first responders to get the important information they need, such as location coordinates to help a person in danger. If crucial information needs to be communicated quickly, a text message is often the channel of choice. According to the Pew Research Center, 98% of text messages are read within two minutes -- a time savings that can literally mean the difference between life and death in an emergency.
However, for all these benefits, social media presents its own set of dangers for law enforcement agencies. All communications sent or received by government organizations -- including police departments, sheriff’s offices, and their employees -- are subject to open records requests. For this reason, law enforcement agencies must develop plans for collecting and archiving every message to deliver the transparency guaranteed by open-records laws, also known as Sunshine Laws. These records might also be needed for internal investigations, case logs and potential litigation.
Facebook is the leading social media platform used by 94% of law enforcement agencies, followed by Twitter at 71% and YouTube at 40%, according to the Social Media Guidebook for Law Enforcement Agencies by the nonprofit Urban Institute. Social media platforms are used by 91% of agencies to notify the public of safety concerns, by 89% for community outreach and citizen engagement and by 86% for public relations and reputation management.
The Florida Department of Law Enforcement, for instance, is committed to providing full and expeditious compliance with Florida’s public record laws. Toward that end, the department recently adopted technology to capture and archive troves of text messages made between officers, staff and citizens. In another example, the police department in Flagstaff, Ariz., is implementing a novel program that will enable residents of Coconino County to text local police rather than calling them, according to the Arizona Daily Sun. The program aims to provide people who are deaf, hard of hearing or unable to speak a safe option in dangerous situations that may require discretion.
Reaching staff and citizens in their preferred digital habitats
Many law enforcement agencies are aware that the desire to use social media and texting to conduct business is driven largely by a youthful, tech-savvy workforce. Millennials make up the biggest demographic percentage of the workforce. More law enforcement agencies are also recognizing the importance of keeping up with new communication trends to better collaborate across departments, with other agencies, and most importantly, with the public.
Departments should create and implement specific written policies for the use of text messages and social media platforms. A solid policy includes clear rules on text messaging and social media interaction, and how those communications will be retained.
The rules will help meet public records requests and permit public-safety employees to use mobile devices to communicate. This set of written policies should describe:
Before finalizing the policy, it is important agencies get feedback from key stakeholders, such as the human resources and legal counsel teams that might have a role in determining the dos and don’ts and in shaping the consequences of non-compliance. This step creates buy-in from the top to ensure that policies align with organizational needs and guidelines.
After the policies are finalized, employees must be trained on the permitted use of text messaging and social media. These policies should be reviewed and updated on a regular basis, especially when new technologies are adopted into the agency’s communications strategies.
New communication channels can provide powerful tools for law enforcement officials to directly reach their constituents and officers. However, the benefits of social media can only be safely achieved by implementing clear policies that allow agencies to capture and securely archive all those messages for open records requests.
About the Author
Robert Cruz is vice president of information governance at Smarsh.
ProPublica is a nonprofit newsroom that investigates abuses of power. Sign up to receive our biggest stories as soon as they’re published.
In mid-July, the Trump administration instructed hospitals to change the way they reported data on their coronavirus patients, promising the new approach would provide better, more up-to-the-minute information about the virus’s toll and allow resources and supplies to be quickly dispatched across the country.
Instead, the move has created widespread confusion, leaving some states in the dark about their hospitals’ remaining bed and intensive care capacity and, at least temporarily, removing this information from public view. As a result, it has been unclear how many people are in hospitals being treated for COVID-19 at a time when the number of infected patients nationally has been soaring.
Hospitalizations for COVID-19 have been seen as a key metric of both the coronavirus’s toll and the health care system’s ability to deal with it.
Since early in the pandemic, hospitals had been reporting data on COVID-19 patients to the U.S. Centers for Disease Control and Prevention through its National Healthcare Safety Network, which traditionally tracks hospital-acquired infections.
In a memo dated July 10, the U.S. Department of Health and Human Services told hospitals to abruptly change course — to stop reporting their data to the CDC and instead to submit it to HHS through a new portal run by a company called TeleTracking. The change took effect within days. Vice President Mike Pence said the administration would continue releasing the data publicly, as the CDC had done.
Almost immediately, the CDC pulled its historical data offline, only to repost it under pressure a couple days later. Meanwhile the website for the administration’s new portal promised to update numbers on a daily basis, but, as of Friday morning, the site hadn’t been updated since July 23. (HHS is posting some data daily on a different federal website but not representative estimates for each state.)
“The most pernicious portion of it is that at the state level and at the regional level we lost our situational awareness,” said Dave Dillon, spokesman for the Missouri Hospital Association. “At the end of this, we may have a fantastic data product out of HHS. I will not beat them up for trying to do something positive about the data, but the rollout of this has been absolutely a catastrophe.”
The Missouri Hospital Association had taken the daily data submitted by its hospitals to the CDC and created a state dashboard. The transition knocked that offline. The dashboard came back online this week, but Dillon said in a follow-up email, “the data is only as good as our ability to know that everyone is reporting the same data, in the correct way, for tracking and comparison purposes at the state level.”
Other states, including Idaho and South Carolina, also experienced temporary information blackouts. And The COVID Tracking Project, which has been following the pandemic’s toll across the country based on state data, noted issues with its figures. “These problems mean that our hospitalization data — a crucial metric of the COVID-19 pandemic — is, for now, unreliable, and likely an undercount. We do not think that either the state-level hospitalization data or the new federal data is reliable in isolation,” according to a blog post Tuesday on the group’s website.
Making matters more complicated, the administration has changed the information that it is requiring hospitals to report, adding many elements, such as the age range of admitted COVID-19 patients, and removing others. As of this week, for instance, HHS told hospitals to stop reporting the total number of deaths they’ve had since Jan. 1, the total number of COVID-19 deaths and the total number of COVID-19 admissions. (Hospitals still report daily figures, just not historical ones.)
“Massachusetts hospitals are continuing to navigate the dramatic increase of daily data requirements,” the Massachusetts Health and Hospital Association said in a newsletter on Monday. “MHA and other state health officials continue to raise concerns about the administrative burden and questionable usefulness of some of the data.”
“Hospitals across the country were given little time to adjust to the unnecessary and seismic changes put forth by the U.S. Department of Health and Human Services, which fundamentally shift both the volume of data and the platforms through which data is submitted,” the association’s CEO, Steve Walsh, said in the newsletter.
A number of state websites also noted problems with hospital data. For days, the Texas Department of State Health Services included a note on its dashboard that it was “reporting incomplete hospitalization numbers … due to a transition in reporting to comply with new federal requirements.” That came just as the state was experiencing a peak in COVID-19 hospitalizations.
California likewise noted problems.
A spokesperson for HHS acknowledged some bumps in the transition but said in an email: “We are pleased with the progress we have made during this transition and the actionable data it is providing. We have had some states and hospital associations report difficulty with the new collection system. When HHS identifies errors in the data submissions, we work directly with the state or hospital association to quickly resolve them.
“Our objective with this new approach is to collaborate with the states and the healthcare system. The goal of full transparency is to acknowledge when we find discrepancies in the data and correct them.”
Last week, HHS noted, 93% of its prioritized list of hospitals, excluding psychiatric, rehabilitation and religious nonmedical facilities, reported data at least once during the week. (The guidance to hospitals asks them to report every day.)
Asked about the lack of timely data on its public website, HHS said it will update the site to “make it clear that the estimates are only updated weekly.” HHS is now posting a date file each day on healthdata.gov with aggregate information on hospitalizations by state.
But unlike the prior releases from CDC, which provided estimates on hospital capacity based on the responses, this file only gives totals for the hospitals that reported data. It’s unclear which hospitals did not report, how large they are, or whether the reported data is representative.
It’s also unclear if it’s accurate. New York state, for instance, reported that fewer than 600 people were currently hospitalized with COVID-19, as of Friday. Federal data released the same day pegged the number of suspected and confirmed COVID-19 hospitalizations at around 1,800.
Louisiana says more than 1,500 people are currently hospitalized with COVID-19. The federal data puts the figure at fewer than 700.
Nationally, The COVID Tracking Project reports that more than 56,000 people were hospitalized around the country with the virus, as of Thursday.
The data released by HHS on Friday puts the figure at more than 70,000.
NPR reported this week that it had found irregularities in the process used by the Trump administration to award the contract to manage the hospital data. Among other things, HHS directly contacted TeleTracking about the contract and the agency used a process that is more often used for innovative scientific research, NPR reported.
An HHS spokesperson told NPR that the contract process it used is a “common mechanism ... for areas of research interest,” and said that the system used by the CDC was “fraught with challenges.”
Ryan Panchadsaram, co-founder of the tracking website CovidExitStrategy.org, has been critical of the problems created by the hospital data changeover.
😡 - 2 weeks since the switch from @HHSGov to @CDCgov & we are in the dark again.https://t.co/jNoIP4oE7u
Daily updates never happened. Last snapshot was from July 23.https://t.co/y0T553qnPi
29 states see increased hospitalizations & this critical indicator is still missing. pic.twitter.com/4TDfdKeHrO
— Ryan Panchadsaram (@rypan) July 28, 2020
“Without real-time accurate monitoring, you can’t make quick and fast and accurate decisions in a crisis,” he said in an interview. “This is just so important. This indicator that’s gone shows how the health system in a state is doing.”
Dillon of the Missouri Hospital Association said the administration could have handled this differently. For big technology projects, he noted, there is often a well-publicized transition with information sessions, an educational program and, perhaps, running the old system and the new one in parallel.
This “was extremely abrupt,” he said. “That is not akin to anything you would expect from HHS about how you would implement a program.”
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As a Jeep drove into a crowd of anti-police violence protesters seeking to shut down a busy highway in Aurora, Colorado, gunshots rang out.
No one was hit by the Jeep, according to police, but two protesters were struck by gunfire and ended up at local hospitals.
Police say the bullets were meant for the SUV and fired by one of the protesters. One man was arrested on multiple counts, including attempted murder. The rally was to protest the death of Elijah McClain, who died following an encounter with police in 2019.
“I heard the screams first and then I heard gunshots,” said Tay Anderson, a Denver School Board member and community organizer who was at that protest when the shooting happened. “I was super concerned, mainly for the women and children that were present.”
The shooting at the protest in Aurora was just one of several similar incidents at protests across the country, from an apparent accident that injured three in Louisville, to a woman accused of pointing a gun at protesters in Boise, to the killing of an armed protester by a driver in Austin, Texas.
What is clear after months of protests against stay-at-home orders and police violence is that the presence of weapons at protests is ratcheting up tensions at a time when stress is high for protesters, counterprotesters and law enforcement alike.
“Anytime you introduce firearms to any event it just makes it more complicated,” said Harry Glidden, Aurora police deputy chief.
While some racial justice protesters have said they have armed themselves for their own protection, especially in the wake of violent law enforcement reaction to protests in Portland, police say it complicates their ability to keep the peace.
“To those people who say they’re not safe, I tell them they’re certainly safe from the police if they’re being peaceful,” Glidden said. “Whether they feel safe around fellow protesters or not, that’s a question you’d have to ask them.”
Carrying a loaded firearm at a protest is an inherently dangerous situation.
Safety experts like Brett Bass, a firearms instructor in Bellevue, Washington, says responsible gun owners should look to stay away from potential confrontations in the first place, “avoiding large crowds of potentially armed people in crowded areas and chaotic situations, things like that.”
That describes a lot of protests in America right now.
Some protesters say they have armed themselves for their own protection. That may be a reaction to the presence at many racial justice protests of armed counterprotesters — mostly white and some members of the militia movement — who have confronted anti-racism rallies in at least 33 states, according to a review by Guns & America
Thanks to permissive state gun laws, protesters in many states are legally allowed to carry their weapons in these crowded and chaotic situations.
Bass said intensive training is important for anyone who carries for self-defense. And if gun owners do decide to carry at protests, that training is only more critical. “In extremely crowded spaces like that, firearms employment becomes extremely challenging because the risk of collateral damage is very high.”
The problem, Bass says, is that some gun owners feel emboldened by their weapons rather than seeing them as a tool of last resort.
“Many people have adopted a very wrong-headed idea that,” Bass said, “ ‘I carry a gun and as a result, I am allowed to do unsafe things, because in the event a problem occurs, I’ll be able to use my gun to fix the problem.’ ”
Following the shooting incident at the Aurora protest, the leader of the Colorado gun group Rally For Our Rights tweeted an offer to train armed protesters.
“People need to be taking a good, hard look at the tension, emotion, unpredictability of these protests,” said Lesley Hollywood, the group’s founder. “ … There are people who just truly need to say, ‘You know what, I’m not trained enough to carry a firearm into this situation.’ ”
Rally For Our Rights advocates for unrestricted gun rights. Hollywood believes protesters have a right to carry but, in this moment, need to think through that decision.
“Just because you can doesn’t mean you should,” she said.
Hollywood says that Rally For Our Rights has no plans to open carry at protest events, though she has plenty of experience doing so, in coordination with an internal security team and in consultation with local law enforcement. Right now, she believes it would only “escalate the situation.”
“For me, as someone who has organized very large, hundreds of people, open carry rallies and protests, I have to understand that when I make the decision to lead one of these events, part of it is my responsibility to make sure everybody stays safe,” Hollywood explained.
She thinks that the groups behind demonstrations both against and in-favor of police need to know if protesters are carrying weapons and plan accordingly.
“The organizers of these need to understand what’s happening internally,” she said, “because people are being put at risk, as we saw in Aurora when two people were shot.”
These armed confrontations at protests are also prompting legal questions.
“I think you will see a number of states and localities move to ban weapons, visible weapons in public places,” said Robert Leider, who studies self-defense issues as a professor at George Mason’s Antonin Scalia School of Law.
Ironically, a Supreme Court decision hailed by gun rights advocates for affirming Second Amendment protections could open the door to restrictions on armed protests. The 2008 case District of Columbia v. Heller recognized the right of individuals to possess firearms but also acknowledged broad powers to regulate guns.
“Heller says that you can ban guns entirely from sensitive places,” Leider said. “And there’s an issue of what constitutes a sensitive place.”
Most gun laws are made at the state-level, leaving a patchwork of rules. A shooting in one state justified as self-defense could be considered murder in another.
“A lot of the gun carrying at the protesters have been probably with the intent to be provocative,” Leider said. “One of the crucial questions is what duties do individuals have to avoid conflict?”
Another question will be proportionality, according to Jacob Charles, executive director of Duke University’s Center For Firearms Law.
“If someone threatens to punch you, you don’t get to take out a gun and shoot them,” he said. “And that would not be proportional.”
Some states require people to retreat if it’s reasonable, others with so-called Stand Your Ground laws do not. What is reasonable, of course, is subjective. And Charles says the often emotional debates around conservative states adopting laws aimed at giving broader latitude to use of deadly force can muddy the understanding of what constitutes an acceptable response.
“What we’re seeing is there’s confusion,” he said. “Especially in the public imagination about what self-defense allows you to do now, especially kind of the rhetoric and symbolism around Stand Your Ground laws.”
Many gun owners do recognize that steering clear of conflict is ideal. Whether courts see that as a legal obligation is yet to be seen.
Guns & America is a public media reporting project on the role of guns in American life.
DETROIT — Despite fears that the coronavirus pandemic will worsen, Victor Gibson said he's not planning to take advantage of Michigan’s expanded vote-by-mail system when he casts his ballot in November.
The retired teacher from Detroit just isn't sure he can trust it. Many Black Americans share similar concerns and are planning to vote in person on Election Day, even as mail-in voting expands to more states as a safety precaution during the pandemic.
For many, historical skepticism of a system that tried to keep Black people from the polls and worries that a mailed ballot won't get counted outweigh the prospect of long lines and health dangers from a virus that's disproportionately affected communities of color. Ironically, suspicion of mail-in voting aligns with the views of President Donald Trump, whom many Black voters want out of office.
Trump took it a step further Tuesday, suggesting a “delay” to the Nov. 3 presidential election — which would take an act of Congress — as he made unsubstantiated allegations in a tweet that increased mail-in voting will result in fraud.
“I would never change my mind” about voting in person in November, said Gibson, who is Black and hopes Trump loses. “I always feel better sliding my ballot in. We’ve heard so many controversies about missing absentee ballots.”
Decades of disenfranchisement are at the heart of the uneasy choice facing Black voters, one of the Democratic Party’s most important voting groups. Widespread problems with mail-in ballots during this year's primary elections have added to the skepticism at a time when making Black voices heard has taken on new urgency during a national reckoning over racial injustice.
Patricia Harris of McDonough, Georgia, south of Atlanta, voted in person in the primary and said she will do the same in November.
“I simply do not trust mail-in or absentee ballots,” said Harris, 73, a retired event coordinator at Albany State University. “After the primary and the results were in, there were thousands of absentee ballots not counted.”
In Georgia, roughly 12,500 mail-in ballots were rejected in the state's June primary, while California tossed more than 100,000 absentee ballots during its March primary.
Reasons vary, from ballots being received after the deadline to voters' signatures not matching the one on file with the county clerk. Multiple studies show mail-in ballots from Black voters, like those from Latino and young voters, are rejected at a higher rate than those of white voters.
In Wisconsin's April primary, thousands of voters in Milwaukee said they didn't receive absentee ballots in time and had to vote in person. Lines stretched several blocks, and people waited two hours or more.
In Kentucky's June primary, more than 8,000 absentee ballots were rejected in Jefferson County, which includes Louisville.
Many people in Louisville's historically Black West End neighborhood voted in person because they didn't receive an absentee ballot or simply wanted to vote in a way that was familiar to them, said Arii Lynton-Smith, an organizer with Black Lives Matter Louisville.
“That’s particularly why we knew we had to have the poll rides as an option,” she said, referring to groups offering voters free transportation to polling places. “It’s not as easy to do an absentee ballot and the things that come along with it than it is to just go in person.”
Mistrust by Black voters runs deep and is tightly bound within the nation’s dark past of slavery and institutional racism.
Black people endured poll taxes, tossed ballots, even lynchings by whites intent on keeping them from voting. Over the decades, that led to a deep suspicion of simply handing off a ballot to the post office. Black people were the demographic least likely to cast votes by mail in 2018, with only 11% using that method, according to the U.S. Census Bureau. By comparison, 24% of whites and 27% of Latinos reported voting by mail that year.
“For Black folks, voting is almost like a social pride because of the way they were denied in the past,” said Ben Barber, a researcher and writer for the Institute for Southern Studies in Durham, North Carolina.
Among the places where Black voters say they have had to overcome institutional obstacles is Shelby County, Tennessee, which includes Memphis. In the past, voters have received ballots for the wrong district, and groups have sued to challenge the security of electronic voting machines, invalidation of voter registration forms and failure to open polling places near predominantly Black neighborhoods.
The Rev. Earle Fisher, senior pastor at Abyssinian Missionary Baptist Church in Memphis and a prominent Black civil rights activist, is one of the plaintiffs in a state lawsuit calling for mail-voting access for everyone. He said he's not pushing his community to vote by mail but wants to ensure it's an option given the health dangers.
To ease doubts, he wants voters to be able to drop off their ballot at a polling place so they won't have to worry about the post office delivering it on time.
“I would like to see every righteous and creative method and measure taken, but we are up against a voter suppression apparatus that oftentimes is orchestrated by, or at least sustained by, people who are elected or appointed to office,” Fisher said.
Trump has made clear he believes widespread mail-in voting would benefit Democrats. He has alleged — without citing evidence — that it will lead to massive fraud, and the Republican National Committee has budgeted $20 million to fight Democratic lawsuits in at least 18 states aimed at expanding voting by mail.
The extent to which Black voters adopt it in November is likely to be dictated by the coronavirus. As infections surge, there are signs more Black voters may be willing to consider the option. In Detroit, for example, about 90,000 requests for mail-in ballots have been made so far — the most ever, City Clerk Janice Winfrey said.
How well the option is promoted also is important. In 2018, Democrat Stacey Abrams’ campaign mailed 1.6 million absentee ballot requests to Georgia voters during her unsuccessful bid for governor, emphasizing that it was a safe, easy way to vote.
Record numbers of Black voters voted by mail in that election. That shows they will embrace the process if they hear from friends and family that it works, said Lauren Groh-Wargo, Abrams’ campaign manager.
NAACP President Derrick Johnson praised how Abrams was able to bridge that gap but said this year is different. The model can’t be replicated nationwide before Nov. 3, he said.
“Stacey did a good job in the four years leading up to 2018 to build out a program to get it done,” Johnson said. “The runway between now and November isn’t long enough to get it done.”
IN SEPTEMBER 2018 Matthew Torne, a British filmmaker, released the third in his trilogy of documentaries about Hong Kong. “Last Exit To Kai Tak” is a bittersweet chronicle of five Hong Kongers who, after the disappointment of the pro-democracy “umbrella” protests of 2014, grapple with what is left for them in the city, as its liberties are chipped away by an increasingly bellicose Chinese government. The burning question, as one character puts it, is this: “revolution or emigration?”
For many people, that question has now been answered. At 11pm on June 30th, one hour before the 23rd anniversary of Hong Kong’s return to Chinese rule, the Communist Party imposed a national-security law designed to squash Hong Kong into submission. The city’s reputation as a haven of free speech within China disappeared overnight, along with the “one country, two systems” framework set up in 1997. In 2014 Communist Party leaders waited for the protesters to lose steam. But by 2020 they had run out of patience.
Several people were arrested for violating the new law on July 1st, but most have been dissuaded from taking to the streets. Then, on July 29th, four students aged 16 to 21 were detained for “inciting secession” on social media. They included Tony Chung, former leader of Studentlocalism, a protest group that had called for Hong Kong’s independence from China. On July 30th Hong Kong’s government said it had disqualified 12 pro-democracy figures from standing in election for the Legislative Council (Legco), Hong Kong’s (until now) semi-democratic parliament. As the euphoria of the protests has dissipated and the new reality has sunk in, the focus for many Hong Kongers has shifted—just as it did a generation before, as the handover loomed—to emigration.
It is not just the crackdown that is pushing people to leave. Hong Kong was already one of the world’s most expensive places to live. It ranked above New York, Tokyo and London in the latest cost of living survey carried out by the Economist Intelligence Unit, a sister company of The Economist. Then came the covid-19 pandemic. The economy shrank by 9% year-on-year in the second quarter of 2020. On July 29th Carrie Lam, the territory’s chief executive, warned the city was “on the verge of a large-scale community outbreak”. On July 31st Mrs Lam, announced what she called the “difficult decision” to delay the Legco elections, citing the territory's spike in coronavirus cases. She gave Hong Kong a generous year to get to grips with it, promising an election on September 5th, 2021. A poll by the Chinese University of Hong Kong conducted in May, after China announced its intention to impose the law, found that half of 15- to 24-year-olds were considering leaving.
“In Hong Kong people learn to survive, not live,” says Thea, a 23-year-old who plans to emigrate. “Even for a middle-class person like me, having my own flat is like an impossible mission.”
Would-be émigrés have many destinations to choose from. Canada is home to more Hong Kong-born people than any other OECD country. More than 275,000 of them emigrated there between 1989 and 1997. A residence permit can be secured by an investment of just C$150,000 ($112,000), a sum easily covered by the sale of a pad in Hong Kong, where the average house price is $1.2m, according to CBRE, a property firm. Australia is offering five-year visa extensions to Hong Kongers already in the country, “with a pathway to permanent residency”. An investment visa is pricier, at around A$1.5m ($1.1m).
Other avenues are also now available. Taiwan has opened an office to help Hong Kongers resettle. Between January and May, there were 3,352 Hong Kong applicants for permanent residence in Taiwan, double the figure in the same period for 2019. Cultural similarity and affordability make Taiwan a popular choice, says Roy Lam, an immigration consultant. A recent poll found that Taiwan was the most popular destination for 50% of Hong Kongers considering emigration.
The biggest difference is that Britain is now offering sanctuary. In 1990 the colonial master offered just 50,000 families British citizenship, and was accused of betrayal for fobbing off the rest (or at least those born before the handover) with a British National (Overseas) passport. This gave Hong Kongers a symbolic connection to Britain, visa-free visits for six months, and some consular protection outside Chinese territory, but not much else. Now, it is offering all 2.9m people who have BNO status the opportunity, with their dependents, to live and work in Britain, with “a path to full British citizenship”. Foreign Secretary Dominic Raab said Britain refuses to “duck our historic responsibilities”. China threatened to take “corresponding measures” (which presumably does not mean letting in 2.9m Brits).
Meanwhile, business is booming for emigration consultancies. Mr Lam relocated 250 families in the first half of 2020, nearly as many as in the whole of 2019. Harvey Law Group, a law firm, had to double the size of its team to meet demand. Andrew Lo’s firm, Anlex, normally receives ten inquiries a day. Since May, it has had 200 a day. He has had to deter bankers from reinventing themselves as butchers for Canada’s rural-immigration programme.
Hong Kong does not track emigration statistics. But there are proxy measures. Applications for certificates of no criminal conviction, a document required for visa applications (as well as adoptions and overseas study), leapt 40% between 2018 and 2019, to more than 33,000. The figure had hovered around 21,600 since 2012.
In 1989 Mr Lo helped people secure escape routes after the June 4th massacre in Beijing sent shudders through Hong Kong. “Today, people are more panicked,” he says. Then, people wanted an insurance plan; now they want to “move immediately”. More than a quarter of the Hong Kongers who moved to Canada between 1991 and 1995 later returned to Hong Kong, heartened by China’s initial light touch. Indeed, most of the 300,000 Canadians in the former colony are Hong Kong-born. “I treasure my Canadian citizenship, and not just as a potential way out of Hong Kong,” says Joyce Lau, who was raised in Canada. Like most foreign-passport holders, she has no plans to leave just yet. Today’s would-be émigrés may be different. “I feel like I need to mentally prepare myself that I might not be able to return to Hong Kong,” says 23-year-old Nicole, who was deeply involved with the protests, and wants to leave.
Some high-profile student leaders have already gone. On July 2nd Nathan Law flew to London, fearing for his safety. For others it is much less clear-cut, not least because those who most want to leave—the young protesters—are the most idealistic about the fight and the least able, financially, to up sticks. “Leaving Hong Kong at this time of desperation just feels wrong,” says Nicole. “I feel like a deserter.”
So, just as in the 1990s, by necessity or choice, there is a third category for Hong Kongers: staying put and making the best of it. The city has always risen from the ashes, say optimists, and perhaps it can again. Many are waiting to see just how bad it gets. Curtis Law, a 28-year-old journalist, is renewing his BNO passport, just in case. “Perhaps it will be useful in the future,” he says. But “without a lot of savings”, moving to Britain is still “a last resort”.■
Editor's note: this article was updated on July 31st to include the decision to delay legislative elections
This article appeared in the China section of the print edition under the headline "One country, two passports"
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In Arizona’s most populated region, the coronavirus is so ubiquitous that contact tracers have been unable to reach a fraction of those infected.
In Austin, Tex., the story is much the same. Just as it is in North Carolina, where the state’s health secretary recently told state lawmakers that its tracking program was hiring outside workers to keep up with a steady rise in cases, as a number of other states have done.
Cities in Florida, another state where Covid-19 cases are surging, have largely given up on tracking cases. Things are equally dismal in California. And in New York City’s tracing program, workers complained of crippling communication and training problems.
Contact tracing, a cornerstone of the public health arsenal to tamp down the coronavirus across the world, has largely failed in the United States; the virus’s pervasiveness and major lags in testing have rendered the system almost pointless. In some regions, large swaths of the population have refused to participate or cannot even be located, further hampering health care workers.
“We are not doing it to the level or extent that it should be done,” said Steve Adler, the mayor of Austin, echoing the view of many state and city leaders. “There are three main reasons. One is the sheer number of people, the second is the delay in getting test results back, the third is the wide community spread of the disease.”
The goal of contact tracing for Covid-19 is to reach people who have spent more than 15 minutes within six feet of an infected person and ask them to quarantine at home voluntarily for two weeks even if they test negative, monitoring themselves for symptoms during that time. But few places have reported systemic success. And from the very beginning of the U.S. epidemic, states and cities have struggled to detect the prevalence of the virus because of spotty and sometimes rationed diagnostic testing and long delays in getting results.
“I think it’s easy to say contact tracing is broken,” said Carolyn Cannuscio, an expert on the method and an associate professor of family medicine and community health at the University of Pennsylvania. “It is broken because so many parts of our prevention system are broken.”
Tracking those exposed is so far behind the virus raging in most places that many public health officials believe the money and personnel involved would be better spent on other resources, like increasing test sites, helping schools prepare for reopening and educating the public about mask wearing. Some public health experts now believe that, at the very least, testing and contact tracing need to be scaled back in places with major outbreaks. In some places, they say the effort may never succeed.
“Contact tracing is the wrong tool for the wrong job at the wrong time,” said Dr. David Lakey, the former state health commissioner of Texas who helped oversee the Ebola response in Dallas in 2014.
“Back when you had ten cases here in Texas, it might have been useful,” said Dr. Lakey, who is now the chief medical officer for the University of Texas System. “But if you don’t have rapid testing, it is going to be very difficult in a disease with 40 percent of people asymptomatic. It is hard to see the benefit of it right now.”
Dr. Thomas R. Frieden, a former director of the C.D.C. who is a strong advocate for robust contact tracing programs, largely agreed that it is impossible to do meaningful or substantial contact tracing with huge numbers of cases. He noted that when testing results lag as much as they have, it becomes almost impossible to keep up with the high volume of infected individuals and those who have been in contact with them.
“At some point when your cases are very high, you have to dial back your testing and contact tracing,” said Dr. Frieden, who now runs Resolve to Save Lives, a nonprofit health advocacy initiative. “We may be in that situation in some parts of the country today.”
Others argue that contact tracing efforts around the country are still nascent, and many workers fanning out in particular zones are still too inexperienced to call it quits. These experts contend that tracking remains an important mechanism that can help as flare-ups continue over the next year and beyond.
Crystal Watson, a risk-assessment specialist at the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, said she had hoped more contact tracers would be trained and in place before states started reopening. For now, she expects it to be feasible only in Massachusetts, New York, North Dakota and the District of Columbia. Massachusetts, where the nonprofit group Partners in Health leads the efforts, has done particularly well.
Contact tracing has been used as a tool for hundreds of years to contain diseases like tuberculosis, yellow fever and Ebola. A rudimentary form was even used to track the route of a syphilis outbreak in the 16th century. Countries like South Korea, Ireland and Australia used the method to successfully control the spread of the coronavirus, too.
The C.D.C. has sent about $11 billion in relief funds to states and local jurisdictions for expanding coronavirus testing and contact tracing. A survey of state health departments by National Public Radio last month found they had roughly 37,000 contact tracers in place, with an additional 31,000 in reserve for when they would be needed. The work force — a mix of government employees, volunteers and contract workers hired by outside companies or nonprofit organizations — still falls short of the 100,000 people that the C.D.C. has recommended.
The contact tracers, whose training varies considerably in length and content depending on what state they are in, have struggled to keep up with the rising number of cases.
“The challenge is that we are not dealing with ones and twos,” said Fran Phillips, a deputy Secretary for Public Health for Maryland, a state that has largely kept the virus in check but still faces over 900 new cases daily. For every new case, there are several if not dozens of people to contact, especially in large cities, which further strains the system.
Contact tracing generally works best, public health experts say, when a disease is easily detected from its onset. That is often impossible with the coronavirus because a large percentage of those infected have no symptoms.
“When you have a situation in which there are so many people who are asymptomatic,” said Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, at a recent Milken Institute event. “That makes that that much more difficult, which is the reason you wanted to get it from the beginning and nip it in the bud. Once you get what they call the logarithmic increase, then it becomes very difficult to do contact tracing. It’s not going well.”
Perhaps most harmful to the effort have been the persistent delays in getting the results of diagnostic tests. Often by the time an individual tests positive, it’s too late for the health care workers tracking that person to do anything.
“It’s a race against time,” Ms. Phillips said. “And if we have lost days and days of infectious period because we didn’t get a lab result back, that really diminishes our ability to do contact tracing.” In Maryland, like many states, some labs are taking as long as nine days to turn around results. “We are getting some assurances from national manufacturers this lag is short term,” she said. “I am not confident.”
In contrast, when sports teams and staff of the White House test people constantly, with fast turnarounds, contact tracing is instant and effective.
Even as health care workers leap over these hurdles, they are also finding that it can be difficult not just to reach people who were potentially exposed to the virus but to get them to cooperate. Sometimes there is no good phone number, and in the cellphone era, unrecognized numbers are often ignored; 25 percent of those called in Maryland don’t pick up. Others, suspicious of contact tracers or fueled by misinformation about them, decline to cooperate, a stark contrast with places like Germany where compliance with contact tracers is viewed as a civic duty.
Updated July 27, 2020
In Florida’s Miami-Dade County, contact tracers employed by the state have reached only 18 percent of those infected over the last two weeks, according to Mayor Dan Gelber of Miami Beach; many of the others were never even called. Mr. Gelber wrote a letter to Gov. Ron DeSantis on Monday decrying the state of the program.
“You think it’s a natural situation where people will say, ‘Oh of course, I’ll cooperate,’” Dr. Fauci said. “But there’s such pushback on authority, on government, on all kinds of things like that. It makes it very complicated.”
In Seattle, tracers found 80 percent of the people they reached were not in quarantine, even if they had symptoms. And there is little appetite in the United States for intrusive technology, such as electronic bracelets or obligatory phone GPS signals, that has worked well for contact tracing in parts of Asia. Although Americans are free to cross state lines, no national tracing program exists.
“We need federal leadership for standards and privacy safeguards, and I don’t see that happening,” said Dr. Luciana Borio, a former director of medical and biodefense preparedness at the National Security Council.
Many epidemiologists believe fixing the program in the United States to combat and contain the coronavirus outbreaks is essential.
“We have to start by supporting people in getting tested, which means making it easy enough for those exposed to someone or has symptoms to just show up and not worry about a doctor’s order,” Ms. Cannuscio said. “People in the Covid era have a hard time telling you what day it is.”
Dr. Joia Mukherjee, the chief medical officer at Partners in Health, the group in charge of the Massachusetts effort, outlined the principles her group insisted on: Tracers must come from the hardest-hit communities and be able to speak Spanish, Haitian Creole or whatever language the communities do.
Every tracer must be paid, not a volunteer. And Massachusetts had to put in enough money to let the tracers “support” anyone expected to self-quarantine.
“We ask: Do you need food? Infant formula? Diapers? Cab fare? Unemployment insurance? And we help them get it,” Dr. Mukherjee said. “That way people feel it’s care, not surveillance.”
Dr. Marcus Plescia, the chief medical officer at the Association of State and Territorial Health Officials, said that despite the failures so far, it was too soon to surrender. States need more time to build up a tracing work force and the infrastructure to do it well, he said, and Americans need to grow more comfortable with the concept, similar to becoming accustomed to wearing masks.
Dr. William Foege, a former director of the C.D.C., said recently that effective tracers should be “psychiatrists, detectives and problem solvers all at once,” and that will also take time for many who are new to the job.
But in the meantime, Dr. Plescia said, even finding a fraction of cases through contact tracing will help slow the virus’s spread.
“We don’t have to strive for perfection on this,” Dr. Plescia said. “It’s a heavy lift and it’s going to take some time. We need to hang in there and keep at it.”
Donald G. McNeil Jr. contributed reporting to this article.
