'The V.A. Prepares to Back Up a Health Care System Threatened by Coronavirus' diff viewer (3/4)

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The V.A. Prepares to Back Up a Health Care System Threatened by Coronavirus	The V.A. Prepares to Back Up a Health Care System Threatened by Coronavirus
2020-03-18 18:06:22 UTC	2020-06-15 06:38:22 UTC (3 months later)
WASHINGTON — The Department of Veterans Affairs, legally designated as the backup health care system in national emergencies, is preparing to absorb the overflow of coronavirus patients from private hospitals if — or when — they become strained to the breaking point. It would be the biggest test the sprawling and sometimes troubled government hospital system has faced.	WASHINGTON — The Department of Veterans Affairs, legally designated as the backup health care system in national emergencies, is preparing to absorb the overflow of coronavirus patients from private hospitals if — or when — they become strained to the breaking point. It would be the biggest test the sprawling and sometimes troubled government hospital system has faced.
The department is experienced in managing an older and vulnerable population, and in many ways, it could be better prepared than the rest of the health care system to take on the task. It has a surplus of beds in many of its 172 hospital centers and a robust number of special rooms for patients with breathing disorders. Leaders at the agency say they have a surplus of supplies that they have been ordering since the beginning of the year.	The department is experienced in managing an older and vulnerable population, and in many ways, it could be better prepared than the rest of the health care system to take on the task. It has a surplus of beds in many of its 172 hospital centers and a robust number of special rooms for patients with breathing disorders. Leaders at the agency say they have a surplus of supplies that they have been ordering since the beginning of the year.
“Nobody has asked for our help at this point, but the American people should know we are ready,” said Dr. Richard A. Stone, who is in charge of the Veterans Health Administration.	“Nobody has asked for our help at this point, but the American people should know we are ready,” said Dr. Richard A. Stone, who is in charge of the Veterans Health Administration.
But several current and former officials said they feared that in this case, the department would be hampered by its highly centralized and often opaque management culture, which has left some critical players unsure of how the department is preparing and what is expected of its tens of thousands of employees.	But several current and former officials said they feared that in this case, the department would be hampered by its highly centralized and often opaque management culture, which has left some critical players unsure of how the department is preparing and what is expected of its tens of thousands of employees.
In 1982, Congress added what is known as a fourth mission to the department — which otherwise focuses on patient care, training and research — to back up the nation’s entire health care system.	In 1982, Congress added what is known as a fourth mission to the department — which otherwise focuses on patient care, training and research — to back up the nation’s entire health care system.
The private-sector health care system has 2.8 hospital beds per 1,000 people and an estimated 45,000 intensive care unit beds, and it could be overwhelmed with an explosion in the number of new, acutely ill patients.	The private-sector health care system has 2.8 hospital beds per 1,000 people and an estimated 45,000 intensive care unit beds, and it could be overwhelmed with an explosion in the number of new, acutely ill patients.
The department has, in theory, the capacity to fill its mission. In addition to its central medical facilities, it has 1,074 outpatient sites and more than 330,000 full-time employees across the country. The veterans’ system has 13,000 acute care beds, including 1,800 intensive care beds, and has far more equipment and specialized care facilities — such as negative pressure rooms meant to isolate those with an infection like the coronavirus — than many private hospital systems.	The department has, in theory, the capacity to fill its mission. In addition to its central medical facilities, it has 1,074 outpatient sites and more than 330,000 full-time employees across the country. The veterans’ system has 13,000 acute care beds, including 1,800 intensive care beds, and has far more equipment and specialized care facilities — such as negative pressure rooms meant to isolate those with an infection like the coronavirus — than many private hospital systems.
It has played a significant and often vital role in recent years, backing up the strained health care system in Puerto Rico after a hurricane — it had intravenous therapy solutions that other centers did not — and providing mobile units after the 2016 mass shooting in the Pulse nightclub in Orlando, Fla. The department is one of the many federal coordinating centers that respond to emergencies; it even played a role in the Ebola outbreak.	It has played a significant and often vital role in recent years, backing up the strained health care system in Puerto Rico after a hurricane — it had intravenous therapy solutions that other centers did not — and providing mobile units after the 2016 mass shooting in the Pulse nightclub in Orlando, Fla. The department is one of the many federal coordinating centers that respond to emergencies; it even played a role in the Ebola outbreak.
Its problem, though, may be management.	Its problem, though, may be management.
When the department decided last week to bar visitors from its nursing homes to protect against a coronavirus outbreak, some were unprepared. The police force of the department, strained by its diminished numbers, is concerned about how to manage situations like a recent visitor to a veterans’ hospital who had to be physically removed under protest after an initial screening showed he was possibly infected with the coronavirus.	When the department decided last week to bar visitors from its nursing homes to protect against a coronavirus outbreak, some were unprepared. The police force of the department, strained by its diminished numbers, is concerned about how to manage situations like a recent visitor to a veterans’ hospital who had to be physically removed under protest after an initial screening showed he was possibly infected with the coronavirus.
Some workers said they were not clear if veterans would be prioritized over civilians in an emergency at their medical centers, and there were mixed messages in the department as to whether it would be called on at all.	Some workers said they were not clear if veterans would be prioritized over civilians in an emergency at their medical centers, and there were mixed messages in the department as to whether it would be called on at all.
“There is not a unified plan of action,” said Bob Fetzer, the president of the Fourth District of the American Federation of Government Employees National Veterans Affairs Council, which represents thousands of workers from the department. He said he had received complaints from members who said they were not receiving communications from Washington.	“There is not a unified plan of action,” said Bob Fetzer, the president of the Fourth District of the American Federation of Government Employees National Veterans Affairs Council, which represents thousands of workers from the department. He said he had received complaints from members who said they were not receiving communications from Washington.
Robert L. Wilkie, the secretary of veterans affairs, was added belatedly to the White House coronavirus task force this month and is rarely visible, other participants said.	Robert L. Wilkie, the secretary of veterans affairs, was added belatedly to the White House coronavirus task force this month and is rarely visible, other participants said.
He was not among the many officials and corporate executives who spoke on Friday at a news conference with President Trump in the Rose Garden. The department was not even mentioned at that event. Several current and former employees at the veterans department and Capitol Hill staff members said they hoped Mr. Wilkie, who does not have a background in public health, would not be sidelined.	He was not among the many officials and corporate executives who spoke on Friday at a news conference with President Trump in the Rose Garden. The department was not even mentioned at that event. Several current and former employees at the veterans department and Capitol Hill staff members said they hoped Mr. Wilkie, who does not have a background in public health, would not be sidelined.
A senior administration official familiar with the task force’s meetings said that Mr. Wilkie’s role in the group, thus far at least, had mostly included offering reassurances that the veterans’ medical system was ready to help. “To my knowledge he was been at all the meetings,” Dr. Stone said.	A senior administration official familiar with the task force’s meetings said that Mr. Wilkie’s role in the group, thus far at least, had mostly included offering reassurances that the veterans’ medical system was ready to help. “To my knowledge he was been at all the meetings,” Dr. Stone said.
Lawmakers in both parties, who have long complained about opacity at the department, are carefully watching.	Lawmakers in both parties, who have long complained about opacity at the department, are carefully watching.
“We recognize that the Covid-19 outbreak is an evolving situation, with a growing impact on the United States and global community, and want to ensure that the V.A. has all of the resources needed to keep veterans, staff and communities safe,” Senator Jon Tester of Montana, the ranking Democrat on the Senate Committee on Veterans’ Affairs, said in a statement, referring to the disease caused by the virus.	“We recognize that the Covid-19 outbreak is an evolving situation, with a growing impact on the United States and global community, and want to ensure that the V.A. has all of the resources needed to keep veterans, staff and communities safe,” Senator Jon Tester of Montana, the ranking Democrat on the Senate Committee on Veterans’ Affairs, said in a statement, referring to the disease caused by the virus.
A group of senators has requested information on the agency’s efforts to increase its response time and preparedness as cases are expected to climb among veterans, who tend to be older and have underlying medical conditions that put them at greater risk.	A group of senators has requested information on the agency’s efforts to increase its response time and preparedness as cases are expected to climb among veterans, who tend to be older and have underlying medical conditions that put them at greater risk.
Dr. Stone has been the department’s lead official speaking to Capitol Hill, the White House and the news media. Congressional staff members receive daily updates on the number and location of veterans who test positive. As of midday Monday, 30 were confirmed or presumed to have the virus and one, a veteran in his 70s in Oregon, had died.	Dr. Stone has been the department’s lead official speaking to Capitol Hill, the White House and the news media. Congressional staff members receive daily updates on the number and location of veterans who test positive. As of midday Monday, 30 were confirmed or presumed to have the virus and one, a veteran in his 70s in Oregon, had died.
The department’s medical centers are far-flung and operate largely independently. They vary greatly in capacity and quality. During a national emergency, local officials would have to explain their needs and abilities to Washington while seeking guidance. The questions would include: How do they prioritize care between veterans and nonveterans? How should workers telecommute?	The department’s medical centers are far-flung and operate largely independently. They vary greatly in capacity and quality. During a national emergency, local officials would have to explain their needs and abilities to Washington while seeking guidance. The questions would include: How do they prioritize care between veterans and nonveterans? How should workers telecommute?
	Updated June 12, 2020
	Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
	So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
	A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
	The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
	Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
	Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
	States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
	Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
	If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
	Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
	The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
	If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
	If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Mr. Wilkie has in the past expressed concern that the department cannot keep proper track of its number of employees or their functions.	Mr. Wilkie has in the past expressed concern that the department cannot keep proper track of its number of employees or their functions.
Older veterans, who make up a large portion of the department’s patient base, as well as those with very difficult injuries and illnesses like spinal cord injuries and kidney failure, need special and acute care and sometimes rely on private contractors for things like dialysis. Those patients are likely to be the department’s focus if supplies dwindle in the American health care system.	Older veterans, who make up a large portion of the department’s patient base, as well as those with very difficult injuries and illnesses like spinal cord injuries and kidney failure, need special and acute care and sometimes rely on private contractors for things like dialysis. Those patients are likely to be the department’s focus if supplies dwindle in the American health care system.
About 60 percent of the department’s medical staff have affiliations with other medical centers, and some workers worry about staff shortages in an extreme situation like those faced in China and Italy, although many of those doctors weight their time heavily toward the department’s facilities. During a hurricane in the Carolinas, medical staff worked overtime to personally move fragile spinal cord injury patients from the area to other states and bunked with department employees there.	About 60 percent of the department’s medical staff have affiliations with other medical centers, and some workers worry about staff shortages in an extreme situation like those faced in China and Italy, although many of those doctors weight their time heavily toward the department’s facilities. During a hurricane in the Carolinas, medical staff worked overtime to personally move fragile spinal cord injury patients from the area to other states and bunked with department employees there.
“The V.A. has some very talented people who work on emergency preparedness,” said David J. Shulkin, a former secretary of veterans affairs. “This is their time to shine.”	“The V.A. has some very talented people who work on emergency preparedness,” said David J. Shulkin, a former secretary of veterans affairs. “This is their time to shine.”