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| Hospital Safety Rules Are Relaxed to Fight Coronavirus | Hospital Safety Rules Are Relaxed to Fight Coronavirus |
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| The federal government announced Monday that it was relaxing many of its usual safety standards for hospitals so they could expand services to fight the coronavirus pandemic. | The federal government announced Monday that it was relaxing many of its usual safety standards for hospitals so they could expand services to fight the coronavirus pandemic. |
| The Centers for Medicare and Medicaid Services is changing rules on what counts as a hospital bed; how closely certain medical professionals need to be supervised; and what kinds of health care can be delivered at home. These broad but temporary changes will last the length of the national emergency. | The Centers for Medicare and Medicaid Services is changing rules on what counts as a hospital bed; how closely certain medical professionals need to be supervised; and what kinds of health care can be delivered at home. These broad but temporary changes will last the length of the national emergency. |
| “This is unprecedented flexibility,” said Seema Verma, the administrator for the centers, in an interview. “But with an unprecedented pandemic, we felt like it was the job of the agency to make sure those health care heroes on the front line had all the flexibility they needed to address the crisis at hand.” | “This is unprecedented flexibility,” said Seema Verma, the administrator for the centers, in an interview. “But with an unprecedented pandemic, we felt like it was the job of the agency to make sure those health care heroes on the front line had all the flexibility they needed to address the crisis at hand.” |
| FEMA and local officials have already begun unconventional expansions that would not meet normal federal standards, like the conversion of New York City’s Javits Convention Center into a temporary hospital facility. The new guidance would allow other communities to employ similar strategies. | FEMA and local officials have already begun unconventional expansions that would not meet normal federal standards, like the conversion of New York City’s Javits Convention Center into a temporary hospital facility. The new guidance would allow other communities to employ similar strategies. |
| It would also allow hospitals to undertake such measures themselves, without the involvement of FEMA. Hospitals could put beds into school gymnasiums, hotels, outpatient surgical centers, or in temporary structures in their parking lots. | It would also allow hospitals to undertake such measures themselves, without the involvement of FEMA. Hospitals could put beds into school gymnasiums, hotels, outpatient surgical centers, or in temporary structures in their parking lots. |
| The changes would also make it easier to separate patients infected with Covid-19, the disease caused by the virus, from others. Currently, hospital emergency rooms must see and stabilize any patient who enters their doors. The new rules would allow hospitals to set up triage centers that would direct patients to different facilities, according to their needs. It would allow the establishment of special hospitals, clinics and dialysis centers to treat only coronavirus patients, an effort to prevent those with other health needs from becoming infected. | The changes would also make it easier to separate patients infected with Covid-19, the disease caused by the virus, from others. Currently, hospital emergency rooms must see and stabilize any patient who enters their doors. The new rules would allow hospitals to set up triage centers that would direct patients to different facilities, according to their needs. It would allow the establishment of special hospitals, clinics and dialysis centers to treat only coronavirus patients, an effort to prevent those with other health needs from becoming infected. |
| Hospitals would be allowed to offer health care providers free meals, laundry or child care services — things that are typically barred under an anti-kickback law. | Hospitals would be allowed to offer health care providers free meals, laundry or child care services — things that are typically barred under an anti-kickback law. |
| The rules being waived were originally put in place to ensure that patients would receive quality care and to deter health care fraud. But Ms. Verma said that it was important to give communities the ability to treat as many patients as possible given surging demand. “A lot of areas are operating in crisis,” she said. | The rules being waived were originally put in place to ensure that patients would receive quality care and to deter health care fraud. But Ms. Verma said that it was important to give communities the ability to treat as many patients as possible given surging demand. “A lot of areas are operating in crisis,” she said. |
| The agency issued the changes through a series of waivers of normal law and by issuing a 221-page regulation. Normally, Ms. Verma said, such a regulation would take a year to write. But her staff was able to publish it in two weeks because of the circumstances, she said. | The agency issued the changes through a series of waivers of normal law and by issuing a 221-page regulation. Normally, Ms. Verma said, such a regulation would take a year to write. But her staff was able to publish it in two weeks because of the circumstances, she said. |
| A message sent to providers from the Department of Health and Human Services’ office of the inspector general on Monday said investigators would be “minimizing burdens” and relaxing reporting deadlines, but continuing to look for malfeasance or fraudulent billing. | A message sent to providers from the Department of Health and Human Services’ office of the inspector general on Monday said investigators would be “minimizing burdens” and relaxing reporting deadlines, but continuing to look for malfeasance or fraudulent billing. |
| Hospital groups welcomed the changes, many of which they had requested in letters to the agency. “I’ve never been in a situation where hospitals needed so much relief, both regulatory and financial, and I’m impressed here that C.M.S. has really taken on the issue and analyzed it well,” said Chip Kahn, the president of the Federation of American Hospitals, a trade group for for-profit hospitals. The American Medical Association, the largest doctors’ group, also welcomed the new rules. | Hospital groups welcomed the changes, many of which they had requested in letters to the agency. “I’ve never been in a situation where hospitals needed so much relief, both regulatory and financial, and I’m impressed here that C.M.S. has really taken on the issue and analyzed it well,” said Chip Kahn, the president of the Federation of American Hospitals, a trade group for for-profit hospitals. The American Medical Association, the largest doctors’ group, also welcomed the new rules. |
| Many of the announced changes would still be subject to state approval. But Ms. Verma said she hoped the new federal guidance would smooth the way for states to make such changes as they see fit. | Many of the announced changes would still be subject to state approval. But Ms. Verma said she hoped the new federal guidance would smooth the way for states to make such changes as they see fit. |
| New rules for doctors would make it easier for medical providers to be paid by Medicare. The government is allowing doctors in private practice to immediately begin treating Medicare patients in hospitals as their services are needed, even if they are not certified as Medicare providers, or are licensed out of state. It will also relax rules about the supervision of medical trainees. Medical residents can now be supervised by senior physicians over video or telephone, instead of only in person. | New rules for doctors would make it easier for medical providers to be paid by Medicare. The government is allowing doctors in private practice to immediately begin treating Medicare patients in hospitals as their services are needed, even if they are not certified as Medicare providers, or are licensed out of state. It will also relax rules about the supervision of medical trainees. Medical residents can now be supervised by senior physicians over video or telephone, instead of only in person. |
| Supervision requirements will also be loosened for nurse anesthetists, nurse practitioners and other health professionals who typically work under the supervision of a physician. States will have the final say over how independently those professionals will be allowed to work. | Supervision requirements will also be loosened for nurse anesthetists, nurse practitioners and other health professionals who typically work under the supervision of a physician. States will have the final say over how independently those professionals will be allowed to work. |
| Updated June 12, 2020 | Updated June 12, 2020 |
| 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. | 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. |
| 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. | |
| 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. | 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. | 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. | 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. | 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. | 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. | 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.) | 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. | 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. | 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’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. | 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. |
| The agency says the changes are allowed by the president’s declaration of a national emergency. They will last only for the duration of that emergency. | The agency says the changes are allowed by the president’s declaration of a national emergency. They will last only for the duration of that emergency. |
| The agency said Medicare would broaden the range of services it would pay for, including care that is not in a traditional medical office or hospital. It would also cover more digital visits called telemedicine as well as more services that can be delivered in a patient’s home, such as testing for the coronavirus. Those rules apply directly only to the Medicare program. But the largest trade group for private insurers has said it will match Medicare’s waivers of normal payment rules for coronavirus, meaning the changes may have much broader reach. | The agency said Medicare would broaden the range of services it would pay for, including care that is not in a traditional medical office or hospital. It would also cover more digital visits called telemedicine as well as more services that can be delivered in a patient’s home, such as testing for the coronavirus. Those rules apply directly only to the Medicare program. But the largest trade group for private insurers has said it will match Medicare’s waivers of normal payment rules for coronavirus, meaning the changes may have much broader reach. |
| Ashish Jha, the director of the Harvard Global Health Institute, who has studied hospital quality and safety, said the new policies could provide an opportunity to better understand whether various safety regulations really make a difference. Over all, he said he welcomes efforts to expand access to care amid the outbreak. | Ashish Jha, the director of the Harvard Global Health Institute, who has studied hospital quality and safety, said the new policies could provide an opportunity to better understand whether various safety regulations really make a difference. Over all, he said he welcomes efforts to expand access to care amid the outbreak. |
| “Right now, the urgent need is expanding capacity, expanding the ability to care for people,” he said. “If people can’t get the care at all, the quality is a secondary issue.” | “Right now, the urgent need is expanding capacity, expanding the ability to care for people,” he said. “If people can’t get the care at all, the quality is a secondary issue.” |