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"title": "Getting Critical COVID-19 Protective Equipment in the Bay Area Has Been a Mess. Here's Why",
"headTitle": "Getting Critical COVID-19 Protective Equipment in the Bay Area Has Been a Mess. Here’s Why | KQED",
"content": "\u003cp>The classic N95 mask is a thin layer of fiber and filter, light enough to slightly flutter when you toss it in the air. For months, health care workers have thought of the masks as a key line of defense against a fast-spreading and insidiously sneaky virus — their perpetual enemy on the job.\u003c/p>\n\u003cp>As the coronavirus spread early on, more than half of California hospitals had just two weeks of critical N95 masks, though they were already experiencing hiccups in the supply chain, public records show. Now, as the Bay Area reopens, some hospitals and other health care facilities in the region are still fighting to keep enough personal protective equipment, or PPE, at the ready to shield workers against COVID-19.\u003c/p>\n\u003cp>There’s no coordinated federal leadership on stabilizing the global supply chain, and state contracts for protective gear have been slow to deliver.\u003c/p>\n\u003cp>That’s bad news for those who say their jobs are already being transformed, perhaps permanently, by the coronavirus. According to the California Department of Public Health, 13,476 workers have tested positive to date.\u003c/p>\n\u003cp>“I’m not afraid to go to work,” said Diane Fagen, who has been an emergency room nurse in Alameda County for 16 years. “My fear is, will I be able to keep up? And will the system that I work for become broke financially and otherwise? Because this burden is something that no system is prepared for.”\u003c/p>\n\u003cp>\u003cstrong>‘Frailties’ of the System\u003c/strong>\u003c/p>\n\u003cp>Health officers around the bay have said that a 30-day supply of PPE at health care facilities is a key threshold for loosening stay-at-home orders. As counties have steadfastly lifted their restrictions, some are still stabilizing the supply chain for protective gear, acting as a safety net both for hospitals that serve poor patients and for more resilient and wealthier hospital chains.\u003c/p>\n\u003cp>[pullquote citation=\"Tosan Boyo, San Francisco General Hospital COO\"]‘I could never depend on an order arriving. I didn’t believe an order was real until it actually showed up at the loading dock.’[/pullquote]“To have COVID-19 come along and just lay bare all of the inadequacies of the unfairnesses of the resources that are available to the place that I work for … is really, really frustrating,” said Fagen, an employee of Highland Hospital, part of the Alameda Health System.\u003c/p>\n\u003cp>The current crisis has revealed not only these persistent inequities among health care facilities, but the extent to which every hospital relies on some public support. It’s also a bad sign for any predicted surges in hospitalizations for COVID-19 cases, not to mention future pandemics.\u003c/p>\n\u003cp>“With any of these disasters, just for a moment, you get kind of a light flash on the frailties of the system,” said Alonzo Plough, vice president and chief science officer for the Robert Wood Johnson Foundation.\u003c/p>\n\u003cp>\u003cstrong>Hospitals Sound the Alarm\u003c/strong>\u003c/p>\n\u003cp>In January and again in March, hospitals and other health care facilities laid it on the line to the California Department of Public Health: There just weren’t enough N95s and other personal protective gear on hand, and the supply chain was shaky to boot.\u003c/p>\n\u003cp>[pullquote]Alameda County has aggressively stockpiled protective gear to support all types of health care facilities, but no two Bay Area counties have handled the challenge of obtaining PPE the same way. \u003ca href=\"https://www.kqed.org/science/1966329/ppe-is-still-a-huge-issue-heres-how-each-county-is-handling-it\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cstrong>Read here to learn how each county is attempting to procure these supplies\u003c/strong>\u003c/a> that are critical to shielding health care workers from the coronavirus and slowing the spread of COVID-19.[/pullquote]That “chain” is more like a global web of links among manufacturers, middlemen, and medical offices that has been torn by sudden, competing demands from all over the world. Even six months ago, before the coronavirus crisis, local hospitals were already starting to feel it.\u003c/p>\n\u003cp>During the pandemic, nurses at Oakland’s Highland Hospital say they have been taught to store N95s that are used, but still functional in paper bags with their names on them, so they can last longer.\u003c/p>\n\u003cp>A spokesman for the Alameda Health System says he is unaware of such a policy, and that there is sufficient PPE on hand generally.\u003c/p>\n\u003cp>Laura Whitten, an emergency room nurse at Highland, said sanitizing wipes are scarce, so she uses improvised antibacterial cleaners, some made from bourbon or gin, to clean fingertip pulse meters between uses. “They remind me of hangovers,” she said. She also makes do with one wipe for an entire shift, saving it in a resealable baggie.\u003c/p>\n\u003cp>Tosan Boyo, San Francisco General’s chief operating officer and the city’s lead for COVID-19 operations, says PPE shortages were acute during the pandemic’s early days.\u003c/p>\n\u003cp>“Things like gloves, face-shields, gowns, sanitizer wipes became extraordinarily scarce across the country. I could never depend on an order arriving. I didn’t believe an order was real until it actually showed up at the loading dock,” Boyo said. “This is not an exaggeration.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" title=\"Hospitals Report Difficulty Procuring N95 Masks\" aria-label=\"Bar Chart\" id=\"datawrapper-chart-N46uH\" src=\"https://datawrapper.dwcdn.net/N46uH/3/\" scrolling=\"no\" frameborder=\"0\" style=\"border: none;\" width=\"800\" height=\"299\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>KQED obtained two state surveys of health care facilities and hospitals, one in January and the other in March, through public record requests. Overwhelmingly, hospitals reported supply chain problems and the need for support and equipment from public agencies. About half said they had on hand just one or two weeks of N95 masks, the protective workplace standard against a transmissible disease like COVID-19.\u003c/p>\n\u003cp>“Supplies are ordered just in time,” Stanford Hospital reported to the California Department of Public Health in January. “We’re concerned that our suppliers will not be able to fulfill our orders given increased demands and that medical supplies are not being exported from China.” The same went for Lucille Packard Children’s Hospital and Stanford-operated ValleyCare in Alameda County, Stanford Hospital said.\u003c/p>\n\u003cp>[pullquote citation=\"Lauren Whitten, Highland Hospital Nurse\"]‘None of us are getting a good picture of how much PPE we’re going through. We have all of the other numbers. Why can’t we get this one?’[/pullquote]Community health centers sounded concerned, too. “We do not have an adequate supply of N95 masks,” wrote Open Door Community Health Centers, which operates a dozen clinics across Humboldt and Del Norte counties. Hundreds of miles to the south, the Community Hospital of the Monterey Peninsula told the state: “We would have enough PPE to supply a few patients at this time … we have an emergency supply, but not confident that will last for 30 days[.]”\u003c/p>\n\u003cp>One reason hospitals were in a precarious situation is that maintaining a cache of supplies takes money, storage space and staff time. Low-inventory management — keeping a short supply on hand — is an increasingly common strategy in health care facilities, permitting a leaner and more decentralized operation.\u003c/p>\n\u003cp>There is no federal policy aimed at compensating for the fraying supply chain. The H1N1-virus crisis in 2009 depleted the Strategic National Stockpile, which warehouses everything from masks to ventilators to nerve agent antidotes in case of national emergency;\u003ca href=\"https://thehill.com/policy/healthcare/491871-federal-stockpile-of-emergency-medical-equipment-depleted-house-panel-says\"> its inventory of masks was never replenished\u003c/a>. During the current pandemic, the Trump administration handed much of the responsibility for locating supplies to the Federal Emergency Management Agency. But according to Plough, a former emergency manager for the Los Angeles County Department of Public Health, while FEMA responds to crises, it does not typically manage and procure supplies.\u003c/p>\n\u003cp>“This is just not the usual way that the supply chain has been managed,” said Plough. “This is a huge departure. It’s going to be hard for them to predict supply for PPE because of this.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" title=\"What PPE Alameda Hospitals Needed in March\" aria-label=\"Grouped Bars\" id=\"datawrapper-chart-GofBr\" src=\"https://datawrapper.dwcdn.net/GofBr/2/\" scrolling=\"no\" frameborder=\"0\" style=\"border: none;\" width=\"800\" height=\"701\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>By March, about half of California hospitals reported they were short on masks, shields, gowns and gloves. Alameda County hospitals were worse off than the state, especially when it came to N95s. As cases began to rise, 10 out of 13 hospitals reported they had at most a couple of weeks’ worth.\u003c/p>\n\u003cp>Because of procurement problems, most hospitals reported having to reuse PPE, including expired equipment, while they requested more supplies from local agencies. Both Alta Bates campuses, Kaiser hospitals in Oakland and Richmond, St. Rose Hospital, Fairmont Hospital, Alameda Hospital, San Leandro Hospital and Highland Hospital were all in this category.\u003c/p>\n\u003cp>In May, KQED asked Alameda County hospitals how many weeks of N95s they had on hand.\u003c/p>\n\u003cp>Hospitals in the Alameda Health System, said spokesman Terry Lightfoot, have a two-week supply of their usual N95s available. AHS updates its characterization of the supply chain once a week, in a \u003ca href=\"http://www.alamedahealthsystem.org/ppe-dashboard/\">document\u003c/a> now published on its website that codes supplies green, yellow or red, depending on availability.\u003c/p>\n\u003cp>But nurses, who are are in contentious negotiations with AHS over a new contract, point out that colors aren’t numbers: green, yellow and red don’t say enough about what’s on hand.\u003c/p>\n\u003cp>“None of us are getting a good picture of how much PPE we’re going through,” said Whitten, a nurse at Highland Hospital. “We have all of the other numbers. Why can’t we get this one?”\u003c/p>\n\u003cp>Kaiser and Sutter hospitals declined to specify how many N95s they had on hand.\u003c/p>\n\u003cp>The state and some counties have said having enough protective gear to account for a surge in coronavirus cases is one of the indicators for loosening health orders. In Alameda County, health officials now have asked hospitals to certify their PPE levels. While the county wouldn’t disclose those certifications, officials have assessed PPE supply readiness countywide as a three on a five-level scale.\u003cbr>\n[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Got PPE? Richer versus Poorer Hospitals\u003c/strong>\u003c/p>\n\u003cp>Consolidated medical groups running multiple hospitals are more resilient to challenges obtaining N95s and other protective gear; money helps explain why.\u003c/p>\n\u003cp>Without confirming how much PPE it has available, Kaiser called supplies for its hospitals in Fremont, Oakland and San Leandro, “adequate.”\u003c/p>\n\u003cp>Sutter Health said it’s working to “closely manage” the supply of protective gear for Alta Bates in Berkeley and Alta Bates’ Summit campus in Oakland, including leveraging its multiple locations to shift supplies where they’re most needed.\u003c/p>\n\u003cp>“Our hospitals are not on their own. They have an entire network backing them up and working to help ensure they have what they need to care for patients now, while continuing to prepare for future surges,” said Monique Binkley Smith, communications manager for Sutter Health. “While we are encouraged by our progress in securing PPE, and our supply is currently adequate to match the current need, our job is far from over.”\u003c/p>\n\u003cp>But safety-net hospitals keep less cash on hand, because the federal government reimburses them for uninsured patients.\u003c/p>\n\u003cp>“They’re a totally different financial structure and resource structure than the big academic medical centers,” said Plough.\u003c/p>\n\u003cp>Alameda Health System operates five hospitals; it was spun off from the county more than 20 years ago with the hopes of making its essential health care network more stable. It hasn’t worked that way. Now the system owes the county tens of millions of dollars, and it has had to ask county supervisors for money to keep going.\u003c/p>\n\u003cp>“I worry that the people who are in charge of this haven’t been stellar in performance prior to this, and so it’s hard to have that leap of faith that everything is going to be OK,” said Fagen, the Highland Hospital nurse.\u003c/p>\n\u003cp>That history is part of why she’s skeptical of current reuse and pandemic protocols, and of using masks that have been resterilized, something that has been discussed but not implemented where she works.\u003c/p>\n\u003cp>“I feel like that’s going to bite us in the butt later.”\u003c/p>\n\u003cp>\u003cstrong>State Tries to Help\u003c/strong>\u003c/p>\n\u003cp>In the months since CDPH checked in with hospitals about their needs, California hasn’t met Gov. Gavin Newsom’s lofty aspirations for a regular distribution of hundreds of millions of pieces of protective gear. At least not yet.\u003c/p>\n\u003cp>California’s \u003ca href=\"https://public.tableau.com/profile/ca.open.data#!/vizhome/COVID-19CountyProfile/COVID-19CountyProfile\">own data shows\u003c/a> that since the beginning of the pandemic, the state has distributed around 50 million N95 and 125 million surgical masks to counties. Earlier this month, Newsom announced the state was finally beginning to receive shipments of N95 masks from BYD, a Chinese manufacturer whose billion-dollar contract had to be extended when it couldn’t get its product federally certified as effective. Other, smaller mask contracts have fallen apart.\u003c/p>\n\u003cp>Even hospitals that report they’ve been able to keep protective gear flowing say federal and state support in an emergency is essential to the health care system, especially for small medical offices, which never used protective equipment this way before, and for nursing homes, whose needs have changed dramatically.\u003c/p>\n\u003cp>“The supply chain is not all equal. And our procurement and our ability to procure and further see into the supply chain is not all equal,” said Amanda Chawla, vice president of supply chain for Stanford University. “When you’re dealing with a pandemic, you need the ability to support the nation and the community in a different way.”\u003c/p>\n\u003cp>State and federal stumbles have made the work of county emergency managers who have shored up supplies through local contracts and donations even more important.\u003c/p>\n\u003cp>The state reports it has distributed nearly 1.3 million N95 masks to Alameda County. By mid-May, the county had distributed about that many masks to health care facilities requesting them. On top of that, the county’s emergency managers have started to build a stockpile of their own.\u003c/p>\n\u003cp>\u003cstrong>Alameda County’s N95 Guy\u003c/strong>\u003c/p>\n\u003cp>In a Dublin warehouse, a team led by Jim Morrissey has amassed a four-month supply of protective gear for Alameda County. That’s enough, he said, to support all of the county’s health facilities at current levels of demand.\u003c/p>\n\u003cp>“I think we have more N95 masks here … than the state of Massachusetts,” Morrissey said. “We’re in good shape.”\u003c/p>\n\u003cp>Morrissey is a linchpin with a mouthful of a title: He’s Alameda County Medical Health Operational Area Coordinator, or MHOAC. Every county has one, actually, as part of California’s emergency management system. But they don’t all operate like Morrissey.\u003c/p>\n\u003cp>Morrissey says he’s been able to fill just about every request from inside the county, distributing more than 15 million pieces of essential supplies in the fight against COVID-19 \u003ci>—\u003c/i> everything from masks to shields to gowns to thermometers to hand sanitizer. Word has traveled, he says, forcing him to turn down requests from elsewhere in the Bay Area and Northern California.\u003c/p>\n\u003cp>“I know other counties, actually, they want to see proof of a back order from a hospital before they will even attempt to fulfill a request,” Morrissey said. “We don’t quite go that far. We just say we want you to try.”\u003c/p>\n\u003cp>\u003cstrong>What Is a 30-Day Supply, Anyway?\u003c/strong>\u003c/p>\n\u003cp>As with every other element of the pandemic response, each county has handled the challenges that health care facilities face in obtaining PPE differently.\u003c/p>\n\u003cp>Some localities have required hospitals and other facilities to certify they have access to 30 days of PPE as part of the set of “indicators” that guide reopening different types of businesses and activities.\u003c/p>\n\u003cp>But health care workers and their advocates point out that no common definition of a 30-day supply exists among counties, facilities or even workers, now that hospitals are using “preservation protocols” to economize PPE use during the pandemic, tactics like using isolation gowns in order to conserve more-protective surgical gowns, or disinfecting and reusing N95s.\u003c/p>\n\u003cp>Sal Rosselli, who heads the National Union of Healthcare Workers, claims that at Santa Rosa Memorial, access to N95s for nurses and other workers in surgery rooms is controlled. St. Joseph Health, which runs the hospital, disputes that. “We never deny a caregiver an N95 respirator in situations that are medically necessary, in fact, we encourage it; it’s our policy,” the hospital said.\u003c/p>\n\u003cp>At Kindred Hospital, says Roselli, health care workers get one N95 a day.\u003c/p>\n\u003cp>“How do you define that they have a 30-day supply compared to, you know, a hospital that makes them readily available?” Rosselli said. “That 30-day supply definition is different from what we say is a must to be safe.”\u003c/p>\n\u003cp>Kindred did not respond to a request for comment.\u003c/p>\n\u003cp>However it’s defined, keeping more supplies at the ready is meant to protect against a surge in hospitalizations — a recurring fear in an often-uncontrolled pandemic.\u003c/p>\n\u003cp>Dr. Jennifer Tong, the associate chief medical officer at Santa Clara Valley Medical Center, said supply chain disruption might continue as long as there’s a state of emergency declared somewhere in the U.S.\u003c/p>\n\u003cp>“We expect that we might need to provide this support even if the local disaster has resolved,” she said.\u003c/p>\n\u003cp>\u003cstrong>Counties Pick Up the Tab\u003c/strong>\u003c/p>\n\u003cp>Shoring up supplies for health care facilities of all shapes and sizes is happening without an entirely clear picture of who will pay for it. At least some of the cost is being borne at the county level at a time when tax revenues, and consequently budgets, are shrinking.\u003c/p>\n\u003cp>The price of PPE is far from stable; Tong said the cost per unit has increased significantly for most items.\u003c/p>\n\u003cp>Morrissey of Alameda County says the county has spent at least $13.6 million on stockpiling protective equipment. According to Sgt. Ray Kelly, a public information officer in Alameda County’s Emergency Operation Center, the plan is to try to recoup 75% of expenses from FEMA for that work, as long as it lasts.\u003c/p>\n\u003cp>“We’re not going to stop buying PPE,” said Kelly. “Do we buy it for the next year, the next two years? Until we get a vaccine? We’re going to have to budget for PPE going into our county budgets for now on.”\u003c/p>\n\u003cp>Kelly points out that for Alameda and most counties, a new fiscal year begins in just a couple of weeks, and the pandemic has already changed spending priorities.\u003c/p>\n\u003cp>“We need to at least budget out for the next couple of years for PPE,” Kelly said. “At some point how much of the cost do you put on the taxpayer, where does our responsibility stop, and where do the corporations take over?\u003c/p>\n\u003cp>Pandemics have occurred before, Kelly says, but nothing like this. He compares COVID-19 to fires, now burning hotter and wilder around the state than they did before a century of mismanagement and changing climate.\u003c/p>\n\u003cp>Those fires caught many Northern Californians by surprise. Increasingly, counties and their residents are learning to prepare, attempting to minimize the consequences that follow, from a risk more frequent and deadlier than before.\u003c/p>\n\u003cp>Eventually, Kelly said, everyone’s got to buy their own flashlight.\u003c/p>\n\u003cp>\u003cstrong>Will Hospitals Plan Differently?\u003c/strong>\u003c/p>\n\u003cp>While Stanford University hospitals sounded concerned about protective equipment in earlier reports to the state, officials report relatively smooth operations for now.\u003c/p>\n\u003cp>Still, “I do think there will be a change in the industry,” said Stanford’s Chawla. At the very least, Chawla suggests that some facilities might change their disaster planning protocols, and move from low-inventory strategies to warehousing supplies.\u003c/p>\n\u003cp>Emergency supplies from the Strategic National Stockpile kept Alameda Health System hospitals safe during the early peak of the pandemic; more than $60,000 worth of donated gear from a GoFundMe campaign helped supply the emergency room at Highland Hospital specifically.\u003c/p>\n\u003cp>But nurses and patient advocates say donations and stockpiles are no way to run a health care system.\u003c/p>\n\u003cp>Essential and safety-net hospitals around the country have been struggling for years, as federal and other reimbursements have dropped.\u003c/p>\n\u003cp>“It should be alarming, but it’s a chronic alarming,” said Plough of the Robert Wood Johnson Foundation.\u003c/p>\n\u003cp>Nurse Whitten’s voice cracks as she talks about fatigue. In the ER, she says, they sometimes feel “alarm fatigue” — so many bells ringing at the same time, hour after hour, relentless.\u003c/p>\n\u003cp>She knows the public is feeling this way, too, because of quarantine and COVID-19 fears.\u003c/p>\n\u003cp>“As tired as you are, think of what it’s like for us,” she said.\u003c/p>\n\u003cp>\u003cem>Polly Stryker and Laura Klivans contributed additional reporting.\u003c/em>\u003c/p>\n\u003cp>\u003cem>An earlier version of this article misidentified Monique Binkley-Smith’s title.\u003c/em>\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"excerpt": "As the Bay Area reopens, some hospitals and other health care facilities in the region are still fighting to keep enough personal protective equipment, or PPE, at the ready to protect workers against COVID-19.",
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"title": "Getting Critical COVID-19 Protective Equipment in the Bay Area Has Been a Mess. Here's Why | KQED",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>The classic N95 mask is a thin layer of fiber and filter, light enough to slightly flutter when you toss it in the air. For months, health care workers have thought of the masks as a key line of defense against a fast-spreading and insidiously sneaky virus — their perpetual enemy on the job.\u003c/p>\n\u003cp>As the coronavirus spread early on, more than half of California hospitals had just two weeks of critical N95 masks, though they were already experiencing hiccups in the supply chain, public records show. Now, as the Bay Area reopens, some hospitals and other health care facilities in the region are still fighting to keep enough personal protective equipment, or PPE, at the ready to shield workers against COVID-19.\u003c/p>\n\u003cp>There’s no coordinated federal leadership on stabilizing the global supply chain, and state contracts for protective gear have been slow to deliver.\u003c/p>\n\u003cp>That’s bad news for those who say their jobs are already being transformed, perhaps permanently, by the coronavirus. According to the California Department of Public Health, 13,476 workers have tested positive to date.\u003c/p>\n\u003cp>“I’m not afraid to go to work,” said Diane Fagen, who has been an emergency room nurse in Alameda County for 16 years. “My fear is, will I be able to keep up? And will the system that I work for become broke financially and otherwise? Because this burden is something that no system is prepared for.”\u003c/p>\n\u003cp>\u003cstrong>‘Frailties’ of the System\u003c/strong>\u003c/p>\n\u003cp>Health officers around the bay have said that a 30-day supply of PPE at health care facilities is a key threshold for loosening stay-at-home orders. As counties have steadfastly lifted their restrictions, some are still stabilizing the supply chain for protective gear, acting as a safety net both for hospitals that serve poor patients and for more resilient and wealthier hospital chains.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘I could never depend on an order arriving. I didn’t believe an order was real until it actually showed up at the loading dock.’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>“To have COVID-19 come along and just lay bare all of the inadequacies of the unfairnesses of the resources that are available to the place that I work for … is really, really frustrating,” said Fagen, an employee of Highland Hospital, part of the Alameda Health System.\u003c/p>\n\u003cp>The current crisis has revealed not only these persistent inequities among health care facilities, but the extent to which every hospital relies on some public support. It’s also a bad sign for any predicted surges in hospitalizations for COVID-19 cases, not to mention future pandemics.\u003c/p>\n\u003cp>“With any of these disasters, just for a moment, you get kind of a light flash on the frailties of the system,” said Alonzo Plough, vice president and chief science officer for the Robert Wood Johnson Foundation.\u003c/p>\n\u003cp>\u003cstrong>Hospitals Sound the Alarm\u003c/strong>\u003c/p>\n\u003cp>In January and again in March, hospitals and other health care facilities laid it on the line to the California Department of Public Health: There just weren’t enough N95s and other personal protective gear on hand, and the supply chain was shaky to boot.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "Alameda County has aggressively stockpiled protective gear to support all types of health care facilities, but no two Bay Area counties have handled the challenge of obtaining PPE the same way. \u003ca href=\"https://www.kqed.org/science/1966329/ppe-is-still-a-huge-issue-heres-how-each-county-is-handling-it\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cstrong>Read here to learn how each county is attempting to procure these supplies\u003c/strong>\u003c/a> that are critical to shielding health care workers from the coronavirus and slowing the spread of COVID-19.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>That “chain” is more like a global web of links among manufacturers, middlemen, and medical offices that has been torn by sudden, competing demands from all over the world. Even six months ago, before the coronavirus crisis, local hospitals were already starting to feel it.\u003c/p>\n\u003cp>During the pandemic, nurses at Oakland’s Highland Hospital say they have been taught to store N95s that are used, but still functional in paper bags with their names on them, so they can last longer.\u003c/p>\n\u003cp>A spokesman for the Alameda Health System says he is unaware of such a policy, and that there is sufficient PPE on hand generally.\u003c/p>\n\u003cp>Laura Whitten, an emergency room nurse at Highland, said sanitizing wipes are scarce, so she uses improvised antibacterial cleaners, some made from bourbon or gin, to clean fingertip pulse meters between uses. “They remind me of hangovers,” she said. She also makes do with one wipe for an entire shift, saving it in a resealable baggie.\u003c/p>\n\u003cp>Tosan Boyo, San Francisco General’s chief operating officer and the city’s lead for COVID-19 operations, says PPE shortages were acute during the pandemic’s early days.\u003c/p>\n\u003cp>“Things like gloves, face-shields, gowns, sanitizer wipes became extraordinarily scarce across the country. I could never depend on an order arriving. I didn’t believe an order was real until it actually showed up at the loading dock,” Boyo said. “This is not an exaggeration.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" title=\"Hospitals Report Difficulty Procuring N95 Masks\" aria-label=\"Bar Chart\" id=\"datawrapper-chart-N46uH\" src=\"https://datawrapper.dwcdn.net/N46uH/3/\" scrolling=\"no\" frameborder=\"0\" style=\"border: none;\" width=\"800\" height=\"299\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>KQED obtained two state surveys of health care facilities and hospitals, one in January and the other in March, through public record requests. Overwhelmingly, hospitals reported supply chain problems and the need for support and equipment from public agencies. About half said they had on hand just one or two weeks of N95 masks, the protective workplace standard against a transmissible disease like COVID-19.\u003c/p>\n\u003cp>“Supplies are ordered just in time,” Stanford Hospital reported to the California Department of Public Health in January. “We’re concerned that our suppliers will not be able to fulfill our orders given increased demands and that medical supplies are not being exported from China.” The same went for Lucille Packard Children’s Hospital and Stanford-operated ValleyCare in Alameda County, Stanford Hospital said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "‘None of us are getting a good picture of how much PPE we’re going through. We have all of the other numbers. Why can’t we get this one?’",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Community health centers sounded concerned, too. “We do not have an adequate supply of N95 masks,” wrote Open Door Community Health Centers, which operates a dozen clinics across Humboldt and Del Norte counties. Hundreds of miles to the south, the Community Hospital of the Monterey Peninsula told the state: “We would have enough PPE to supply a few patients at this time … we have an emergency supply, but not confident that will last for 30 days[.]”\u003c/p>\n\u003cp>One reason hospitals were in a precarious situation is that maintaining a cache of supplies takes money, storage space and staff time. Low-inventory management — keeping a short supply on hand — is an increasingly common strategy in health care facilities, permitting a leaner and more decentralized operation.\u003c/p>\n\u003cp>There is no federal policy aimed at compensating for the fraying supply chain. The H1N1-virus crisis in 2009 depleted the Strategic National Stockpile, which warehouses everything from masks to ventilators to nerve agent antidotes in case of national emergency;\u003ca href=\"https://thehill.com/policy/healthcare/491871-federal-stockpile-of-emergency-medical-equipment-depleted-house-panel-says\"> its inventory of masks was never replenished\u003c/a>. During the current pandemic, the Trump administration handed much of the responsibility for locating supplies to the Federal Emergency Management Agency. But according to Plough, a former emergency manager for the Los Angeles County Department of Public Health, while FEMA responds to crises, it does not typically manage and procure supplies.\u003c/p>\n\u003cp>“This is just not the usual way that the supply chain has been managed,” said Plough. “This is a huge departure. It’s going to be hard for them to predict supply for PPE because of this.”\u003c/p>\n\u003cp>\u003c!-- iframe plugin v.4.3 wordpress.org/plugins/iframe/ -->\u003cbr>\n\u003ciframe loading=\"lazy\" title=\"What PPE Alameda Hospitals Needed in March\" aria-label=\"Grouped Bars\" id=\"datawrapper-chart-GofBr\" src=\"https://datawrapper.dwcdn.net/GofBr/2/\" scrolling=\"no\" frameborder=\"0\" style=\"border: none;\" width=\"800\" height=\"701\" class=\"iframe-class\">\u003c/iframe>\u003c/p>\n\u003cp>By March, about half of California hospitals reported they were short on masks, shields, gowns and gloves. Alameda County hospitals were worse off than the state, especially when it came to N95s. As cases began to rise, 10 out of 13 hospitals reported they had at most a couple of weeks’ worth.\u003c/p>\n\u003cp>Because of procurement problems, most hospitals reported having to reuse PPE, including expired equipment, while they requested more supplies from local agencies. Both Alta Bates campuses, Kaiser hospitals in Oakland and Richmond, St. Rose Hospital, Fairmont Hospital, Alameda Hospital, San Leandro Hospital and Highland Hospital were all in this category.\u003c/p>\n\u003cp>In May, KQED asked Alameda County hospitals how many weeks of N95s they had on hand.\u003c/p>\n\u003cp>Hospitals in the Alameda Health System, said spokesman Terry Lightfoot, have a two-week supply of their usual N95s available. AHS updates its characterization of the supply chain once a week, in a \u003ca href=\"http://www.alamedahealthsystem.org/ppe-dashboard/\">document\u003c/a> now published on its website that codes supplies green, yellow or red, depending on availability.\u003c/p>\n\u003cp>But nurses, who are are in contentious negotiations with AHS over a new contract, point out that colors aren’t numbers: green, yellow and red don’t say enough about what’s on hand.\u003c/p>\n\u003cp>“None of us are getting a good picture of how much PPE we’re going through,” said Whitten, a nurse at Highland Hospital. “We have all of the other numbers. Why can’t we get this one?”\u003c/p>\n\u003cp>Kaiser and Sutter hospitals declined to specify how many N95s they had on hand.\u003c/p>\n\u003cp>The state and some counties have said having enough protective gear to account for a surge in coronavirus cases is one of the indicators for loosening health orders. In Alameda County, health officials now have asked hospitals to certify their PPE levels. While the county wouldn’t disclose those certifications, officials have assessed PPE supply readiness countywide as a three on a five-level scale.\u003cbr>\n\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Got PPE? Richer versus Poorer Hospitals\u003c/strong>\u003c/p>\n\u003cp>Consolidated medical groups running multiple hospitals are more resilient to challenges obtaining N95s and other protective gear; money helps explain why.\u003c/p>\n\u003cp>Without confirming how much PPE it has available, Kaiser called supplies for its hospitals in Fremont, Oakland and San Leandro, “adequate.”\u003c/p>\n\u003cp>Sutter Health said it’s working to “closely manage” the supply of protective gear for Alta Bates in Berkeley and Alta Bates’ Summit campus in Oakland, including leveraging its multiple locations to shift supplies where they’re most needed.\u003c/p>\n\u003cp>“Our hospitals are not on their own. They have an entire network backing them up and working to help ensure they have what they need to care for patients now, while continuing to prepare for future surges,” said Monique Binkley Smith, communications manager for Sutter Health. “While we are encouraged by our progress in securing PPE, and our supply is currently adequate to match the current need, our job is far from over.”\u003c/p>\n\u003cp>But safety-net hospitals keep less cash on hand, because the federal government reimburses them for uninsured patients.\u003c/p>\n\u003cp>“They’re a totally different financial structure and resource structure than the big academic medical centers,” said Plough.\u003c/p>\n\u003cp>Alameda Health System operates five hospitals; it was spun off from the county more than 20 years ago with the hopes of making its essential health care network more stable. It hasn’t worked that way. Now the system owes the county tens of millions of dollars, and it has had to ask county supervisors for money to keep going.\u003c/p>\n\u003cp>“I worry that the people who are in charge of this haven’t been stellar in performance prior to this, and so it’s hard to have that leap of faith that everything is going to be OK,” said Fagen, the Highland Hospital nurse.\u003c/p>\n\u003cp>That history is part of why she’s skeptical of current reuse and pandemic protocols, and of using masks that have been resterilized, something that has been discussed but not implemented where she works.\u003c/p>\n\u003cp>“I feel like that’s going to bite us in the butt later.”\u003c/p>\n\u003cp>\u003cstrong>State Tries to Help\u003c/strong>\u003c/p>\n\u003cp>In the months since CDPH checked in with hospitals about their needs, California hasn’t met Gov. Gavin Newsom’s lofty aspirations for a regular distribution of hundreds of millions of pieces of protective gear. At least not yet.\u003c/p>\n\u003cp>California’s \u003ca href=\"https://public.tableau.com/profile/ca.open.data#!/vizhome/COVID-19CountyProfile/COVID-19CountyProfile\">own data shows\u003c/a> that since the beginning of the pandemic, the state has distributed around 50 million N95 and 125 million surgical masks to counties. Earlier this month, Newsom announced the state was finally beginning to receive shipments of N95 masks from BYD, a Chinese manufacturer whose billion-dollar contract had to be extended when it couldn’t get its product federally certified as effective. Other, smaller mask contracts have fallen apart.\u003c/p>\n\u003cp>Even hospitals that report they’ve been able to keep protective gear flowing say federal and state support in an emergency is essential to the health care system, especially for small medical offices, which never used protective equipment this way before, and for nursing homes, whose needs have changed dramatically.\u003c/p>\n\u003cp>“The supply chain is not all equal. And our procurement and our ability to procure and further see into the supply chain is not all equal,” said Amanda Chawla, vice president of supply chain for Stanford University. “When you’re dealing with a pandemic, you need the ability to support the nation and the community in a different way.”\u003c/p>\n\u003cp>State and federal stumbles have made the work of county emergency managers who have shored up supplies through local contracts and donations even more important.\u003c/p>\n\u003cp>The state reports it has distributed nearly 1.3 million N95 masks to Alameda County. By mid-May, the county had distributed about that many masks to health care facilities requesting them. On top of that, the county’s emergency managers have started to build a stockpile of their own.\u003c/p>\n\u003cp>\u003cstrong>Alameda County’s N95 Guy\u003c/strong>\u003c/p>\n\u003cp>In a Dublin warehouse, a team led by Jim Morrissey has amassed a four-month supply of protective gear for Alameda County. That’s enough, he said, to support all of the county’s health facilities at current levels of demand.\u003c/p>\n\u003cp>“I think we have more N95 masks here … than the state of Massachusetts,” Morrissey said. “We’re in good shape.”\u003c/p>\n\u003cp>Morrissey is a linchpin with a mouthful of a title: He’s Alameda County Medical Health Operational Area Coordinator, or MHOAC. Every county has one, actually, as part of California’s emergency management system. But they don’t all operate like Morrissey.\u003c/p>\n\u003cp>Morrissey says he’s been able to fill just about every request from inside the county, distributing more than 15 million pieces of essential supplies in the fight against COVID-19 \u003ci>—\u003c/i> everything from masks to shields to gowns to thermometers to hand sanitizer. Word has traveled, he says, forcing him to turn down requests from elsewhere in the Bay Area and Northern California.\u003c/p>\n\u003cp>“I know other counties, actually, they want to see proof of a back order from a hospital before they will even attempt to fulfill a request,” Morrissey said. “We don’t quite go that far. We just say we want you to try.”\u003c/p>\n\u003cp>\u003cstrong>What Is a 30-Day Supply, Anyway?\u003c/strong>\u003c/p>\n\u003cp>As with every other element of the pandemic response, each county has handled the challenges that health care facilities face in obtaining PPE differently.\u003c/p>\n\u003cp>Some localities have required hospitals and other facilities to certify they have access to 30 days of PPE as part of the set of “indicators” that guide reopening different types of businesses and activities.\u003c/p>\n\u003cp>But health care workers and their advocates point out that no common definition of a 30-day supply exists among counties, facilities or even workers, now that hospitals are using “preservation protocols” to economize PPE use during the pandemic, tactics like using isolation gowns in order to conserve more-protective surgical gowns, or disinfecting and reusing N95s.\u003c/p>\n\u003cp>Sal Rosselli, who heads the National Union of Healthcare Workers, claims that at Santa Rosa Memorial, access to N95s for nurses and other workers in surgery rooms is controlled. St. Joseph Health, which runs the hospital, disputes that. “We never deny a caregiver an N95 respirator in situations that are medically necessary, in fact, we encourage it; it’s our policy,” the hospital said.\u003c/p>\n\u003cp>At Kindred Hospital, says Roselli, health care workers get one N95 a day.\u003c/p>\n\u003cp>“How do you define that they have a 30-day supply compared to, you know, a hospital that makes them readily available?” Rosselli said. “That 30-day supply definition is different from what we say is a must to be safe.”\u003c/p>\n\u003cp>Kindred did not respond to a request for comment.\u003c/p>\n\u003cp>However it’s defined, keeping more supplies at the ready is meant to protect against a surge in hospitalizations — a recurring fear in an often-uncontrolled pandemic.\u003c/p>\n\u003cp>Dr. Jennifer Tong, the associate chief medical officer at Santa Clara Valley Medical Center, said supply chain disruption might continue as long as there’s a state of emergency declared somewhere in the U.S.\u003c/p>\n\u003cp>“We expect that we might need to provide this support even if the local disaster has resolved,” she said.\u003c/p>\n\u003cp>\u003cstrong>Counties Pick Up the Tab\u003c/strong>\u003c/p>\n\u003cp>Shoring up supplies for health care facilities of all shapes and sizes is happening without an entirely clear picture of who will pay for it. At least some of the cost is being borne at the county level at a time when tax revenues, and consequently budgets, are shrinking.\u003c/p>\n\u003cp>The price of PPE is far from stable; Tong said the cost per unit has increased significantly for most items.\u003c/p>\n\u003cp>Morrissey of Alameda County says the county has spent at least $13.6 million on stockpiling protective equipment. According to Sgt. Ray Kelly, a public information officer in Alameda County’s Emergency Operation Center, the plan is to try to recoup 75% of expenses from FEMA for that work, as long as it lasts.\u003c/p>\n\u003cp>“We’re not going to stop buying PPE,” said Kelly. “Do we buy it for the next year, the next two years? Until we get a vaccine? We’re going to have to budget for PPE going into our county budgets for now on.”\u003c/p>\n\u003cp>Kelly points out that for Alameda and most counties, a new fiscal year begins in just a couple of weeks, and the pandemic has already changed spending priorities.\u003c/p>\n\u003cp>“We need to at least budget out for the next couple of years for PPE,” Kelly said. “At some point how much of the cost do you put on the taxpayer, where does our responsibility stop, and where do the corporations take over?\u003c/p>\n\u003cp>Pandemics have occurred before, Kelly says, but nothing like this. He compares COVID-19 to fires, now burning hotter and wilder around the state than they did before a century of mismanagement and changing climate.\u003c/p>\n\u003cp>Those fires caught many Northern Californians by surprise. Increasingly, counties and their residents are learning to prepare, attempting to minimize the consequences that follow, from a risk more frequent and deadlier than before.\u003c/p>\n\u003cp>Eventually, Kelly said, everyone’s got to buy their own flashlight.\u003c/p>\n\u003cp>\u003cstrong>Will Hospitals Plan Differently?\u003c/strong>\u003c/p>\n\u003cp>While Stanford University hospitals sounded concerned about protective equipment in earlier reports to the state, officials report relatively smooth operations for now.\u003c/p>\n\u003cp>Still, “I do think there will be a change in the industry,” said Stanford’s Chawla. At the very least, Chawla suggests that some facilities might change their disaster planning protocols, and move from low-inventory strategies to warehousing supplies.\u003c/p>\n\u003cp>Emergency supplies from the Strategic National Stockpile kept Alameda Health System hospitals safe during the early peak of the pandemic; more than $60,000 worth of donated gear from a GoFundMe campaign helped supply the emergency room at Highland Hospital specifically.\u003c/p>\n\u003cp>But nurses and patient advocates say donations and stockpiles are no way to run a health care system.\u003c/p>\n\u003cp>Essential and safety-net hospitals around the country have been struggling for years, as federal and other reimbursements have dropped.\u003c/p>\n\u003cp>“It should be alarming, but it’s a chronic alarming,” said Plough of the Robert Wood Johnson Foundation.\u003c/p>\n\u003cp>Nurse Whitten’s voice cracks as she talks about fatigue. In the ER, she says, they sometimes feel “alarm fatigue” — so many bells ringing at the same time, hour after hour, relentless.\u003c/p>\n\u003cp>She knows the public is feeling this way, too, because of quarantine and COVID-19 fears.\u003c/p>\n\u003cp>“As tired as you are, think of what it’s like for us,” she said.\u003c/p>\n\u003cp>\u003cem>Polly Stryker and Laura Klivans contributed additional reporting.\u003c/em>\u003c/p>\n\u003cp>\u003cem>An earlier version of this article misidentified Monique Binkley-Smith’s title.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cp>Bayer will pay up to $10.9 billion to settle litigation over the subsidiary Monsanto’s weed killer Roundup, which has faced thousands of lawsuits over claims it causes cancer, the German-based company said Wednesday.\u003c/p>\n\u003cp>Bayer said it was also paying up to $1.22 billion to settle two additional areas of intense litigation, one involving PCB in water, and one involving dicamba, another weed killer.\u003c/p>\n\u003cp>The company said the Roundup settlement involves about 125,000 filed and unfiled claims. Under the agreement, Bayer will make a payment of $8.8 billion to $9.6 billion to resolve current litigation, and $1.25 billion to address potential future litigation.\u003c/p>\n\u003cp>Any future settlements are subject to approval by Judge Vince Chhabria of the U.S. District Court for the Northern District of California, the company said.\u003c/p>\n\u003cp>“First and foremost, the Roundup settlement is the right action at the right time for Bayer to bring a long period of uncertainty to an end,” Bayer CEO Werner Baumann said in a statement. “It resolves most current claims and puts in place a clear mechanism to manage risks of potential future litigation. It is financially reasonable when viewed against the significant financial risks of continued, multi-year litigation and the related impacts to our reputation and to our business.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Monsanto developed glyphosate — a key ingredient in Roundup — in the 1970s. The weed killer has been sold in more than 160 countries and widely used in the U.S. The company has long maintained that it is safe. Bayer said last year that all government regulators that have looked at the issue have rejected a link between cancer and glyphosate.\u003c/p>\n\u003cp>But the herbicide came under increasing scrutiny after the France-based International Agency for Research on Cancer, which is part of the World Health Organization, classified it as a “probable human carcinogen” in 2015.\u003c/p>\n\u003cp>Lawsuits against Monsanto followed. Monsanto has attacked the international research agency’s opinion as an outlier. The U.S. Environmental Protection Agency says glyphosate is safe for people when used in accordance with label directions.\u003c/p>\n\u003cp>Bayer purchased St. Louis-based Monsanto in 2018.\u003c/p>\n\u003cp>In August, a California jury ordered Monsanto to pay a combined $2.055 billion to a couple claiming that Roundup Ready caused their cancers. It was the third such courtroom loss for Monsanto in California since August.\u003c/p>\n\u003cp>Bayer said Wednesday that the appeals process will continue for those three cases, which are not covered by the settlement.\u003c/p>\n\u003cp>Bayer said it would also pay up to $400 million to settle cases claiming that the weed killer dicamba drifted onto plants that weren’t bred to resist it, killing them. Claimants will be required to provide proof of damage to crop yields and evidence that it was due to dicamba, Bayer said.\u003c/p>\n\u003cp>The company said it expects contributions from co-defendant BASF toward the dicamba settlement.\u003c/p>\n\u003cp>A further payment of up to $820 million will be made to settle “most” claims for exposure to PCB, a highly carcinogenic chemical that Monsanto produced until 1977 and that has been found in U.S. waters.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Bayer said it would start making payments this year and these would be financed from existing liquidity, future income, proceeds from the sale of its animal health business and the issuance of additional bonds.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Bayer will pay up to $10.9 billion to settle litigation over the subsidiary Monsanto’s weed killer Roundup, which has faced thousands of lawsuits over claims it causes cancer, the German-based company said Wednesday.\u003c/p>\n\u003cp>Bayer said it was also paying up to $1.22 billion to settle two additional areas of intense litigation, one involving PCB in water, and one involving dicamba, another weed killer.\u003c/p>\n\u003cp>The company said the Roundup settlement involves about 125,000 filed and unfiled claims. Under the agreement, Bayer will make a payment of $8.8 billion to $9.6 billion to resolve current litigation, and $1.25 billion to address potential future litigation.\u003c/p>\n\u003cp>Any future settlements are subject to approval by Judge Vince Chhabria of the U.S. District Court for the Northern District of California, the company said.\u003c/p>\n\u003cp>“First and foremost, the Roundup settlement is the right action at the right time for Bayer to bring a long period of uncertainty to an end,” Bayer CEO Werner Baumann said in a statement. “It resolves most current claims and puts in place a clear mechanism to manage risks of potential future litigation. It is financially reasonable when viewed against the significant financial risks of continued, multi-year litigation and the related impacts to our reputation and to our business.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Monsanto developed glyphosate — a key ingredient in Roundup — in the 1970s. The weed killer has been sold in more than 160 countries and widely used in the U.S. The company has long maintained that it is safe. Bayer said last year that all government regulators that have looked at the issue have rejected a link between cancer and glyphosate.\u003c/p>\n\u003cp>But the herbicide came under increasing scrutiny after the France-based International Agency for Research on Cancer, which is part of the World Health Organization, classified it as a “probable human carcinogen” in 2015.\u003c/p>\n\u003cp>Lawsuits against Monsanto followed. Monsanto has attacked the international research agency’s opinion as an outlier. The U.S. Environmental Protection Agency says glyphosate is safe for people when used in accordance with label directions.\u003c/p>\n\u003cp>Bayer purchased St. Louis-based Monsanto in 2018.\u003c/p>\n\u003cp>In August, a California jury ordered Monsanto to pay a combined $2.055 billion to a couple claiming that Roundup Ready caused their cancers. It was the third such courtroom loss for Monsanto in California since August.\u003c/p>\n\u003cp>Bayer said Wednesday that the appeals process will continue for those three cases, which are not covered by the settlement.\u003c/p>\n\u003cp>Bayer said it would also pay up to $400 million to settle cases claiming that the weed killer dicamba drifted onto plants that weren’t bred to resist it, killing them. Claimants will be required to provide proof of damage to crop yields and evidence that it was due to dicamba, Bayer said.\u003c/p>\n\u003cp>The company said it expects contributions from co-defendant BASF toward the dicamba settlement.\u003c/p>\n\u003cp>A further payment of up to $820 million will be made to settle “most” claims for exposure to PCB, a highly carcinogenic chemical that Monsanto produced until 1977 and that has been found in U.S. waters.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>Bayer said it would start making payments this year and these would be financed from existing liquidity, future income, proceeds from the sale of its animal health business and the issuance of additional bonds.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp class=\"p1\">At the beginning of the coronavirus crisis, Margo Henderson ordered a lot of takeout pizza and quesadillas. But she worried that the greasy comfort foods she indulged in at the pandemic’s outset had nudged her down a slippery slope.\u003c/p>\n\u003cp>[pullquote]‘I grew up pretty much on an all-beige diet,” says Margo Henderson. “I [had] the palate of a 4-year-old until I was 25.’[/pullquote]\u003c/p>\n\u003cp class=\"p1\">For most of her 29 years, Henderson has grappled with an eating disorder that caused a deep aversion, even disgust, for most foods.\u003c/p>\n\u003cp class=\"p1\">“I grew up pretty much on an all-beige diet,” she said, perched on the edge of her weathered leather couch in a sparsely furnished San Francisco apartment. “Absolutely nothing green. No fruits or vegetables. I pretty much had the palate of a 4-year-old until I was 25.”\u003c/p>\n\u003cp class=\"p1\">When she was a child, her mother tried bribing her with treats. Sometimes her mom refused to let her leave the table if she didn’t eat something other than bread and pasta. When those tactics failed, her mother dragged her to pediatricians, dieticians and even a hypnotist. The specialists shrugged off her intolerant palate as age-related.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp class=\"p1\">But fussy eating was more than a phase. Even into adulthood, Henderson preferred the kids menu. She cringed at the sight and smell of certain foods, especially cold and crunchy items like salads or pickles. Her stomach lurched when she neared the produce section of a grocery story. While a lot of people will opt for the fries instead of the salad, just the sight of lettuce next to a burger nauseated Henderson. Her worst nightmare was a boxed lunch.\u003c/p>\n\u003cp class=\"p1\">“Like, God forbid someone gave me a turkey sandwich with soggy lettuce and tomato that’s been all touching,” said Henderson. \u003cspan class=\"s1\">\u003ci>“\u003c/i>\u003c/span>Even if you were sitting next to me eating a carrot stick or a celery stick, I’d gag.”\u003c/p>\n\u003cp class=\"p1\">As the years passed, her limited diet led to greater isolation. She always had a menu of excuses at the ready in case of invitations: Let’s just do drinks. I’m not hungry. I don’t want dinner.\u003c/p>\n\u003cp class=\"p1\">“Food was such an anxious thing in my life,” she said. “I definitely tried to steer away from it. I had such a strong physical reaction to being around food, let alone eating it.”\u003c/p>\n\u003cp class=\"p1\">Though Henderson was never diagnosed with any medical complications stemming from her restricted eating habits, she frequently felt sluggish.\u003c/p>\n\u003cp class=\"p1\">“It definitely affected my energy level,” she said. “My skin was really gray-looking.”\u003c/p>\n\u003cp class=\"p1\">She knew something was wrong, but what? She didn’t have a name for it, let alone a solution.\u003c/p>\n\u003cp class=\"p1\">\u003cb>A New Diagnosis\u003c/b>\u003c/p>\n\u003cp class=\"p1\">Then one night while surfing the web, Henderson stumbled across a link on \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725687/pdf/ndt-12-213.pdf\">\u003cspan class=\"s2\">avoidant/restrictive food intake disorder\u003c/span>\u003c/a>, or ARFID. She was stunned. For the first time in her life, she read about other people who were repulsed by certain flavors, aromas and textures.\u003c/p>\n\u003cp class=\"p1\">Doctors are still studying what causes the illness. Unlike other eating disorders, it’s not related to body image. Early research suggests that people who have ARFID are not just extreme versions of a choosy young eater, but potentially “supertasters.”\u003c/p>\n\u003cp class=\"p1\">“Meaning that their palates are much more sensitive and they taste things in a really intense way,” said Erin Accurso, clinical director of the UCSF Eating Disorders Program.\u003c/p>\n\u003cp class=\"p1\">A traumatic event like a choking incident or a bad case of food poisoning can trigger the disorder, Accurso says. Over time, someone’s initially small roster of disliked foods tends to lengthen, until their eating selection has become uncommonly narrow.\u003c/p>\n\u003cp class=\"p1\">Common \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/24343807/\">\u003cspan class=\"s2\">behaviors\u003c/span>\u003c/a> include food avoidance, loss of appetite, abdominal pain and fear of vomiting. Eventually, ARFID can lead to nutritional deficiencies, weight loss and depression. One British \u003ca href=\"https://www.acpjournals.org/doi/10.7326/L19-0361\" target=\"_blank\" rel=\"noopener noreferrer\">teenager\u003c/a> who ate only chips, sausages, processed ham and white bread lost his sight permanently after malnutrition led to optic nerve damage.\u003c/p>\n\u003cp class=\"p1\">Henderson and her doctors speculate her sensitivities stemmed from a childhood illness called \u003ca href=\"https://www.ucsf.edu/news/2018/06/410786/unbearable-sensation-being-living-sensory-processing-disorder\">\u003cspan class=\"s2\">sensory processing disorder\u003c/span>\u003c/a>.\u003c/p>\n\u003cp class=\"p3\">“I think my brain incorrectly processed sensory information like the textures and smells of foods,” said Henderson. “Instead of recognizing some foods as healthy, my brain would try to protect me. That’s how I developed a gag reflex.”\u003c/p>\n\u003cp class=\"p1\">\u003cb>Doctors Treating More Cases\u003c/b>\u003c/p>\n\u003cp class=\"p1\">ARFID is a recent addition to the psychiatric bible, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5.\u003c/p>\n\u003cp class=\"p1\">Accurso says preliminary studies suggest about \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725687/pdf/ndt-12-213.pdf\">\u003cspan class=\"s2\">1 in 20\u003c/span>\u003c/a> kids may have the illness. Nancy Zucker, director of the Duke Center for Eating Disorders, says about 30% of calls to the center were related to ARFID between November and January last year.\u003c/p>\n\u003cp>“It’s an illness that we are really hearing more about in our field,” said Claire Mysko, the chief executive officer of the National Eating Disorders Association.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s2\">\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534269/pdf/nihms-995861.pdf\">Research\u003c/a>\u003c/span> suggests the disorder can occur in individuals of all ages, although it usually presents before age 12 and is more common in males. Experts theorize that doctors routinely misdiagnose ARFID for anorexia.\u003c/p>\n\u003cp class=\"p1\">Clinicians are experimenting with treatments. Henderson’s doctors helped her dissect her reflexive aversions to foods like kale and cucumber juice.\u003c/p>\n\u003cp class=\"p1\">“Oh, it’s green, and the thought is like, green is bad, vegetables are bad,” Henderson said. “And it’s kind of funny when you really sit there to break down your thoughts, you’re like, these are kind of ridiculous statements.”\u003c/p>\n\u003cp class=\"p1\">Over time, counselors encouraged her to try foods she despised. Then they would role-play social eating situations to help relieve anxiety around meals. Just as the coronavirus was starting to spread, Henderson was enjoying eating out with friends for the first time in her life. Now, she is using the forced time at home to sharpen her cooking skills; she eats healthier when she’s the chef.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp class=\"p1\">“I think it has something to do with control,” she said, smiling.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"p1\">But fussy eating was more than a phase. Even into adulthood, Henderson preferred the kids menu. She cringed at the sight and smell of certain foods, especially cold and crunchy items like salads or pickles. Her stomach lurched when she neared the produce section of a grocery story. While a lot of people will opt for the fries instead of the salad, just the sight of lettuce next to a burger nauseated Henderson. Her worst nightmare was a boxed lunch.\u003c/p>\n\u003cp class=\"p1\">“Like, God forbid someone gave me a turkey sandwich with soggy lettuce and tomato that’s been all touching,” said Henderson. \u003cspan class=\"s1\">\u003ci>“\u003c/i>\u003c/span>Even if you were sitting next to me eating a carrot stick or a celery stick, I’d gag.”\u003c/p>\n\u003cp class=\"p1\">As the years passed, her limited diet led to greater isolation. She always had a menu of excuses at the ready in case of invitations: Let’s just do drinks. I’m not hungry. I don’t want dinner.\u003c/p>\n\u003cp class=\"p1\">“Food was such an anxious thing in my life,” she said. “I definitely tried to steer away from it. I had such a strong physical reaction to being around food, let alone eating it.”\u003c/p>\n\u003cp class=\"p1\">Though Henderson was never diagnosed with any medical complications stemming from her restricted eating habits, she frequently felt sluggish.\u003c/p>\n\u003cp class=\"p1\">“It definitely affected my energy level,” she said. “My skin was really gray-looking.”\u003c/p>\n\u003cp class=\"p1\">She knew something was wrong, but what? She didn’t have a name for it, let alone a solution.\u003c/p>\n\u003cp class=\"p1\">\u003cb>A New Diagnosis\u003c/b>\u003c/p>\n\u003cp class=\"p1\">Then one night while surfing the web, Henderson stumbled across a link on \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725687/pdf/ndt-12-213.pdf\">\u003cspan class=\"s2\">avoidant/restrictive food intake disorder\u003c/span>\u003c/a>, or ARFID. She was stunned. For the first time in her life, she read about other people who were repulsed by certain flavors, aromas and textures.\u003c/p>\n\u003cp class=\"p1\">Doctors are still studying what causes the illness. Unlike other eating disorders, it’s not related to body image. Early research suggests that people who have ARFID are not just extreme versions of a choosy young eater, but potentially “supertasters.”\u003c/p>\n\u003cp class=\"p1\">“Meaning that their palates are much more sensitive and they taste things in a really intense way,” said Erin Accurso, clinical director of the UCSF Eating Disorders Program.\u003c/p>\n\u003cp class=\"p1\">A traumatic event like a choking incident or a bad case of food poisoning can trigger the disorder, Accurso says. Over time, someone’s initially small roster of disliked foods tends to lengthen, until their eating selection has become uncommonly narrow.\u003c/p>\n\u003cp class=\"p1\">Common \u003ca href=\"https://pubmed.ncbi.nlm.nih.gov/24343807/\">\u003cspan class=\"s2\">behaviors\u003c/span>\u003c/a> include food avoidance, loss of appetite, abdominal pain and fear of vomiting. Eventually, ARFID can lead to nutritional deficiencies, weight loss and depression. One British \u003ca href=\"https://www.acpjournals.org/doi/10.7326/L19-0361\" target=\"_blank\" rel=\"noopener noreferrer\">teenager\u003c/a> who ate only chips, sausages, processed ham and white bread lost his sight permanently after malnutrition led to optic nerve damage.\u003c/p>\n\u003cp class=\"p1\">Henderson and her doctors speculate her sensitivities stemmed from a childhood illness called \u003ca href=\"https://www.ucsf.edu/news/2018/06/410786/unbearable-sensation-being-living-sensory-processing-disorder\">\u003cspan class=\"s2\">sensory processing disorder\u003c/span>\u003c/a>.\u003c/p>\n\u003cp class=\"p3\">“I think my brain incorrectly processed sensory information like the textures and smells of foods,” said Henderson. “Instead of recognizing some foods as healthy, my brain would try to protect me. That’s how I developed a gag reflex.”\u003c/p>\n\u003cp class=\"p1\">\u003cb>Doctors Treating More Cases\u003c/b>\u003c/p>\n\u003cp class=\"p1\">ARFID is a recent addition to the psychiatric bible, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, or DSM-5.\u003c/p>\n\u003cp class=\"p1\">Accurso says preliminary studies suggest about \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4725687/pdf/ndt-12-213.pdf\">\u003cspan class=\"s2\">1 in 20\u003c/span>\u003c/a> kids may have the illness. Nancy Zucker, director of the Duke Center for Eating Disorders, says about 30% of calls to the center were related to ARFID between November and January last year.\u003c/p>\n\u003cp>“It’s an illness that we are really hearing more about in our field,” said Claire Mysko, the chief executive officer of the National Eating Disorders Association.\u003c/p>\n\u003cp class=\"p1\">\u003cspan class=\"s2\">\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534269/pdf/nihms-995861.pdf\">Research\u003c/a>\u003c/span> suggests the disorder can occur in individuals of all ages, although it usually presents before age 12 and is more common in males. Experts theorize that doctors routinely misdiagnose ARFID for anorexia.\u003c/p>\n\u003cp class=\"p1\">Clinicians are experimenting with treatments. Henderson’s doctors helped her dissect her reflexive aversions to foods like kale and cucumber juice.\u003c/p>\n\u003cp class=\"p1\">“Oh, it’s green, and the thought is like, green is bad, vegetables are bad,” Henderson said. “And it’s kind of funny when you really sit there to break down your thoughts, you’re like, these are kind of ridiculous statements.”\u003c/p>\n\u003cp class=\"p1\">Over time, counselors encouraged her to try foods she despised. Then they would role-play social eating situations to help relieve anxiety around meals. Just as the coronavirus was starting to spread, Henderson was enjoying eating out with friends for the first time in her life. Now, she is using the forced time at home to sharpen her cooking skills; she eats healthier when she’s the chef.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp class=\"p1\">“I think it has something to do with control,” she said, smiling.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp class=\"p1\">Weathering a pandemic offers the perfect recipe for exacerbating an eating disorder: stress, anxiety and solitude.\u003c/p>\n\u003cp>[pullquote]‘You’re not skinny enough to warrant care. There were literally times … where I was losing weight so I could get treatment.’[/pullquote]\u003c/p>\n\u003cp class=\"p1\">This spring, the National Eating Disorders Association saw a 78% increase over last year in people sending messages to its helpline. Crisis Text Line, another nonprofit, is receiving 50% more texts about eating disorders now than before the coronavirus outbreak.\u003c/p>\n\u003cp>“We know that eating disorders thrive in isolation, and people with eating disorders are very good at keeping their behavior secret,” said Claire Mysko, the chief executive officer of the National Eating Disorders Association.\u003c/p>\n\u003cp class=\"p1\">The vast majority of helpline requests come from young women.\u003c/p>\n\u003cp class=\"p1\">Annie, a 27-year-old San Francisco resident, is surviving the coronavirus crisis, but it hasn’t been easy. (At her request, we’re using only Annie’s first name to protect her privacy.)\u003c/p>\n\u003cp>“Maintaining recovery now is harder than before the pandemic,” she said. “I have so much more time with my thoughts right now.”\u003c/p>\n\u003cp class=\"p1\">Restricting food is one way to take control when the outside world feels chaotic. The illness Annie grapples with is called atypical anorexia nervosa, also known as higher weight anorexia. The disease has led her to experience all the classic anorexic symptoms but one: While in the past she has obsessively dieted, overexercised, and suffered from a distorted body image, she did not become emaciated.\u003c/p>\n\u003cp>“These are people who are starving themselves but don’t look the part,” said Mysko.\u003c/p>\n\u003cp class=\"p3\">\u003cb>Same Illness, Bigger Body\u003c/b>\u003c/p>\n\u003cp class=\"p1\">“This idea that one could have anorexia nervosa at a higher weight or a seemingly normal weight is a very new concept,” said Andrea Garber, the chief nutritionist at the \u003ca href=\"https://www.ucsfbenioffchildrens.org/clinics/eating_disorders_program/\">\u003cspan class=\"s2\">UCSF Eating Disorders Program\u003c/span>.\u003c/a>\u003c/p>\n\u003cp class=\"p1\">A recent UCSF\u003ca href=\"https://pediatrics.aappublications.org/content/144/6/e20192339?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token\">\u003cspan class=\"s2\"> study\u003c/span>\u003c/a> published in the journal \u003ci>Pediatrics\u003c/i> found that atypical anorexia patients are just as likely as their underweight counterparts to have a slow heart rate, menstrual dysfunction and electrolyte imbalance. They may also experience an orthostatic heart rate increase, which normally occurs when someone lying down stands up.\u003c/p>\n\u003cp>If you’re not eating enough calories to sustain your body’s basic metabolic needs, it is bad for your health no matter what your starting weight.\u003c/p>\n\u003cp class=\"p1\">“If they lose the same amount of weight, over the same period of time, they will be just as malnourished and just as medically unstable as a so-called skinny kid,” said Garber.\u003c/p>\n\u003cp class=\"p1\">For all types of anorexia, these medical complications can result from behaviors like binging, purging, starving and overexercising. Anorexia affects\u003ca href=\"https://www.nimh.nih.gov/health/statistics/eating-disorders.shtml\">\u003cspan class=\"s2\"> less than 1% \u003c/span>\u003c/a>of Americans, but its 5% mortality rate is higher than for any other psychiatric illness, and similar to the rates for childhood cancers.\u003c/p>\n\u003cp class=\"p1\">In Annie’s case, she used food to regulate the emotions she experienced after a series of childhood traumas. She was sexually abused by someone outside her family. Her father had cancer. Her parents divorced.\u003c/p>\n\u003cp class=\"p1\">“I think I just became super-overwhelmed with a lot of things, and I just stopped eating,” she said.\u003c/p>\n\u003cp class=\"p1\">When she was 8, she refused solid foods, surviving mostly on liquids. “All those sort of negative emotions like sadness and grief disappeared because I didn’t have the energy to feel them.”\u003c/p>\n\u003cp class=\"p1\">Eventually, things settled down at home. She started eating again in the fourth grade, but relapsed in high school when her body suddenly felt too big. Her hips spread, and within a year she grew 7 inches.\u003c/p>\n\u003cp class=\"p1\">“I didn’t feel at home in my body,” she said. “If I could restrict my food and get my body to the way that felt safe, then I felt safe.”\u003c/p>\n\u003cp class=\"p1\">She wouldn’t allow herself to eat more than 500 calories a day. After school at cross-country practice, she ran until collapse. When she stepped on her scale, the numbers started to go way down.\u003c/p>\n\u003cp class=\"p1\">“My doctor saw my weight,” said Annie. “He was like, ‘Do you eat?’ And I said, ‘Well, yeah. I eat.’ And he was like, ‘OK.’ And that was it.”\u003c/p>\n\u003cp class=\"p1\">Because Annie’s doctor knew she was a long-distance runner, he did not question the weight loss. Yet she was also anemic, stopped menstruating, passed out after races and sustained stress fractures, likely due to \u003ca href=\"https://www.eatingdisorderhope.com/information/eating-disorder/osteoporosis-bone-density-loss\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan class=\"s1\">low bone-mineral density\u003c/span>\u003c/a>.\u003c/p>\n\u003cp class=\"p1\">She judged herself harshly.\u003c/p>\n\u003cp class=\"p1\">“It was just this overwhelming self-hatred,” she said.\u003c/p>\n\u003cp class=\"p1\">Even though she dreamed of elaborate meals at night, she resisted any urge to indulge. The less she ate, the better she felt emotionally.\u003c/p>\n\u003cp class=\"p1\">\u003ci>“\u003c/i>I felt like it was this thing that I was just so good at,” said Annie. “I felt like even if everything else was going wrong, at least I was losing weight, because that meant I was doing well.”\u003c/p>\n\u003cp class=\"p1\">As the years passed, Annie landed in the hospital more and more. In her early 20s, she was hospitalized 10 times in less than two years. During one episode, her heart slowed to a dangerously low 20 beats per minute, three times below normal.\u003c/p>\n\u003cp class=\"p3\">\u003cb>Too Heavy to Treat\u003c/b>\u003c/p>\n\u003cp class=\"p1\">Despite her medical problems, Annie didn’t qualify under her insurance plan for in-patient treatment, where she could have received counseling and assistance with meals. She wasn’t covered because her body mass index, which measures body fat relative to height and weight, was slightly too high.\u003c/p>\n\u003cp class=\"p1\">“I was denied treatment for the psychological aspect of my care, which is a very hard thing to hear as an eating disorder patient,” she said. “You’re not skinny enough to warrant care.”\u003c/p>\n\u003cp class=\"p1\">She said a few years ago, “There were literally times … where I was losing weight so I could get treatment.”\u003c/p>\n\u003cp class=\"p1\">Finally, doctors at UCSF helped Annie petition her insurance carrier to cover residential treatment based on the diagnosis of atypical anorexia nervosa.\u003c/p>\n\u003cp class=\"p3\">\u003cb>Recovery\u003c/b>\u003c/p>\n\u003cp class=\"p1\">After two rounds of residential treatment, Annie feels healthy, though, “I wouldn’t call myself recovered,” she said. “If I do get sick or miss a couple meals just out of circumstances, the thoughts start to come back.”\u003c/p>\n\u003cp class=\"p1\">These days, those thoughts do circle around in her head more than usual. During the early days of the pandemic, she became triggered when witnessing people swarming the grocery store aisles and overloading their carts with food. Her stress level spiked even more when she lost her job. Social media was a landmine, because it’s filled with jokes about gaining the “\u003ca href=\"https://www.dailymail.co.uk/femail/article-8128075/People-share-hilarious-tweets-gaining-weight-quarantine.html\">\u003cspan class=\"s1\">COVID 19\u003c/span>\u003c/a>,” a play on the notorious “freshman 15” pounds that some people put on during their first year of college.\u003c/p>\n\u003cp class=\"p1\">But her weekly video therapy sessions offer a crucial anchor in these otherwise unstructured days. This fall she starts medical school on a full scholarship to study pediatrics, and she is looking forward to the regular schedule.\u003c/p>\n\u003cp class=\"p1\">Someday she hopes to help young people with eating disorders.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"p1\">This spring, the National Eating Disorders Association saw a 78% increase over last year in people sending messages to its helpline. Crisis Text Line, another nonprofit, is receiving 50% more texts about eating disorders now than before the coronavirus outbreak.\u003c/p>\n\u003cp>“We know that eating disorders thrive in isolation, and people with eating disorders are very good at keeping their behavior secret,” said Claire Mysko, the chief executive officer of the National Eating Disorders Association.\u003c/p>\n\u003cp class=\"p1\">The vast majority of helpline requests come from young women.\u003c/p>\n\u003cp class=\"p1\">Annie, a 27-year-old San Francisco resident, is surviving the coronavirus crisis, but it hasn’t been easy. (At her request, we’re using only Annie’s first name to protect her privacy.)\u003c/p>\n\u003cp>“Maintaining recovery now is harder than before the pandemic,” she said. “I have so much more time with my thoughts right now.”\u003c/p>\n\u003cp class=\"p1\">Restricting food is one way to take control when the outside world feels chaotic. The illness Annie grapples with is called atypical anorexia nervosa, also known as higher weight anorexia. The disease has led her to experience all the classic anorexic symptoms but one: While in the past she has obsessively dieted, overexercised, and suffered from a distorted body image, she did not become emaciated.\u003c/p>\n\u003cp>“These are people who are starving themselves but don’t look the part,” said Mysko.\u003c/p>\n\u003cp class=\"p3\">\u003cb>Same Illness, Bigger Body\u003c/b>\u003c/p>\n\u003cp class=\"p1\">“This idea that one could have anorexia nervosa at a higher weight or a seemingly normal weight is a very new concept,” said Andrea Garber, the chief nutritionist at the \u003ca href=\"https://www.ucsfbenioffchildrens.org/clinics/eating_disorders_program/\">\u003cspan class=\"s2\">UCSF Eating Disorders Program\u003c/span>.\u003c/a>\u003c/p>\n\u003cp class=\"p1\">A recent UCSF\u003ca href=\"https://pediatrics.aappublications.org/content/144/6/e20192339?sso=1&sso_redirect_count=1&nfstatus=401&nftoken=00000000-0000-0000-0000-000000000000&nfstatusdescription=ERROR%3a+No+local+token\">\u003cspan class=\"s2\"> study\u003c/span>\u003c/a> published in the journal \u003ci>Pediatrics\u003c/i> found that atypical anorexia patients are just as likely as their underweight counterparts to have a slow heart rate, menstrual dysfunction and electrolyte imbalance. They may also experience an orthostatic heart rate increase, which normally occurs when someone lying down stands up.\u003c/p>\n\u003cp>If you’re not eating enough calories to sustain your body’s basic metabolic needs, it is bad for your health no matter what your starting weight.\u003c/p>\n\u003cp class=\"p1\">“If they lose the same amount of weight, over the same period of time, they will be just as malnourished and just as medically unstable as a so-called skinny kid,” said Garber.\u003c/p>\n\u003cp class=\"p1\">For all types of anorexia, these medical complications can result from behaviors like binging, purging, starving and overexercising. Anorexia affects\u003ca href=\"https://www.nimh.nih.gov/health/statistics/eating-disorders.shtml\">\u003cspan class=\"s2\"> less than 1% \u003c/span>\u003c/a>of Americans, but its 5% mortality rate is higher than for any other psychiatric illness, and similar to the rates for childhood cancers.\u003c/p>\n\u003cp class=\"p1\">In Annie’s case, she used food to regulate the emotions she experienced after a series of childhood traumas. She was sexually abused by someone outside her family. Her father had cancer. Her parents divorced.\u003c/p>\n\u003cp class=\"p1\">“I think I just became super-overwhelmed with a lot of things, and I just stopped eating,” she said.\u003c/p>\n\u003cp class=\"p1\">When she was 8, she refused solid foods, surviving mostly on liquids. “All those sort of negative emotions like sadness and grief disappeared because I didn’t have the energy to feel them.”\u003c/p>\n\u003cp class=\"p1\">Eventually, things settled down at home. She started eating again in the fourth grade, but relapsed in high school when her body suddenly felt too big. Her hips spread, and within a year she grew 7 inches.\u003c/p>\n\u003cp class=\"p1\">“I didn’t feel at home in my body,” she said. “If I could restrict my food and get my body to the way that felt safe, then I felt safe.”\u003c/p>\n\u003cp class=\"p1\">She wouldn’t allow herself to eat more than 500 calories a day. After school at cross-country practice, she ran until collapse. When she stepped on her scale, the numbers started to go way down.\u003c/p>\n\u003cp class=\"p1\">“My doctor saw my weight,” said Annie. “He was like, ‘Do you eat?’ And I said, ‘Well, yeah. I eat.’ And he was like, ‘OK.’ And that was it.”\u003c/p>\n\u003cp class=\"p1\">Because Annie’s doctor knew she was a long-distance runner, he did not question the weight loss. Yet she was also anemic, stopped menstruating, passed out after races and sustained stress fractures, likely due to \u003ca href=\"https://www.eatingdisorderhope.com/information/eating-disorder/osteoporosis-bone-density-loss\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cspan class=\"s1\">low bone-mineral density\u003c/span>\u003c/a>.\u003c/p>\n\u003cp class=\"p1\">She judged herself harshly.\u003c/p>\n\u003cp class=\"p1\">“It was just this overwhelming self-hatred,” she said.\u003c/p>\n\u003cp class=\"p1\">Even though she dreamed of elaborate meals at night, she resisted any urge to indulge. The less she ate, the better she felt emotionally.\u003c/p>\n\u003cp class=\"p1\">\u003ci>“\u003c/i>I felt like it was this thing that I was just so good at,” said Annie. “I felt like even if everything else was going wrong, at least I was losing weight, because that meant I was doing well.”\u003c/p>\n\u003cp class=\"p1\">As the years passed, Annie landed in the hospital more and more. In her early 20s, she was hospitalized 10 times in less than two years. During one episode, her heart slowed to a dangerously low 20 beats per minute, three times below normal.\u003c/p>\n\u003cp class=\"p3\">\u003cb>Too Heavy to Treat\u003c/b>\u003c/p>\n\u003cp class=\"p1\">Despite her medical problems, Annie didn’t qualify under her insurance plan for in-patient treatment, where she could have received counseling and assistance with meals. She wasn’t covered because her body mass index, which measures body fat relative to height and weight, was slightly too high.\u003c/p>\n\u003cp class=\"p1\">“I was denied treatment for the psychological aspect of my care, which is a very hard thing to hear as an eating disorder patient,” she said. “You’re not skinny enough to warrant care.”\u003c/p>\n\u003cp class=\"p1\">She said a few years ago, “There were literally times … where I was losing weight so I could get treatment.”\u003c/p>\n\u003cp class=\"p1\">Finally, doctors at UCSF helped Annie petition her insurance carrier to cover residential treatment based on the diagnosis of atypical anorexia nervosa.\u003c/p>\n\u003cp class=\"p3\">\u003cb>Recovery\u003c/b>\u003c/p>\n\u003cp class=\"p1\">After two rounds of residential treatment, Annie feels healthy, though, “I wouldn’t call myself recovered,” she said. “If I do get sick or miss a couple meals just out of circumstances, the thoughts start to come back.”\u003c/p>\n\u003cp class=\"p1\">These days, those thoughts do circle around in her head more than usual. During the early days of the pandemic, she became triggered when witnessing people swarming the grocery store aisles and overloading their carts with food. Her stress level spiked even more when she lost her job. Social media was a landmine, because it’s filled with jokes about gaining the “\u003ca href=\"https://www.dailymail.co.uk/femail/article-8128075/People-share-hilarious-tweets-gaining-weight-quarantine.html\">\u003cspan class=\"s1\">COVID 19\u003c/span>\u003c/a>,” a play on the notorious “freshman 15” pounds that some people put on during their first year of college.\u003c/p>\n\u003cp class=\"p1\">But her weekly video therapy sessions offer a crucial anchor in these otherwise unstructured days. This fall she starts medical school on a full scholarship to study pediatrics, and she is looking forward to the regular schedule.\u003c/p>\n\u003cp class=\"p1\">Someday she hopes to help young people with eating disorders.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "Should You Get Tested for the Coronavirus? What Do the Results Mean? Our Testing FAQ",
"headTitle": "Should You Get Tested for the Coronavirus? What Do the Results Mean? Our Testing FAQ | KQED",
"content": "\u003cp>Health experts say widespread testing for the novel coronavirus is key to containing its spread and helping counties make decisions about reopening as the pandemic continues.\u003c/p>\n\u003cp>Previously, shortages of swabs, reagents and other materials limited testing to people with more severe symptoms or to those with high risk of exposure. But now that these supplies are more readily available, Bay Area counties have ramped up testing and loosened criteria so that more people can learn if they are or have ever been infected with the coronavirus, the pathogen that causes COVID-19.\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/science/1964257/interactive-map-find-coronavirus-testing-sites-throughout-california\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Use this map to find a COVID-19 test site near you\u003c/em>\u003c/a>\u003c/p>\n\u003cp>But just because more people in the Bay Area can get a test, does that mean everyone with access should? We asked medical experts who should get tested for COVID-19, when to get tested, and what the results can and can’t tell us.\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"#Q1\">First: Which Test — Viral or Antibody?\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"#Q2\">Who’s Eligible for Coronavirus Testing?\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"#Q3\">Who Needs to Get Tested? Should I?\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"#Q4\">What About Mild Symptoms?\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"#Q5\">What Does a Negative Test Mean?\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"#Q6\">I Want to Visit Relatives, Should I Consider Getting a Test?\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"#Q7\">When Should I Get Tested After a Protest?\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"#Q8\">What Should I Do If I Test Positive?\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003ca id=\"Q1\">\u003c/a>\u003cstrong>First: Which Test — Viral or Antibody?\u003c/strong>\u003c/p>\n\u003cp>\u003cb>Viral tests, often called PCR or RNA tests\u003c/b>, are typically administered by taking a swab sample from the back of the nasal cavity or throat. This can detect if your body is shedding virus — that is, if you currently have an active SARS-CoV-2 infection.\u003c/p>\n\u003cp>Experts say to keep in mind that it generally takes about five days after infection before it registers as positive, and you can still be exposed after you’ve been tested. So doctors say a negative PCR test result doesn’t mean you should let your guard down.\u003c/p>\n\u003cp>\u003cb>Antibody, or serology, tests\u003c/b>, screen the blood for specific COVID-19 antibodies. These are proteins the immune system makes to fight the virus. Antibodies can take one to three weeks to build up, but are still detectable after patients recover from infection.\u003c/p>\n\u003cp>Antibody tests can reveal if you already had the virus, even if you didn’t have symptoms. But experts don’t know for certain how protective COVID-19 antibodies are against future infection, so a positive test for antibodies doesn’t mean you are immune to the virus.\u003c/p>\n\u003cp>Neither viral nor antibody tests are 100% accurate. Research suggests PCR tests \u003ca href=\"https://www.acpjournals.org/doi/10.7326/M20-1495\" target=\"_blank\" rel=\"noopener noreferrer\">may miss positive cases\u003c/a> about 20% of the time. The Food and Drug Administration now provides \u003ca href=\"https://www.fda.gov/medical-devices/emergency-situations-medical-devices/eua-authorized-serology-test-performance\" target=\"_blank\" rel=\"noopener noreferrer\">performance results\u003c/a> for antibody tests from different manufacturers.\u003c/p>\n\u003cp>\u003ca id=\"Q2\">\u003c/a>\u003cstrong>Who’s Eligible for PCR Testing?\u003c/strong>\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention has posted\u003ca href=\"https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html\" target=\"_blank\" rel=\"noopener noreferrer\"> guidelines for diagnostic testing\u003c/a> on its website.\u003c/p>\n\u003cp>In the Bay Area, a growing number of county health departments — including Santa Clara, Contra Costa and Solano — offer COVID-19 tests to all residents regardless of symptoms, and these are free if you don’t have insurance. Others, like San Francisco and Marin, require at least one symptom or some risk of exposure.\u003c/p>\n\u003cp>Many hospital clinics, private labs and health care providers like Kaiser and One Medical offer testing as well. Pop-up sites and community testing programs through Verily’s \u003ca href=\"https://www.projectbaseline.com/study/covid-19/\" target=\"_blank\" rel=\"noopener noreferrer\">Project Baseline\u003c/a> provide additional avenues to get tested. Bay Area health departments have been working to increase testing in underserved communities, though gaps still exist in the Bay Area and across the state.\u003c/p>\n\u003cp>\u003cstrong>Who Needs to Get Tested? Should I?\u003c/strong>\u003c/p>\n\u003cp>\u003ci>“\u003c/i>We need to be able to test people with symptoms, and contacts of people with the virus,” said Dr. Bob Wachter, chair of the Department of Medicine at UCSF.\u003c/p>\n\u003cp>Groups that experts say should get tested include medical and other front-line workers, vulnerable populations, and those who have attended mass gatherings like protests. Also included are those who have come into contact with a lot of other people, perhaps while commuting or at work.\u003c/p>\n\u003cp>Some hospitals, including UCSF and Stanford, test patients who are getting a medical procedure or are hospitalized with another illness. Wachter says testing a portion of people without symptoms will help public health experts anticipate a \u003ca href=\"https://www.kqed.org/science/1964968/charts-the-bay-area-is-opening-up-again-heres-tracking-data-for-each-county-to-see-how-its-going\" target=\"_blank\" rel=\"noopener noreferrer\">surge in cases\u003c/a>.\u003c/p>\n\u003cp>But he doesn’t see a good reason for people who don’t have symptoms and are following stay-at-home orders to seek out a viral test. This is in part because the chances are low that a person without symptoms in the Bay Area has been infected with or is spreading the coronavirus.\u003c/p>\n\u003cp>Only around 1 in 250 patients at UCSF without COVID-19 symptoms have tested positive for SARS-CoV-2, he says.\u003c/p>\n\u003cp>Dr. John Swartzberg, clinical professor emeritus at UC Berkeley School of Public Health’s infectious disease division, said, “The more testing we do on a daily basis, the more accurate our numbers will be.”\u003c/p>\n\u003cp>But Swartzberg agrees that not everyone needs a COVID-19 test. Public health departments, he says, can monitor cases by testing a representative sample of the population in line with the state’s goal of 200 tests a day per 100,000 residents. Researchers in the Bay Area are also screening large communities like\u003ca href=\"https://www.ucsf.edu/news/2020/05/417356/initial-results-mission-district-covid-19-testing-announced\" target=\"_blank\" rel=\"noopener noreferrer\"> San Francisco’s Mission District\u003c/a> to find out what percentage of people have the virus.\u003c/p>\n\u003cp>If you’re healthy and practicing social distancing, Swartzberg said, “There’s really not a particular value in screening to learn about yourself.\u003ci>”\u003c/i>\u003c/p>\n\u003cp>\u003ca id=\"Q4\">\u003c/a>\u003cstrong>What About Mild Symptoms?\u003c/strong>\u003c/p>\n\u003cp>There’s “no hard and fast rule” about when a symptom becomes serious enough to warrant a test, says Dr. Yvonne Maldonado, professor of pediatrics, epidemiology and population health at the Stanford School of Medicine.\u003c/p>\n\u003cp>She recognizes this can be tricky to navigate for people with mild symptoms, given the source of a sore throat or runny nose could be something unrelated to the coronavirus, like pollen allergies.\u003c/p>\n\u003cp>But people with a fever, difficulty breathing or multiple or persistent symptom should arrange for a test, she says.\u003c/p>\n\u003cp>“If you [just] have an itchy throat, probably not,” Maldonado said. “If you have an itchy throat and that night you develop a low-grade fever, yes, get a test.”\u003c/p>\n\u003cp>Testing those with less serious symptoms, Maldonado says, can prompt people to isolate sooner if they have the virus. It can also help patients seek medical attention more quickly if symptoms progress.\u003c/p>\n\u003cp>If you’re on the fence about needing a test, Maldonado says you can wait a day or two and self-monitor while you keep socially distanced or call your health care provider for advice.\u003c/p>\n\u003cp>\u003ca id=\"Q5\">\u003c/a>\u003cstrong>What Does a Negative Test Mean?\u003c/strong>\u003c/p>\n\u003cp>Wachter says that because PCR, or RNA, test results only show whether or not patients currently have COVID-19, there’s a limit to how you should use the information.\u003c/p>\n\u003cp>It can take three to five days, he says, between when you are exposed to when you would test positive. In some cases, the incubation period can last up to 14 days, and a patient could test negative during this “presymptomatic” period. The test also can’t account for any future exposure.\u003c/p>\n\u003cp>“A week from now, that test that you had today that was negative means virtually nothing,” Wachter said.\u003c/p>\n\u003cp>Getting one negative PCR test, he says, shouldn’t give people a license to disregard social distancing practices, stop wearing masks or socialize in large groups. This, he says, would only increase the chances of getting the virus.\u003c/p>\n\u003cp>Wachter also cautions that PCR tests can also give false negatives.\u003c/p>\n\u003cp>“If you do have it, it’ll pick it up maybe four out of five times, meaning it’s going to be wrong one out of five times.” he said.\u003c/p>\n\u003cp>Wachter says it all comes down to probabilities. Getting a negative test significantly, but not entirely, reduces the chance you have the coronavirus for at least a few days.\u003c/p>\n\u003cp>\u003ca id=\"Q6\">\u003c/a>\u003cstrong>I Want to Visit Elderly Relatives or Loved Ones, Should I Consider Getting a Test?\u003c/strong>\u003c/p>\n\u003cp>Some health experts say yes, this is one scenario where a person without symptoms should consider getting a test.\u003c/p>\n\u003cp>“If I was on the fence about visiting and I had a negative test in the last couple of days, it might get me to leave the fence and go,” Wachter said. “But it would not lead me to give them a hug and a kiss, and I would still sit six feet away, and I would still wear a mask.”\u003c/p>\n\u003cp>Maldonado says given the choice between driving or flying to visit her 87-year-old dad, she would elect to drive. If you have to take a flight, she recommends getting tested beforehand and again about five days after arrival to make sure you weren’t exposed en route. In between tests, she says, she would “be very careful” and follow social distancing guidelines.\u003c/p>\n\u003cp>In this scenario, Maldonado says the risk that you have or are spreading the virus “is extremely low, but it’s not zero.” You’ll also want to get a test about five days after your return, she says, or be committed to isolating for a few weeks.\u003c/p>\n\u003cp>\u003ca id=\"Q7\">\u003c/a>\u003cstrong>When Should I Get Tested After Attending a Protest?\u003c/strong>\u003c/p>\n\u003cp>If you are at a protest or other mass gathering and get tested immediately after, that will likely be too soon for the test to detect the virus. Maldonado says people should instead wait about five days before getting a test.\u003c/p>\n\u003cp>“If you are being careful and you’re generally wearing a mask around other people and socially distancing, washing your hands, you’re probably not going to transmit,” she said. “But I would say by day five after exposure, I would consider getting a test at that point.”\u003c/p>\n\u003cp>For many of the questions about travel, mass gatherings and testing, Maldonado says there are no firm answers. Rigorous studies, she says, will ultimately be needed to provide more clarity.\u003c/p>\n\u003cp>\u003ca id=\"Q8\">\u003c/a>\u003cstrong>What Should I Do if I Test Positive?\u003c/strong>\u003c/p>\n\u003cp>If you don’t have symptoms and receive a positive test, the \u003ca href=\"https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/end-home-isolation.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprevent-getting-sick%2Fwhen-its-safe.html\" target=\"_blank\" rel=\"noopener noreferrer\">CDC\u003c/a> and \u003ca href=\"https://www.onemedical.com/blog/live-well/positive-covid-19-now-what\" target=\"_blank\" rel=\"noopener noreferrer\">many health care providers\u003c/a> say the best practice is to self-isolate for 10 days. At this point, provided no symptoms develop, Wachter says, it would be unlikely that you have an active infection you could spread to others. But regardless, you would want to follow recommended social distancing guidelines.\u003c/p>\n\u003cp>A follow-up test is generally not required in this case, he says, and some people continue to test positive after they are recovered and no longer contagious. The CDC says your health care provider can provide guidance and, “If you will be tested, you can be around others after you receive two negative test results in a row, at least 24 hours apart.”\u003c/p>\n\u003cp>For people with symptoms and a positive test, CDC guidance is to remain isolated until you have gone three days without fever and 10 days since symptoms first appeared, provided the symptoms have improved.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Health experts say widespread testing for the novel coronavirus is key to containing its spread and helping counties make decisions about reopening as the pandemic continues.\u003c/p>\n\u003cp>Previously, shortages of swabs, reagents and other materials limited testing to people with more severe symptoms or to those with high risk of exposure. But now that these supplies are more readily available, Bay Area counties have ramped up testing and loosened criteria so that more people can learn if they are or have ever been infected with the coronavirus, the pathogen that causes COVID-19.\u003c/p>\n\u003cp>\u003ca href=\"https://www.kqed.org/science/1964257/interactive-map-find-coronavirus-testing-sites-throughout-california\" target=\"_blank\" rel=\"noopener noreferrer\">\u003cem>Use this map to find a COVID-19 test site near you\u003c/em>\u003c/a>\u003c/p>\n\u003cp>But just because more people in the Bay Area can get a test, does that mean everyone with access should? We asked medical experts who should get tested for COVID-19, when to get tested, and what the results can and can’t tell us.\u003c/p>\n\u003cul>\n\u003cli>\u003ca href=\"#Q1\">First: Which Test — Viral or Antibody?\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"#Q2\">Who’s Eligible for Coronavirus Testing?\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"#Q3\">Who Needs to Get Tested? Should I?\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"#Q4\">What About Mild Symptoms?\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"#Q5\">What Does a Negative Test Mean?\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"#Q6\">I Want to Visit Relatives, Should I Consider Getting a Test?\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"#Q7\">When Should I Get Tested After a Protest?\u003c/a>\u003c/li>\n\u003cli>\u003ca href=\"#Q8\">What Should I Do If I Test Positive?\u003c/a>\u003c/li>\n\u003c/ul>\n\u003cp>\u003ca id=\"Q1\">\u003c/a>\u003cstrong>First: Which Test — Viral or Antibody?\u003c/strong>\u003c/p>\n\u003cp>\u003cb>Viral tests, often called PCR or RNA tests\u003c/b>, are typically administered by taking a swab sample from the back of the nasal cavity or throat. This can detect if your body is shedding virus — that is, if you currently have an active SARS-CoV-2 infection.\u003c/p>\n\u003cp>Experts say to keep in mind that it generally takes about five days after infection before it registers as positive, and you can still be exposed after you’ve been tested. So doctors say a negative PCR test result doesn’t mean you should let your guard down.\u003c/p>\n\u003cp>\u003cb>Antibody, or serology, tests\u003c/b>, screen the blood for specific COVID-19 antibodies. These are proteins the immune system makes to fight the virus. Antibodies can take one to three weeks to build up, but are still detectable after patients recover from infection.\u003c/p>\n\u003cp>Antibody tests can reveal if you already had the virus, even if you didn’t have symptoms. But experts don’t know for certain how protective COVID-19 antibodies are against future infection, so a positive test for antibodies doesn’t mean you are immune to the virus.\u003c/p>\n\u003cp>Neither viral nor antibody tests are 100% accurate. Research suggests PCR tests \u003ca href=\"https://www.acpjournals.org/doi/10.7326/M20-1495\" target=\"_blank\" rel=\"noopener noreferrer\">may miss positive cases\u003c/a> about 20% of the time. The Food and Drug Administration now provides \u003ca href=\"https://www.fda.gov/medical-devices/emergency-situations-medical-devices/eua-authorized-serology-test-performance\" target=\"_blank\" rel=\"noopener noreferrer\">performance results\u003c/a> for antibody tests from different manufacturers.\u003c/p>\n\u003cp>\u003ca id=\"Q2\">\u003c/a>\u003cstrong>Who’s Eligible for PCR Testing?\u003c/strong>\u003c/p>\n\u003cp>The Centers for Disease Control and Prevention has posted\u003ca href=\"https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/testing.html\" target=\"_blank\" rel=\"noopener noreferrer\"> guidelines for diagnostic testing\u003c/a> on its website.\u003c/p>\n\u003cp>In the Bay Area, a growing number of county health departments — including Santa Clara, Contra Costa and Solano — offer COVID-19 tests to all residents regardless of symptoms, and these are free if you don’t have insurance. Others, like San Francisco and Marin, require at least one symptom or some risk of exposure.\u003c/p>\n\u003cp>Many hospital clinics, private labs and health care providers like Kaiser and One Medical offer testing as well. Pop-up sites and community testing programs through Verily’s \u003ca href=\"https://www.projectbaseline.com/study/covid-19/\" target=\"_blank\" rel=\"noopener noreferrer\">Project Baseline\u003c/a> provide additional avenues to get tested. Bay Area health departments have been working to increase testing in underserved communities, though gaps still exist in the Bay Area and across the state.\u003c/p>\n\u003cp>\u003cstrong>Who Needs to Get Tested? Should I?\u003c/strong>\u003c/p>\n\u003cp>\u003ci>“\u003c/i>We need to be able to test people with symptoms, and contacts of people with the virus,” said Dr. Bob Wachter, chair of the Department of Medicine at UCSF.\u003c/p>\n\u003cp>Groups that experts say should get tested include medical and other front-line workers, vulnerable populations, and those who have attended mass gatherings like protests. Also included are those who have come into contact with a lot of other people, perhaps while commuting or at work.\u003c/p>\n\u003cp>Some hospitals, including UCSF and Stanford, test patients who are getting a medical procedure or are hospitalized with another illness. Wachter says testing a portion of people without symptoms will help public health experts anticipate a \u003ca href=\"https://www.kqed.org/science/1964968/charts-the-bay-area-is-opening-up-again-heres-tracking-data-for-each-county-to-see-how-its-going\" target=\"_blank\" rel=\"noopener noreferrer\">surge in cases\u003c/a>.\u003c/p>\n\u003cp>But he doesn’t see a good reason for people who don’t have symptoms and are following stay-at-home orders to seek out a viral test. This is in part because the chances are low that a person without symptoms in the Bay Area has been infected with or is spreading the coronavirus.\u003c/p>\n\u003cp>Only around 1 in 250 patients at UCSF without COVID-19 symptoms have tested positive for SARS-CoV-2, he says.\u003c/p>\n\u003cp>Dr. John Swartzberg, clinical professor emeritus at UC Berkeley School of Public Health’s infectious disease division, said, “The more testing we do on a daily basis, the more accurate our numbers will be.”\u003c/p>\n\u003cp>But Swartzberg agrees that not everyone needs a COVID-19 test. Public health departments, he says, can monitor cases by testing a representative sample of the population in line with the state’s goal of 200 tests a day per 100,000 residents. Researchers in the Bay Area are also screening large communities like\u003ca href=\"https://www.ucsf.edu/news/2020/05/417356/initial-results-mission-district-covid-19-testing-announced\" target=\"_blank\" rel=\"noopener noreferrer\"> San Francisco’s Mission District\u003c/a> to find out what percentage of people have the virus.\u003c/p>\n\u003cp>If you’re healthy and practicing social distancing, Swartzberg said, “There’s really not a particular value in screening to learn about yourself.\u003ci>”\u003c/i>\u003c/p>\n\u003cp>\u003ca id=\"Q4\">\u003c/a>\u003cstrong>What About Mild Symptoms?\u003c/strong>\u003c/p>\n\u003cp>There’s “no hard and fast rule” about when a symptom becomes serious enough to warrant a test, says Dr. Yvonne Maldonado, professor of pediatrics, epidemiology and population health at the Stanford School of Medicine.\u003c/p>\n\u003cp>She recognizes this can be tricky to navigate for people with mild symptoms, given the source of a sore throat or runny nose could be something unrelated to the coronavirus, like pollen allergies.\u003c/p>\n\u003cp>But people with a fever, difficulty breathing or multiple or persistent symptom should arrange for a test, she says.\u003c/p>\n\u003cp>“If you [just] have an itchy throat, probably not,” Maldonado said. “If you have an itchy throat and that night you develop a low-grade fever, yes, get a test.”\u003c/p>\n\u003cp>Testing those with less serious symptoms, Maldonado says, can prompt people to isolate sooner if they have the virus. It can also help patients seek medical attention more quickly if symptoms progress.\u003c/p>\n\u003cp>If you’re on the fence about needing a test, Maldonado says you can wait a day or two and self-monitor while you keep socially distanced or call your health care provider for advice.\u003c/p>\n\u003cp>\u003ca id=\"Q5\">\u003c/a>\u003cstrong>What Does a Negative Test Mean?\u003c/strong>\u003c/p>\n\u003cp>Wachter says that because PCR, or RNA, test results only show whether or not patients currently have COVID-19, there’s a limit to how you should use the information.\u003c/p>\n\u003cp>It can take three to five days, he says, between when you are exposed to when you would test positive. In some cases, the incubation period can last up to 14 days, and a patient could test negative during this “presymptomatic” period. The test also can’t account for any future exposure.\u003c/p>\n\u003cp>“A week from now, that test that you had today that was negative means virtually nothing,” Wachter said.\u003c/p>\n\u003cp>Getting one negative PCR test, he says, shouldn’t give people a license to disregard social distancing practices, stop wearing masks or socialize in large groups. This, he says, would only increase the chances of getting the virus.\u003c/p>\n\u003cp>Wachter also cautions that PCR tests can also give false negatives.\u003c/p>\n\u003cp>“If you do have it, it’ll pick it up maybe four out of five times, meaning it’s going to be wrong one out of five times.” he said.\u003c/p>\n\u003cp>Wachter says it all comes down to probabilities. Getting a negative test significantly, but not entirely, reduces the chance you have the coronavirus for at least a few days.\u003c/p>\n\u003cp>\u003ca id=\"Q6\">\u003c/a>\u003cstrong>I Want to Visit Elderly Relatives or Loved Ones, Should I Consider Getting a Test?\u003c/strong>\u003c/p>\n\u003cp>Some health experts say yes, this is one scenario where a person without symptoms should consider getting a test.\u003c/p>\n\u003cp>“If I was on the fence about visiting and I had a negative test in the last couple of days, it might get me to leave the fence and go,” Wachter said. “But it would not lead me to give them a hug and a kiss, and I would still sit six feet away, and I would still wear a mask.”\u003c/p>\n\u003cp>Maldonado says given the choice between driving or flying to visit her 87-year-old dad, she would elect to drive. If you have to take a flight, she recommends getting tested beforehand and again about five days after arrival to make sure you weren’t exposed en route. In between tests, she says, she would “be very careful” and follow social distancing guidelines.\u003c/p>\n\u003cp>In this scenario, Maldonado says the risk that you have or are spreading the virus “is extremely low, but it’s not zero.” You’ll also want to get a test about five days after your return, she says, or be committed to isolating for a few weeks.\u003c/p>\n\u003cp>\u003ca id=\"Q7\">\u003c/a>\u003cstrong>When Should I Get Tested After Attending a Protest?\u003c/strong>\u003c/p>\n\u003cp>If you are at a protest or other mass gathering and get tested immediately after, that will likely be too soon for the test to detect the virus. Maldonado says people should instead wait about five days before getting a test.\u003c/p>\n\u003cp>“If you are being careful and you’re generally wearing a mask around other people and socially distancing, washing your hands, you’re probably not going to transmit,” she said. “But I would say by day five after exposure, I would consider getting a test at that point.”\u003c/p>\n\u003cp>For many of the questions about travel, mass gatherings and testing, Maldonado says there are no firm answers. Rigorous studies, she says, will ultimately be needed to provide more clarity.\u003c/p>\n\u003cp>\u003ca id=\"Q8\">\u003c/a>\u003cstrong>What Should I Do if I Test Positive?\u003c/strong>\u003c/p>\n\u003cp>If you don’t have symptoms and receive a positive test, the \u003ca href=\"https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/end-home-isolation.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fprevent-getting-sick%2Fwhen-its-safe.html\" target=\"_blank\" rel=\"noopener noreferrer\">CDC\u003c/a> and \u003ca href=\"https://www.onemedical.com/blog/live-well/positive-covid-19-now-what\" target=\"_blank\" rel=\"noopener noreferrer\">many health care providers\u003c/a> say the best practice is to self-isolate for 10 days. At this point, provided no symptoms develop, Wachter says, it would be unlikely that you have an active infection you could spread to others. But regardless, you would want to follow recommended social distancing guidelines.\u003c/p>\n\u003cp>A follow-up test is generally not required in this case, he says, and some people continue to test positive after they are recovered and no longer contagious. The CDC says your health care provider can provide guidance and, “If you will be tested, you can be around others after you receive two negative test results in a row, at least 24 hours apart.”\u003c/p>\n\u003cp>For people with symptoms and a positive test, CDC guidance is to remain isolated until you have gone three days without fever and 10 days since symptoms first appeared, provided the symptoms have improved.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"title": "Weighing the Risks of Sending Kids to Camp or Day Care During the Coronavirus Pandemic",
"headTitle": "Weighing the Risks of Sending Kids to Camp or Day Care During the Coronavirus Pandemic | KQED",
"content": "\u003cp class=\"p1\">After three months of juggling work at home while I care for my 1-year-old daughter, my nerves are fried. Yet, the decision of whether or not to send my little girl back to day care while the coronavirus is still spreading is fraught, to say the least.\u003c/p>\n\u003cp class=\"p1\">Fortunately an early \u003ca href=\"https://www.kqed.org/science/1958031/kids-are-less-susceptible-to-covid-19-but-its-not-clear-why\">\u003cspan class=\"s1\">trend\u003c/span>\u003c/a> in the outbreak continues to be true.\u003c/p>\n\u003cp class=\"p1\">“Kids very rarely get sick,” said Bob Wachter, chair of the Department of Medicine at UCSF.\u003c/p>\n\u003cp class=\"p1\">The stats back him up. Only 1.1% of the nearly 2 million\u003ca href=\"https://www.cdc.gov/covid-data-tracker/index.html#demographics\">\u003cspan class=\"s1\"> cases of coronavirus\u003c/span>\u003c/a> in the nation are children under 4, and less than 4% are ages 5-17, according to the Centers for Disease Control and Prevention. \u003ca href=\"https://www.nature.com/articles/s41591-020-0962-9\">\u003cspan class=\"s1\">Research \u003c/span>\u003c/a>analyzing data from six countries, including China and Italy, concludes that kids and teens are half as likely as adults to catch COVID-19.\u003c/p>\n\u003cp class=\"p1\">“We know globally COVID hits adults more than children,” said Dr. Lee Atkinson-McEvoy, division chief of general pediatrics at UCSF. “The younger the child, the less the prevalence. And that includes countries that have had access to wider testing than we’ve had here in the United States.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp class=\"p1\">\u003cb>Are Kids Contagious?\u003c/b>\u003c/p>\n\u003cp class=\"p1\">Doctors say kids do not likely make up a significant cohort\u003cb> \u003c/b>of\u003cb> \u003c/b> the notorious asymptomatic or presymptomatic coronavirus cases we have heard so much about. Dr. Yvonne Maldonado, an infectious disease expert at Stanford, says outbreaks in China suggest kids are catching the coronavirus at home from adults and not the other way around.\u003c/p>\n\u003cp class=\"p1\">“It’s relatively unusual for kids to transmit the virus to adults,” said Wachter. “That’s different than many other viruses, where the kids are really important vectors. And it’s not 100 percent clear why that is.”\u003c/p>\n\u003cp class=\"p2\">One \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/2766524\">\u003cspan class=\"s2\">study\u003c/span>\u003c/a> suggests COVID-19 may not be gaining a foothold in kids because they lack the host receptor for coronaviruses, which likely burrow into a protein on the surface of our nasal membranes. Researchers at the Icahn School of Medicine at Mount Sina\u003cspan class=\"s3\">i\u003c/span> Hospital in New York City report finding fewer of these structures, which are called ACE2, in the noses of children than are found in those of adults. But a lot more research is needed to confirm this.\u003c/p>\n\u003cp class=\"p1\">At least one case cluster, however, suggests kids can pass the virus on to each other. When a school recently opened in Israel, at least 130 students and staff \u003ca href=\"https://www.npr.org/sections/coronavirus-live-updates/2020/06/03/868507524/israel-orders-schools-to-close-when-covid-19-cases-are-discovered\">\u003cspan class=\"s1\">fell ill\u003c/span>\u003c/a>. Plus, the low-prevalence data we are seeing in American kids mostly reflects a time when families were staying at home. It’s possible the picture could change dramatically when schools open up.\u003c/p>\n\u003cp class=\"p1\">Scientists are not likely to gain a complete understanding of the virus’ transmission pathways until the widespread availability of antibody testing, which can identify prior infections.\u003c/p>\n\u003cp class=\"p1\">\u003cb>COVID-19 Cases in Children\u003c/b>\u003c/p>\n\u003cp class=\"p1\">When kids do catch COVID-19, they experience cold-like symptoms such as fever, runny nose and cough. Vomiting and diarrhea are rare. And children are, so far, not experiencing acute respiratory distress syndrome or septic shock, which is occurring in some adults.\u003c/p>\n\u003cp class=\"p1\">Infants, however, can be quite vulnerable. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190200/\">\u003cspan class=\"s1\">Research\u003c/span>\u003c/a> from Italy suggests infants experience severe cases. A \u003ca href=\"https://pediatrics.aappublications.org/content/early/2020/03/16/peds.2020-0702/tab-article-info?versioned=true\">\u003cspan class=\"s1\">study\u003c/span>\u003c/a> from China looking at 2,143 pediatric patients found that 10% of babies who contracted the virus required hospital care, even if\u003cspan class=\"Apple-converted-space\"> \u003c/span>the patients had good overall outcomes.\u003c/p>\n\u003cp class=\"p1\">A few hundred children have developed a new inflammatory syndrome, similar to \u003ca href=\"https://www.cdc.gov/kawasaki/index.html\">\u003cspan class=\"s1\">Kawasaki disease\u003c/span>\u003c/a>, several weeks after a mild or asymptomatic COVID-19 infection. The \u003ca href=\"https://www.npr.org/2020/06/07/864493574/doctors-race-for-answers-as-kids-fight-rare-inflammatory-syndrome-tied-to-corona\">\u003cspan class=\"s1\">illness\u003c/span>\u003c/a>, Multisystem-Inflammatory Syndrome in Children, or MIS-C, can lead to swelling, high fever, body rash, red eyes and lips, and a strawberry-colored tongue.\u003c/p>\n\u003cp class=\"p1\">Whether COVID-19 is triggering this new disease or it’s a completely separate entity was the subject of a recent UCSF \u003ca href=\"https://www.youtube.com/watch?v=ny4NivhjHAQ\">\u003cspan class=\"s1\">discussion\u003c/span>\u003c/a>. “It’s not clear yet,” said UCSF pediatric rheumatologist Susan Kim.\u003c/p>\n\u003cp class=\"p1\">Doctors also caution that premature infants and children with underlying chronic health conditions are still at high risk for developing complications.\u003c/p>\n\u003cp class=\"p1\">\u003cb>Is Child Care or Summer Camp Safe?\u003c/b>\u003c/p>\n\u003cp class=\"p1\">So what about my dilemma over whether to send my toddler to day care?\u003c/p>\n\u003cp class=\"p1\">“It feels like it’s safe enough to do as long as we’re watching very, very carefully,” Wachter said.\u003c/p>\n\u003cp>But when the The \u003cspan class=\"s1\">New York Times\u003c/span> \u003ca href=\"https://www.nytimes.com/2020/06/12/upshot/epidemiologists-decisions-children-school-coronavirus.html\" target=\"_blank\" rel=\"noopener noreferrer\">asked\u003c/a> hundreds of epidemiologists at what point they’d send their kids back to school, camp or child care, just 10 percent said they’d feel comfortable “now.” Twenty percent said they would wait until this summer, and 40 percent said not until fall. All of which is considerably sooner than the majority felt comfortable attending other indoor group events like concerts or movies. Comments from the professionals ranged from “Children are relatively safe” to “Really. Stupid.”\u003c/p>\n\u003cp class=\"p1\">Atkinson-McEvoy recommends parents ask child care providers lots of questions to ensure programs follow \u003ca href=\"https://covid19.ca.gov/pdf/guidance-childcare.pdf\">\u003cspan class=\"s1\">state\u003c/span>\u003c/a> and \u003ca href=\"https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/schools-faq.html\">\u003cspan class=\"s1\">federal\u003c/span>\u003c/a> guidelines requiring social distancing and sanitized play structures. California is also limiting child care groups to fewer than 12 kids, and families must enroll in programs for three continuous weeks to ensure lower student turnover. Doctors are optimistic these strategies will reduce transmission.\u003c/p>\n\u003cp class=\"p1\">If possible, ask to tour a facility before signing up. When Atkinson-McEvoy considered sending her daughter to a competitive softball program this summer, she took the leap after she saw the coach was diligently ensuring players stayed far enough apart from each other.\u003c/p>\n\u003cp class=\"p1\">She notes that parents have to weigh potential exposure for the family against the mental well-being of their children.\u003c/p>\n\u003cp class=\"p1\">“We’re definitely starting to see behavioral changes in our children from being at home, including seeing children who are showing signs of anxiety and/or depression,” she said. “Being able to socially connect with peers and resume some normal activity is an important tool one would use to help with that.”\u003c/p>\n\u003cp class=\"p1\">Plus, camps or day care may help tired parents refuel their tanks. If you do take the child-care plunge, you can lower your family’s overall risk by reducing other behaviors like taking fewer trips to the grocery store.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp class=\"p1\">Public health experts recommend children follow the same preventive actions as adults to avoid infection. Wash hands frequently throughout the day with hot soapy water. Try to teach your children to avoid touching their face. Carry alcohol-based hand sanitizer or disinfectant wipes. Here is CDC \u003ca href=\"https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/schools-faq.html\">\u003cspan class=\"s1\">advice\u003c/span>\u003c/a> related to schools and child care in the age of COVID-19.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"p1\">After three months of juggling work at home while I care for my 1-year-old daughter, my nerves are fried. Yet, the decision of whether or not to send my little girl back to day care while the coronavirus is still spreading is fraught, to say the least.\u003c/p>\n\u003cp class=\"p1\">Fortunately an early \u003ca href=\"https://www.kqed.org/science/1958031/kids-are-less-susceptible-to-covid-19-but-its-not-clear-why\">\u003cspan class=\"s1\">trend\u003c/span>\u003c/a> in the outbreak continues to be true.\u003c/p>\n\u003cp class=\"p1\">“Kids very rarely get sick,” said Bob Wachter, chair of the Department of Medicine at UCSF.\u003c/p>\n\u003cp class=\"p1\">The stats back him up. Only 1.1% of the nearly 2 million\u003ca href=\"https://www.cdc.gov/covid-data-tracker/index.html#demographics\">\u003cspan class=\"s1\"> cases of coronavirus\u003c/span>\u003c/a> in the nation are children under 4, and less than 4% are ages 5-17, according to the Centers for Disease Control and Prevention. \u003ca href=\"https://www.nature.com/articles/s41591-020-0962-9\">\u003cspan class=\"s1\">Research \u003c/span>\u003c/a>analyzing data from six countries, including China and Italy, concludes that kids and teens are half as likely as adults to catch COVID-19.\u003c/p>\n\u003cp class=\"p1\">“We know globally COVID hits adults more than children,” said Dr. Lee Atkinson-McEvoy, division chief of general pediatrics at UCSF. “The younger the child, the less the prevalence. And that includes countries that have had access to wider testing than we’ve had here in the United States.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"p1\">\u003cb>Are Kids Contagious?\u003c/b>\u003c/p>\n\u003cp class=\"p1\">Doctors say kids do not likely make up a significant cohort\u003cb> \u003c/b>of\u003cb> \u003c/b> the notorious asymptomatic or presymptomatic coronavirus cases we have heard so much about. Dr. Yvonne Maldonado, an infectious disease expert at Stanford, says outbreaks in China suggest kids are catching the coronavirus at home from adults and not the other way around.\u003c/p>\n\u003cp class=\"p1\">“It’s relatively unusual for kids to transmit the virus to adults,” said Wachter. “That’s different than many other viruses, where the kids are really important vectors. And it’s not 100 percent clear why that is.”\u003c/p>\n\u003cp class=\"p2\">One \u003ca href=\"https://jamanetwork.com/journals/jama/fullarticle/2766524\">\u003cspan class=\"s2\">study\u003c/span>\u003c/a> suggests COVID-19 may not be gaining a foothold in kids because they lack the host receptor for coronaviruses, which likely burrow into a protein on the surface of our nasal membranes. Researchers at the Icahn School of Medicine at Mount Sina\u003cspan class=\"s3\">i\u003c/span> Hospital in New York City report finding fewer of these structures, which are called ACE2, in the noses of children than are found in those of adults. But a lot more research is needed to confirm this.\u003c/p>\n\u003cp class=\"p1\">At least one case cluster, however, suggests kids can pass the virus on to each other. When a school recently opened in Israel, at least 130 students and staff \u003ca href=\"https://www.npr.org/sections/coronavirus-live-updates/2020/06/03/868507524/israel-orders-schools-to-close-when-covid-19-cases-are-discovered\">\u003cspan class=\"s1\">fell ill\u003c/span>\u003c/a>. Plus, the low-prevalence data we are seeing in American kids mostly reflects a time when families were staying at home. It’s possible the picture could change dramatically when schools open up.\u003c/p>\n\u003cp class=\"p1\">Scientists are not likely to gain a complete understanding of the virus’ transmission pathways until the widespread availability of antibody testing, which can identify prior infections.\u003c/p>\n\u003cp class=\"p1\">\u003cb>COVID-19 Cases in Children\u003c/b>\u003c/p>\n\u003cp class=\"p1\">When kids do catch COVID-19, they experience cold-like symptoms such as fever, runny nose and cough. Vomiting and diarrhea are rare. And children are, so far, not experiencing acute respiratory distress syndrome or septic shock, which is occurring in some adults.\u003c/p>\n\u003cp class=\"p1\">Infants, however, can be quite vulnerable. \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7190200/\">\u003cspan class=\"s1\">Research\u003c/span>\u003c/a> from Italy suggests infants experience severe cases. A \u003ca href=\"https://pediatrics.aappublications.org/content/early/2020/03/16/peds.2020-0702/tab-article-info?versioned=true\">\u003cspan class=\"s1\">study\u003c/span>\u003c/a> from China looking at 2,143 pediatric patients found that 10% of babies who contracted the virus required hospital care, even if\u003cspan class=\"Apple-converted-space\"> \u003c/span>the patients had good overall outcomes.\u003c/p>\n\u003cp class=\"p1\">A few hundred children have developed a new inflammatory syndrome, similar to \u003ca href=\"https://www.cdc.gov/kawasaki/index.html\">\u003cspan class=\"s1\">Kawasaki disease\u003c/span>\u003c/a>, several weeks after a mild or asymptomatic COVID-19 infection. The \u003ca href=\"https://www.npr.org/2020/06/07/864493574/doctors-race-for-answers-as-kids-fight-rare-inflammatory-syndrome-tied-to-corona\">\u003cspan class=\"s1\">illness\u003c/span>\u003c/a>, Multisystem-Inflammatory Syndrome in Children, or MIS-C, can lead to swelling, high fever, body rash, red eyes and lips, and a strawberry-colored tongue.\u003c/p>\n\u003cp class=\"p1\">Whether COVID-19 is triggering this new disease or it’s a completely separate entity was the subject of a recent UCSF \u003ca href=\"https://www.youtube.com/watch?v=ny4NivhjHAQ\">\u003cspan class=\"s1\">discussion\u003c/span>\u003c/a>. “It’s not clear yet,” said UCSF pediatric rheumatologist Susan Kim.\u003c/p>\n\u003cp class=\"p1\">Doctors also caution that premature infants and children with underlying chronic health conditions are still at high risk for developing complications.\u003c/p>\n\u003cp class=\"p1\">\u003cb>Is Child Care or Summer Camp Safe?\u003c/b>\u003c/p>\n\u003cp class=\"p1\">So what about my dilemma over whether to send my toddler to day care?\u003c/p>\n\u003cp class=\"p1\">“It feels like it’s safe enough to do as long as we’re watching very, very carefully,” Wachter said.\u003c/p>\n\u003cp>But when the The \u003cspan class=\"s1\">New York Times\u003c/span> \u003ca href=\"https://www.nytimes.com/2020/06/12/upshot/epidemiologists-decisions-children-school-coronavirus.html\" target=\"_blank\" rel=\"noopener noreferrer\">asked\u003c/a> hundreds of epidemiologists at what point they’d send their kids back to school, camp or child care, just 10 percent said they’d feel comfortable “now.” Twenty percent said they would wait until this summer, and 40 percent said not until fall. All of which is considerably sooner than the majority felt comfortable attending other indoor group events like concerts or movies. Comments from the professionals ranged from “Children are relatively safe” to “Really. Stupid.”\u003c/p>\n\u003cp class=\"p1\">Atkinson-McEvoy recommends parents ask child care providers lots of questions to ensure programs follow \u003ca href=\"https://covid19.ca.gov/pdf/guidance-childcare.pdf\">\u003cspan class=\"s1\">state\u003c/span>\u003c/a> and \u003ca href=\"https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/schools-faq.html\">\u003cspan class=\"s1\">federal\u003c/span>\u003c/a> guidelines requiring social distancing and sanitized play structures. California is also limiting child care groups to fewer than 12 kids, and families must enroll in programs for three continuous weeks to ensure lower student turnover. Doctors are optimistic these strategies will reduce transmission.\u003c/p>\n\u003cp class=\"p1\">If possible, ask to tour a facility before signing up. When Atkinson-McEvoy considered sending her daughter to a competitive softball program this summer, she took the leap after she saw the coach was diligently ensuring players stayed far enough apart from each other.\u003c/p>\n\u003cp class=\"p1\">She notes that parents have to weigh potential exposure for the family against the mental well-being of their children.\u003c/p>\n\u003cp class=\"p1\">“We’re definitely starting to see behavioral changes in our children from being at home, including seeing children who are showing signs of anxiety and/or depression,” she said. “Being able to socially connect with peers and resume some normal activity is an important tool one would use to help with that.”\u003c/p>\n\u003cp class=\"p1\">Plus, camps or day care may help tired parents refuel their tanks. If you do take the child-care plunge, you can lower your family’s overall risk by reducing other behaviors like taking fewer trips to the grocery store.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp class=\"p1\">Public health experts recommend children follow the same preventive actions as adults to avoid infection. Wash hands frequently throughout the day with hot soapy water. Try to teach your children to avoid touching their face. Carry alcohol-based hand sanitizer or disinfectant wipes. Here is CDC \u003ca href=\"https://www.cdc.gov/coronavirus/2019-ncov/community/schools-childcare/schools-faq.html\">\u003cspan class=\"s1\">advice\u003c/span>\u003c/a> related to schools and child care in the age of COVID-19.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>California will require people to wear masks in most indoor settings and outdoors when distancing isn’t possible under a statewide order issued Thursday.\u003c/p>\n\u003cp>“Science shows that face coverings and masks work,” Gov Gavin Newsom said in a statement announcing the order. “They are critical to keeping those who are around you safe, keeping businesses open and restarting our economy.”\u003c/p>\n\u003cp>A number of other states, including Michigan, New York, Maine, Delaware and Maryland already have statewide mask orders in place.\u003c/p>\n\u003cp>The order comes as California broadly reopens the economy; in most counties, people can now shop, dine in at restaurants, get their hair done and go to church, among other things. Meanwhile, coronavirus cases are increasing, something the state says is expected as more people get tested. More than 3,400 people were in the hospital as of Wednesday, the most patients hospitalized since April.\u003c/p>\n\u003cp>The order will require people to wear masks when inside or in line for any indoor public spaces, in health care settings like hospitals and pharmacies, while waiting for or riding public transportation and in outdoor spaces where its not possible to stay six feet (1.8 meters) apart from other people.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Until now, the Democratic governor had let local governments decide whether to mandate masks, an issue that’s become politically fraught as some Americans resist orders to wear them. He said he’s issuing the order now because too many people are going out in public without face coverings as businesses, restaurants and other sectors of the economy reopen.\u003c/p>\n\u003cp>Orange County’s public health officer resigned last week after she faced threats over her order that people wear masks, and the county sheriff said he wouldn’t enforce it. Los Angeles County requires people to wear masks whenever they are outside their homes, as do San Francisco and Santa Clara counties.\u003c/p>\n\u003cp>The state’s news release didn’t say how it would enforce the order or what the penalty would be for people who don’t comply.\u003c/p>\n\u003cp>The order also applies to workplaces where people interact with the public, prepare or package food and share common spaces like hallways and elevators. Office workers would have to wear masks if they can’t physically distance.\u003c/p>\n\u003cp>The order includes several exceptions, including for outdoor recreation and exercise such as walking, hiking, running or bicycling. But if people are doing such activities and cannot stay six feet (1.8 meters) apart from others, the state says they should wear masks.\u003c/p>\n\u003cp>Other exceptions include: Children under 2, people with medical conditions that prevent them from wearing a mask, people who are hearing impaired or communicate with people who are hearing impaired and people receiving treatments on their nose and mouth. There’s also an exception if wearing a face covering would violate workplace safety guidelines.\u003c/p>\n\u003cp>People eating out at restaurants wouldn’t have to wear masks when they are eating and drinking as long as they are six feet away from others.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia and death.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>California will require people to wear masks in most indoor settings and outdoors when distancing isn’t possible under a statewide order issued Thursday.\u003c/p>\n\u003cp>“Science shows that face coverings and masks work,” Gov Gavin Newsom said in a statement announcing the order. “They are critical to keeping those who are around you safe, keeping businesses open and restarting our economy.”\u003c/p>\n\u003cp>A number of other states, including Michigan, New York, Maine, Delaware and Maryland already have statewide mask orders in place.\u003c/p>\n\u003cp>The order comes as California broadly reopens the economy; in most counties, people can now shop, dine in at restaurants, get their hair done and go to church, among other things. Meanwhile, coronavirus cases are increasing, something the state says is expected as more people get tested. More than 3,400 people were in the hospital as of Wednesday, the most patients hospitalized since April.\u003c/p>\n\u003cp>The order will require people to wear masks when inside or in line for any indoor public spaces, in health care settings like hospitals and pharmacies, while waiting for or riding public transportation and in outdoor spaces where its not possible to stay six feet (1.8 meters) apart from other people.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Until now, the Democratic governor had let local governments decide whether to mandate masks, an issue that’s become politically fraught as some Americans resist orders to wear them. He said he’s issuing the order now because too many people are going out in public without face coverings as businesses, restaurants and other sectors of the economy reopen.\u003c/p>\n\u003cp>Orange County’s public health officer resigned last week after she faced threats over her order that people wear masks, and the county sheriff said he wouldn’t enforce it. Los Angeles County requires people to wear masks whenever they are outside their homes, as do San Francisco and Santa Clara counties.\u003c/p>\n\u003cp>The state’s news release didn’t say how it would enforce the order or what the penalty would be for people who don’t comply.\u003c/p>\n\u003cp>The order also applies to workplaces where people interact with the public, prepare or package food and share common spaces like hallways and elevators. Office workers would have to wear masks if they can’t physically distance.\u003c/p>\n\u003cp>The order includes several exceptions, including for outdoor recreation and exercise such as walking, hiking, running or bicycling. But if people are doing such activities and cannot stay six feet (1.8 meters) apart from others, the state says they should wear masks.\u003c/p>\n\u003cp>Other exceptions include: Children under 2, people with medical conditions that prevent them from wearing a mask, people who are hearing impaired or communicate with people who are hearing impaired and people receiving treatments on their nose and mouth. There’s also an exception if wearing a face covering would violate workplace safety guidelines.\u003c/p>\n\u003cp>People eating out at restaurants wouldn’t have to wear masks when they are eating and drinking as long as they are six feet away from others.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>For most people, the coronavirus causes mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia and death.\u003c/p>\n\n\u003c/div>\u003c/p>",
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"content": "\u003cp>Most public restrooms are grungy in the best of times. Now, we have the coronavirus risk to contend with, too. There are lots of risks — dirty sinks and door handles, airborne particles and other people in small, enclosed spaces who may or may not be breathing out the coronavirus.\u003c/p>\n\u003cp>So, how do you stay safe when you’re away from home and you’ve really got to go?\u003c/p>\n\u003cp>As a medical doctor and epidemiologist, I study infectious diseases involving the gastrointestinal tract. Here are four things to pay attention to when it comes to any public restroom.\u003c/p>\n\u003cp>\u003cstrong>What Goes Into the Toilet Doesn’t Always Stay There\u003c/strong>\u003c/p>\n\u003cp>Have you ever thought about what happens when you flush a toilet?\u003c/p>\n\u003cp>Scientists who worry about disease transmission in hospitals have, and their findings are worth remembering when you’re in a public restroom.\u003c/p>\n\u003cp>All that bubbling, swirling and splashing can\u003ca href=\"https://doi.org/10.1080/02786826.2013.814911\" target=\"_blank\" rel=\"noopener noreferrer\"> aerosolize fecal waste\u003c/a>, sending tiny particles airborne. A \u003ca href=\"https://doi.org/10.1186/s13756-018-0301-9\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> on hospital bathrooms found that the amount of those particles spiked after a toilet was flushed, and the concentration in the air remained high 30 minutes later. It didn’t matter if the test was done right next to the toilet or 3 feet away. Second and third flushes continued to spread particles. Another \u003ca href=\"https://aip.scitation.org/doi/10.1063/5.0013318\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a>, published June 16, simulated toilet plumes from flushing and also found that a large number of particles rose above the toilet seat and lingered in the air. The scientists’ advice: close the lid before flushing.\u003c/p>\n\u003cp>Researchers have found that the new coronavirus, SARS-CoV-2, can be shed in feces for up to a month after the illness. That’s longer than in respiratory samples, though how much of that time the virus could be causing infections and whether the virus has infected humans through fecal waste isn’t yet known.\u003c/p>\n\u003cp>\u003cstrong>Surfaces Can Harbor the Virus, so Wash Up\u003c/strong>\u003c/p>\n\u003cp>The aerosols generated when someone infected with coronavirus coughs or even talks can be inhaled, of course, but they also settle out on surrounding surfaces, such as bathroom countertops.\u003c/p>\n\u003cp>To stay safe, be extra careful and touch as little as possible in public restrooms, including door handles. Whatever you do, don’t touch your eyes, nose or mouth after touching these surfaces — your mucous membranes are the coronavirus’ entryway into your body.\u003c/p>\n\u003cp>When you’re done, thoroughly wash your hands with soap and water, and maybe skip the hot-air hand dryer, which can also create aerosols and blow them toward you.\u003c/p>\n\u003cp>Carrying face masks, hand sanitizer and disinfectant wipes with you can help you be prepared, particularly if the facilities lack soap or running water.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003cstrong>Enclosed Spaces Are a Problem\u003c/strong>\u003c/p>\n\u003cp>The air in an enclosed space like a public restroom can have coronavirus particles in it for several hours after someone infectious with COVID-19 was there.\u003c/p>\n\u003cp>Scientists still don’t know how much of the virus you have to take in to become infected, but it’s better to be safe than sorry.\u003c/p>\n\u003cp>Limiting the amount of time spent in any enclosed indoor space — restrooms and restaurants included — can reduce the potential for getting sick from the coronavirus.\u003c/p>\n\u003cp>\u003cstrong>Wear a Mask, and Walk Out if Others Aren’t\u003c/strong>\u003c/p>\n\u003cp>One of the more insidious characteristics of the new coronavirus is that someone infected with the virus can be spreading it two to three days before they show any symptoms. Some people don’t show symptoms at all, but they can still be infectious for days.\u003c/p>\n\u003cp>Based on surveillance during the Princess cruise ship outbreak in Yokohama, Japan, 15% to 20% of the people tested positive for the coronavirus had no symptoms. Data from Wuhan, China, put the number of asymptomatic cases at closer to 40%.\u003c/p>\n\u003cp>Keeping at least 6 feet away from others and wearing a mask can help you avoid spreading the coronavirus if you’re asymptomatic and don’t realize it. They can also help protect you, though social distancing in small public restrooms isn’t always possible.\u003c/p>\n\u003cp>If someone else is in the restroom without a mask on, the best advice is to walk out. It isn’t worth the risk.\u003c/p>\n\u003cp>\u003cem>This article is republished from The Conversation under a Creative Commons license. \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Most public restrooms are grungy in the best of times. Now, we have the coronavirus risk to contend with, too. There are lots of risks — dirty sinks and door handles, airborne particles and other people in small, enclosed spaces who may or may not be breathing out the coronavirus.\u003c/p>\n\u003cp>So, how do you stay safe when you’re away from home and you’ve really got to go?\u003c/p>\n\u003cp>As a medical doctor and epidemiologist, I study infectious diseases involving the gastrointestinal tract. Here are four things to pay attention to when it comes to any public restroom.\u003c/p>\n\u003cp>\u003cstrong>What Goes Into the Toilet Doesn’t Always Stay There\u003c/strong>\u003c/p>\n\u003cp>Have you ever thought about what happens when you flush a toilet?\u003c/p>\n\u003cp>Scientists who worry about disease transmission in hospitals have, and their findings are worth remembering when you’re in a public restroom.\u003c/p>\n\u003cp>All that bubbling, swirling and splashing can\u003ca href=\"https://doi.org/10.1080/02786826.2013.814911\" target=\"_blank\" rel=\"noopener noreferrer\"> aerosolize fecal waste\u003c/a>, sending tiny particles airborne. A \u003ca href=\"https://doi.org/10.1186/s13756-018-0301-9\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> on hospital bathrooms found that the amount of those particles spiked after a toilet was flushed, and the concentration in the air remained high 30 minutes later. It didn’t matter if the test was done right next to the toilet or 3 feet away. Second and third flushes continued to spread particles. Another \u003ca href=\"https://aip.scitation.org/doi/10.1063/5.0013318\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a>, published June 16, simulated toilet plumes from flushing and also found that a large number of particles rose above the toilet seat and lingered in the air. The scientists’ advice: close the lid before flushing.\u003c/p>\n\u003cp>Researchers have found that the new coronavirus, SARS-CoV-2, can be shed in feces for up to a month after the illness. That’s longer than in respiratory samples, though how much of that time the virus could be causing infections and whether the virus has infected humans through fecal waste isn’t yet known.\u003c/p>\n\u003cp>\u003cstrong>Surfaces Can Harbor the Virus, so Wash Up\u003c/strong>\u003c/p>\n\u003cp>The aerosols generated when someone infected with coronavirus coughs or even talks can be inhaled, of course, but they also settle out on surrounding surfaces, such as bathroom countertops.\u003c/p>\n\u003cp>To stay safe, be extra careful and touch as little as possible in public restrooms, including door handles. Whatever you do, don’t touch your eyes, nose or mouth after touching these surfaces — your mucous membranes are the coronavirus’ entryway into your body.\u003c/p>\n\u003cp>When you’re done, thoroughly wash your hands with soap and water, and maybe skip the hot-air hand dryer, which can also create aerosols and blow them toward you.\u003c/p>\n\u003cp>Carrying face masks, hand sanitizer and disinfectant wipes with you can help you be prepared, particularly if the facilities lack soap or running water.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cstrong>Enclosed Spaces Are a Problem\u003c/strong>\u003c/p>\n\u003cp>The air in an enclosed space like a public restroom can have coronavirus particles in it for several hours after someone infectious with COVID-19 was there.\u003c/p>\n\u003cp>Scientists still don’t know how much of the virus you have to take in to become infected, but it’s better to be safe than sorry.\u003c/p>\n\u003cp>Limiting the amount of time spent in any enclosed indoor space — restrooms and restaurants included — can reduce the potential for getting sick from the coronavirus.\u003c/p>\n\u003cp>\u003cstrong>Wear a Mask, and Walk Out if Others Aren’t\u003c/strong>\u003c/p>\n\u003cp>One of the more insidious characteristics of the new coronavirus is that someone infected with the virus can be spreading it two to three days before they show any symptoms. Some people don’t show symptoms at all, but they can still be infectious for days.\u003c/p>\n\u003cp>Based on surveillance during the Princess cruise ship outbreak in Yokohama, Japan, 15% to 20% of the people tested positive for the coronavirus had no symptoms. Data from Wuhan, China, put the number of asymptomatic cases at closer to 40%.\u003c/p>\n\u003cp>Keeping at least 6 feet away from others and wearing a mask can help you avoid spreading the coronavirus if you’re asymptomatic and don’t realize it. They can also help protect you, though social distancing in small public restrooms isn’t always possible.\u003c/p>\n\u003cp>If someone else is in the restroom without a mask on, the best advice is to walk out. It isn’t worth the risk.\u003c/p>\n\u003cp>\u003cem>This article is republished from The Conversation under a Creative Commons license. \u003c/em>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>",
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"title": "Getting Off Drugs Takes a Community. But How Do You Do That in a Pandemic?",
"headTitle": "Getting Off Drugs Takes a Community. But How Do You Do That in a Pandemic? | KQED",
"content": "\u003cp>Before the coronavirus pandemic, patients would drop in to Arlene Brown’s clinic to treat their drug addiction whenever it was open.\u003c/p>\n\u003cp>“If they feel like they’re in crisis or they feel like they want to relapse, they know that they have access to our team at any time,” said Brown, a recovery support navigator at Northern Inyo Hospital in the Eastern Sierra town of Bishop.\u003c/p>\n\u003cp>[pullquote citation=\"Dr. Barry Zevin, San Francisco Department of Public Health\"]‘Our very key message has consistently been: ‘Don’t use alone.’ Now we are doing everything in our power to say to people, ‘Stay alone.’ And it’s really hard to have both of those things work.’[/pullquote]Some patients would go to meet with counselors and get prescription medications like buprenorphine to treat opioid addiction. Others needed harm-reduction supplies like clean needles and naloxon, the drug that reverses opioid overdoses.\u003c/p>\n\u003cp>There was also a weekly support group, for both “social interaction” and “accountability to other group members,” Brown said. A hot lunch was yet another draw, with leftovers usually available to take home.\u003c/p>\n\u003cp>But since the COVID-19 pandemic upended daily norms, there is no lunch and there is no group. And there is no dropping-in any time you need to.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Across the state, many of these familiar routines have been cut off. Clinics, drug counselors and patients, practiced at facing an overdose epidemic, are now figuring out what confronting that means in the face of a global pandemic.\u003c/p>\n\u003cp>At the center of this shift is how to maintain a sense of community, which Brown says is key to addressing addiction, at the same time that best practices urge people to keep their distance.\u003c/p>\n\u003cp>In Bishop, clinic staff aim to mitigate the spread of COVID-19 by minimizing in-person services when possible. They write prescriptions that will last longer so patients don’t have to come in as frequently, and people who are using drugs now take home larger quantities of safety supplies.\u003c/p>\n\u003cp>Instead of in-person check-ins, Brown says, counselors connect with their clients over the phone.\u003c/p>\n\u003cp>“Now more than ever, it’s important to have more communication with that patient,” she said.\u003c/p>\n\u003cp>While in the past, Brown may have each week connected with a patient once, she now talks to them two or three times.\u003c/p>\n\u003cp>“Imagine that you’re a patient and the only place that you go to get services is the clinic, that’s your support,” Brown said. “We have social workers. We have nurses. We have myself. We have the doctors. [Patients] have a whole team of people.”\u003c/p>\n\u003cp>But the public health message is to isolate, and this intensifies a problem that already exists for the people she works with.\u003c/p>\n\u003cp>“Addiction in itself is a very isolating disease,” Brown said. “Then you have social distancing, self-isolation. And so you have this perfect storm brewing for a relapse.”\u003c/p>\n\u003cp>That’s been the case for a lot of new patients lately who have lost their sobriety during the pandemic, she said. Before the coronavirus hit, most new clients were people who’d never been clean in the first place.\u003c/p>\n\u003cp>\u003cstrong>‘Don’t Use Alone’ — No Longer the Message\u003c/strong>\u003c/p>\n\u003cp>Another concern for Brown is that social distancing will mean more people may use drugs alone.\u003c/p>\n\u003cp>“It’s not safe, because if you overdose, no one’s there to save you,” she said.\u003c/p>\n\u003cp>In San Francisco, Dr. Barry Zevin agrees. He’s the medical director of street medicine at the San Francisco Department of Public Health.\u003c/p>\n\u003cp>“People are really struggling with the basic harm reduction messages that we have been giving … for many years,” Zevin said. “Our very key message has consistently been: ‘Don’t use alone.’ Now we are doing everything in our power to say to people, ‘Stay alone.’ And it’s really hard to have both of those things work.”\u003c/p>\n\u003cp>Though he doesn’t yet have data, Zevin believes the number of people using on their own has increased even if overdoses haven’t.\u003c/p>\n\u003cp>“And that has made it harder for people to have a reversal of their overdose,” he said. “What might have been somebody’s life saved, now, potentially, is his life lost because there wasn’t somebody around to give them naloxone.”\u003c/p>\n\u003cp>\u003cstrong>A New Kind of Normal\u003c/strong>\u003c/p>\n\u003cp>Kristen Marshall, of the advocacy group Harm Reduction Coalition, says San Francisco has seen a steady rise in drug overdose deaths in the last two years, including during the shelter in place. She traces that increase to availability of the powerful opioid fentanyl in the city’s drug supply.\u003c/p>\n\u003cp>Marshall says it’s hard to know whether the continuing rise in deaths is due to the pandemic. But the stress of the pandemic and recent protests “exacerbate people’s risk for all sorts of harms related to living in poverty,” she said.\u003c/p>\n\u003cp>San Francisco public health officials reported a \u003ca href=\"https://www.kqed.org/news/11820967/deaths-of-homeless-people-spike-in-san-francisco\" target=\"_blank\" rel=\"noopener noreferrer\">spike in the number of homeless people\u003c/a> who died this spring, many likely due to overdoses from fentanyl and indirect impacts from the coronavirus pandemic.\u003c/p>\n\u003cp>“What’s happening right now absolutely contributed to those people’s deaths,” Marshall said.\u003c/p>\n\u003cp>Despite the isolation born from the pandemic, some clinics and their patients have managed to create a new kind of normal.\u003c/p>\n\u003cp>That’s the case for Ronald, a patient at the Opiate Treatment Outpatient Program at San Francisco General Hospital. We’re not using Ronald’s last name to protect his privacy.\u003c/p>\n\u003cp>When he first showed up to the clinic 16 years ago, Ronald was addicted to heroin and alcohol. He lived on the street and was often sick.\u003c/p>\n\u003cp>Ronald speaks about the clinic with admiration. “They saved my life. I’m productive and happy now,” he said.\u003c/p>\n\u003cp>Sober, and living in a San Francisco apartment, he has a job providing in-home support for a client with disabilities.\u003c/p>\n\u003cp>For years, he’s walked, biked or bused to the clinic every Tuesday to get medication and counseling. While he is stable on his medications, and staff have offered him the option to come in less frequently, he’s always decided against it.\u003c/p>\n\u003cp>“Maybe even part of it is social. I’m really not sure,” Ronald said. “But it’s a routine I’ve gotten into and I just like what I’m doing.”\u003c/p>\n\u003cp>Even if Ronald doesn’t want to change, the pandemic means his treatment has to. There are the small changes when Ronald picks up his medications on Tuesdays from the clinic: He wears a face mask, and he socially distances. But the big change is that his and every other patient’s regular counseling now happens mostly by phone.\u003c/p>\n\u003cp>To make this work, clinic staff have distributed nearly 500 flip phones with unlimited talk and text, a critical donation from an anonymous supporter. Many of the program’s patients are homeless.\u003c/p>\n\u003cp>The clinic now dispenses daily doses of methadone or buprenorphine from a mobile van in a parking lot outside the hospital. In order to do this, the clinic had to get permission from the hospital, state, federal government and the U.S. Drug Enforcement Administration.\u003c/p>\n\u003cfigure id=\"attachment_1965439\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1965439\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2020/06/Trailer-800x450.jpg\" alt=\"Nurse Ana Mota at the Opiate Treatment Outpatient Program (OTOP) mobile van at Zuckerberg San Francisco General Hospital. Since March, medical staff have treated many methadone patients outside to allow for social distancing.\" width=\"800\" height=\"450\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Trailer-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Trailer-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Trailer-768x432.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Trailer-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Trailer.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Nurse Ana Mota at the Opiate Treatment Outpatient Program mobile van at Zuckerberg San Francisco General Hospital. Since March, medical staff have treated many methadone patients outside to allow for social distancing. \u003ccite>(Courtesy David Beuerman, Opiate Treatment Outpatient Program)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Amid Changes, an Opportunity\u003c/strong>\u003c/p>\n\u003cp>Opiate Treatment Outpatient Program social worker David Beuerman says the changes are both good and bad. Like Arlene Brown in Bishop, he worries about the impact of isolation on clients.\u003c/p>\n\u003cp>“Some of our folks, this is the only thing they have in their life,” he said about the clinic. “They feel safe, they’re not judged.”\u003c/p>\n\u003cp>But he also sees an opportunity, as the pandemic has forced a loosening of state and federal regulations around how drug treatment happens.\u003c/p>\n\u003cp>For example, the clinic has given some people small amounts of take-home medication that previously wouldn’t have been allowed, for fear of possible overdose or misuse. There’ve been some surprises.\u003c/p>\n\u003cp>“We may find that in some cases it’s safer to have done these things than we originally thought,” Beuerman said.\u003c/p>\n\u003cp>Some unexpected benefits to counseling over the phone have also been revealed, he said. “Some folks who didn’t open up in counseling, per se, have taken to using the phones to really reach out and talk to us and let us know what their experience is like.”\u003c/p>\n\u003cp>Beuerman says upending how drug clinics work could change treatment in a post-pandemic world, spurring less of a one-size-fits-all approach.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>While the sign in the San Francisco General Hospital parking lot reads “physical distance, social connection,” the pandemic has forced drug counselors like Beuerman and Brown to reassess just how that connection is made.\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Before the coronavirus pandemic, patients would drop in to Arlene Brown’s clinic to treat their drug addiction whenever it was open.\u003c/p>\n\u003cp>“If they feel like they’re in crisis or they feel like they want to relapse, they know that they have access to our team at any time,” said Brown, a recovery support navigator at Northern Inyo Hospital in the Eastern Sierra town of Bishop.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>Some patients would go to meet with counselors and get prescription medications like buprenorphine to treat opioid addiction. Others needed harm-reduction supplies like clean needles and naloxon, the drug that reverses opioid overdoses.\u003c/p>\n\u003cp>There was also a weekly support group, for both “social interaction” and “accountability to other group members,” Brown said. A hot lunch was yet another draw, with leftovers usually available to take home.\u003c/p>\n\u003cp>But since the COVID-19 pandemic upended daily norms, there is no lunch and there is no group. And there is no dropping-in any time you need to.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Across the state, many of these familiar routines have been cut off. Clinics, drug counselors and patients, practiced at facing an overdose epidemic, are now figuring out what confronting that means in the face of a global pandemic.\u003c/p>\n\u003cp>At the center of this shift is how to maintain a sense of community, which Brown says is key to addressing addiction, at the same time that best practices urge people to keep their distance.\u003c/p>\n\u003cp>In Bishop, clinic staff aim to mitigate the spread of COVID-19 by minimizing in-person services when possible. They write prescriptions that will last longer so patients don’t have to come in as frequently, and people who are using drugs now take home larger quantities of safety supplies.\u003c/p>\n\u003cp>Instead of in-person check-ins, Brown says, counselors connect with their clients over the phone.\u003c/p>\n\u003cp>“Now more than ever, it’s important to have more communication with that patient,” she said.\u003c/p>\n\u003cp>While in the past, Brown may have each week connected with a patient once, she now talks to them two or three times.\u003c/p>\n\u003cp>“Imagine that you’re a patient and the only place that you go to get services is the clinic, that’s your support,” Brown said. “We have social workers. We have nurses. We have myself. We have the doctors. [Patients] have a whole team of people.”\u003c/p>\n\u003cp>But the public health message is to isolate, and this intensifies a problem that already exists for the people she works with.\u003c/p>\n\u003cp>“Addiction in itself is a very isolating disease,” Brown said. “Then you have social distancing, self-isolation. And so you have this perfect storm brewing for a relapse.”\u003c/p>\n\u003cp>That’s been the case for a lot of new patients lately who have lost their sobriety during the pandemic, she said. Before the coronavirus hit, most new clients were people who’d never been clean in the first place.\u003c/p>\n\u003cp>\u003cstrong>‘Don’t Use Alone’ — No Longer the Message\u003c/strong>\u003c/p>\n\u003cp>Another concern for Brown is that social distancing will mean more people may use drugs alone.\u003c/p>\n\u003cp>“It’s not safe, because if you overdose, no one’s there to save you,” she said.\u003c/p>\n\u003cp>In San Francisco, Dr. Barry Zevin agrees. He’s the medical director of street medicine at the San Francisco Department of Public Health.\u003c/p>\n\u003cp>“People are really struggling with the basic harm reduction messages that we have been giving … for many years,” Zevin said. “Our very key message has consistently been: ‘Don’t use alone.’ Now we are doing everything in our power to say to people, ‘Stay alone.’ And it’s really hard to have both of those things work.”\u003c/p>\n\u003cp>Though he doesn’t yet have data, Zevin believes the number of people using on their own has increased even if overdoses haven’t.\u003c/p>\n\u003cp>“And that has made it harder for people to have a reversal of their overdose,” he said. “What might have been somebody’s life saved, now, potentially, is his life lost because there wasn’t somebody around to give them naloxone.”\u003c/p>\n\u003cp>\u003cstrong>A New Kind of Normal\u003c/strong>\u003c/p>\n\u003cp>Kristen Marshall, of the advocacy group Harm Reduction Coalition, says San Francisco has seen a steady rise in drug overdose deaths in the last two years, including during the shelter in place. She traces that increase to availability of the powerful opioid fentanyl in the city’s drug supply.\u003c/p>\n\u003cp>Marshall says it’s hard to know whether the continuing rise in deaths is due to the pandemic. But the stress of the pandemic and recent protests “exacerbate people’s risk for all sorts of harms related to living in poverty,” she said.\u003c/p>\n\u003cp>San Francisco public health officials reported a \u003ca href=\"https://www.kqed.org/news/11820967/deaths-of-homeless-people-spike-in-san-francisco\" target=\"_blank\" rel=\"noopener noreferrer\">spike in the number of homeless people\u003c/a> who died this spring, many likely due to overdoses from fentanyl and indirect impacts from the coronavirus pandemic.\u003c/p>\n\u003cp>“What’s happening right now absolutely contributed to those people’s deaths,” Marshall said.\u003c/p>\n\u003cp>Despite the isolation born from the pandemic, some clinics and their patients have managed to create a new kind of normal.\u003c/p>\n\u003cp>That’s the case for Ronald, a patient at the Opiate Treatment Outpatient Program at San Francisco General Hospital. We’re not using Ronald’s last name to protect his privacy.\u003c/p>\n\u003cp>When he first showed up to the clinic 16 years ago, Ronald was addicted to heroin and alcohol. He lived on the street and was often sick.\u003c/p>\n\u003cp>Ronald speaks about the clinic with admiration. “They saved my life. I’m productive and happy now,” he said.\u003c/p>\n\u003cp>Sober, and living in a San Francisco apartment, he has a job providing in-home support for a client with disabilities.\u003c/p>\n\u003cp>For years, he’s walked, biked or bused to the clinic every Tuesday to get medication and counseling. While he is stable on his medications, and staff have offered him the option to come in less frequently, he’s always decided against it.\u003c/p>\n\u003cp>“Maybe even part of it is social. I’m really not sure,” Ronald said. “But it’s a routine I’ve gotten into and I just like what I’m doing.”\u003c/p>\n\u003cp>Even if Ronald doesn’t want to change, the pandemic means his treatment has to. There are the small changes when Ronald picks up his medications on Tuesdays from the clinic: He wears a face mask, and he socially distances. But the big change is that his and every other patient’s regular counseling now happens mostly by phone.\u003c/p>\n\u003cp>To make this work, clinic staff have distributed nearly 500 flip phones with unlimited talk and text, a critical donation from an anonymous supporter. Many of the program’s patients are homeless.\u003c/p>\n\u003cp>The clinic now dispenses daily doses of methadone or buprenorphine from a mobile van in a parking lot outside the hospital. In order to do this, the clinic had to get permission from the hospital, state, federal government and the U.S. Drug Enforcement Administration.\u003c/p>\n\u003cfigure id=\"attachment_1965439\" class=\"wp-caption aligncenter\" style=\"max-width: 800px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"size-medium wp-image-1965439\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2020/06/Trailer-800x450.jpg\" alt=\"Nurse Ana Mota at the Opiate Treatment Outpatient Program (OTOP) mobile van at Zuckerberg San Francisco General Hospital. Since March, medical staff have treated many methadone patients outside to allow for social distancing.\" width=\"800\" height=\"450\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Trailer-800x450.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Trailer-160x90.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Trailer-768x432.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Trailer-1020x574.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Trailer.jpg 1920w\" sizes=\"(max-width: 800px) 100vw, 800px\">\u003cfigcaption class=\"wp-caption-text\">Nurse Ana Mota at the Opiate Treatment Outpatient Program mobile van at Zuckerberg San Francisco General Hospital. Since March, medical staff have treated many methadone patients outside to allow for social distancing. \u003ccite>(Courtesy David Beuerman, Opiate Treatment Outpatient Program)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>\u003cstrong>Amid Changes, an Opportunity\u003c/strong>\u003c/p>\n\u003cp>Opiate Treatment Outpatient Program social worker David Beuerman says the changes are both good and bad. Like Arlene Brown in Bishop, he worries about the impact of isolation on clients.\u003c/p>\n\u003cp>“Some of our folks, this is the only thing they have in their life,” he said about the clinic. “They feel safe, they’re not judged.”\u003c/p>\n\u003cp>But he also sees an opportunity, as the pandemic has forced a loosening of state and federal regulations around how drug treatment happens.\u003c/p>\n\u003cp>For example, the clinic has given some people small amounts of take-home medication that previously wouldn’t have been allowed, for fear of possible overdose or misuse. There’ve been some surprises.\u003c/p>\n\u003cp>“We may find that in some cases it’s safer to have done these things than we originally thought,” Beuerman said.\u003c/p>\n\u003cp>Some unexpected benefits to counseling over the phone have also been revealed, he said. “Some folks who didn’t open up in counseling, per se, have taken to using the phones to really reach out and talk to us and let us know what their experience is like.”\u003c/p>\n\u003cp>Beuerman says upending how drug clinics work could change treatment in a post-pandemic world, spurring less of a one-size-fits-all approach.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"headTitle": "Things Are Getting Really Ugly for California Public Health Officers | KQED",
"content": "\u003cp>Leigh Dundas angrily wagged her finger at Orange County supervisors at their board \u003ca href=\"https://ocgov.granicus.com/player/clip/3709?\" target=\"_blank\" rel=\"noopener noreferrer\">meeting\u003c/a> last month as she ticked off what she thought were damning details about the professional background of county health officer Nichole Quick. The anti-vaccination attorney named Quick’s boyfriend and disclosed her home address, saying she was going to bring protesters in masks to do calisthenics on her front doorstep until they passed out.\u003c/p>\n\u003cp>“She needs to be fired,” Dundas declared.\u003c/p>\n\u003cp>[pullquote align='right' citation='Kat DeBurgh, executive director of the Health Officers Association of California']‘We’ve never seen this level of public comment becoming threatening, a personal attack, a questioning of a health officer’s motivation.’[/pullquote]\u003c/p>\n\u003cp>It was a strikingly personal attack on Quick, who had vexed many local officials and residents alike with her recent order requiring that people wear masks when in public to prevent the spread of the novel coronavirus. The county sheriff provided her with a security detail even as he said he would not enforce the mask order. Finally, under pressure from both county supervisors and the public, Quick resigned last week, the third high-level Orange County health official to do so during the pandemic. And Orange County \u003ca href=\"https://www.cnn.com/2020/06/12/health/california-lifts-mask-requirement-trnd/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">reversed her mask order\u003c/a>.\u003c/p>\n\u003cp>Local public health officers haven’t been this important in a century. They’re also being second-guessed, harassed and threatened by residents, and sometimes local leaders, \u003ca href=\"https://calmatters.org/politics/2020/05/anti-newsom-protests-reopen-california-coronavirus-pandemic/\" target=\"_blank\" rel=\"noopener noreferrer\">angry about pandemic shutdowns\u003c/a>. Some have simply quit.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Four other health officers in California have resigned or retired in the last two months, in Nevada, San Benito, Yolo and Butte counties, as have two public health department directors in San Bernardino and Orange counties (in addition to Quick). On Monday, the state \u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">reported\u003c/a> nearly 150,000 confirmed COVID-19 cases and more than 5,000 deaths.\u003c/p>\n\u003cp>This isn’t just happening in California. Ohio’s state health director, Amy Acton, \u003ca href=\"https://abcnews.go.com/US/amy-acton-ohios-embattled-health-director-resigns-amid/story?id=71202353\" target=\"_blank\" rel=\"noopener noreferrer\">resigned last week\u003c/a> after facing legal challenges to her authority and protests in front of her home. Wisconsin state health director Jeanne Ayers \u003ca href=\"https://www.jsonline.com/story/news/2020/06/08/evers-administration-wont-say-why-state-top-public-health-official-asked-resign-amid-outbreak/5319973002/\" target=\"_blank\" rel=\"noopener noreferrer\">was asked to resign\u003c/a> in early May, at a time when COVID-19 cases in the state \u003ca href=\"https://www.dhs.wisconsin.gov/covid-19/cases.htm\" target=\"_blank\" rel=\"noopener noreferrer\">had surpassed 10,000\u003c/a>, and top officials would not say why.\u003c/p>\n\u003cp>“Things have gotten ugly,” said one Northern California health officer who asked not to be named over personal safety concerns. “The health officers are kind of in this position where everything that everyone is angry about is the health officer’s fault.”\u003c/p>\n\u003cp>The official described death threats received by email and on social media as well as protesters showing up to their home. “It … makes you feel that there is nowhere that’s safe.”\u003c/p>\n\u003cfigure id=\"attachment_1965798\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1965798\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2020/06/Orange-County-coronavirus-800x533.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Orange-County-coronavirus-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Orange-County-coronavirus-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Orange-County-coronavirus-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Orange-County-coronavirus-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Orange-County-coronavirus.jpg 1920w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">An unidentified woman wears a face scarf as a preventive measure against the spread of the coronavirus during a demonstration on May 1, 2020, in Huntington Beach, California. \u003ccite>(Apu Gomes/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>California Gov. Gavin Newsom’s \u003ca href=\"https://calmatters.org/politics/2020/05/newsom-defiant-counties-churches-coronavirus-shutdown-restrictions/\" target=\"_blank\" rel=\"noopener noreferrer\">reopening strategy\u003c/a>, which asks counties to certify that their COVID-19 cases are under control, was a “terrible decision…that deflected all the political pressure to local officers,” the Northern California officer said.\u003c/p>\n\u003cp>County health officers occupy a unique position in local government. They’re responsible for overseeing the public health response to disease outbreaks, among many other duties. Every county, and a few cities that run their own public health departments, must designate one. They are not elected officials and typically are appointed by county executives.\u003c/p>\n\u003cp>In emergency situations, health officers have \u003ca href=\"https://www.smgov.net/departments/oem/sems/proclamations-and-declarations/authorities-and-responsibilities-of-local-health-officers-in-disasters.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">legal authority\u003c/a> to shut down businesses, order millions of people to stay at home, isolate or quarantine people, even order mass evacuations. They also can issue orders, such as requiring people to wear masks in public, that are stricter than state mandates.\u003c/p>\n\u003cp>Their authority can be challenged in court, and health officers are subject to due process, said Kat DeBurgh, executive director of the Health Officers Association of California.\u003c/p>\n\u003cp>But that power comes with a price as the worst pandemic in a century unfolds in a politically polarized nation.\u003c/p>\n\u003cp>“Health officers are always there working in the background to protect communities from communicable disease. This is the first time I’ve seen this level of animosity,” DeBurgh said, noting that one health officer she would not name has a sheriff’s security detail posted outside her home.\u003c/p>\n\u003cp>“Health officers all over the state are feeling tremendous pressure, not just the expected pressures of working really hard to stop this virus,” she added. “We’ve never seen this level of public comment becoming threatening, a personal attack, a questioning of a health officer’s motivation.”\u003c/p>\n\u003cp>Californians emboldened by a president who initially \u003ca href=\"https://www.washingtonpost.com/video/politics/44-times-trump-downplayed-the-coronavirus/2020/03/05/790f5afb-4dda-48bf-abe1-b7d152d5138c_video.html\" target=\"_blank\" rel=\"noopener noreferrer\">played down\u003c/a> the pandemic and now \u003ca href=\"https://www.npr.org/2020/05/08/852093558/the-president-as-a-model-for-the-nation-from-toasters-and-sweaters-to-masks\" target=\"_blank\" rel=\"noopener noreferrer\">refuses to wear a mask\u003c/a>, feel freer to vent their frustrations on health officers placed front-and-center at press conferences and government meetings, said Dr. Jonathan Fielding, who served as Los Angeles County’s health officer for 16 years and now is a professor at the UCLA school of public health that bears his name.\u003c/p>\n\u003cp>“None of us has the unfettered right to do what we want,” Fielding said. “People are saying, ‘Our president’s not doing this, why do I have to?’ That’s one of the roots of this problem — the radicalization of views on individual rights.”\u003c/p>\n\u003cp>A full-page \u003ca href=\"https://www.facebook.com/MorganHillChamber/photos/a.427963328578/10157624383213579/?type=3&theater\">ad\u003c/a> published in the The Mercury News in San Jose blasted Santa Clara County health officer Dr. Sara Cody, \u003ca href=\"https://www.mercurynews.com/2020/03/29/she-shut-down-the-bay-area-to-slow-the-deadly-coronavirus-none-of-us-really-believed-we-would-do-it/\" target=\"_blank\" rel=\"noopener noreferrer\">who ordered\u003c/a> the nation’s first local shelter-in-place lockdown. It accused Cody of “cratering our economy” and asked her to permanently donate her salary and pension to “those you are impoverishing.”\u003c/p>\n\u003cp>On social media, people \u003ca href=\"https://apnews.com/afs:Content:8956530071\" target=\"_blank\" rel=\"noopener noreferrer\">circulated a doctored photo\u003c/a> of Los Angeles county health officer Dr. Barbara Ferrer that made her appear very ill, with pale skin and deep circles under her eyes. A \u003ca href=\"https://twitter.com/jakecoco/status/1261372969147699201\" target=\"_blank\" rel=\"noopener noreferrer\">tweet\u003c/a> calling Ferrer “the most unhealthy looking person I’ve ever seen” was retweeted 29,000 times and “liked” by more than 89,000 people.\u003c/p>\n\u003cp>In a sign of just how tense things have become, Santa Cruz County supervisors in late May \u003ca href=\"https://www.santacruzsentinel.com/2020/05/29/amid-rancor-santa-cruz-county-applies-for-reopening-variance/\" target=\"_blank\" rel=\"noopener noreferrer\">briefly shut down\u003c/a> a public meeting about reopening when a pizzeria owner approaching a microphone veered away and started walking toward the county’s health officer. He told the supervisors he was just trying to read her name, the Santa Cruz Sentinel reported, but they weren’t taking chances.\u003c/p>\n\u003cp>“We are deeply concerned that politics may be trumping public interest in some of these cases, and that the public’s health may be compromised as a result,” California Medical Association President Dr. Peter Bretan Jr. said in a statement.\u003c/p>\n\u003cp>Nearly nine in 10 Californians agree that shelter-in-place orders are necessary to protect public health, according to California Health Care Foundation polling. But about 38% of Californians agree that the COVID-19 regulations “go too far,” the poll shows.\u003c/p>\n\u003cp>Former Santa Barbara County health officer Dr. Charity Dean, who had become second-in-command at the state Department of Public Health, submitted her resignation June 4, as \u003ca href=\"https://www.cnbc.com/2020/06/12/coronavirus-public-health-officials-face-political-pressure-threats-and-armed-protests.html\" target=\"_blank\" rel=\"noopener noreferrer\">first reported\u003c/a> by CNBC. A few days later, she tweeted her encouragement to other health officers:\u003c/p>\n\u003cp>https://twitter.com/drcharitydean/status/1270582184915554310?s=20\u003c/p>\n\u003cp>State Sen. Richard Pan, a pediatrician who has received death threats and been \u003ca href=\"https://www.sacbee.com/news/politics-government/capitol-alert/article234231737.html\" target=\"_blank\" rel=\"noopener noreferrer\">shoved\u003c/a> by an activist over his childhood immunization lawmaking, described the statewide harassment of public health officers as “shameful.”\u003c/p>\n\u003cp>“Our public health officers are given the responsibility to act in the best interest of the public – they certainly should not be personally attacked and bullied and intimidated,” Pan said. “The job’s already challenging enough.”\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://calmatters.org/\">CalMatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/em>\u003c/p>\n\u003cdiv class=\"SandboxRoot env-bp-350\" data-twitter-event-id=\"0\">\n\u003cdiv id=\"twitter-widget-0\" class=\"EmbeddedTweet EmbeddedTweet--cta js-clickToOpenTarget\" lang=\"en\" data-click-to-open-target=\"https://twitter.com/drcharitydean/status/1270582184915554310\" data-iframe-title=\"Twitter Tweet\" data-scribe=\"page:tweet\" data-twitter-event-id=\"1\">\n\u003cdiv class=\"EmbeddedTweet-tweetContainer\">\n\u003cdiv class=\"EmbeddedTweet-tweet\">\n\u003cblockquote class=\"Tweet h-entry js-tweetIdInfo subject expanded\" cite=\"https://twitter.com/drcharitydean/status/1270582184915554310\" data-tweet-id=\"1270582184915554310\" data-scribe=\"section:subject\">\n\u003cdiv class=\"Tweet-header\">\u003c/div>\n\u003c/blockquote>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\n",
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"excerpt": "Local public health officers haven’t been this important in a century. They’re also being second-guessed, harassed and threatened by residents angry about pandemic precautions.",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>Leigh Dundas angrily wagged her finger at Orange County supervisors at their board \u003ca href=\"https://ocgov.granicus.com/player/clip/3709?\" target=\"_blank\" rel=\"noopener noreferrer\">meeting\u003c/a> last month as she ticked off what she thought were damning details about the professional background of county health officer Nichole Quick. The anti-vaccination attorney named Quick’s boyfriend and disclosed her home address, saying she was going to bring protesters in masks to do calisthenics on her front doorstep until they passed out.\u003c/p>\n\u003cp>“She needs to be fired,” Dundas declared.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>It was a strikingly personal attack on Quick, who had vexed many local officials and residents alike with her recent order requiring that people wear masks when in public to prevent the spread of the novel coronavirus. The county sheriff provided her with a security detail even as he said he would not enforce the mask order. Finally, under pressure from both county supervisors and the public, Quick resigned last week, the third high-level Orange County health official to do so during the pandemic. And Orange County \u003ca href=\"https://www.cnn.com/2020/06/12/health/california-lifts-mask-requirement-trnd/index.html\" target=\"_blank\" rel=\"noopener noreferrer\">reversed her mask order\u003c/a>.\u003c/p>\n\u003cp>Local public health officers haven’t been this important in a century. They’re also being second-guessed, harassed and threatened by residents, and sometimes local leaders, \u003ca href=\"https://calmatters.org/politics/2020/05/anti-newsom-protests-reopen-california-coronavirus-pandemic/\" target=\"_blank\" rel=\"noopener noreferrer\">angry about pandemic shutdowns\u003c/a>. Some have simply quit.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Four other health officers in California have resigned or retired in the last two months, in Nevada, San Benito, Yolo and Butte counties, as have two public health department directors in San Bernardino and Orange counties (in addition to Quick). On Monday, the state \u003ca href=\"https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization/ncov2019.aspx\" target=\"_blank\" rel=\"noopener noreferrer\">reported\u003c/a> nearly 150,000 confirmed COVID-19 cases and more than 5,000 deaths.\u003c/p>\n\u003cp>This isn’t just happening in California. Ohio’s state health director, Amy Acton, \u003ca href=\"https://abcnews.go.com/US/amy-acton-ohios-embattled-health-director-resigns-amid/story?id=71202353\" target=\"_blank\" rel=\"noopener noreferrer\">resigned last week\u003c/a> after facing legal challenges to her authority and protests in front of her home. Wisconsin state health director Jeanne Ayers \u003ca href=\"https://www.jsonline.com/story/news/2020/06/08/evers-administration-wont-say-why-state-top-public-health-official-asked-resign-amid-outbreak/5319973002/\" target=\"_blank\" rel=\"noopener noreferrer\">was asked to resign\u003c/a> in early May, at a time when COVID-19 cases in the state \u003ca href=\"https://www.dhs.wisconsin.gov/covid-19/cases.htm\" target=\"_blank\" rel=\"noopener noreferrer\">had surpassed 10,000\u003c/a>, and top officials would not say why.\u003c/p>\n\u003cp>“Things have gotten ugly,” said one Northern California health officer who asked not to be named over personal safety concerns. “The health officers are kind of in this position where everything that everyone is angry about is the health officer’s fault.”\u003c/p>\n\u003cp>The official described death threats received by email and on social media as well as protesters showing up to their home. “It … makes you feel that there is nowhere that’s safe.”\u003c/p>\n\u003cfigure id=\"attachment_1965798\" class=\"wp-caption alignright\" style=\"max-width: 640px\">\u003cimg loading=\"lazy\" decoding=\"async\" class=\"wp-image-1965798\" src=\"https://ww2.kqed.org/app/uploads/sites/35/2020/06/Orange-County-coronavirus-800x533.jpg\" alt=\"\" width=\"640\" height=\"427\" srcset=\"https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Orange-County-coronavirus-800x533.jpg 800w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Orange-County-coronavirus-160x107.jpg 160w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Orange-County-coronavirus-768x512.jpg 768w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Orange-County-coronavirus-1020x680.jpg 1020w, https://cdn.kqed.org/wp-content/uploads/sites/35/2020/06/Orange-County-coronavirus.jpg 1920w\" sizes=\"(max-width: 640px) 100vw, 640px\">\u003cfigcaption class=\"wp-caption-text\">An unidentified woman wears a face scarf as a preventive measure against the spread of the coronavirus during a demonstration on May 1, 2020, in Huntington Beach, California. \u003ccite>(Apu Gomes/Getty Images)\u003c/cite>\u003c/figcaption>\u003c/figure>\n\u003cp>California Gov. Gavin Newsom’s \u003ca href=\"https://calmatters.org/politics/2020/05/newsom-defiant-counties-churches-coronavirus-shutdown-restrictions/\" target=\"_blank\" rel=\"noopener noreferrer\">reopening strategy\u003c/a>, which asks counties to certify that their COVID-19 cases are under control, was a “terrible decision…that deflected all the political pressure to local officers,” the Northern California officer said.\u003c/p>\n\u003cp>County health officers occupy a unique position in local government. They’re responsible for overseeing the public health response to disease outbreaks, among many other duties. Every county, and a few cities that run their own public health departments, must designate one. They are not elected officials and typically are appointed by county executives.\u003c/p>\n\u003cp>In emergency situations, health officers have \u003ca href=\"https://www.smgov.net/departments/oem/sems/proclamations-and-declarations/authorities-and-responsibilities-of-local-health-officers-in-disasters.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">legal authority\u003c/a> to shut down businesses, order millions of people to stay at home, isolate or quarantine people, even order mass evacuations. They also can issue orders, such as requiring people to wear masks in public, that are stricter than state mandates.\u003c/p>\n\u003cp>Their authority can be challenged in court, and health officers are subject to due process, said Kat DeBurgh, executive director of the Health Officers Association of California.\u003c/p>\n\u003cp>But that power comes with a price as the worst pandemic in a century unfolds in a politically polarized nation.\u003c/p>\n\u003cp>“Health officers are always there working in the background to protect communities from communicable disease. This is the first time I’ve seen this level of animosity,” DeBurgh said, noting that one health officer she would not name has a sheriff’s security detail posted outside her home.\u003c/p>\n\u003cp>“Health officers all over the state are feeling tremendous pressure, not just the expected pressures of working really hard to stop this virus,” she added. “We’ve never seen this level of public comment becoming threatening, a personal attack, a questioning of a health officer’s motivation.”\u003c/p>\n\u003cp>Californians emboldened by a president who initially \u003ca href=\"https://www.washingtonpost.com/video/politics/44-times-trump-downplayed-the-coronavirus/2020/03/05/790f5afb-4dda-48bf-abe1-b7d152d5138c_video.html\" target=\"_blank\" rel=\"noopener noreferrer\">played down\u003c/a> the pandemic and now \u003ca href=\"https://www.npr.org/2020/05/08/852093558/the-president-as-a-model-for-the-nation-from-toasters-and-sweaters-to-masks\" target=\"_blank\" rel=\"noopener noreferrer\">refuses to wear a mask\u003c/a>, feel freer to vent their frustrations on health officers placed front-and-center at press conferences and government meetings, said Dr. Jonathan Fielding, who served as Los Angeles County’s health officer for 16 years and now is a professor at the UCLA school of public health that bears his name.\u003c/p>\n\u003cp>“None of us has the unfettered right to do what we want,” Fielding said. “People are saying, ‘Our president’s not doing this, why do I have to?’ That’s one of the roots of this problem — the radicalization of views on individual rights.”\u003c/p>\n\u003cp>A full-page \u003ca href=\"https://www.facebook.com/MorganHillChamber/photos/a.427963328578/10157624383213579/?type=3&theater\">ad\u003c/a> published in the The Mercury News in San Jose blasted Santa Clara County health officer Dr. Sara Cody, \u003ca href=\"https://www.mercurynews.com/2020/03/29/she-shut-down-the-bay-area-to-slow-the-deadly-coronavirus-none-of-us-really-believed-we-would-do-it/\" target=\"_blank\" rel=\"noopener noreferrer\">who ordered\u003c/a> the nation’s first local shelter-in-place lockdown. It accused Cody of “cratering our economy” and asked her to permanently donate her salary and pension to “those you are impoverishing.”\u003c/p>\n\u003cp>On social media, people \u003ca href=\"https://apnews.com/afs:Content:8956530071\" target=\"_blank\" rel=\"noopener noreferrer\">circulated a doctored photo\u003c/a> of Los Angeles county health officer Dr. Barbara Ferrer that made her appear very ill, with pale skin and deep circles under her eyes. A \u003ca href=\"https://twitter.com/jakecoco/status/1261372969147699201\" target=\"_blank\" rel=\"noopener noreferrer\">tweet\u003c/a> calling Ferrer “the most unhealthy looking person I’ve ever seen” was retweeted 29,000 times and “liked” by more than 89,000 people.\u003c/p>\n\u003cp>In a sign of just how tense things have become, Santa Cruz County supervisors in late May \u003ca href=\"https://www.santacruzsentinel.com/2020/05/29/amid-rancor-santa-cruz-county-applies-for-reopening-variance/\" target=\"_blank\" rel=\"noopener noreferrer\">briefly shut down\u003c/a> a public meeting about reopening when a pizzeria owner approaching a microphone veered away and started walking toward the county’s health officer. He told the supervisors he was just trying to read her name, the Santa Cruz Sentinel reported, but they weren’t taking chances.\u003c/p>\n\u003cp>“We are deeply concerned that politics may be trumping public interest in some of these cases, and that the public’s health may be compromised as a result,” California Medical Association President Dr. Peter Bretan Jr. said in a statement.\u003c/p>\n\u003cp>Nearly nine in 10 Californians agree that shelter-in-place orders are necessary to protect public health, according to California Health Care Foundation polling. But about 38% of Californians agree that the COVID-19 regulations “go too far,” the poll shows.\u003c/p>\n\u003cp>Former Santa Barbara County health officer Dr. Charity Dean, who had become second-in-command at the state Department of Public Health, submitted her resignation June 4, as \u003ca href=\"https://www.cnbc.com/2020/06/12/coronavirus-public-health-officials-face-political-pressure-threats-and-armed-protests.html\" target=\"_blank\" rel=\"noopener noreferrer\">first reported\u003c/a> by CNBC. A few days later, she tweeted her encouragement to other health officers:\u003c/p>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\n\u003cp>State Sen. Richard Pan, a pediatrician who has received death threats and been \u003ca href=\"https://www.sacbee.com/news/politics-government/capitol-alert/article234231737.html\" target=\"_blank\" rel=\"noopener noreferrer\">shoved\u003c/a> by an activist over his childhood immunization lawmaking, described the statewide harassment of public health officers as “shameful.”\u003c/p>\n\u003cp>“Our public health officers are given the responsibility to act in the best interest of the public – they certainly should not be personally attacked and bullied and intimidated,” Pan said. “The job’s already challenging enough.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003cem>\u003ca href=\"http://calmatters.org/\">CalMatters.org\u003c/a> is a nonprofit, nonpartisan media venture explaining California policies and politics.\u003c/em>\u003c/p>\n\u003cdiv class=\"SandboxRoot env-bp-350\" data-twitter-event-id=\"0\">\n\u003cdiv id=\"twitter-widget-0\" class=\"EmbeddedTweet EmbeddedTweet--cta js-clickToOpenTarget\" lang=\"en\" data-click-to-open-target=\"https://twitter.com/drcharitydean/status/1270582184915554310\" data-iframe-title=\"Twitter Tweet\" data-scribe=\"page:tweet\" data-twitter-event-id=\"1\">\n\u003cdiv class=\"EmbeddedTweet-tweetContainer\">\n\u003cdiv class=\"EmbeddedTweet-tweet\">\n\u003cblockquote class=\"Tweet h-entry js-tweetIdInfo subject expanded\" cite=\"https://twitter.com/drcharitydean/status/1270582184915554310\" data-tweet-id=\"1270582184915554310\" data-scribe=\"section:subject\">\n\u003cdiv class=\"Tweet-header\">\u003c/div>\n\u003c/blockquote>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\u003c/div>\n\n\u003c/div>\u003c/p>",
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"title": "Who's Dying of COVID-19 May Be Determined Just as Much by Race as by Age",
"headTitle": "Who’s Dying of COVID-19 May Be Determined Just as Much by Race as by Age | KQED",
"content": "\u003cp>\u003cspan class=\"big-cap-wrap\">\u003cspan class=\"big-cap\">W\u003c/span>\u003c/span>hile early studies of who was dying of COVID-19 identified risks such as obesity and having diabetes, there is a growing realization that those initial conclusions might have been misleading, obscuring a more significant explanation.\u003c/p>\n\u003cp>As researchers pull back their lens from individuals to population-level risk factors, they’re finding that, in the U.S., race may be as important as age in gauging a person’s likelihood of dying from the disease.\u003c/p>\n\u003cp>The higher the percentage of black residents in a county, the higher its death rate from COVID-19 — even after accounting for income, health insurance coverage, rates of diabetes and obesity, and public transit use, finds a new \u003ca href=\"http://ceepr.mit.edu/files/papers/2020-009.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> by researchers at the MIT Sloan School of Management. With those plausible explanations ruled out, “the causal mechanism has to be something else,” said applied economist Chris Knittel, the study’s senior author. “If I were a public official, I’d be looking at differences in the quality of insurance, conditions such as chronic stress, and systemic discrimination.”\u003c/p>\n\u003cp>The county-by-county analysis of COVID-19 death rates in the U.S. comes as more and more studies shift from the initial focus on individual-level factors that seem to increase people’s risk of dying to population-level ones, too, said experts in public health, demographics and infectious disease.\u003c/p>\n\u003cp>One reason for the new focus is that “we’re not learning much more beyond what’s been observed from the start of the pandemic: that sex, age, and preexisting conditions put you at greater risk of dying” from COVID-19, said Aaron Glatt, an infectious disease physician at the Icahn School of Medicine at Mount Sinai. In \u003ca href=\"https://globalhealth5050.org/covid19/sex-disaggregated-data-tracker/\" target=\"_blank\" rel=\"noopener noreferrer\">almost every country\u003c/a>, for instance, more men than women are dying of COVID-19, an imbalance that likely reflects both biology — women have stronger immune systems — and socialization: They seem to be following social distancing guidelines more than men, which could decrease the viral load they’re exposed to.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Also driving the shift in focus is that society-level influences are potentially more “actionable” than individual risk factors; you can’t change your blood type. A \u003ca href=\"https://www.medrxiv.org/content/10.1101/2020.05.31.20114991v1\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> posted to the preprint site medRxiv this month reported that type O is associated with lower risk of respiratory failure from COVID-19 and type A with a higher risk, but the paper hasn’t been peer-reviewed and it’s not clear how much difference blood type might make. “I wouldn’t tell one patient, thank god you have type O, but another, start preparing your will because you’re type A,” Glatt said.\u003c/p>\n\u003cp>To investigate population-level factors, MIT’s Knittel and graduate student Bora Ozaltun analyzed county-by-county mortality rates — the number of deaths from COVID-19 as a percentage of population, from April 4 to May 27. The mortality rate is more precise than the infection rate or the case fatality rate (the percent of diagnosed cases who die), which are imprecise because of inadequate testing. In contrast, although some COVID-19 deaths were incorrectly attributed to other causes, especially early in the U.S. outbreak, “deaths, sadly, are an absolute,” Knittel said.\u003c/p>\n\u003cp>They then used standard statistical tools to tease out which factors are most strongly correlated with mortality rates. Race stood out. Nationwide, the average county-level death rate from COVID-19 is 12 per 100,000 people. Counties with a black population above 85% had a death rate up to 10 times higher. For every 10 percentage point increase in a county’s black population, its COVID-19 death rate roughly doubles, Knittel said.\u003c/p>\n\u003cp>That meshes with other research. A \u003ca href=\"https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00598?\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> last month of 1,052 COVID-19 patients treated at Sutter Health hospitals in California, for instance, found that black patients had 2.7 times the odds of hospitalization as non-Hispanic white patients, indicating more severe disease. And an \u003ca href=\"https://cdn1.sph.harvard.edu/wp-content/uploads/sites/1266/2020/04/HCPDS_Volume-19_No_1_20_covid19_RevealingUnequalBurden_HCPDSWorkingPaper_04212020-1.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> by scientists at the Harvard T.H. Chan School of Public Health found that the death rate in predominantly non-white areas is six times that in non-Hispanic white areas.\u003c/p>\n\u003cp>“Black people are dying of COVID-19 at a rate more than twice our share of the population,” said Malika Fair, an emergency medicine physician in Washington, D.C., and senior director of health equity programs at the Association of American Medical Colleges.\u003c/p>\n\u003cp>The MIT researchers’ key finding is that the underlying reasons for the link between race and death rate are not the usual suspects.\u003c/p>\n\u003cp>“Policymakers’ natural instinct is to think this correlation is because of income disparities, or having health insurance, or diabetes, obesity rates, smoking rates, or even use of public transit,” Knittel said. “It’s not. We controlled for all of those. The reason why [black people] face higher death rates is not because they have higher rates of uninsured, poverty, diabetes, or these other factors.”\u003c/p>\n\u003cp>The Sutter study, too, adjusted for age, sex, comorbidities, and income; the higher hospitalization rate for black patients wasn’t explained by any of those.\u003c/p>\n\u003cp>That leaves other factors. “If I were a policymaker,” Knittel said, “I’d be looking at things like the systemic racism that affects the quality of insurance African Americans have and the quality of the health care they receive.”\u003c/p>\n\u003cp>People with Medicaid or high-deductible plans, for instance, are less likely to have a primary care physician; 34% of black people and 15% of white individuals are \u003ca href=\"https://www.kff.org/medicaid/state-indicator/rate-by-raceethnicity-3/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\" target=\"_blank\" rel=\"noopener noreferrer\">covered by\u003c/a> Medicaid and therefore less likely than people with employer-sponsored insurance to have a regular physician.\u003c/p>\n\u003cp>“People who didn’t have a relationship with a primary care provider were much less likely to get tested,” said Georges Benjamin, a physician and executive director of the American Public Health Association. “Testing sites were put in affluent communities, or required a car, and testing kits were in short supply. Any time there is a shortage of something, minorities are less likely to get it.”\u003c/p>\n\u003cp>Without a primary care provider, black people who thought they were infected were also likely to be turned away from hospitals, Benjamin said. “Someone without a primary care doctor doesn’t get into the ER as fast as someone whose doctor calls ahead,” he said. “At what point were your symptoms severe enough that you got into the health care system?” For people of color, it was likely later, he suggests.\u003c/p>\n\u003cp>“Black patients presenting with fever and cough were less likely to receive a referral for a COVID-19 test,” Fair said. That delayed appropriate care.\u003c/p>\n\u003cp>And once they do get into the system, \u003ca href=\"https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2012.1400\" target=\"_blank\" rel=\"noopener noreferrer\">research\u003c/a> has found, the quality of care black people receive for a variety of conditions, such as \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJM199902253400806\" target=\"_blank\" rel=\"noopener noreferrer\">cardiovascular disease\u003c/a>, is likely to be lower. Racism “is apparent in how we treat patients,” Fair said. “We still see differences in the care [for many conditions] given to blacks and whites.”\u003c/p>\n\u003cp>Another possible factor in the high death rate among black Americans is the well-documented \u003ca href=\"https://www.statnews.com/2020/06/09/systemic-racism-black-health-disparities/\" target=\"_blank\" rel=\"noopener noreferrer\">health effects\u003c/a>, including on the immune system, of chronic stress such as that caused by a lifetime of discrimination.\u003c/p>\n\u003cp>In the MIT study, the correlation between a county’s COVID-19 death rate and its proportion of black residents was stronger within any given state than between states. “That tells me that there are important state-level differences that drive these deaths,” Knittel said. “African Americans are more likely to live in states with poor health care systems.”\u003c/p>\n\u003cp>Commuting via public transportation, relative to telecommuting, is also linked to a higher death rate. When public transit use is 20.6 percentage points higher in one county than another, its death rate is about tenfold higher.\u003c/p>\n\u003cp>Driving to work was also linked to a higher death rate. Many people working at their place of employment rather than home were in public-facing and therefore risky occupations such as health care, grocery stores and public safety. “The correlation between death rate and driving to work suggests that just being at work, no matter how you get there, increases your risk of dying,” Knittel said.\u003c/p>\n\u003cp>Those positions are also filled disproportionately with people of color, likely contributing to the correlation between race and death rates. “Clearly, people who have jobs where they come into contact with others, from health care workers to bus drivers, are more likely to become infected,” the APHA’s Benjamin said. Although much about the pathology of the new coronavirus remains a mystery, the chance of becoming infected is partly a function of how much virus one is exposed to; the more infected people someone encounters, the higher that viral load can be.\u003c/p>\n\u003cp>The new population-level approach to understanding risk has prompted a rethinking of the role of conditions such as obesity and Type 2 diabetes.\u003c/p>\n\u003cp>“Obesity is a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198075/\" target=\"_blank\" rel=\"noopener noreferrer\">marker of poverty\u003c/a> and therefore of access to high-quality health care,” said Nina Schwalbe of the Mailman School of Public Health at Columbia University. Although the physiological consequences of obesity, notably high rates of inflammation, might contribute to COVID-19 severity, “obesity is a signal for so many of the social determinants of health, and we have to ask what this signal is telling us about vulnerabilities,” Schwalbe said.\u003c/p>\n\u003cp>That holds for Type 2 diabetes as well. An \u003ca href=\"https://www.journalofinfection.com/article/S0163-4453(20)30234-6/pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> of 13 separate studies found that the disease is associated with 3.7 times the risk of having severe COVID-19 or dying from it compared to not having any underlying illness. This, too, is a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4021012/\" target=\"_blank\" rel=\"noopener noreferrer\">disease of poverty\u003c/a>, which means those who have it are more likely to live in crowded homes where “social distancing” is impossible, more likely not to have a primary care physician, and more likely to have jobs that increase their exposure to infected people.\u003c/p>\n\u003cp>The Sutter and MIT studies cast doubt on whether individual risk factors are as important as social determinants of health in affecting someone’s chances of contracting severe and even fatal COVID-19. “It should cause us to ask a different set of questions about what puts you at risk of hospitalization or death,” Schwalbe said.\u003c/p>\n\u003cp>More and more evidence is pointing to social determinants of risk, which puts the role of underlying health conditions in a new light. “Comorbidities are still used to blame people for how hard they are hit by COVID-19,” said Philip Alberti, senior director for health equity research at the AAMC. To reduce the U.S. death toll now that many states are seeing a new surge in cases, he said, “our response to this disease” must look beyond the strictly medical.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003cem>This \u003ca href=\"https://www.statnews.com/2020/06/15/whos-dying-of-covid19-look-to-social-factors-like-race/\" target=\"_blank\" rel=\"noopener noreferrer\">story\u003c/a> was originally published by \u003ca href=\"https://www.statnews.com/\">STAT\u003c/a>, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/em>\u003c/p>\n\n",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003cp>\u003cspan class=\"big-cap-wrap\">\u003cspan class=\"big-cap\">W\u003c/span>\u003c/span>hile early studies of who was dying of COVID-19 identified risks such as obesity and having diabetes, there is a growing realization that those initial conclusions might have been misleading, obscuring a more significant explanation.\u003c/p>\n\u003cp>As researchers pull back their lens from individuals to population-level risk factors, they’re finding that, in the U.S., race may be as important as age in gauging a person’s likelihood of dying from the disease.\u003c/p>\n\u003cp>The higher the percentage of black residents in a county, the higher its death rate from COVID-19 — even after accounting for income, health insurance coverage, rates of diabetes and obesity, and public transit use, finds a new \u003ca href=\"http://ceepr.mit.edu/files/papers/2020-009.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> by researchers at the MIT Sloan School of Management. With those plausible explanations ruled out, “the causal mechanism has to be something else,” said applied economist Chris Knittel, the study’s senior author. “If I were a public official, I’d be looking at differences in the quality of insurance, conditions such as chronic stress, and systemic discrimination.”\u003c/p>\n\u003cp>The county-by-county analysis of COVID-19 death rates in the U.S. comes as more and more studies shift from the initial focus on individual-level factors that seem to increase people’s risk of dying to population-level ones, too, said experts in public health, demographics and infectious disease.\u003c/p>\n\u003cp>One reason for the new focus is that “we’re not learning much more beyond what’s been observed from the start of the pandemic: that sex, age, and preexisting conditions put you at greater risk of dying” from COVID-19, said Aaron Glatt, an infectious disease physician at the Icahn School of Medicine at Mount Sinai. In \u003ca href=\"https://globalhealth5050.org/covid19/sex-disaggregated-data-tracker/\" target=\"_blank\" rel=\"noopener noreferrer\">almost every country\u003c/a>, for instance, more men than women are dying of COVID-19, an imbalance that likely reflects both biology — women have stronger immune systems — and socialization: They seem to be following social distancing guidelines more than men, which could decrease the viral load they’re exposed to.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>",
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"content": "\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Also driving the shift in focus is that society-level influences are potentially more “actionable” than individual risk factors; you can’t change your blood type. A \u003ca href=\"https://www.medrxiv.org/content/10.1101/2020.05.31.20114991v1\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> posted to the preprint site medRxiv this month reported that type O is associated with lower risk of respiratory failure from COVID-19 and type A with a higher risk, but the paper hasn’t been peer-reviewed and it’s not clear how much difference blood type might make. “I wouldn’t tell one patient, thank god you have type O, but another, start preparing your will because you’re type A,” Glatt said.\u003c/p>\n\u003cp>To investigate population-level factors, MIT’s Knittel and graduate student Bora Ozaltun analyzed county-by-county mortality rates — the number of deaths from COVID-19 as a percentage of population, from April 4 to May 27. The mortality rate is more precise than the infection rate or the case fatality rate (the percent of diagnosed cases who die), which are imprecise because of inadequate testing. In contrast, although some COVID-19 deaths were incorrectly attributed to other causes, especially early in the U.S. outbreak, “deaths, sadly, are an absolute,” Knittel said.\u003c/p>\n\u003cp>They then used standard statistical tools to tease out which factors are most strongly correlated with mortality rates. Race stood out. Nationwide, the average county-level death rate from COVID-19 is 12 per 100,000 people. Counties with a black population above 85% had a death rate up to 10 times higher. For every 10 percentage point increase in a county’s black population, its COVID-19 death rate roughly doubles, Knittel said.\u003c/p>\n\u003cp>That meshes with other research. A \u003ca href=\"https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00598?\" target=\"_blank\" rel=\"noopener noreferrer\">study\u003c/a> last month of 1,052 COVID-19 patients treated at Sutter Health hospitals in California, for instance, found that black patients had 2.7 times the odds of hospitalization as non-Hispanic white patients, indicating more severe disease. And an \u003ca href=\"https://cdn1.sph.harvard.edu/wp-content/uploads/sites/1266/2020/04/HCPDS_Volume-19_No_1_20_covid19_RevealingUnequalBurden_HCPDSWorkingPaper_04212020-1.pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> by scientists at the Harvard T.H. Chan School of Public Health found that the death rate in predominantly non-white areas is six times that in non-Hispanic white areas.\u003c/p>\n\u003cp>“Black people are dying of COVID-19 at a rate more than twice our share of the population,” said Malika Fair, an emergency medicine physician in Washington, D.C., and senior director of health equity programs at the Association of American Medical Colleges.\u003c/p>\n\u003cp>The MIT researchers’ key finding is that the underlying reasons for the link between race and death rate are not the usual suspects.\u003c/p>\n\u003cp>“Policymakers’ natural instinct is to think this correlation is because of income disparities, or having health insurance, or diabetes, obesity rates, smoking rates, or even use of public transit,” Knittel said. “It’s not. We controlled for all of those. The reason why [black people] face higher death rates is not because they have higher rates of uninsured, poverty, diabetes, or these other factors.”\u003c/p>\n\u003cp>The Sutter study, too, adjusted for age, sex, comorbidities, and income; the higher hospitalization rate for black patients wasn’t explained by any of those.\u003c/p>\n\u003cp>That leaves other factors. “If I were a policymaker,” Knittel said, “I’d be looking at things like the systemic racism that affects the quality of insurance African Americans have and the quality of the health care they receive.”\u003c/p>\n\u003cp>People with Medicaid or high-deductible plans, for instance, are less likely to have a primary care physician; 34% of black people and 15% of white individuals are \u003ca href=\"https://www.kff.org/medicaid/state-indicator/rate-by-raceethnicity-3/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D\" target=\"_blank\" rel=\"noopener noreferrer\">covered by\u003c/a> Medicaid and therefore less likely than people with employer-sponsored insurance to have a regular physician.\u003c/p>\n\u003cp>“People who didn’t have a relationship with a primary care provider were much less likely to get tested,” said Georges Benjamin, a physician and executive director of the American Public Health Association. “Testing sites were put in affluent communities, or required a car, and testing kits were in short supply. Any time there is a shortage of something, minorities are less likely to get it.”\u003c/p>\n\u003cp>Without a primary care provider, black people who thought they were infected were also likely to be turned away from hospitals, Benjamin said. “Someone without a primary care doctor doesn’t get into the ER as fast as someone whose doctor calls ahead,” he said. “At what point were your symptoms severe enough that you got into the health care system?” For people of color, it was likely later, he suggests.\u003c/p>\n\u003cp>“Black patients presenting with fever and cough were less likely to receive a referral for a COVID-19 test,” Fair said. That delayed appropriate care.\u003c/p>\n\u003cp>And once they do get into the system, \u003ca href=\"https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2012.1400\" target=\"_blank\" rel=\"noopener noreferrer\">research\u003c/a> has found, the quality of care black people receive for a variety of conditions, such as \u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJM199902253400806\" target=\"_blank\" rel=\"noopener noreferrer\">cardiovascular disease\u003c/a>, is likely to be lower. Racism “is apparent in how we treat patients,” Fair said. “We still see differences in the care [for many conditions] given to blacks and whites.”\u003c/p>\n\u003cp>Another possible factor in the high death rate among black Americans is the well-documented \u003ca href=\"https://www.statnews.com/2020/06/09/systemic-racism-black-health-disparities/\" target=\"_blank\" rel=\"noopener noreferrer\">health effects\u003c/a>, including on the immune system, of chronic stress such as that caused by a lifetime of discrimination.\u003c/p>\n\u003cp>In the MIT study, the correlation between a county’s COVID-19 death rate and its proportion of black residents was stronger within any given state than between states. “That tells me that there are important state-level differences that drive these deaths,” Knittel said. “African Americans are more likely to live in states with poor health care systems.”\u003c/p>\n\u003cp>Commuting via public transportation, relative to telecommuting, is also linked to a higher death rate. When public transit use is 20.6 percentage points higher in one county than another, its death rate is about tenfold higher.\u003c/p>\n\u003cp>Driving to work was also linked to a higher death rate. Many people working at their place of employment rather than home were in public-facing and therefore risky occupations such as health care, grocery stores and public safety. “The correlation between death rate and driving to work suggests that just being at work, no matter how you get there, increases your risk of dying,” Knittel said.\u003c/p>\n\u003cp>Those positions are also filled disproportionately with people of color, likely contributing to the correlation between race and death rates. “Clearly, people who have jobs where they come into contact with others, from health care workers to bus drivers, are more likely to become infected,” the APHA’s Benjamin said. Although much about the pathology of the new coronavirus remains a mystery, the chance of becoming infected is partly a function of how much virus one is exposed to; the more infected people someone encounters, the higher that viral load can be.\u003c/p>\n\u003cp>The new population-level approach to understanding risk has prompted a rethinking of the role of conditions such as obesity and Type 2 diabetes.\u003c/p>\n\u003cp>“Obesity is a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3198075/\" target=\"_blank\" rel=\"noopener noreferrer\">marker of poverty\u003c/a> and therefore of access to high-quality health care,” said Nina Schwalbe of the Mailman School of Public Health at Columbia University. Although the physiological consequences of obesity, notably high rates of inflammation, might contribute to COVID-19 severity, “obesity is a signal for so many of the social determinants of health, and we have to ask what this signal is telling us about vulnerabilities,” Schwalbe said.\u003c/p>\n\u003cp>That holds for Type 2 diabetes as well. An \u003ca href=\"https://www.journalofinfection.com/article/S0163-4453(20)30234-6/pdf\" target=\"_blank\" rel=\"noopener noreferrer\">analysis\u003c/a> of 13 separate studies found that the disease is associated with 3.7 times the risk of having severe COVID-19 or dying from it compared to not having any underlying illness. This, too, is a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4021012/\" target=\"_blank\" rel=\"noopener noreferrer\">disease of poverty\u003c/a>, which means those who have it are more likely to live in crowded homes where “social distancing” is impossible, more likely not to have a primary care physician, and more likely to have jobs that increase their exposure to infected people.\u003c/p>\n\u003cp>The Sutter and MIT studies cast doubt on whether individual risk factors are as important as social determinants of health in affecting someone’s chances of contracting severe and even fatal COVID-19. “It should cause us to ask a different set of questions about what puts you at risk of hospitalization or death,” Schwalbe said.\u003c/p>\n\u003cp>More and more evidence is pointing to social determinants of risk, which puts the role of underlying health conditions in a new light. “Comorbidities are still used to blame people for how hard they are hit by COVID-19,” said Philip Alberti, senior director for health equity research at the AAMC. 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"content": "\u003cp>The coronavirus pandemic and the recent killing of George Floyd have brought longstanding racial inequities into sharp focus. One of those disparities concerns the high rate of coronavirus transmission among people of color. To talk about the intersection of race and health, KQED’s Brian Watt spoke last week with California Surgeon General Dr. Nadine Burke Harris, who is known for her pioneering work on the role that childhood stress and trauma play on the wellness of minority populations. Here are excerpts from the interview, edited for length and clarity.\u003c/p>\n\u003cp>[pullquote]‘We recognize that COVID-19 is a scary pandemic and it is killing people. But we also have to recognize that racism is killing people. We have to attack both.’[/pullquote]\u003cstrong>Brian Watt\u003c/strong>: You \u003ca href=\"https://medium.com/@caosginfo/george-floyds-death-is-killing-me-36b279f8c2a1\" target=\"_blank\" rel=\"noopener noreferrer\">wrote\u003c/a> in Medium recently that you are often asked what it is about black and brown people that makes us vulnerable to the coronavirus, and that the question infuriates you. But I think people need to hear your answer.\u003c/p>\n\u003cp>\u003cstrong>Dr. Nadine Burke Harris:\u003c/strong> There have been decades of science that demonstrate our experiences and our environments shape our biology. If the experiences are nurturing and enriching, that activates a pathway of wellness and resilience. But if those experiences are threatening or adverse, they increase our risk of early disease and death.\u003c/p>\n\u003cp>As a black woman, I understand that when you are repeatedly exposed to dehumanizing, traumatizing experiences, these things literally get under our skin and change our biology. And they increase our risk for disease. And so when we are asking the question why it is that we see black and brown people dying at a higher rate from COVID-19, we have to keep in mind that in addition to more people of color being in front-line jobs, they have greater underlying health conditions, and this is part of the reason why.\u003c/p>\n\u003cp>\u003cstrong>Watt\u003c/strong>: What can public health officials do to change that?\u003c/p>\n\u003cp>\u003cstrong>Burke Harris:\u003c/strong> Those are some of the big questions we’re asking. One of the pieces is making sure we are raising awareness and reaching out to communities of color so that they are tested early. A recent study from Sutter showed that black folks with COVID-19 were more likely to be tested in the emergency room or in the hospital, meaning after they’ve developed some pretty severe symptoms. And we know that the earlier someone is tested and is identified as having COVID-19, the better their survival rate.\u003c/p>\n\u003cp>So one of the really important things is to make sure that our black and brown communities understand that if you are even remotely concerned that you’ve been exposed, free testing is available and you should get tested as early as possible.\u003c/p>\n\u003cp>[pullquote]‘It is so wrenching, because our kids are so adorable and so beautiful and so cute, and you look at them and realize it doesn’t matter how cute they are — by nature of the racist attitudes that infect our nation, they are at risk.’[/pullquote]\u003cstrong>Watt:\u003c/strong> Public health officials have told us not to gather, but for the last couple of weeks, tens of thousands of people have been marching and protesting. Does this concern you?\u003c/p>\n\u003cp>\u003cstrong>Burke Harris: \u003c/strong>Of course it concerns me from a public health perspective. I’m certainly very, very worried about the health of the protesters. We recognize that COVID-19 is a scary pandemic and it is killing people. But we also have to recognize that racism is killing people. We have to attack both. We can’t just attack the pandemic and not attack the other endemic disease of American society, which is racism.\u003c/p>\n\u003cp>\u003cstrong>Watt:\u003c/strong> For the people who might want to go out into the streets but have been trying to heed the calls to stay away from where lots of people are gathering, what can they do?\u003c/p>\n\u003cp>\u003cstrong>Burke Harris\u003c/strong>: The good news is that protests are not the only way; there is a very important role that all of us can play in dismantling structural racism. Every single one of us, in our own sphere of influence, whether it’s working with our employer or with our school groups, can look at our policies and practices. Racism is embedded in racist policies. I think every single black and brown person has experienced this themselves.\u003c/p>\n\u003cp>An incredibly important thing is to vote. Or better yet, run for office. Get involved, because ultimately lasting change is going to come when we change the systems, the policies, the practices in a much deeper way.\u003c/p>\n\u003cp>\u003cstrong>Watt\u003c/strong>: In your role as surgeon general, can you describe what you’re doing to change the health inequities in California?\u003c/p>\n\u003cp>\u003cstrong>Burke Harris\u003c/strong>: One of the things I’m really pleased about is that California has launched a first-in-the-nation effort to train physicians, to train health care providers on how to recognize and respond to the impact that trauma has on health.\u003c/p>\n\u003cp>The name of the initiative is \u003ca href=\"https://www.acesaware.org/\" target=\"_blank\" rel=\"noopener noreferrer\">ACEs Aware\u003c/a>, and it’s really focused on the science of how adverse childhood experiences can lead to a biological response called the toxic stress response. This toxic stress response can lead to long-term harms in terms of increased risk of heart disease, stroke, cancer, etc.\u003c/p>\n\u003cp>Although the traditional adverse childhood experiences criteria don’t include discrimination — because the CDC research was done in a population that was majority Caucasian — the science demonstrates that discrimination and racism are also risk factors for developing the toxic stress response rate.\u003c/p>\n\u003cp>So as part of this effort of helping doctors recognize how to identify and respond to the toxic stress response, we are also including a recognition of the role of discrimination, so that we in health care can be a very important part of the solution.\u003c/p>\n\u003cp>\u003cstrong>Watt\u003c/strong>: I am the father of two half-Asian, half-black children, and I really struggle with how I want to explain this moment to them. We’ve heard a lot of black parents express the fear they have for their children. As a mother of four black sons, do you have fear for your children?\u003c/p>\n\u003cp>\u003cstrong>Burke Harris\u003c/strong>: Of course I do. My God, I think it is a horrible rite of passage for every black parent to have to have “the talk” with their children, and particularly with my husband and I having four black boys. It is particularly salient, and It’s heartbreaking. Honestly, I have been tearful in this process. It’s been very, very difficult.\u003c/p>\n\u003cp>\u003cstrong>Watt\u003c/strong>: I look at my children and, like, they have too much of this cute invincibility right now for us to think they could be in a difficult altercation with law enforcement. And I get overcome and don’t want to ruin that. And yet I feel like, right now, I have to do something.\u003c/p>\n\u003cp>\u003cstrong>Burke Harris\u003c/strong>: It is so wrenching, because our kids are so adorable and so beautiful and so cute, and you look at them and realize it doesn’t matter how cute they are — by nature of the racist attitudes that infect our nation, they are at risk.\u003c/p>\n\u003cp>And that is what I am anguishing over, because I see how beautiful they are. I see how cute they are, how handsome they are. And I also know that racist attitudes don’t care how cute your kid is.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n",
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"tagline": "Exploring the Bay Area, one question at a time",
"info": "KQED’s new podcast, Bay Curious, gets to the bottom of the mysteries — both profound and peculiar — that give the Bay Area its unique identity. And we’ll do it with your help! You ask the questions. You decide what Bay Curious investigates. And you join us on the journey to find the answers.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Bay-Curious-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Bay Curious",
"officialWebsiteLink": "/news/series/baycurious",
"meta": {
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"source": "kqed",
"order": 3
},
"link": "/podcasts/baycurious",
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"npr": "https://www.npr.org/podcasts/500557090/bay-curious",
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}
},
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"id": "bbc-world-service",
"title": "BBC World Service",
"info": "The day's top stories from BBC News compiled twice daily in the week, once at weekends.",
"airtime": "MON-FRI 9pm-10pm, TUE-FRI 1am-2am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/BBC-World-Service-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.bbc.co.uk/sounds/play/live:bbc_world_service",
"meta": {
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"source": "BBC World Service"
},
"link": "/radio/program/bbc-world-service",
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"apple": "https://itunes.apple.com/us/podcast/global-news-podcast/id135067274?mt=2",
"tuneIn": "https://tunein.com/radio/BBC-World-Service-p455581/",
"rss": "https://podcasts.files.bbci.co.uk/p02nq0gn.rss"
}
},
"californiareport": {
"id": "californiareport",
"title": "The California Report",
"tagline": "California, day by day",
"info": "KQED’s statewide radio news program providing daily coverage of issues, trends and public policy decisions.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-California-Report-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED The California Report",
"officialWebsiteLink": "/californiareport",
"meta": {
"site": "news",
"source": "kqed",
"order": 8
},
"link": "/californiareport",
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"amazon": "https://music.amazon.com/podcasts/26099305-72af-4542-9dde-ac1807fe36d5/kqed-s-the-california-report",
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"rss": "https://ww2.kqed.org/news/tag/tcram/feed/podcast"
}
},
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"id": "californiareportmagazine",
"title": "The California Report Magazine",
"tagline": "Your state, your stories",
"info": "Every week, The California Report Magazine takes you on a road trip for the ears: to visit the places and meet the people who make California unique. The in-depth storytelling podcast from the California Report.",
"airtime": "FRI 4:30pm-5pm, 6:30pm-7pm, 11pm-11:30pm",
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"officialWebsiteLink": "/californiareportmagazine",
"meta": {
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"order": 10
},
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM3NjkwNjk1OTAz",
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"rss": "https://ww2.kqed.org/news/tag/tcrmag/feed/podcast"
}
},
"city-arts": {
"id": "city-arts",
"title": "City Arts & Lectures",
"info": "A one-hour radio program to hear celebrated writers, artists and thinkers address contemporary ideas and values, often discussing the creative process. Please note: tapes or transcripts are not available",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/05/cityartsandlecture-300x300.jpg",
"officialWebsiteLink": "https://www.cityarts.net/",
"airtime": "SUN 1pm-2pm, TUE 10pm, WED 1am",
"meta": {
"site": "news",
"source": "City Arts & Lectures"
},
"link": "https://www.cityarts.net",
"subscribe": {
"tuneIn": "https://tunein.com/radio/City-Arts-and-Lectures-p692/",
"rss": "https://www.cityarts.net/feed/"
}
},
"closealltabs": {
"id": "closealltabs",
"title": "Close All Tabs",
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"info": "Close All Tabs breaks down how digital culture shapes our world through thoughtful insights and irreverent humor.",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/02/CAT_2_Tile-scaled.jpg",
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"officialWebsiteLink": "/podcasts/closealltabs",
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"source": "kqed",
"order": 1
},
"link": "/podcasts/closealltabs",
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"code-switch-life-kit": {
"id": "code-switch-life-kit",
"title": "Code Switch / Life Kit",
"info": "\u003cem>Code Switch\u003c/em>, which listeners will hear in the first part of the hour, has fearless and much-needed conversations about race. Hosted by journalists of color, the show tackles the subject of race head-on, exploring how it impacts every part of society — from politics and pop culture to history, sports and more.\u003cbr />\u003cbr />\u003cem>Life Kit\u003c/em>, which will be in the second part of the hour, guides you through spaces and feelings no one prepares you for — from finances to mental health, from workplace microaggressions to imposter syndrome, from relationships to parenting. The show features experts with real world experience and shares their knowledge. Because everyone needs a little help being human.\u003cbr />\u003cbr />\u003ca href=\"https://www.npr.org/podcasts/510312/codeswitch\">\u003cem>Code Switch\u003c/em> offical site and podcast\u003c/a>\u003cbr />\u003ca href=\"https://www.npr.org/lifekit\">\u003cem>Life Kit\u003c/em> offical site and podcast\u003c/a>\u003cbr />",
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"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Code-Switch-Life-Kit-Podcast-Tile-360x360-1.jpg",
"meta": {
"site": "radio",
"source": "npr"
},
"link": "/radio/program/code-switch-life-kit",
"subscribe": {
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"google": "https://podcasts.google.com/feed/aHR0cHM6Ly93d3cubnByLm9yZy9yc3MvcG9kY2FzdC5waHA_aWQ9NTEwMzEy",
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"rss": "https://feeds.npr.org/510312/podcast.xml"
}
},
"commonwealth-club": {
"id": "commonwealth-club",
"title": "Commonwealth Club of California Podcast",
"info": "The Commonwealth Club of California is the nation's oldest and largest public affairs forum. As a non-partisan forum, The Club brings to the public airwaves diverse viewpoints on important topics. The Club's weekly radio broadcast - the oldest in the U.S., dating back to 1924 - is carried across the nation on public radio stations and is now podcasting. Our website archive features audio of our recent programs, as well as selected speeches from our long and distinguished history. This podcast feed is usually updated twice a week and is always un-edited.",
"airtime": "THU 10pm, FRI 1am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Commonwealth-Club-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.commonwealthclub.org/podcasts",
"meta": {
"site": "news",
"source": "Commonwealth Club of California"
},
"link": "/radio/program/commonwealth-club",
"subscribe": {
"apple": "https://itunes.apple.com/us/podcast/commonwealth-club-of-california-podcast/id976334034?mt=2",
"google": "https://podcasts.google.com/feed/aHR0cDovL3d3dy5jb21tb253ZWFsdGhjbHViLm9yZy9hdWRpby9wb2RjYXN0L3dlZWtseS54bWw",
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}
},
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"id": "forum",
"title": "Forum",
"tagline": "The conversation starts here",
"info": "KQED’s live call-in program discussing local, state, national and international issues, as well as in-depth interviews.",
"airtime": "MON-FRI 9am-11am, 10pm-11pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Forum-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED Forum with Mina Kim and Alexis Madrigal",
"officialWebsiteLink": "/forum",
"meta": {
"site": "news",
"source": "kqed",
"order": 9
},
"link": "/forum",
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"apple": "https://podcasts.apple.com/us/podcast/kqeds-forum/id73329719",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM5NTU3MzgxNjMz",
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}
},
"freakonomics-radio": {
"id": "freakonomics-radio",
"title": "Freakonomics Radio",
"info": "Freakonomics Radio is a one-hour award-winning podcast and public-radio project hosted by Stephen Dubner, with co-author Steve Levitt as a regular guest. It is produced in partnership with WNYC.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/freakonomicsRadio.png",
"officialWebsiteLink": "http://freakonomics.com/",
"airtime": "SUN 1am-2am, SAT 3pm-4pm",
"meta": {
"site": "radio",
"source": "WNYC"
},
"link": "/radio/program/freakonomics-radio",
"subscribe": {
"npr": "https://rpb3r.app.goo.gl/4s8b",
"apple": "https://itunes.apple.com/us/podcast/freakonomics-radio/id354668519",
"tuneIn": "https://tunein.com/podcasts/WNYC-Podcasts/Freakonomics-Radio-p272293/",
"rss": "https://feeds.feedburner.com/freakonomicsradio"
}
},
"fresh-air": {
"id": "fresh-air",
"title": "Fresh Air",
"info": "Hosted by Terry Gross, \u003cem>Fresh Air from WHYY\u003c/em> is the Peabody Award-winning weekday magazine of contemporary arts and issues. One of public radio's most popular programs, Fresh Air features intimate conversations with today's biggest luminaries.",
"airtime": "MON-FRI 7pm-8pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Fresh-Air-Podcast-Tile-360x360-1.jpg",
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"meta": {
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"source": "npr"
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"link": "/radio/program/fresh-air",
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=214089682&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/381444908/podcast.xml"
}
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"here-and-now": {
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"title": "Here & Now",
"info": "A live production of NPR and WBUR Boston, in collaboration with stations across the country, Here & Now reflects the fluid world of news as it's happening in the middle of the day, with timely, in-depth news, interviews and conversation. Hosted by Robin Young, Jeremy Hobson and Tonya Mosley.",
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"rss": "https://feeds.npr.org/510051/podcast.xml"
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},
"hidden-brain": {
"id": "hidden-brain",
"title": "Hidden Brain",
"info": "Shankar Vedantam uses science and storytelling to reveal the unconscious patterns that drive human behavior, shape our choices and direct our relationships.",
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"officialWebsiteLink": "https://www.npr.org/series/423302056/hidden-brain",
"airtime": "SUN 7pm-8pm",
"meta": {
"site": "news",
"source": "NPR"
},
"link": "/radio/program/hidden-brain",
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"tuneIn": "https://tunein.com/podcasts/Science-Podcasts/Hidden-Brain-p787503/",
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},
"how-i-built-this": {
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"title": "How I Built This with Guy Raz",
"info": "Guy Raz dives into the stories behind some of the world's best known companies. How I Built This weaves a narrative journey about innovators, entrepreneurs and idealists—and the movements they built.",
"imageSrc": "https://ww2.kqed.org/news/wp-content/uploads/sites/10/2018/05/howIBuiltThis.png",
"officialWebsiteLink": "https://www.npr.org/podcasts/510313/how-i-built-this",
"airtime": "SUN 7:30pm-8pm",
"meta": {
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"source": "npr"
},
"link": "/radio/program/how-i-built-this",
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"npr": "https://rpb3r.app.goo.gl/3zxy",
"apple": "https://itunes.apple.com/us/podcast/how-i-built-this-with-guy-raz/id1150510297?mt=2",
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},
"hyphenacion": {
"id": "hyphenacion",
"title": "Hyphenación",
"tagline": "Where conversation and cultura meet",
"info": "What kind of no sabo word is Hyphenación? For us, it’s about living within a hyphenation. Like being a third-gen Mexican-American from the Texas border now living that Bay Area Chicano life. Like Xorje! Each week we bring together a couple of hyphenated Latinos to talk all about personal life choices: family, careers, relationships, belonging … everything is on the table. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2025/03/Hyphenacion_FinalAssets_PodcastTile.png",
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"officialWebsiteLink": "/podcasts/hyphenacion",
"meta": {
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"order": 15
},
"link": "/podcasts/hyphenacion",
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"spotify": "https://open.spotify.com/show/2p3Fifq96nw9BPcmFdIq0o?si=39209f7b25774f38",
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},
"jerrybrown": {
"id": "jerrybrown",
"title": "The Political Mind of Jerry Brown",
"tagline": "Lessons from a lifetime in politics",
"info": "The Political Mind of Jerry Brown brings listeners the wisdom of the former Governor, Mayor, and presidential candidate. Scott Shafer interviewed Brown for more than 40 hours, covering the former governor's life and half-century in the political game – and Brown has some lessons he'd like to share. ",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/The-Political-Mind-of-Jerry-Brown-Podcast-Tile-703x703-1.jpg",
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"officialWebsiteLink": "/podcasts/jerrybrown",
"meta": {
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"source": "kqed",
"order": 18
},
"link": "/podcasts/jerrybrown",
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"apple": "https://itunes.apple.com/us/podcast/id1492194549",
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}
},
"latino-usa": {
"id": "latino-usa",
"title": "Latino USA",
"airtime": "MON 1am-2am, SUN 6pm-7pm",
"info": "Latino USA, the radio journal of news and culture, is the only national, English-language radio program produced from a Latino perspective.",
"imageSrc": "https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/latinoUsa.jpg",
"officialWebsiteLink": "http://latinousa.org/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/latino-usa",
"subscribe": {
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"apple": "https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=79681317&at=11l79Y&ct=nprdirectory",
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"rss": "https://feeds.npr.org/510016/podcast.xml"
}
},
"marketplace": {
"id": "marketplace",
"title": "Marketplace",
"info": "Our flagship program, helmed by Kai Ryssdal, examines what the day in money delivered, through stories, conversations, newsworthy numbers and more. Updated Monday through Friday at about 3:30 p.m. PT.",
"airtime": "MON-FRI 4pm-4:30pm, MON-WED 6:30pm-7pm",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Marketplace-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.marketplace.org/",
"meta": {
"site": "news",
"source": "American Public Media"
},
"link": "/radio/program/marketplace",
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"rss": "https://feeds.publicradio.org/public_feeds/marketplace-pm/rss/rss"
}
},
"masters-of-scale": {
"id": "masters-of-scale",
"title": "Masters of Scale",
"info": "Masters of Scale is an original podcast in which LinkedIn co-founder and Greylock Partner Reid Hoffman sets out to describe and prove theories that explain how great entrepreneurs take their companies from zero to a gazillion in ingenious fashion.",
"airtime": "Every other Wednesday June 12 through October 16 at 8pm (repeats Thursdays at 2am)",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Masters-of-Scale-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://mastersofscale.com/",
"meta": {
"site": "radio",
"source": "WaitWhat"
},
"link": "/radio/program/masters-of-scale",
"subscribe": {
"apple": "http://mastersofscale.app.link/",
"rss": "https://rss.art19.com/masters-of-scale"
}
},
"mindshift": {
"id": "mindshift",
"title": "MindShift",
"tagline": "A podcast about the future of learning and how we raise our kids",
"info": "The MindShift podcast explores the innovations in education that are shaping how kids learn. Hosts Ki Sung and Katrina Schwartz introduce listeners to educators, researchers, parents and students who are developing effective ways to improve how kids learn. We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Mindshift-Podcast-Tile-703x703-1.jpg",
"imageAlt": "KQED MindShift: How We Will Learn",
"officialWebsiteLink": "/mindshift/",
"meta": {
"site": "news",
"source": "kqed",
"order": 12
},
"link": "/podcasts/mindshift",
"subscribe": {
"apple": "https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985",
"google": "https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5",
"npr": "https://www.npr.org/podcasts/464615685/mind-shift-podcast",
"stitcher": "https://www.stitcher.com/podcast/kqed/stories-teachers-share",
"spotify": "https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"
}
},
"morning-edition": {
"id": "morning-edition",
"title": "Morning Edition",
"info": "\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.",
"airtime": "MON-FRI 3am-9am",
"imageSrc": "https://cdn.kqed.org/wp-content/uploads/2024/04/Morning-Edition-Podcast-Tile-360x360-1.jpg",
"officialWebsiteLink": "https://www.npr.org/programs/morning-edition/",
"meta": {
"site": "news",
"source": "npr"
},
"link": "/radio/program/morning-edition"
},
"onourwatch": {
"id": "onourwatch",
"title": "On Our Watch",
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