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| Who Gets Lifesaving Care? Tennessee Changes Rules After Federal Complaint | Who Gets Lifesaving Care? Tennessee Changes Rules After Federal Complaint |
| (5 days later) | |
| Health officials on Friday announced sweeping changes to guidelines in Tennessee on who would get lifesaving treatments, and who would not, if resources fell dramatically short during a medical crisis like the coronavirus pandemic. | Health officials on Friday announced sweeping changes to guidelines in Tennessee on who would get lifesaving treatments, and who would not, if resources fell dramatically short during a medical crisis like the coronavirus pandemic. |
| The action came after disability groups filed a federal civil rights complaint, arguing that key features of the plan were discriminatory. Multiple states and hospitals have adopted similar rules on rationing care, raising questions about whether change is afoot elsewhere. | The action came after disability groups filed a federal civil rights complaint, arguing that key features of the plan were discriminatory. Multiple states and hospitals have adopted similar rules on rationing care, raising questions about whether change is afoot elsewhere. |
| “We think this is a great model and hope other states will follow Tennessee’s lead in being comprehensive in accounting for the rights of persons with disabilities,” said Roger Severino, the director of the Office for Civil Rights at the U.S. Department of Health and Human Services, which received the complaint and worked with Tennessee to resolve it. | “We think this is a great model and hope other states will follow Tennessee’s lead in being comprehensive in accounting for the rights of persons with disabilities,” said Roger Severino, the director of the Office for Civil Rights at the U.S. Department of Health and Human Services, which received the complaint and worked with Tennessee to resolve it. |
| “People with disabilities are already more vulnerable to bad outcomes during this crisis,” Mr. Severino added. “This is a time to provide more protections, not fewer.” | “People with disabilities are already more vulnerable to bad outcomes during this crisis,” Mr. Severino added. “This is a time to provide more protections, not fewer.” |
| The new plan allocates medical care based on how likely patients are to survive their immediate illness if they receive treatment. The previous plan considered their long-term survival prospects as well. That provision was removed because it could disproportionately penalize those who are older or have disabilities. | The new plan allocates medical care based on how likely patients are to survive their immediate illness if they receive treatment. The previous plan considered their long-term survival prospects as well. That provision was removed because it could disproportionately penalize those who are older or have disabilities. |
| Some critics argued that factoring in who might live the longest could also disadvantage members of racial minority groups that have higher rates of underlying health conditions. Many of the same groups — particularly African-Americans, Native Americans and Hispanics — have seen a higher incidence of illness and death from Covid-19. | Some critics argued that factoring in who might live the longest could also disadvantage members of racial minority groups that have higher rates of underlying health conditions. Many of the same groups — particularly African-Americans, Native Americans and Hispanics — have seen a higher incidence of illness and death from Covid-19. |
| The new guidance contains other changes. When patients have underlying speech and movement disorders, doctors may need to modify their survival scoring system because its assessment of brain injury could be inaccurate. And the new rules state that if age or disability may require longer treatment or more resources, patients should not be made a lower priority because of that. | The new guidance contains other changes. When patients have underlying speech and movement disorders, doctors may need to modify their survival scoring system because its assessment of brain injury could be inaccurate. And the new rules state that if age or disability may require longer treatment or more resources, patients should not be made a lower priority because of that. |
| Both versions of the guidelines provide for removing ventilators — with or without consent — from patients if they are not improving after a certain period so the machines can go to others. Those who rely on personal ventilators to survive in their normal lives are exempted under the new plan. “No person with disabilities on a ventilator should ever be afraid of going to a hospital because it might be taken away from them,” Mr. Severino said. | Both versions of the guidelines provide for removing ventilators — with or without consent — from patients if they are not improving after a certain period so the machines can go to others. Those who rely on personal ventilators to survive in their normal lives are exempted under the new plan. “No person with disabilities on a ventilator should ever be afraid of going to a hospital because it might be taken away from them,” Mr. Severino said. |
| Tennessee’s plan also no longer categorically excludes certain patients from receiving hospital care, including those with conditions such as multiple sclerosis, amyotrophic lateral sclerosis and spinal muscular atrophy who require ventilators or assistance with common activities. One of the people who brought the complaint against the state has A.L.S. | Tennessee’s plan also no longer categorically excludes certain patients from receiving hospital care, including those with conditions such as multiple sclerosis, amyotrophic lateral sclerosis and spinal muscular atrophy who require ventilators or assistance with common activities. One of the people who brought the complaint against the state has A.L.S. |
| Hospitals and nursing homes that are limiting visitation to control the spread of the virus should consider allowing visits at the end of life, to facilitate the exercise of religion and to support people with disabilities, the new policy says. | Hospitals and nursing homes that are limiting visitation to control the spread of the virus should consider allowing visits at the end of life, to facilitate the exercise of religion and to support people with disabilities, the new policy says. |
| Updated June 30, 2020 | |
| 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. | |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| 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. | 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. |
| 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.) |
| 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. |
| “We think today’s a big deal,” said Alison Barkoff, advocacy director at the Center for Public Representation, one of several groups that have jointly filed about a dozen disability-related civil rights complaints during the pandemic. “We hope that states really look closely at their own plans, and we think it will give a lot of momentum to a number of other complaints.” | “We think today’s a big deal,” said Alison Barkoff, advocacy director at the Center for Public Representation, one of several groups that have jointly filed about a dozen disability-related civil rights complaints during the pandemic. “We hope that states really look closely at their own plans, and we think it will give a lot of momentum to a number of other complaints.” |
| Last week, her group and others alleged in a letter to the civil rights office that Nebraska’s drive-through Covid-19 testing program was inaccessible to people at high risk of the disease in group and nursing homes, arguing that the state had made little provision for testing those who lacked access to the sites. “It’s shocking,” she said. “The highest risk people are excluded.” | Last week, her group and others alleged in a letter to the civil rights office that Nebraska’s drive-through Covid-19 testing program was inaccessible to people at high risk of the disease in group and nursing homes, arguing that the state had made little provision for testing those who lacked access to the sites. “It’s shocking,” she said. “The highest risk people are excluded.” |
| The groups expect to continue their efforts. “We will keep fighting for revisions to discriminatory policies that could mean the difference between life and death for people with disabilities,” said Shira Wakschlag, director of legal advocacy for The Arc, a disability rights organization. | The groups expect to continue their efforts. “We will keep fighting for revisions to discriminatory policies that could mean the difference between life and death for people with disabilities,” said Shira Wakschlag, director of legal advocacy for The Arc, a disability rights organization. |
| A spokeswoman for Tennessee’s health department said it cooperated with disability advocates and the civil rights office to make the changes. It was not found to be legally liable. | A spokeswoman for Tennessee’s health department said it cooperated with disability advocates and the civil rights office to make the changes. It was not found to be legally liable. |
| This is the fourth time during the pandemic that the office reached a resolution with a state regarding disability discrimination. Two of those cases involved smaller changes to triage guidelines. In the most recent, Connecticut ordered hospitals to make exceptions to no-visitor policies so that people with disabilities may have family members or care providers present if needed. | This is the fourth time during the pandemic that the office reached a resolution with a state regarding disability discrimination. Two of those cases involved smaller changes to triage guidelines. In the most recent, Connecticut ordered hospitals to make exceptions to no-visitor policies so that people with disabilities may have family members or care providers present if needed. |