Ampnation Volume 2 Issue 3 2020

AMPNATION

MAGAZINE MAGAZINE

VOLUME 2 ISSUE 3 MARCH 2020

COVID-19 COVID-19...

Was It A Real Pandemic?

The President was fooled, we all were fooled by a hidden agenda... how can we ever trust our Government again?

Economic Effects of the 1918 Influenza Pandemic Implications for a Modern-day Pandemic Report

The Virus That Changed The O&P Industry and Healthcare

Are You Helping or Part of the Problem?

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Contents 28

COVID-19 Long-Term Care Facilities

COVID-19 The Virus That Changed O&P

33

Q&A Understanding Medicare Coverage w/ Sean Harrison

6

Better Outcomes

New York Antibody Test Results Suggest COVID Death Rate Could Be Significantly Lower Than Reported

37

Health & Fitness Vitamin D

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AMPNATION

GREETINGS AMPNATION!

During these last few weeks I must admit it has been to focus on working to put together the magazine because I try to keep it’s focus on the positive and it seems there is nothing but negative news that comes from this virus which has caused so much devastation, or really has it? The Corona Virus is a strain of the Flu and we know it very well as the Flu comes to visit us every year. Why is that this COVID-19 has raised so much concern and “Fear” and controversy over the normal Flu? I am no medical expert but my Mama did not raise a fool and I can understand basic math. And the numbers don’t make sense for all that was done in reaction to a virus that is a bit worse than the Flu. First the numbers, I did a basic search on Google and found; “CDC: 80,000 people died of flu last winter in U.S., highest death toll in 40 years”.

John Hopkins reported 50,500.00 deaths in the US at the time of the article. 4/26/20 @6:47 AM. Let it sink in for a moment... now we have destroyed our economy, laid off over 23 million people and thousands if not a million small businesses have been lost due to our reaction of a virus that killed 30,000 people less than the Flu of 2018 which according to CDC was declared the worst in 40 years. And not one media source reported it and not one political official pass any law or legislation to close a business, social distance or shut down a school. Now do you see why I have been finding it hard to work because to work means I need to spread the truth which many of you will not like but that’s what true journalism is, the facts. And these facts don’t add up. Thousands of amputees were affected by the medical industry (O&P) shutting down. Surgeries were delayed and some medical offices closed. Patients are now scared to go to their doctors which is forcing them to lay off people, which leads to delays in care. It is a vicious cycle that I don’t think patients fully understand yet.

The was a politically motivated move to shut down our country to hurt one man, the President by a corrupt system - the news media, the Democratic Party and “Trump Haters” the Obama holders.

They didn’t care about hurting you or your loved ones. And that’s my two cents.

Editor’s Message Sean Harrison

A Publication For Amputees

Ampnation Magazine publishes unbiased journalism that seeks to “empower and inform” amputees and those affected by limb loss. The magazine’s audience is primarily amputees and their families and is provided free electronically (digital) to anyone who subscribes subscribe@ ampnationmagazine.com and there is a hard copy available for purchase ass well. Each issue covers health, well-being, better outcomes of amputees living and thriving, O&P News, Vascular News, Tech and products & services.

INSIDE THIS ISSUE 8 Correspondence

Headline News and Opinion

10 COVID-19

Was It A Real Pandemic?

27 TECH

FitTrack New Scale Lets You Look Inside Your Body

32 Show Notes

Amp Life Talk Radio Show Notes

Feature Contacts

Better Outcomes - Editor@ampnationmagazine.com Correspondence - Editor@ampnationmagazine.com Vascular & Orthopedic - Editor@ampnationmagazine.com Prosthetic & Orthotic - Editor@ampnationmagazine.com Q&A - Editor@ampnationmagazine.com If would like be involved with Amp Nation Magazine please send inquires to: Contact@ampnationmagazine.com 3

Long-term Care Facilities and As COVID-19 spread from China to the US, hospitals scrabbled to prepare for outbreak. As the numbers started to increase a panic set in. The President, Governs and Mayors put in place measures to protect the public.

But somehow in all the chaos skilled nursing facilities and nursing homes were forgot overlooked.

It became clear in early March that skilled nursing facilities and nursing homes were about to explode as major incubators of coronavirus outbreaks.

COVID-19

nation’s eyes were riveted on cruise ships, stay-home orders, ventilator and N-95 mask $ toilet paper shortages, and video footage of increasingly overwhelmed hospitals. The outbreaks started happening in nursing homes all across the country.

A deadly outbreak at a Washington state nursing home perhaps should have raised concerns, but collectively, local officials kind of Dr. Mehrdad Ayati, a geriatric care abandoned skilled nursing homes specialist who teaches at Stanford and assisted living facilities. and his colleagues were fielding desperate questions from skilled But then tidbits of information nursing facilities asking how they began trickling out of the murky waters of the news media. Which could protect patients and staff has not been helpful at during from getting COVID-19. this situation, as they have been spreaders of “fear” and “propaWhere could they find personal protective equipment like masks, ganda” more than they have gowns and gloves for their staff? been of actual news. In California some Bay Area nursing homes If their mostly elderly patients started showing COVID-19 symp- and assisted living facilities revealed that a few patients and toms, should they keep them inside or transfer them to hospi- some employees had been infected by the coronavirus. tals?1

facilities in an effort to stem the tide of infections and deaths. And we wonder how things got so bad in California, with a response like this from the leader of the state no wonder why the skilled nursing community was forgotten about.

But seriously, how did the problem reach such epic proportions?

Experts say it starts with chronically understaffed facilities whose employees seldom are trained to handle medical emergencies, much less how to put on some of the protective equipment and masks needed to deal with a pandemic. Low pay — some certified nurse assistants make little more than minimum wage — requires many to work multiple jobs across multiple facilities, potentially carrying disease as they go.

Working in this industry and visiting skilled nursing facilities some of these places are ripe for a disaster like; some of the weaknesses are sort of built into the structure of the way nursing facilSuddenly, more facilities began ities are run and made them sort It seemed that no-one was payconfirming cases of patients and of perfect places for this disease ing attention paid attention to health care workers infected with to spread. how this virus would affect the elderly and ill community of the COVID-19, and the numbers skilled nursing homes if this was became staggering, including the From what I know about skilled nursing facilities and medi-care to land. Officials (especially Gov- revelation last week (04/10/20) that nine of at least 66 people and medi-cal, given how little ernment thanks to Democrats) were so consumed and distracted who contracted the virus at Gate- money goes to nursing facility & with impeaching the President on way Care and Rehabilitation Cen- home care, they are short-staffed ter in Hayward had died. with a single nurse having 20 pabogus false charges they comtients to care for during her shift. pletely missed the first signs of In San Jose, outbreaks at The this virus. President Trump did Ridge (formerly Mt. Pleasant California, these problems were however shut down the border Nursing Center) and Canyon compounded by the failure of and travel from outside counties state regulatory agencies to take which prevented a wider spread. Springs Post-Acute Care Center have included dozens of patients charge of the dire situation early, and staff diagnoses. though the skilled nursing faciliAbout those earlier days of the ties and nursing homes are now coronavirus pandemic, when the In response, Gov. Gavin Newsom clearly now on the radar of everypromised to send “SWAT teams of one. In a daily news conference 1 How COVID-19 exploded from the chaos with- infectious disease specialists” into during this time, Newsom said in nursing homes, Early focus on hospitals left the growing number of infected the state is monitoring 191 of the 4 facilities to languish as outbreak spread

1,224 skilled nursing facilities in California where 1,266 patients and workers have tested positive.

funding and programs such as loan forgiveness to attract more employees to long-term care careers.

Although the early focus after shelter-in-place orders went into effect was to keep family members outside the front door of nursing homes to prevent them from possibly infecting patients, the employees are now suspected of having introduced the virus through the back door.

Employees at skilled nursing facilities are working longer hours than ever while administrators call for reinforcements from staffing agencies and local health departments to step in for those stricken by the virus.

The industry also admits it needs help in fighting the pandemic. With the lack of PPE at all skilled nursing homes, some existing regulations that interfere with training more staff and moving residents, and help with support efforts to hire and retain additional staff while they try to deal with COVID-19. It is very sad and unfortunate that this virus is exposing the shortcomings and government’s failures to properly pass laws and legislation that benefit our healthcare workers that serve in this greatly unappreciated community. Governors like Gavin Newsom, New York’s Governor Andrew M. Cuomo and others who have failed to properly prepare their states for such events as this by wasting millions of taxpayers on what?

The skilled nursing and nursing home industry acknowledged its staffing issues in the past. When lawmakers in California last year proposed a bill revising minimum nurse staffing requirements, the American Health Care Association and National Center for Assisted Living called for additional

If your business or industry was affected please contact me at media@ampnationmagazine.com

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Better Outcomes down.”

New York Antibody Test Results Suggest COVID Death Rate Could Be Significantly Lower When antibody testing was recentThan Reported ly conducted in California, it was DailyWire.com

also found that the death rate for COVID-19 appears to be significantly Medicare will accelerate paylower than reported.

According to early antibody test results out of New York City, it is estimated that one in five New Yorkers have had the China-orig- “Highly anticipated antibody testing inated novel coronavirus, thus results out of Santa Clara County significantly dropping the reportin California headed by a Stanford ed fatality rate of the virus.

University professor were released on “More than 21% of the New York Friday, showing that the estimated number of positive novel coronavirus City residents given coronavirus antibody tests earlier this week cases is likely 50-80 times higher than tested positive, Gov. Andrew Cuo- reported, thus significantly dropping mo said Thursday,” a report from the estimated fatality rate,” The Daily MarketWatch outlined WednesWire reported last week. “The study, day. the first large-scale community antibody testing in the nation and led “Monday marked the start of a

by Dr. Eran Bendavid, the associate statewide initiative to test 3,000 New Yorkers for the presence of professor of medicine at Stanford antibodies, which are made in University, found that 2.5 to 4.2% of response to viral infections,” the the 3,330 subjects tested were found to report added. “The preliminary have COVID-19 antibodies.” results mean that one in five of the city residents tested have had coronavirus and developed the antibodies to fight it. Across the state, 13.9% of the individuals tested were positive for antibodies, Cuomo told reporters at a daily news briefing.”

As noted by The New York Times, the eyeopening testing results suggest that as many as 2.7 million New Yorkers have been infected with coronavirus without necessarily knowing so.

Americans back to work. Last week, President Donald Trump released guidance for states to meet as they open their economies back up in phases. ments to providers and suppliers, CMS announces McKnight’s Senior Living

On Saturday, the Centers for Medicare & Medicaid Services announced that it is expanding its accelerated and advance payment program for Medicare providers to ensure that they have the resources to fight COVID-19.

The move was part of the Coronavirus Aid, Relief and Economic Security Act, which President Trump signed into law on Friday.

For skilled nursing providers, COVID-19 has significantly affected operating expenses, with many facilities depleting supplies much more quickly than usual and spending extra on additional “These prevalence estimates represent infection control efforts.

a range between 48,000 and 81,000 people infected in Santa Clara County by early April, 50-85-fold more than the number of confirmed cases,” the study’s abstract said.

“The population prevalence of SARSCoV-2 antibodies in Santa Clara County implies that the infection is much more widespread than indicated by the number of confirmed cases,” according to the researchers.

If the number of the recovered cases are similarly undercounted across the nation, the fatality rate would accordingly be overstated.

“The testing also can tell you the infection rate in the population — where it’s higher, where it’s lower — to inform you on a reopening strategy,” Gov. Cuomo said Wednesday during a press conference. “Then when you start Antibody testing has been noted by reopening, you can watch that leaders on the White House coronainfection rate to see if it’s going virus task force as a tool in getting 6 up, and if it’s going up, slow

The expedited payments typically are offered during natural disasters to accelerate cash flow to affected healthcare providers and suppliers, CMS officials said.

But in the midst of the pandemic, CMS is expanding the program for all Medicare providers throughout the country.

“With our nation’s healthcare providers on the front lines in the fight against COVID-19, dollars and cents shouldn’t be adding to their worries,” CMS Administrator Seema Verma said. “Unfortunately, the major disruptions to the healthcare system caused by COVID-19 are a significant financial burden on providers.”

Verma added that the expansion

will help ensure that Medicare providers have the resources they need to maintain their focus on resident and patient care during the pandemic.

To qualify for advanced or accelerated payments, providers or suppliers must: Have billed Medicare for claims within 180 days immediately before the date of signature on the provider’s / supplier’s request form, • Not be in bankruptcy, • Not be under active medical review or program integrity investigation, and • Not have any outstanding delinquent Medicare over-payments.

The agency will start accepting and processing requests immediately and said payments could go out within seven days.

Senate OKs bill to expand family planning services through Medicaid

By Sahalie Donaldson Deseet news

The Senate gave final approval to a bill that would allow more Utahns to receive family planning

services and birth control under Medicaid.

SB74 soared through the Senate 23-1 on the third reading Tuesday and will head to the House for consideration.

The bill would require the state Division of Health Care Financing to apply for a Medicaid waiver or state plan amendment seeking a 90/10 match of federal government funds. If approved, Utah women who make up to 250% of the federal poverty level — equaling about $30,000 a year — would be given access to family planning services.

The legislation, according to bill sponsor Sen. Derek Kitchen, D-Salt Lake City, would also prevent around 2,000 unintended pregnancies and 730 abortions a year.

The bill was amended during debate Monday after Republican lawmakers expressed concerns that the legislation would override a parent’s right to choose whether or not their child should have access to contraceptives.

Kitchen brought an amended version of the bill before the Senate Tuesday that would exclude minors from the services, however, he clarified that most children that would have been covered under the original bill already have ac-

cess through alternative services such as the Children’s Health Insurance Program.

For this reason and in consultation with those who had expressed concerns, Kitchen said he decided to stick with the floor amendment rather than seeking to introduce another amendment to make it so minors could get access under his bill with parental permission.

“There’s some concern that any amendments beyond what we amended yesterday might stall this policy from moving forward,” Kitchen said. “The consensus among all of us is to move forward with the amendment as proposed.”

Stroke Alert Signs

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Correspondence ters, inpatient rehabilitation hospitals, hotels, and dormitories.

Transferring uninfected patients will help hospital staffs to focus on the most critical COVID-19 At President Trump’s direction, the patients, maintain infection control protocols, and conserve Centers for Medicare & Medicaid personal protective equipment Services (CMS) today is issuing (PPE). an unprecedented array of temporary regulatory waivers and “Every day, heroic nurses, docnew rules to equip the American healthcare system with maximum tors, and other healthcare workflexibility to respond to the 2019 ers are dedicating long hours to their patients. This means sacriNovel Coronavirus (COVID-19) pandemic. CMS sets and enforces ficing time with their families and essential quality and safety stan- risking their very lives to care for coronavirus patients,” said CMS dards for the nation’s healthcare system, and is the nation’s largest Administrator Seema Verma. health insurer serving more than “Front line healthcare providers need to be able to focus on 140 million Americans through Medicare, Medicaid, the Children’s patient care in the most flexible and innovative ways possible.

Health Insurance Program, and This unprecedented temporary Federal Exchanges. relaxation in regulation will help the healthcare system deal with Made possible by President Trump’s recent emergency decla- patient surges by giving it tools and support to create non-tradiration and emergency rule maktional care sites and staff them ing, these temporary changes will apply immediately across the quickly.”

Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge

entire U.S. healthcare system for the duration of the emergency declaration. This allows hospitals and health systems to deliver services at other locations to make room for COVID-19 patients needing acute care in their main facility.

CMS’s announcement will also waive certain requirements to enable and encourage hospitals to hire local physicians and other providers to address potential surges. New rules allow hospitals to support physician practices by transferring critical equipment, including items used The changes complement and for telehealth, as well as providaugment the work of FEMA and ing meals and childcare for their state and local public health authorities by empowering local hos- healthcare workers. pitals and healthcare systems to Other temporary CMS waivers rapidly expand treatment capacand rule changes dramatically ity that allows them to separate lessen administrative burdens, patients infected with COVID-19 from those who are not affected. knowing that front line providers CMS’s waivers and flexibilities will will be operating with high volumes and under extraordinary permit hospitals and healthcare system stresses. systems to expand capacity by triaging patients to a variety of community-based locales, includ- CMS recently approved hundreds of waiver requests from healthing ambulatory surgery cen8 care providers, state govern-

News, Opinion & Information

ments, and state hospital associations in the following states: Ohio; Tennessee; Virginia; Missouri; Michigan; New Hampshire; Oregon; California; Washington; Illinois; Iowa; South Dakota; Texas; New Jersey; and North Carolina. With today’s announcement of blanket waivers, other states and providers do not need to apply for these waivers and can begin using the flexibilities immediately.

Administrator Verma added that she applauds the March 23, 2020, pledge by America’s Health Insurance Plans (AHIP) to match CMS’s waivers for Medicare beneficiaries in areas where in-patient capacity is under strain. “It’s a terrific example of public-private partnership and will expand the impact of Medicare’s changes,” Verma said.

CMS’s temporary actions announced today empower local hospitals and healthcare systems to: Increase Hospital Capacity – CMS Hospitals Without Walls: CMS will allow communities to take advantage of local ambulatory surgery centers that have canceled elective surgeries, per federal recommendations. Surgery centers can contract with local healthcare systems to provide hospital services, or they can enroll and bill as hospitals during the emergency declaration as long as they are not inconsistent with their State’s Emergency Preparedness or Pandemic Plan. The new flexibilities will also leverage these types of sites to decant services typically provided by hospitals such as cancer procedures, trauma surgeries and other essential surgeries.

CMS will now temporarily permit non-hospital buildings and spaces

to be used for patient care and quarantine sites, provided that the location is approved by the State and ensures the safety and comfort of patients and staff. This will expand the capacity of communities to develop a system of care that safely treats patients without COVID-19, and isolate and treat patients with COVID-19.

CMS will also allow hospitals, laboratories, and other entities to perform tests for COVID-19 on people at home and in other community-based settings outside of the hospital. This will both increase access to testing and reduce risks of exposure. The new guidance allows healthcare systems, hospitals, and communities to set up testing sites exclusively for the purpose of identifying COVID-19-positive patients in a safe environment.

ments of hospitals can use telehealth services to quickly assess patients to determine the most appropriate site of care, freeing emergency space for those that need it most. New rules ensure that patients can be screened at alternate treatment and testing sites which are not subject to the Emergency Medical Labor and Treatment Act (EMTALA) as long as the national emergency remains in force.

This will allow hospitals, psychiatric hospitals, and critical access hospitals (CAHs) to screen patients at a location off-site from the hospital’s campus to prevent the spread of COVID-19.

Rapidly Expand the Healthcare Workforce:

Local private practice clinicians and their trained staff may be available for temporary employment since nonessential medical and surgical In addition, CMS will allow hospi- services are postponed during the tal emergency departments to test public health emergency. CMS’s and screen patients for COVID-19 temporary requirements allow at drive-through and off-campus hospitals and healthcare systems test sites. to increase their workforce capacity by removing barriers for physicians, During the public health emernurses, and other clinicians to be gency, ambulances can transport readily hired from the local compatients to a wider range of loca- munity as well as those licensed tions when other transportation is from other states without violating not medically appropriate. These Medicare rules. destinations include community mental health centers, federally These healthcare workers can then qualified health centers (FQHCs), perform the functions they are physician’s offices, urgent care qualified and licensed for, while facilities, ambulatory surgery cen- awaiting completion of federal paters, and any locations furnishing perwork requirements. dialysis services when an ESRD facility is not available.

CMS is issuing waivers so that hospitals can use other practitioners, Physician-owned hospitals can such as physician assistants and temporarily increase the number nurse practitioners, to the fullest of their licensed beds, operating extent possible, in accordance with rooms, and procedure rooms. a state’s emergency preparedness For example, a physician-owned or pandemic plan. These clinicians hospital may temporarily convert can perform services such as order observation beds to inpatient beds tests and medications that may to accommodate patient surge have previously required a physiduring the public health emergen- cian’s order where this is permitted cy. under state law.

In addition, hospitals can bill for services provided outside their four walls. Emergency depart-

CMS is waiving the requirements that a certified registered nurse anesthetist (CRNA) is under the

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supervision of a physician. This will allow CRNAs to function to the fullest extent allowed by the state, and free up physicians from the supervisory requirement and expand the capacity of both CRNAs and physicians.

CMS also is issuing a blanket waiver to allow hospitals to provide benefits and support to their medical staffs, such as multiple daily meals, laundry service for personal clothing, or child care services while the physicians and other staff are at the hospital and engaging in activities that benefit the hospital and its patients.

CMS will also allow healthcare providers (clinicians, hospitals and other institutional providers, and suppliers) to enroll in Medicare temporarily to provide care during the public health emergency.

Put Patients over Paperwork: CMS is temporarily eliminating paperwork requirements and allowing clinicians to spend more time with patients. Medicare will now cover respiratory-related devices and equipment for any medical reason determined by clinicians so that patients can get the care they need; previously Medicare only covered them under certain circumstances.

During the public health emergency, hospitals will not be required to have written policies on processes and visitation of patients who are in COVID-19 isolation.

Hospitals will also have more time to provide patients a copy of their medical record.

ing reporting deadlines and susstaff using virtual technologies pending documentation requests when appropriate, instead of rewhich would take time away from quiring in-person presence. patient care.

For additional background inFurther Promote Telehealth in formation on the waivers and Medicare: rule changes, go to: https:// Building on prior action to expand www.cms.gov/newsroom/factreimbursement for telehealth sheets/additional-backgroundservices to Medicare beneficiaries, sweeping-regulatory-changCMS will now allow for more than es-help-us-healthcare-sys80 additional services to be furtem-address-covid-19-patient nished via telehealth. During the public health emergencies, indiFor more information on the viduals can use interactive apps COVID-19 waivers and guidance, with audio and video capabilities and the Interim Final Rule, please to visit with their clinician for an go to the CMS COVID-19 flexibileven broader range of services. ities webpage: https://www.cms.

Providers also can evaluate ben- gov/about-cms/emergency-preeficiaries who have audio phones paredness-response-operations/ only. current-emergencies/coronavirus-waivers.

These temporary changes will ensure that patients have access These actions, and earlier CMS to physicians and other providers actions in response to COVID-19, while remaining safely at home. are part of the ongoing White House Coronavirus Task Force Providers can bill for telehealth efforts. To keep up with the imvisits at the same rate as in-per- portant work the Task Force is son visits. Telehealth visits include doing in response to COVID-19, emergency department visits, ini- visit www.coronavirus.gov. For a tial nursing facility and discharge complete and updated list of CMS visits, home visits, and therapy actions, and other information services, which must be provided specific to CMS, please visit the by a clinician that is allowed to Current Emergencies Website. provide telehealth. New as well as established patients now may stay at home and have a telehealth First known U.S. coronavirus death visit with their provider. occurred on Feb. 6 in Santa Clara CMS is allowing telehealth to fulfill County many face-to-face visit requirements for clinicians to see their patients in inpatient rehabilitation facilities, hospice and home health.

A person who died at home in Santa Clara County on Feb. 6 was infected with the coronavirus at the time of death, a stunning discovery that makes that individual the first recorded CMS is making it clear that cliniCOVID-19 fatality in the UnitCMS is providing temporary relief cians can provide remote patient ed States, according to autopsy from many audit and reporting monitoring services to patients results released by public health requirements so that providers, with acute and chronic conditions, officials late Tuesday. healthcare facilities, Medicare and can be provided for patients Advantage health plans, Medicare with only one disease. For examThat death — three weeks before Part D prescription drug plans, ple, remote patient monitoring the first fatality was reported in and states can focus on providcan be used to monitor a patient’s the U.S., in Washington state ing needed care to Medicare and oxygen saturation levels using on Feb. 28 — adds to increasing Medicaid beneficiaries affected by pulse oximetry. evidence that the virus was in COVID-19. the country far earlier than once In addition, CMS is allowing phythought.

10 This is being done by extend- sicians to supervise their clinical

News, Opinion & Information

Correspondence

Santa Clara County on Tuesday announced three previously unidentified deaths from the coronavirus: the Feb. 6 case; one on Feb. 17, which also predates the death that was earlier believed to be the first; and one on March 6. Initially, the first death in the county had been reported March 9.

“What it means is we had coronavirus circulating in the community much earlier than we had documented and much earlier than we had thought,” said Dr. Sara Cody, Santa Clara County’s public health officer. “Those deaths probably represent many, many more infections. And so there had to be chains of transmission that go back much earlier.”

Cody did not provide details about the people who died in February but said the deaths “tell us we had community transmission probably significant community transmission - far before we realized it and documented it.”

“From what we understand, neither of the cases had a history of travel,” Cody said. “So we assume that they were acquired locally.”

People typically die of COVID-19 about a month after they are infected with the coronavirus, suggesting that the person who died Feb. 6 likely was infected in early January. At that time, the virus had been reported only in China — the U.S. Centers for Disease Control and Prevention had not yet issued any advisories to Americans about the potential threat.

the coronavirus on Tuesday.

The county also confirmed a resident who died March 6 had died from COVID-19.

fatality rate of about 4.5 percent, she said, the study suggests that 0.1 percent to 0.2 percent of people infected by the virus will die, which would make COVID-19 only somewhat more deadly than the seasonal flu.

All three residents died at home “during a time when very limited testing was available only through Based on a representative samthe CDC,” the county statement ple of 863 adults tested early said. this month, researchers at the University of Southern California “Testing criteria set by the CDC at (USC), working in collaboration the time restricted testing to only with the public health departindividuals with a known travel ment, found that “approximately history and who sought medical 4.1% of the county’s adult popucare for specific symptoms,” the lation has antibody to the virus.” statement said. “As the mediTaking into account the statistical cal examiner-coroner continues margin of error, the results indito carefully investigate deaths cate that “2.8% to 5.6% of the throughout the county, we ancounty’s adult population has anticipate additional deaths from tibody to the virus—which transCOVID-19 will be identified.” lates to approximately 221,000 to 442,000 adults in the county As of Tuesday, Santa Clara Coun- who have had the infection.” That ty had reported 1,946 confirmed is 28 to 55 times higher than the cases of the coronavirus and 88 tally of confirmed cases at the deaths.1 time of the study.

L.A. County Antibody Tests Suggest the Fatality Rate for COVID-19 Is Much Lower Than People Feared The tests indicate that the number of infections in the county is around 40 times as high as the number of confirmed cases.

Preliminary results from antibody tests in Los Angeles County indicate that the true number of COVID-19 infections is much higher than the number of confirmed cases there, which implies Santa Clara County officials said that the fatality rate is much in a statement that the medical lower than the official tallies sugexaminer-coroner had performed gest. “The mortality rate now has autopsies on two people who died dropped a lot,” Barbara Ferrer, at home on Feb. 6 and Feb. 17 director of the Los Angeles County and sent tissue samples to the Department of Public Health, said CDC. The CDC confirmed that at a press briefing today. In conboth samples were positive for trast with the current crude case

As of noon today, Los Angeles County had reported 617 deaths out of 13,816 confirmed cases, which implies a fatality rate of 4.5 percent. Based on that death toll, the new study suggests the true fatality rate among everyone infected by the virus is somewhere between 0.1 percent and 0.3 percent (without taking into account people infected since the study was conducted). The lower end of that range is about the same as the estimated fatality rate for the seasonal flu.

“These results indicate that many persons may have been unknowingly infected and at risk of transmitting the virus to others,” Ferrer said in a press release.

“These findings underscore the importance of expanded polymerase chain reaction (PCR) 11 testing to diagnose those

COVID-19...

Was It A Real Pandemic? my eyes to the fact that we as a people have been lied too.

Even the President of the United States of America has been lead down a rabbit hole of lies and over=stated facts. One would think we are America, we have contingency plans for just about everything, right? Well, there was one produced to give us an idea of what to expect with a Flu outbreak of the 1918 Spanish Flu pandemic. And when you compare the numbers to the short lived COVID-19 pandemic you will see this was nothing more than a paper-cut (I mean disrespect to those who passed because of this).

Here is what I found while doing some research on pandemics, a report by Thomas A. Garrett people thought Corona Beer was who received his doctoral and ur entire world changed in infected) so it was changed to matter of one week. We were told COVID-19 because it was deemed master’s degrees in economics to stay inside of homes, not to go more appropriate. No matter what from West Virginia University in Morgantown, W.Va., in 1998 and to work, not to go to church, to name or title you give it, this was 1997, respectively. He received the doctors, businesses were lost an advance form of the Flu man his bachelor’s in business adand millions of Americans were made or nature made. But how ministration from Shippensburg without jobs ... and healthcare. did a Flu virus manage to shut University of Pennsylvania in Even now people are still afraid to down an entire country the size 1993. Before coming to the St. go outside, people are canceling of the U.S.? Except for those 8 Louis Fed, he was an assistant doctor’s appointments and treat- states that refused to closed. professor in the Department of ments putting themselves at risk Agricultural Economics at Kansas of health complications or even Was COVID-19 worst than the State University. His research death.

Spanish Flu which set the record interests include state and lofor deaths world wide and in the cal public finance and public What could cause people, a naU.S. Had this reached this magnichoice, public finance aspects tion to completely stop? Fearing tude? And even during the Spanof state lotteries and gambling, your neighbor, anyone you see as ish Flu people still went about and economic history. His report if they have the “Black Plague”. their lives and work, the entire was a future warning to us about The Flu... The Flu? Yes, a Flu economy didn’t shut down. So, is an influenza outbreak could be virus. Not many of us have ever COVID-19 more deadly than the thought much about the Flu, there Spanish Flu? It must be! I had to bigger than the 1918 Spanish Flu that was the largest pandemwas more concern about the Flu know because this has left 23 ic in our history. Why was this than the actual Flu. Most peomillion people with jobs and cripreport not used by medical exple didn’t believe in the shot and pled our healthcare system. perts on the President’s team of thought it caused more harm than advisors? As you read this very good, it was a hot topic on social While doing research and readdetailed report you will see the media. Then came along a little ing a lot of information and I current COVID-19 situation is a thing called the Chinese-Virus, mean a lot of information on this mere “paper-cut” compared to but this offended people (even COVID-19 I came across somethe Spanish Flu of 1819 which though it came from China) then thing that shocked me and open leads me to question the medical 12 became Coronavirus (but

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experts advising our President.

The report: Abstract The possibility of a worldwide influenza pandemic in the near future is of growing concern for many countries around the globe.

Many predictions of the economic and social costs of a modern-day influenza pandemic are based on the effects of the influenza pandemic of 1918.

partment of Health and Human Services paints a more dire picture—up to 1.9 million dead in the United States and initial economic costs near $200 billion.3

While researchers and public officials can only speculate on the likelihood of a global influenza pandemic, many of the worstcase scenario predictions for a current pandemic are based on the global influenza pandemic of 1918, which killed 675,000 This report begins by providing people in the United States a brief historical back-ground on (nearly 0.8 percent of the 1910 the 1918 influenza pandemic, a population) and 40 million people short-lived, but tragic event that worldwide from the early spring has all but escaped the public’s of 1918 through the late spring consciousness today. Detailed of 1919.4 In all of recorded influenza mortality statistics for history, only the Black Death that cities and states, including those occurred throughout Europe from in the Eighth Federal Reserve 1348-1351 is estimated to have District, are presented. These killed more people (roughly 60 data provide insight into mortality million) over a similar time peridifferences based on race, income od.5 and place of residence. Next, anecdotal evidence on the economic The years 1918 and 1919 were effects of the 1918 influenza are difficult not only as a result of reported using newspaper articles the influenza pandemic; these published during the pandemic. years also marked the height of There is also a survey of ecoU.S. involvement in World War nomic research on the subject.

I. Given the magnitude and the The information presented in this concurrence of both the influreport and information provided in enza pandemic and World War two prominent publications on the I, one would expect volumes of 1918 influenza pandemic are then research on the economic effects used to formulate a list of the of each event. Although signiflikely economic effects of a mod- icant literature on the economic ern-day influenza pandemic. consequences of World War I does exist, the scope of research on the economic effects Introduction The possibility of a worldwide in- of the 1918 influenza pandemic fluenza pandemic (e.g., the avian is scant at best. Most research flu) in the near future is of grow- has focused on the health and economic outcomes of descening concern for many countries around the globe. The World Bank dants of pandemic survivors and estimates that a global influenza the mortality differences across socioeconomic classes.6 Certainpandemic would cost the world ly an event that caused 40 mileconomy $800 billion and kill lion worldwide deaths in a year tens-of-millions of people.1 Researchers at the U.S. Centers for should be closely examined not only for its historical significance, Disease Control and Prevention calculate that deaths in the United but also for what we can learn in the unfortunate chance the world States could reach 207,000 and experiences another influenza the initial cost to the economy pandemic. could approach $166 billion, or roughly 1.5 percent of the GDP.2 This report discusses some of Long-run costs are expected to the economic effects of the 1918 be much greater. The U.S. De-

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influenza pandemic in the United States. The first sections of the report present and discuss demographic differences in pandemic mortalities. Were deaths higher in cities than in rural areas? Did deaths differ by race? Did deaths differ by income? Detailed influenza mortality data at various geographic and demographic levels at the time of the pandemic are available. The presentation of numerous mortality data series allows for an almost unlimited number of comparisons and analyses that afford the reader the opportunity to study the available data and generate his own analyses and conclusions in addition to those presented here.

influenza pandemic are also likely to be related to race, income and place of residence. Thus, the geographic and demographic differences in pandemic mortalities from 1918 can shed light on the possible effects of a modern-day pandemic, a point that is taken up in the last section of the report.

Overview of the 1918 Influenza Pandemic The influenza pandemic in the United States occurred in three waves during 1918 and 1919.7 The first wave began in March 1918 and lasted throughout the summer of 1918. The more devastating second and third waves (the second being the worst) occurred in the fall of 1918 and the Evidence of the effects of the spring of 1919. According to one pandemic on business and indus- researcher: try is obtained from news-paper “Spanish influenza moved across articles printed during the panthe United States in the same demic, with most of the articles way as the pioneers had, for it appearing in newspapers from followed their trails which had the Eighth Federal Reserve Disbecome railroads...the pandemic trict cities of Little Rock, Ark., started along the axis from Masand Memphis, Tenn. Newspasachusetts to Virginia...leaped the per articles from the fall of 1918 Appalachians...positioned along were used because of the almost the inland waterways...it jumped complete absence of economic clear across the plains and the data from the era, such as data Rockies to Los Angeles, San Franon income, employment, sales cisco, and Seattle. Then, with seand wages. This absence of cure bases on both coasts...took data, especially at local levels its time to seep into every niche (e.g., city and county) is a likely and corner of America.”8 reason for the scarcity of economic research on the subject, But the pandemic’s impact on though several studies that have communities and regions was used available economic data are not uniform across the counreviewed here and nicely comtry. For example, Pennsylvaplement the information obtained nia, Maryland and Colorado had from newspaper articles. the highest mortality rates, but these states had very little in Although the influenza pandemic common. Arguments have been occurred nearly 90 years ago in made that mortality rates were a world that was much different lower in later-hit cities because than today, the limited economic officials in these cities were able data and more readily available to take precautions to minimize mortality data from the time of the impending influenza, such the event can be used to make as closing schools and churchreasonable inferences about es and limiting commerce. The economic and social consequenc- virulence of the influenza, like a es of a modern-day pandemic. typical influenza, weakens over Despite technological advances in time, so the influenza that struck medicine and greater health cov- on the West Coast was somewhat erage throughout the 20th centu- weaker than when it struck the 14 ry, deaths from a modern-day East Coast. But these reasons

cannot completely explain why some cities and regions experienced massive mortality rates while others were barely hit with the influenza. Much research has been conducted over the past decades to provide insights into why the pandemic had such different effects on different regions of the country.9 The global magnitude and spread of the pandemic was exacerbated by World War I, which itself is estimated to have killed roughly 10 million civilians and 9 million troops.10Not only did the mass movement of troops from around the world lead to the spread of the disease, tens of thousands of Allied and Central Power troops died as a result of the influenza pandemic rather than combat.11 Although combat deaths in World War I did increase the mortality rates for participating countries, civilian mortality rates from the influenza pandemic of 1918 were typically much higher. For the United States, estimates of combat-related troop mortalities are about one-tenth that of civilian mortalities from the 1918 influenza pandemic.

Mortality rates from a typical influenza tend to be the greatest for the very young and the very old. What made the 1918 influenza unique was that mortality rates were the high-est for the segment of the population aged 18 to 40, and more so for males than females of this age group. In general, death was not caused by the influenza virus itself, but by the body’s immunological reaction to the virus. Individuals with the strongest immune systems were more likely to die than individuals with weaker immune systems.12 One source reports that out of 272,500 male influenza deaths in 1918, nearly 49 percent were aged 20 to 39, whereas only 18 percent were under age 5 and 13 percent were over age 50.13 The fact that males aged 18 to 40 were the hard-est hit by the influenza had serious economic

consequences for the families that had lost their primary breadwinner. As discussed later in the report, the significant loss of prime working-age employees also had economic consequences for businesses.

overwhelmed city and medical officials (partly exacerbated by personnel absences from the war).

In some cities, like Philadelphia, bodies lay along the streets and in morgues for days, similar to medieval Europe during the Black Death. In light of the potential Despite the severity of the paneconomic turmoil and human sufdemic, it is reasonable to say that fering, an understanding of state the influenza of 1918 has almost and federal government response been forgotten as a tragic event to the 1918 pandemic may also in American history. This is not provide some light into what, if good, as learning from past pan- anything, government at any level demics may be the only way to can do to prevent or minimize a reasonably prepare for any future modern-day pandemic. pandemics. Several factors may explain why the influenza panII. Pandemic Mortalities in demic of 1918 has not received the United States a notable place in U.S. history.

Data on mortalities from the 1918 14First, the pandemic occurred influenza pandemic are found in at the same time as World War Mortality Statistics, an annual I. The influenza struck soldiers publication that is released by the especially hard, given their living U.S. Census.15 Mortalities resultconditions and close contact with ing from hundreds of causes of highly mobile units. Much of the death are listed (depending upon news from the day focused on the level of data aggregation), wartime events overseas and the and are also broken down, in current status of America troops. some cases, by age, race and sex.

Thus, the pandemic and World Data are available at the national, War I were almost seen as one state and municipal levels, and event rather than two separate may be available by week, month events. Second, diseases of the and year. In terms of coverage, day like polio, smallpox and syph- “(a)ll death rates are based on ilis were incurable and a permatotal deaths, including deaths of nent part of society. Influenza, by non-residents, deaths in hospitals contrast, swept into communities, and institutions, and deaths of killed members of the population, soldiers, sailors, and marines.”16 and was gone. Finally, unlike polio and smallpox, no famous The mortality rates used in this people of the era died from the in- study represent deaths from both fluenza; thus there was no public influenza and pneumonia in a givperception that even the political- en year because “it is not believed ly powerful and rich and famous to be best to study separately were not immune from the virus. influenza and the various forms of Although the influenza pandemic pneumonia....for doubtless many of 1918 may be an event that has cases were returned as influenza been relegated to the shadows of when the deaths were caused by American history, the event had pneumonia and vice versa.”17 significant economic effects. The fact that most of these effects Although Mortality Statistics were relatively short-lived does provides a remarkable number of not make them less important to statistics, a major dis-advantage study, especially given the nonze- of the earlier reports is that, in ro probability of a future influenza the 1910s, data coverage is for 75 pandemic. While not a primary to 80 percent of the total popufocus of this report, the influenlation. This is because the U.S. za pandemic of 1918 resulted in Census acquired the mortality great human suffering in select data from a registration area that areas, as increasing body counts consisted of a growing group of

states over time. So, mortality data for certain states are not consistently available over time.

For the purposes here, influenza mortality data for the 1910s are available for about 30 states and encompass, on average, about 79.5 percent of the U.S. population. A casual look at the states that did and did not report mortality information does not reveal any systematic differences across each group of states with regard to population, income and race. So, the available mortality statistics are unlikely to provide a biased picture of influenza mortalities.

The following sections report select influenza mortality data at various levels of data aggregation (city and state), by race (white and nonwhite) and residence (urban versus rural). The abundance of mortality statistics makes it impossible to use all existing data in a single report.

However, the statistics used here do reveal some general mortality patterns that provide insights into which groups of people may be most/least affected by a modern-day pandemic, as well as how influenza mortalities differed across cities and states.

State and City Pandemic Mortalities Pandemic mortality rates (per 100,000) for 27 states are shown in Table 1 for years 1918 and 1919. The mortality rate for 1915 is also included, and the ratio of 1918 mortalities to 1915 mortalities is shown to reveal the relative magnitude of deaths in 1918 to a non-pandemic year.

Pennsylvania, Maryland and New Jersey had the highest mortality rates in 1918, whereas Michigan, Minnesota and Wisconsin had the lowest. The pandemic also lasted throughout the spring of 1919; so, the ranking of states in 1918 does not reflect total mortalities in each state for the entire pandemic (though the rankings 15 do remain similar). For the

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states shown in Table 1 above.

The ratio of the 1918 mortality rate and the 1915 mortality rate ranges from a low of 3.2 (Indiana and New York) to a high of 6.5 (Montana). This means that the 1918 influenza mortality rates in Indiana and New York were 3.2 times greater than influenza mortality rates in a non-pandemic year, whereas 1918 rates in Montana were more than 6 times greater than a non-pandemic year. One caveat is that an equal increase in mortalities for a low-population state and a higher-population state will result in a greater mortality ratio for the lower-population state because the increase in mortalities is a greater percentage of the low state’s pop18 ulation. Nevertheless, a comparison of 1915

mortality rates with those in 1918 and 1919 clearly reveals how much more severe the 1918 influenza was relative to influenza in a non-pandemic year.

Also shown in Table 1 are state population, area and population density. It serves as an interesting exercise to see if there is a relation-ship between mortalities and state population, size and population density. It is also worth exploring whether the relationships are different in a pandemic year versus a non-pandemic year. Table 2 presents correlations (and their statistical significance) between state population, area and population density, and 1915 mortality rates, 1918 mortalities rates and the ratio of the two mortality rates.

cities with the highest 1918 mortality rates (Pittsburgh, Scranton and Philadelphia) are all located in Pennsylvania, and the cities with the lowest rates Grand Rapids, Minneapolis and Toledo are all located in the Midwest.

To get an idea of the influenza’s effect on rural areas versus urban areas, the average 1918 mortality in all cities in a state (for which mortality data were available) was calculated and then divided by the state-level mortality rate.19

This publication is brought to you from donations to The correlations shown in Table 2 reveal that mortality rates in 1915 were greater in more densely populated states (0.632), but lower in larger states (-0.566).

State size had no significant correlation with 1918 mortality rates, but population density was correlated with 1918 mortality rates (0.447). Note, however, that the correlation between mortality rates and density is less for 1918 mortalities than for 1915 mortalities. This finding, in addition to the fewer significant correlations (albeit just one), suggest that state size and population density had less influence on mortality rates in 1918 than in 1915. Thus, as suggested by earlier research, the location of individuals was less of a factor in dying from the 1918 influenza than from a non-pandemic influenza.18 Furthermore, the ratio of mortality rates had no relationship with state size, population or population density, as seen in the last column of Table 2.

Mortality statistics for 49 cities are listed in Table 3. As seen in the state-level statistics, influenza mortalities in U.S. cities during the pandemic were three to five times higher, on average, than during a non-pandemic year (1915). There is slightly more variation in 1918 mortality rates across cities (standard deviation = 182) than across states (standard deviation = 146). The

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talities were less in 1915 than in 1918. Thus, white influenza mortality rates were typically less than nonwhite mortality rates, but this difference decreased in the influenza pandemic of 1918. As a group, whites were struck relatively harder by the influenza pandemic than nonwhites. This is supported by the last two columns of Table 5 that show 1915 influenza mortality rates relative to 1918 mortality rates for each racial group. Clearly, across the 14 cities listed, the relative difference in mortality rates for the two years is larger for whites than it is for nonwhites.

It is reasonable to assume that racial differences in influenza mortality rates are reflecting, to some degree, differences in population density (as seen in Table 2) and geography (as seen in Table 4). To confirm this hypothesis, data on white and nonwhite population, as well as rural and urban place of residence, were gathered for several decennial Census years. These data are shown in Table 6.

These ratios are shown in Table 4. A ratio >1 suggests influenza deaths were, on average, greater in a stateâ&#x20AC;&#x2122;s cities than in the rural areas of the state, and vice versa for a ratio <1. As seen in Table 4, most of the ratios are >1, with some much >1 (Missouri, Kansas, Tennessee), thus revealing that cities in their respective state had higher mortality rates than rural areas of the states. This finding supports the positive correlation between population density and influenza mortalities shown in Table 2.

as the modern-day mortality statistics. Mortality statistics for 1918 are provided on the basis of white and nonwhite.

Table 5 presents a break-down of white and nonwhite mortality rates (per 100,000 for each racial group) for 14 U.S. cities.

For each racial group, influenza mortality rates for 1915 are also included; so, a comparison can be made between a pandemic year and a non-pandemic year.

In 1910, the great majority of the urban population (having a higher population density than rural areas) in the United States was white (over 90 percent). This can explain why whites as a group had a much larger increase in influenza mortalities during the pandemic than did nonwhites.

What does this imply if an influenza pandemic struck today?

The last two columns of Table 6 reveal that the nonwhite population in the United States has become much more urban (27 percent in 1910 and 88 percent in 1990) compared with the white population (49 percent in 1910 and 72 percent in 1990). However, the fact that both Looking at the first six columns racial groups are becoming of Table 5, it is evident that non- more urban does not bode well white mortalities from influenza for either group because popuare higher than white influenza Influenza Mortalities and lation density will certainly be a mortalities in both pandemic and significant determinant of morRace Influenza mortalities by race are non-pandemic years (except for tality. A modern-day pandemic Kansas City in 1918). However, may result in greater nonwhite available for some cities in the United States, though the racial white influenza mortalities as mortality rates because a greater 18 breakdown is not as detailed a percentage of nonwhite morpercentage of the nonwhite popu-

lation in the United States lives in urban areas. Of course, race and place of residence (and population density) are not the only factors that are likely to influence mortality rates. Access to health care is likely to be critical (assuming health professionals themselves are not decimated by the pandemic). So, it stands to reason that mortality rates in urban areas may be somewhat mitigated given the relatively greater access to health care than in rural areas. Ability to pay, which relates to income, may also be important. Urban areas, on average, tend to have greater incomes, but this is an average and ignores those individuals with low incomes in urban areas who cannot afford health care. The ability of free clinics and emergency rooms to remain open during a pandemic will be crucial to the treatment of lower-income individuals. The final section of this report discusses the implications for a modern-day pandemic and will expand on these points.

Pandemic Mortalities in Eighth Federal Reserve District States Data on mortalities from 1915 to 1920 for cities located in Eighth Federal Reserve District States are shown in Table 7. The first column of data contains mortality rates per 100,000 population (from Mortality Statistics 1920). These data are also shown in Figure 1. The number of deaths (found by multiplying the rate in the first column by city population) is shown in the second column. The third column contains â&#x20AC;&#x153;normalâ&#x20AC;? influenza deaths and was calculated by subtracting the number of excess deaths in each year from the total number of deaths shown in column 2 (see notes to Table 7). Normal influenza deaths reflect the number of influenza deaths absent a pandemic. The ratio of

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total deaths to normal deaths presented in column 4 provides a measure of the severity of influenza in each year relative to a normal influenza. Clearly, this ratio is much larger for the years 1918 and 1919.

The data in Table 7 allow for several interesting comparisons. First, in all cities, the ratio of total deaths to normal deaths in pandemic years was at least twice the normal rate. The ratio was more than four times as high in Nashville and Kansas City in 1918 and at least three times as high in 20 Memphis, St. Louis and Indianapolis. Chicago

and Louisville had the lowest ratios in 1918 (2.47 and 2.59, respectively). So, although larger cities like Chicago had more influenza deaths in 1918 (and other years as well), the relative mortality of influenza in a larger city like Chicago was less than in other cities like Nashville and Kansas City.

State-level mortality rates and rural mortality rates for states located in the Eighth Federal Reserve District are shown in Table 8. The rural mortality rates are not necessarily reflective of what one thinks a rural area to be: The rural mortality rates in Table 8 are computed by subtracting the num-

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ber of mortalities in a state’s city (from Table 7) from the number of mortalities at the state level (first column of Table 8).20 Thus, for example, the rural mortality rate in Kentucky is the mortality rate for all of Kentucky except for Louisville. Certainly there are other non-rural areas in Kentucky in addition to Louisville, but mortality data on these areas are not available. Nevertheless, because mortality rates are generally available for the largest cities in a state, the rural mortality rates are likely to provide an approximate picture of the influenza’s impact on less populated areas of a state.

The rural mortality rate relative to the city rate for each state is similar to the data presented in Table 4, but the data in Table 8 allow for multiple-year comparisons and a comparison-son between rural and city rather than city and state. As Table 8 shows, the state rural rate is almost always less than the city rate (except Kentucky in 1920), which also supports the results in Table 2 that reveal a positive correlation between population density and influenza mortalities.

Although the rural mortality rate is less than the city rate in most cases, there are differences in rates across states and over time. For example, the ruralto-city rate in Illinois aver-ages about 94 percent whereas the rate aver-ages around 77 percent in Missouri. There does not appear to be, however, a consistent difference in mortality rates between pandemic years and non-pandemic years when comparing across the states, though it appears that the rural-to-city ratio is substantially higher in non-pandemic years in Kansas City, Louisville and Nashville.

What one can conclude from Table 8 is that rural influenza mortality rates were typically less than city influenza rates in both pandemic and non-pandemic 22 years, and only in the case of

a few cities is there evidence that the rural-to-city mortality ratio was less in a pandemic year compared with non-pandemic years.

III. Economic Effects of the 1918 Influenza Pandemic This section of the report sheds light on some economic effects of the 1918 influenza pandemic.

As mentioned earlier, the greatest disadvantage of studying the economic effects of the 1918 influenza is the lack of economic data. There are some academic studies that have looked at the economic effects of the pandemic using available data, and these studies are reviewed later. Given the general lack of economic data, however, a remaining source for information on (some) economic effects of the 1918 pandemic is print media.

described the influenza’s effects on the local economy were far less numerous. The several articles that appeared in the fall of 1918 that did dis-cuss the economic impact of the influenza are summarized below.

Little Rock, Ark. “How Influenza Affects Business.”

The Arkansas Gazette, Oct. 19, 1918, page 4.

• Merchants in Little Rock say their business has declined 40 percent. Others estimate the decrease at 70 percent.

• The retail grocery business has been reduced by one-third.

• One department store, which has a business of $15,000 daily ($200,265 in 2006 dollars), is not doing more than half that.

• Bed rest is emphasized in the treatment of influenza. As a result, there has been an increase in Newspapers in the Eighth Feder- demand for beds, mattresses and al Reserve District cities of Little springs.

• Little Rock businesses are losRock and Memphis that were ing $10,000 a day on average printed in the fall of 1918 were ($133,500 in 2006 dollars). This is researched for information on the effects of the influenza pan- actual loss, not a decrease in business that may be covered by an demic in these cities. Piecing increase in sales when the quartogether anecdotal information from individual cities can provide antine order is over. Certain items cannot be sold later. a relatively good picture of the general effects of the pandemic. • The only business in Little Rock in which there has been an inThese general effects in 1918 can be used to extrapolate to the crease in activity is the drug store. potential economic effects of a Memphis, Tenn. modern-day pandemic.

“Influenza Crippling Memphis InThe 1918 Influenza Pandem- dustries.” The Commercial Appeal, Oct. 5, 1918, page 7. ic in the News • Physicians report they are kept This section presents headlines too busy combating the disease to and summaries from articles appearing in two newspapers in report the number of their patients and have little time to devote to Eighth Federal Reserve District other matters. cities: The Arkansas Gazette (Little Rock) and The Commercial • Industrial plants are running Appeal (Memphis). Articles listing under a great handicap. Many of the number of sick or dead from them were already short of help because of the draft. the influenza appeared almost • Out of a total of about 400 men daily in these newspapers and used in the transportation departother papers as well (St. Louis and Louisville, for example). Also ment of the Memphis Street Railway, 124 men were incapacitated appearing frequently were artiyesterday. This curtailed service. cles on church, school and theater closings, as well as dubious • The Cumberland Telephone Co. reported more than a hundred remedies and cures for the influenza.21 However, articles that operators absent from their posts.

The telephone company asked that unnecessary calls be eliminated.

“Tennessee Mines May Shut Down.” The Commercial Appeal, Oct. 18, 1918, page 12.

• Fifty percent decrease in production reported by coal mine operators.

• Mines throughout east Tennessee and southern Kentucky are on the verge of closing down owing to the epidemic that is raging through the mining camps.

• Coalfield, Tenn., with a popu-

lation of 500, has “only 2 percent during and immediately after the of well people.

1918 influenza. The hypothesis is based on a simple economic model of the labor market: A decrease in Survey of Economic Rethe supply of manufacturing worksearch ers that resulted from influenza One research paper examines the immediate (short-run) effect mortalities would have had the of influenza mortalities on man- initial effect of reducing manufacturing labor supply, increasing the ufacturing wages in U.S. cities marginal product of labor and capand states for the period 1914 ital per worker, and thus increasto 1919. The testable hypothesis of the paper is that influenza ing real wages. In the short term, mortalities had a direct impact on labor immobility across cities and wage rates in the manufacturing states is likely to have prevented wage equalization across the 23 sector in U.S. cities and states

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states, and a substitution away from relatively more expensive labor to capital is unlikely to have occurred.22The empirical results support the hypothesis: Cities and states having greater influenza mortalities experienced a greater increase in manufacturing wage growth over the period 1914 to 1919.

pandemic had reduced educational attainment, higher rates of physical disability and lower income. Specifically, “men and women show large and discontinuous reductions in educational attainment if they had been in utero during the pandemic. The children of infected mothers were up to 15 percent less likely to graduate from high school. WagAnother study explored state in- es of men were 5-9 percent lower come growth for the decade after because of infection.”25 the influenza pandemic using a similar methodology.23 In their Summary unpublished manuscript, the Most of the evidence indicates authors argue that states that that the economic effects of the experienced larger numbers of 1918 influenza pandemic were influenza deaths per capita would short-term. Many businesses, have experienced higher rates of especially those in the service growth in per capita income after and entertainment industries, the pandemic. Essentially, states suffered double-digit losses in with higher influenza mortality revenue. Other businesses that rates would have had a greater specialized in health care prodincrease in capital per worker, ucts experienced an increase in and thus output per worker and revenues. higher incomes after the pandemic. Using state-level personal Some academic research sugincome estimates for 1919-1921 gests that the 1918 influenza and 1930, the authors do find a pandemic caused a shortage positive and statistically signifiof labor that resulted in higher cant relationship between state- wages (at least temporarily) for wide influenza mortality rates workers, though no reason-able and subsequent state per capita argument can be made that this income growth. benefit outweighed the costs from the tremendous loss of A recent paper explored the life and overall economic aclonger-term effect of the 1918 tivity. Research also suggests influenza.24 The author questions that the 1918 influenza caused whether in utero exposure to the reductions in human capital for influenza had negative economic those individuals in utero during consequences for individuals later the pandemic, therefore having in their lives. The study came implications for economic activabout after the author reviewed ity occurring decades after the evidence that suggested pregpandemic. nant women who were exposed to the influenza in 1918 gave IV. Implications for a Modbirth to children who had great- ern-day Pandemic er medical problems later in life, The potential financial costs and such as schizophrenia, diabetes death tolls from a modern-day and stroke. The author’s hyinfluenza pandemic in the United pothesis is that an individual’s States that were presented at the health endowment is positively beginning of this report suggest related to his human capital and an initial cost of several hundred productivity, and thus wages and billion dollars and the deaths of income. hundreds of thousands to several million people. The information Using 1960-1980 decennial cen- presented in this report and insus data, the author found that formation provided in two promcohorts in utero during the 1918 inent publications on the 1918

influenza pandemic are now used to formulate a list of the likely economic effects of a modern-day influenza pandemic and possible ways to mitigate the severity of any future pandemic: • Given the positive correlation between population density and influenza mortalities, cities are likely to have greater mortality rates than rural areas. Compared with 1918, however, urban and rural areas are more connected today—this may decrease the difference in mortality rates between cities and rural areas. Similarly, a greater percentage of the U.S. population is now considered urban (about 80 percent) com-pared with the U.S. population at the time of the pandemic (51 percent in 1920).

• Nonwhite groups as a whole have a greater chance of death because roughly 90 percent of all nonwhites live in urban areas (com-pared with about 77 percent of whites). This correlates with lower-income individuals being more likely to die—nonwhite (excluding Asians) households have a lower median income ($30,858 in 2005) compared with white households ($50,784 in 2005).26 Similarly, only 10 percent of whites were below the poverty level in 2005 compared with more than 20 percent for various minority groups (except Asians).27 • Urban dwellers are likely to have, on average, better physical access to quality health care, though nearly 19 percent of the city population in the United States has no health coverage compared with only 14 percent of the rural population.28 The question remains as to afford-ability of health care and whether free-service health-care providers, clinics and emergency rooms (the most likely choices for the uninsured) are able to handle victims of the pandemic.

• Health care is irrelevant unless there are systems in place to ensure that an influenza pandemic will not knock out healthcare provision and prevent the 25 rapid disposal of the dead in

the cities (as it did in Philadelphia, which was exacerbated by medical leaves during World War I). If medical staff succumbs to the influenza and facilities are overwhelmed, the duration and severity of the pandemic will be increased. In Philadelphia during the 1918 pandemic, “the city morgue had as many as ten times as many bodies as coffins.”29 • A greater percentage of families with life insurance would mitigate the financial effects from the loss of a family’s primary breadwinner. However, life insurance is a normal good (positively correlated with income); so, low-income families are less likely to be protected with insurance than are higher-income families.30 • Local quarantines would likely hurt businesses in the short run.

Employees would likely be laid off. Families with no contact to the influenza may too experience financial hardships. To prevent spread, quarantines would have to be complete (i.e., no activity allowed outside of the home).

Partial quarantines, such as closing schools and churches but not public transportation or restaurants (as done in Philadelphia, St. Louis and Washington, D.C.) would do little to stop the spread of influenza.

• Some businesses could suffer revenue losses in excess of 50 percent. Others, such as those providing health services and products, may experience an increase in business (unless a full quarantine exists). If the pandemic causes a shortage of employees, there could be a temporary increase in wages for remaining employees in some industries. This is less likely than in 1918, however, given the greater mobility of workers that exists today.

• Can we rely on local, state and federal governments to help in the case of a modern-day pandemic? Government has shown its inability to 26 handle disasters in the past

(e.g., Hurricane Katrina). Local preparedness by health departments and hospitals, volunteer services (e.g., Red Cross) and private businesses, and responsible actions of the population are likely to mitigate the effects of a modern-day influenza pandemic.

gests that the United States is not prepared for an influenza pandemic.32 Although federal, state and local governments in the United States have started to focus on preparedness in recent years, it is fair to say that progress has been slow, especially at local levels of government.33 Different levels of governments have been relatively ineffective in coordinating a response to disasters in the past, whereas private charities and volunteer organizations like the American Red Cross often perform admirably and are often the first responders. Assuming that citizens want government to mitigate an influenza outbreak, there should be concern about government’s readiness and ability to protect citizens from a pandemic. Perhaps public education on flu mitigation, a greater reliance on charitable and volunteer organizations, and a dose of personal responsibility may be the best ways to protect Americans in the event of a future influenza pandemic.

V. Final Thoughts The influenza of 1918 was the most serious epidemic in the history of the United States. Hundreds of thousands of people died and millions were infected with the highly contagious influenza virus. The possibility of a future influenza pandemic has focused research back to the 1918 pandemic as a foundational model for the likely effects of a modern-day influenza outbreak in the United States. Despite the severity of the 1918 influenza, however, there has been relatively little research done on the economic effects of the pandemic. This report has provided a concise, albeit certainly not complete, discussion and analysis of the economic effects of the 1918 influenThis report was scary to read za pandemic based on available because it revealed somethings data and research. about our government and us as The influenza of 1918 was short- a people, Nation. Given the right opportunity the government will lived and “had a permanent over-reach and violate our rights influence not on the collectivito healthcare and protection ties but on the atoms of human against disease by providing facsociety – individuals.”31 Society tual and truth in the information as a whole recovered from the 1918 influenza quickly, but indi- regarding a disaster or pandemic. viduals who were affected by the influenza had their lives changed This report shows the number of death and those affected by the forever. Given our highly mobile Spanish Flu and when you comand connected society, any future influenza pandemic is likely pare the 675,000 killed by this Flu to the 55,500 we have currently to be more severe in its reach, and perhaps in its virulence, than had by this COVID-19, it does not warrant the response from govthe 1918 influenza despite imernment of shutting down an enprovements in health care over tire country. Even the during the the past 90 years. Perhaps lesSpanish Flu there was a court orsons learned from the past can help mitigate the severity of any dered quarantine but businesses were “allowed” remain open and future pandemic. make decisions about business.

Of course, mitigating a pandemic Not have the local state or federal will require cooperation and plan- officials step in. As he pointed out ning by all levels of government in the report states and governments are horrible with handling and the private sector. Unfordisasters, it’s proven fact. And tunately, a 2005 report sug-

as we have learned once again with this COVID-19 nothing has changed.

For instance New York, New York state has more than 190,000 cases and about 9,400 deaths.

The highest in the US. As March began in New York, officials were encouraging people to go about their business. On March 2, New York City Mayor Bill de Blasio tweeted he was “encouraging New Yorkers to go on with your lives” and “get out on the town despite Coronavirus” — offering a movie recommendation for The Traitor.

That did come before New York state confirmed a case of community transmission, but it also came after Cuomo, in a press conference with de Blasio, called community transmission “inevitable.” What a “failure” of leadership. We saw this with Nancy Pelosi in California as well, inviting people to China Town to a parade.

fering from this COVID-19 here is what Nancy Pelosi and her party were holding up the Stimulus Bill for: Among other things, Pelosi would have: • Mandated “diversity” on corporate boards and in banks.

• Required airlines to disclose and reduce emissions.

• Mandated that states allow voting by mail.

• Increased union bargaining power.

• Expanded tax credits for wind and solar power.

• Prohibited universities from disclosing the citizenship status of their students.

• Provided a bailout for some private pensions.

And that’s just the tip of the iceberg.

This report as well as other information revealed to me that the numbers don’t add up or make When you add into the mix a sense for the type of response news media that has turned into a we have seen from our elected political propaganda machine for officials, not that the lost of life a political party facts and correct is not real but I think it reveals information about this COVID-19 more about us as a people, as a are hidden and lies are reported Nation. as the news. The media is using it’s power to spread fear and will Endnotes shut down anyone who spreads an 1. Brahmbhatt, Milan. (Sept. 23, 2005) “Avian Influenza: Economic and Social Impacts.” Speech. World Bank, ounce of truth. The President of Washington, D.C. the United States can’t even hold 2. Meltzer, M.; Cox, N.; and Fukunda, K. (1999). “The Economic Impact of Pandemic Influenza in the United a press conference without it beStates: Priorities for Intervention.” Emerging Infectious Diseases, 5(5): 659-671. coming a twisted lie about what he 3. U.S. Department of Health and Human Services.

(2005). “HHS Pandemic Influenza Plan.” Washington, D.C. said. Even his advisors are in on 4. Potter, C. (2001). “A History of Influenza.” Journal of Applied Microbiology, 91: 572-579. The influenza pandembring this Nation to it knees.

Why is this so important? Why am I writing about this in Ampnation Magazine? Because look at the devastation this has caused to the healthcare industry. It also reveals some scary facts that our healthcare system is not supported at the state level as well as the federal level. A simple Bill that would provide funding and support to our medical professionals during this time was held up by a political party (taken hostage) until they could add money for their buddies.

Millions of our tax dollar going to all the wrong places. As your suf-

ic of 1918 was termed the “Spanish Flu” by the Allies of World War I because Spain had one of the worst early outbreaks of the disease, with nearly 8 million people infected by early 1918.

5. Bloom, David and Mahal, Ajay. (1997). “AIDS, Flu, and the Black Death: Impacts on Economic Growth and Well-Being.” In Bloom, David and Godwin, Peter, eds. The Economics of HIV and AIDS: The Case of South and Southeast Asia. Delhi: Oxford University Press, 22-52.

6. Keyfits, Nathan and Flieger, Wilhelm. (1968). World Population: An Analysis of Vital Data. Chicago: University of Chicago Press; Almond, Doug-las. (2006). “Is the 1918 Influenza Pandemic Over? Long-Term Effects of In Utero Influenza Exposures in the Post-1940 U.S. Population.” Journal of Political Economy, 114, 672-712; Noymer, Andrew and Garenne, Michel. (2000). “The 1918 Influenza Epidemic’s Effects on Sex Differentials in Mortality in the United States.” Population and Development Review,26(3), 565-581; Mamelund, Svenn-Erik. (2006).

“A Socially Neutral Disease? Individual Social Class, Household Wealth and Mortality from Spanish Influenza in Two Socially Contrasting Parishes in Kristiania 1918-19.”

Social Science and Medicine, 62, 923-940.

7. For much more information on the influ-enza pandemic, including its origins, see Barry, John M. (2004). The Great Influenza: The Epic Story of the Deadliest Plague in History. Penguin Group, New York; Crosby, Alfred W. (2003). America’s Forgotten Pandemic: The Influenza of 1918. Cambridge University Press, Cambridge UK. 8.

Crosby, Alfred W. (2003). America’s Forgotten Pandem-

ic: The Influenza of 1918. Cambridge University Press, Cambridge, pages 63-64.

9. Barry, John M. (2004). The Great Influenza: The Epic Story of the Deadliest Plague in History. Penguin Group, New York and Crosby, Alfred W. (2003). America’s Forgotten Pandemic: The Influenza of 1918. Cambridge University Press, Cambridge.

10. Source: http://en.wikipedia.org/wiki/World_War_I_casualties for a list of sources on World War I casualties.

11. Ayres, Leonard. (1919). The War With Ger-many: A Statistical Summary. Government Printing Office, Washington D.C. 12. Barry, John M. (2004). The Great Influenza: The Epic Story of the Deadliest Plague in History. Penguin Group, New York.

13. The 272,500 deaths are from a sample of about 30 states. See Crosby, Alfred W. (2003). America’s Forgotten Pandemic: The Influenza of 1918. Cambridge University Press, Cambridge, page 209.

14. Crosby, Alfred W. (2003). America’s Forgotten Pandemic: The Influenza of 1918. Cambridge University Press, Cambridge, pages 319-322.

15. Copies of the historical reports are avail-able at the Centers for Disease Control, National Center for Health Statistics, or at www.cdc.gov/nchs/products/pubs/pubd/vsus/historical/historical.htm.

16. U.S Bureau of the Census, Mortality Statistics 1920, page 9.

17. U.S Bureau of the Census, Mortality Statistics 1919, page 28.

18. See Crosby, Alfred W. (2003). America’s Forgotten Pandemic: The Influenza of 1918. Cambridge University Press, Cambridge.

19. Mortality rates for 64 cities (49 of which appear in Table 3) were used in the calculations. The 15 cities were not included in Table 3 because of missing data. The mortality rates for these 15 cities can be obtained from the author.

20. See the note in Table 8 for more information on how the rural mortality rate was calculated.

21. Copies of all articles are available from the author, including articles from the St. Louis Post-Dispatch and the Louis-ville Courier-Journal.

22. The long-run effect of influenza and war mortalities on manufacturing wage growth is less clear. One popular growth model suggests that capital per worker will eventually fall (due to diminishing returns to capital) and therefore decrease wages. However, another growth model predicts capital per worker will continue to rise over time as a result of non-diminishing returns to capital, thereby increasing wages. Over time, there may have also been an opportunity for some degree of wage equalization across the states. It is also possible that the war and the pandemic decreased consumer confidence, investment and savings, and long-term income growth of house-holds due to the death of households’ primary breadwinners. These factors would result in lower aggregate output and production, thereby decreasing the demand for labor and placing downward pressure on manufacturing wages.

23. Brainerd, Elizabeth and Siegler, Mark. (2003). “The Economic Effect of the 1918 Influenza Epidemic.” Discussion Paper 3791, Centre for Economic Policy Research.

24. Almond, Douglas. (2006) “Is the 1918 Influenza Pandemic Over? Long-term Effect of In Utero Influenza Exposure in the Post-1940 U.S. Population.” Journal of Political Economy, 114(4): 672-712.

25. Almond, Douglas. (2006) “Is the 1918 Influenza Pandemic Over? Long-term Effect of In Utero Influenza Exposure in the Post-1940 U.S. Population.” Journal of Political Economy, 114(4): 673.

26. U.S. Census Bureau. Income, Poverty, and Health Insurance Coverage in the United States: 2005, Table 1 (www.census.gov/prod/2006pubs/p60-231.pdf).

27. U.S. Census Bureau. Income, Poverty, and Health Insurance Coverage in the United States: 2005, Table 4 (www.census.gov/prod/2006pubs/p60-231.pdf).

28. U.S. Census Bureau. Income, Poverty, and Health Insurance Coverage in the United States: 2005, Table 8 (www.census.gov/prod/2006pubs/p60-231.pdf).

29. Crosby, Alfred W. (2003). America’s Forgotten Pandemic: The Influenza of 1918. Cambridge University Press, Cambridge, page 82.

30. Cummins, J. David and Mahul, Olivier. (June 2004).

“The Demand for Insurance with an Upper Limit on Cover-age.” Journal of Risk and Insurance, 71(2): 253-264.

31. Crosby, Alfred W. (2003). America’s Forgotten Pandemic: The Influenza of 1918. Cambridge University Press, Cambridge, page 323.

32. Infectious Diseases Society of America. “IDSA’s Principles for Actions Needed 25to Prepare the U.S. to Effectively Respond to Inter-pandemic/Pandemic Influenza.” March 2005. www.idsociety. org.

33. See www.pandemicflu.gov, a site managed by the U.S. Department of Health and Human Services. The lack of influenza vaccines, low production capacity, inadequate supply networks, slow government response and poor public education are cited as problems

27

Correspondence

Nearly 3 in 5 Medicare beneficiaries oppose Medicare for All, eHealth CEO says with infection so they can be isolated and quarantined, while also maintaining the broad social distancing interventions.”

groups so the sample would reflect the county’s adult population.

As for the accuracy of the antibody tests, Sood said validation Since the number of infections by the manufacturer of the test in Los Angeles County is much kits, Premier Biotech, found a higher than the official numbers false positive rate of 0.5 percent indicate, Ferrer said at the press in 371 samples. In subsequent briefing, the risk of infection is tests by a Stanford laboratory, correspondingly higher, which there were no false positives. reinforces the case for social “We think that the false positive distancing measures. At the same rate of the tests is really low,” time, she said, the fact that 95 Sood said. percent or so of the county’s adult population remains uninWhile Ferrer portrayed the study fected shows those measures, inas proof of the need for aggrescluding the statewide lock-down, sive control measures, a fatality are working. She also acknowlrate as low as the Los Angeles edged that the revised estimate County and Santa Clara County of the fatality rate, which is dratests suggest also changes the matically lower than many people calculus of those policies’ costs feared, is good news for residents and benefits. If COVID-19 really who are infected despite those is only a bit more lethal than the precautions. seasonal flu, the benefits that can be expected from continued “The fatality rate is lower than we lock-downs, in terms of deaths thought it would be,” said Neerprevented, are much lower than aj Sood, the USC public policy most projections assumed. If professor who oversaw the study. these results are confirmed, they But he also emphasized that “we should play an important role in are very early in the epidemic,” discussions about when and how meaning the number of infections to reopen the economy.2 and the death toll are bound to rise.

Meanwhile, states continue to explore when and how to restart Sood addressed two of the their economies. The National methodological concerns that Governors Association released were raised by a recent study of a 10-point plan to guide state Santa Clara County residents, officials, while suggesting a lack which likewise estimated that the of tests, medical supplies, and COVID-19 fatality rate is not far properly trained staff were chokefrom the rate for the flu. Critics of points in wide-scale reopening. that study suggested it may have been undermined by biased samAs more information comes out pling and false-positive antibody about this virus I think we will test results. see that there was a big overreaction to a virus that was nothing The sample for the Los Angeles more than a flu virus, which both County study, Sood said, was kill thousands every year comrandomly drawn from a database mon sense is the cure. maintained by the LRW Group, a market research firm. The reStory source: https://reason.com/2020/04/20/ searchers capped subjects repre- 2 senting specific demographic l-a-county-antibody-tests-suggest-the-fatality-rate-for28

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COVID-19

The Virus That Changed

The O&P Industry and Healthcare

More than 861,305 people have been infected with the virus from China, with significant outbreaks in the US (New York), Italy and Spain, and 1,789 deaths in the UK

becoming the first country to surpass China’s total confirmed cases. As of April 1 the country has 189,633 confirmed infections and 4,081 deaths. In Italy, China office heard the first rewhere the death toll surpassed ports of a previously-unknown that of China on March 19, the virus behind a number of pneugovernment took the unprecmonia cases in Wuhan, a city in edented step of extending a Eastern China with a population lock-down to the entire counof over 11 million.

The Chinese government retry, shutting cinemas, theaters, sponded to the initial outbreak gyms, discos and pubs and What started as an epidemic by placing Wuhan and nearby banning funerals and weddings. mainly limited to China has now cities under a de-facto quaranIn the UK, the government has become a truly global pandemtine encompassing roughly 50 shut schools, pubs, restaurants, ic. There have now been over million people in Hubei province. bars cafés and all non-essential 861,305 confirmed cases and This quarantine is now slowly be- shops.

42,365 deaths, according the ing lifted, as authorities watch to John Hopkins University Covid-19 see whether cases will rise again. As of March 23, 2020, at least dashboard, which collates inforThe US is now the new epicen11 states (Delaware, Kentucky, mation from national and intertre of the Covid-19 outbreak, Louisiana, Ohio, California, New 30 national health authorities.

On December 31, 2019, the World Health Organization’s (WHO)

The disease has been detected in more than 200 countries and territories, with Italy, the US and Spain experiencing the most widespread outbreaks outside of China. In the UK, there have been 25,150 confirmed cases and 1,789 deaths as of March 31.

Jersey, New York, Illinois, Connecticut, Oregon, and Pennsylvania) and multiple local municipalities have issued orders that restrict or close “non-essential” businesses until further notice.

AOPA has reviewed each of these orders and found very consistent language that clearly considers the continued operation of healthcare facilities as “essential” services that are exempt.

This exemption applies to both patients who may continue to receive care from healthcare facilities and employees who may continue to work at these facilities.

fight is over, leading to unnecessary suffering and death,” Adhanom said.

On March 23, prime minister Boris Johnson put the UK under lock-down saying that police will now have the power to fine people who gather in groups of more than two or who are outside for non-essential reasons. People with the main coronavirus symptoms – a fever or dry cough – are required to stay at home for seven days while households in which at least one person is displaying symptoms should quarantine themselves for 14 days.

Four days later the prime minister and health secretary Matt Hancock both tested positive for the virus – they are currently self-isolating while working on the UK’s response.

While the cause of the current outbreak was initially unknown, The hunt for the animal source on January 7 of Covid-19 is still unknown, Chinese health authorities idenalthough there are some strong tified that it was caused by to a contenders. A team of virologists strain of coronavirus that hadn’t at the Wuhan Institute for Virol- been encountered in humans ogy released a detailed paper before. Five days later the Chishowing that the new coronanese government shared the viruses’ genetic makeup is 96 genetic sequence of the virus so per cent identical to that of a that other countries could develcoronavirus found in bats, while op their own diagnostic kits. That a study published on March 26 virus is now called Sars-CoV-2. argues that genetic sequences of coronavirus in pangolins Although symptoms of coronaviare between 88.5 and 92.4 per ruses are often mild – the most cent similar to the human virus. common symptoms are a fever Some early cases of Covid-19, and dry cough – in some cases however, appear to have inflicted they lead to more serious repeople with no link to the Wuhan spiratory tract illness including market at all, suggesting that pneumonia and bronchitis. These the initial route of human infeccan be particularly dangerous tion may pre-date the market in older patients, or people who cases. have existing health conditions, and this appears to be the case The Wuhan market was shut with Covid-19. A study of 44,415 down for inspection and cleaning early Chinese Covid-19 patients on January 1, but by then it ap- found that 81 per cent of people pears that Covid-19 was already with confirmed infections expestarting to spread beyond the rienced only mild symptoms. Of market itself. On January 21, the remaining cases, 14 per cent the WHO Western Pacific office were in a severe condition while said the disease was also being five per cent of people were transmitted between humans critical cases, suffering from – evidence of which is apparrespiratory failure, septic shock ent after medical staff became or multiple organ failure. In the infected with the virus. Since Chinese study, 2.3 per cent of all then, evidence of widespread confirmed cases died, although human-to-human transmission the actual death rate is probably outside of China has been well much lower as many more peoestablished, making chances of ple will have been infected 31

On March 11 the WHO officially declared that the Covid-19 outbreak is a pandemic. “WHO has been assessing this outbreak around the clock and we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction,” said its director-general Tedros Adhanom Ghebreyesus. Although the WHO designated Covid-19 a “public health emergency of international concern” (PHEIC) on January 30, it had been reluctant to call it a pandemic. “Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the

How did Covid-19 start?

There has been a lot of speculation around this question but all the evidence leads to the disease originated from a Wuhan seafood market where wild animals, including marmots, birds, rabbits, bats and snakes, are traded illegally. Coronaviruses are known to jump from animals to humans, so it’s thought that the first people infected with the disease – a group primarily made up of stallholders from the seafood market – contracted it from contact with animals.

containing the virus much harder.

What exactly is Covid-19?

Coronaviruses are a large group of viruses that are known to infect both humans and animals, and in humans cause respiratory illness that range from common colds to much more serious infections. The most well-known case of a coronavirus epidemic was Severe Acute Respiratory Syndrome (Sars), which, after first being detected in southern China in 2002, went on to affect 26 countries and resulted in more than 8,000 cases and 774 deaths.

with the virus than tested positive.

What Are The Symptoms of COVID-19?

The most common Covid-19 symptoms are a fever and a dry cough. Of 55,924 early Chinese cases of the disease, nearly 90 per cent of patients experienced a fever and just over two-thirds suffered with a dry cough. That’s why the UK government is advising anyone with a high temperature or a new, continuous cough to stay at home for seven days or, if they live with other people, for the entire household to isolate for 14 days from the first onset of symptoms.

Other Covid-19 symptoms are less common. Just under 40 per cent of people with the disease experience fatigue, while a third of people cough up sputum – a thick mucus from within the lungs. Other rarer symptoms include shortness of breath, muscle pain, sore throats, headaches or chills, loss of smell or taste.

According to the WHO, symptoms tend to appear between five and six days after infection.

WIRED.co.uk Health

How Coronavirus is Affecting O&P and Healthcare Healthcare providers across the country are working to keep their teams and communities safe and healthy and also contending with the full range of effects—to the economy, to employees, their patients, supply chains, to their operations and more—of the COVID-19 outbreak. reveals the state of the industry as the situation unfolds.

pandemic. Made possible by President Trump’s recent emergency declaration and emergency rule making, these temporary changes will apply immediately across the entire U.S. healthcare system for the duration of the emergency declaration. The goals of these actions are to 1) to ensure that local hospitals and health systems have the capacity to handle a potential surge of COVID-19 patients through temporary expansion sites (also known as CMS Hospital Without Walls); 2) remove barriers for physicians, nurses, and other clinicians to be readily hired from the community or from other states so the healthcare system can rapidly expands its workforce; 3) increase access to telehealth in Medicare to ensure patients have access to physicians and other clinicians while keeping patients safe at home; 4) expand in-place testing to allow for more testing at home or in community based settings; and 5) put Patients Over Paperwork to give temporary relief from many paperwork, reporting and audit requirements so providers, health care facilities, Medicare Advantage and Part D plans, and States can focus on providing needed care to Medicare and Medicaid beneficiaries affected by COVID-19.

A study back in June of 2018 revealed 33.8% of suppliers have closed their businesses since 2010. The new April 2018 data reveals there are currently roughly 6,470 “traditional” supplier companies with 9,622 locations across the country. This was due to the implementation of competitive bidding. One out of three DME suppliers closed since 2010 due to this impact on the DME industry. How will and has COVID-19 affected the DME industry?

development have come to a standstill as hospitals, and skilled nursing and assisted living facilities have stopped allowing outside visitors, O&P clinics have had to get creative.

Employees, sales reps, peer visitors, marketing directors and patient liaisons at P&Os, have had to adopt new measures in reaching out to its patients, doctors, hospitals and skilled nursing facilities whom are homebound or under lockdown orders.

Communications are now via emails, social media and personal phone calls. Also the use of video calls are now being used to handle appointments and assessments. As the majority of companies continue tot follow CDC and WHO recommendations.

The other day I was on the phone with Larry Borowsky from Amplitude Magazine.

Discussing the effects of COVID-19 on the O&P industry and amputees. Not many were able to foresee the devastating effects this would have especially amputees. We talked about how this is affected the amputee community and what can be done immediately that would help and have some type of impact. As most demographics show the amputees community lacks proper personal transportation. Which affects their ability to keep appointments and necessary shopping, etc.

With Social Distancing orders in place by the CDC this can make getting around hard on amputees. I know some O&P The O&P Industry, CMS and companies like Hanger ClinCOVID-19 ic have made adjustments in The Trump Administration is isorder to continue care to pasuing an unprecedented array of tients. They posted informatemporary regulatory waivers and COVID-19 has created an unprec- tion on the website. Most local new rules to equip the American edented environment for O&P “mom & Pop” shops have been healthcare system with maximum clinics and distributors. shut down altogether while the flexibility to respond to the 2019 others struggle to provide care Novel Coronavirus (COVID-19) 32 Now that marketing and business to patients. Studying social

EMPLOYEE RIGHTS

PAID SICK LEAVE AND EXPANDED FAMILY AND MEDICAL LEAVE UNDER THE FAMILIES FIRST CORONAVIRUS RESPONSE ACT

The Families First Coronavirus Response Act (FFCRA or Act) requires certain employers to provide their employees with paid sick leave and expanded family and medical leave for specified reasons related to COVID-19.

These provisions will apply from April 1, 2020 through December 31, 2020. ►

PAID LEAVE ENTITLEMENTS

Generally, employers covered under the Act must provide employees: Up to two weeks (80 hours, or a part-time employee’s two-week equivalent) of paid sick leave based on the higher of their regular rate of pay, or the applicable state or Federal minimum wage, paid at: • 100% for qualifying reasons #1-3 below, up to $511 daily and $5,110 total; • 2/3 for qualifying reasons #4 and 6 below, up to $200 daily and $2,000 total; and • Up to 10 weeks more of paid sick leave and expanded family and medical leave paid at 2/3 for qualifying reason #5 below for up to $200 daily and $12,000 total.

A part-time employee is eligible for leave for the number of hours that the employee is normally scheduled to work over that period. ►

ELIGIBLE EMPLOYEES

In general, employees of private sector employers with fewer than 500 employees, and certain public sector employers, are eligible for up to two weeks of fully or partially paid sick leave for COVID-19 related reasons (see below).

Employees who have been employed for at least 30 days prior to their leave request may be eligible for up to an additional 10 weeks of partially paid expanded family and medical leave for reason #5 below. ►

QUALIFYING REASONS FOR LEAVE RELATED TO COVID-19

An employee is entitled to take leave related to COVID-19 if the employee is unable to work, including unable to telework, because the employee: 1. is subject to a Federal, State, or local quarantine or isolation order related to COVID-19; 2. has been advised by a health care provider to self-quarantine related to COVID-19; 3. is experiencing COVID-19 symptoms and is seeking a medical diagnosis;

5. is caring for his or her child whose school or place of care is closed (or child care provider is unavailable) due to COVID-19 related reasons; or 6. is experiencing any other substantially-similar condition specified by the U.S. Department of Health and Human Services.

4. is caring for an individual subject to an order described in (1) or self-quarantine as described in (2); ►

ENFORCEMENT

The U.S. Department of Labor’s Wage and Hour Division (WHD) has the authority to investigate and enforce compliance with the FFCRA. Employers may not discharge, discipline, or otherwise discriminate against any employee who lawfully takes paid sick leave or expanded family and medical leave under the FFCRA, files a complaint, or institutes a proceeding under or related to this Act. Employers in violation of the provisions of the FFCRA will be subject to penalties and enforcement by WHD. WAGE AND HOUR DIVISION UNITED STATES DEPARTMENT OF LABOR

For additional information or to file a complaint:

1-866-487-9243 TTY: 1-877-889-5627 dol.gov/agencies/whd WH1422 REV 03/20

32

COVID-19 The Virus That Changed O&P

media post in amputee support pages reveals the devastating effects of COVID-19 on the amputee community.

economy and costing millions of jobs to Americans, this was a bit of overreach in my opinion.

stay in place long after the virus is gone.

Contingency Plans Now that marketing and busiBad Practices ness development have come Not everyone in O&P, howevto a standstill as hospitals, and er, appears to be reacting as skilled nursing and assisted strongly to the COVID-19 situaliving facilities have stopped tion. allowing outside visitors, O&P clinics have had to get creative.

There are some in the industry With shelter in place being the who are not taking this serious new norm many O&P compaThe members of the O&P commu- nies are now having employees and placing patients and themnity find themselves in harms way work from home or go on work selves in harms way. An example of this was found in the O&P when requested to visit skilled furloughs. Social media platnursing and long term care faEdge. forms are being considered as cilities during these times. Givnew forms of communication Tyler Harrison is in the O&P mas- en their congregate nature and instead of time wasters. Comparesident population served (e.g., ter’s program at the Baylor Colnies and individuals who never older adults often with underlylege of Medicine in Houston. She thought much about having a ing chronic medical conditions), attended the Academy’s annual social media presence are findnursing home populations are at meeting in Chicago last month. ing themselves playing catch up the highest risk of being affectShe said the college provided to others who have invested in ed by COVID-19. If infected with helpful information regarding social media.

SARS-CoV-2, the virus that causprecautions to take while traveling, which alleviated her concerns. es COVID-19, residents are at Got Apps? Google Duo and increased risk of serious illness.

Zoom are the new office meetShe believes the media has addings places, many doctors and Facilities must take immediate ed to the frenzy. “The media has practitioners are having patient action to protect residents, famover-hyped this and made many visits, examinations and more ilies, and healthcare personnel people paranoid, similar to othusing apps like these. I am big (HCP) from severe infections, er outbreaks in previous years,” on tech and especially software Harrison said. “I am a firm believ- hospitalizations, and death. Some that allows you to work as team O&P companies have completely er that practicing good hygiene in real time from anywhere. and keeping your immune system shut down leaving patients withApplications like these will behealthy, [such as] eating right and out O&P care. I have seen several come valuable assets after the getting enough sleep and exercis- amputees on social media voicing COVID-19 dust settles. concerns about where can they ing, will give your body the best now get care. chance to fight off any illnesses.”

Someday, we will look back and recall the coronavirus lock-down This type of mindset is why this Unfortunately, Visitors and HCP as a formative experience. For continue to be sources of introvirus is doing so well. People some it will be a heartbreaking who are completely oblivious to duction of COVID-19 into nursing affair, where businesses, jobs what is going on around them is homes. To protect the vulnerloved ones were struck down by a big part of the problem and to able nursing home population, Covid-19 and their bodies laid to aggressive efforts toward visitor have individuals like this in the rest without dignified formalities. restrictions and implementing O&P industry is scary for paMost of us will hopefully avoid temperature checks policies for ill the virus and tragedy. Some tients and co-workers.

HCP, and actively checking every may even find fortune, spending person entering a facility for fever time with family, creating art This virus needs to be treatand symptoms of illness continue or even kicking bad habits. But ed just like any other and now more than ever washing hands, to be recommended. depending on the ultimate cost PPE and common sense when of the disease, both in human O&P clinics must also make in a medical environment is and economic terms, a host of changes to how they are seeing more important than ever. I behaviors are likely to changed. patients and these changes may don’t agree with shutting the 33 Preparing for COVID-19: Longterm Care Facilities, Nursing Homes COVID-19 cases have been reported in all 50 states, the District of Columbia, and multiple U.S. territories; many having widespread community transmission.

Understanding Medicare Coverage Q. Do I have to enroll in Medicare if I continue to have health coverage after age 65 from my own or my spouse’s employer?

A: No — if the employer has 20 or more employees. Probably — if the employer has fewer than 20 workers.

Q. I’m about to retire. My employer has offered me 18 months of COBRA coverage. Can I delay signing up for Medicare until the COBRA runs out?

A: No, you can’t delay Medicare enrollment until COBRA expires — not without facing a gap in coverage and late penalties.

Q&A

Q. I receive health insurance from my domestic partner’s employer.

Can I delay Part B enrollment after I become eligible for Medicare, without risking late penalties?

A: No, if you’re not formally married you can’t delay Part B enrollment without penalty, except in some limited circumstances.

Q. I will continue to work after turning 65. My employer’s health insurance is a high-deductible health plan paired with a health savings account. How would this fit in with Medicare?

A: Under IRS rules, you cannot contribute to a health savings account (HSA) at work in any month that you are enrolled in any part of Medicare. But there are steps you can take to keep your HSA without being penalized.

Q: I will be retiring soon from my job in the federal government. I will continue to receive good health coverage from the Federal Employees Health Benefits Program (FEHB). So do I need Medicare Part B? A: The FEHB program does not require you to sign up for Medicare Part B, but you may want to consider some factors before making the decision.

Q: I will continue on active duty with the military after I turn 65. I have health insurance under the TRICARE program. Do I need to sign up for Medicare Part B? A: No, you need not sign up for Part B while you’re still on active duty in one of the U.S. military services.

Sean R. Harrison

Editor & Host of Amp Life Talk Radio

Q: If I have TRICARE, do I need to have Part D? A: Generally, if you have TRICARE, you don’t need to enroll in Medicare Part D. Q. I get my prescriptions filled through the VA. Do I need Medicare Part D prescription drug coverage as well?

A: You are not required to take Part D coverage. But having drug coverage from both the VA and Part D gives you more choice and convenience.

former employer? Can I keep it or will Medicare make me drop it and enroll in a Part D drug plan?

A: You always have the option to keep other drug coverage you may have instead of taking Part D. But to avoid late penalties you need to find out whether the employer coverage is “creditable.”

Q. I will soon retire and I’ll be eligible for three types of Q: I am a federal employee and will health insurance: TRICARE For Q. I’m retired and receive compre- continue to work for the governLife due to my service in the ment after I turn 65, with health hensive health insurance from a military; retiree benefits from former employer. Do I need to sign care coverage from the Federal my current employer; and Employees Health Benefits Program up for Medicare Part B when I turn Medicare. How will these work (FEHB). Do I have to do anything 65? together? about Medicare?

A: Part B enrollment is not comA: In this specific situation, A: No, not yet. Like other people pulsory. You don’t need to sign Medicare pays first, the retiree up if you don’t want to. But if you who work for large employers after plan second, and TFL third. change your mind at a later date, age 65, you can delay signing up for Medicare until you retire. If Medicare will always cost you far Q. If I receive health care from you’re married and your FEHB plan more than if you sign up at 65. the Indian Health Service, do I covers your spouse, he or she can need to enroll in Medicare? also delay Medicare enrollment until A: Yes, you are required to Q: What if I have prescription your employment ends. drug coverage from a current or sign up for Medicare Parts 34

LIMB LOSS AWARENESS EVENT

Run, Walk & Kick SATURDAY, APRIL 18, 2020 | 8:00 A.M. – 4:00 P.M. Encompass Health | 1303 Mable Avenue | Modesto CA, 95355 April is limb loss awareness month, and Encompass Healthcare and Hanger Clinic have partnered up to bring you Run, Walk & Kick, an event aimed at raising awareness for the limb loss and limb difference community, their families, and caregivers. The day will be filled with expert knowledge and education for those affected by limb loss as they build their independence through increased mobility. This event is open to anyone in the limb loss and limb difference community, family members, therapists, caregivers, and volunteers.

EDUCATION + ACTIVITIES + PEER SUPPORT •

Gait training and assessments

•

Prosthetic evaluations, assessments and physical therapy tips

• • •

Walking clinic and walking course Two mile fun run & walk Nutritional advice for diabetics

• •

Virtual Reality: MiGO peer support Amputee classes: Putting on & cleaning liners, socks, prosthetic sleeves, etc.

FOR QUESTIONS OR TO VOLUNTEER, CONTACT: Sean Harrison, Hanger Clinic | (209) 672-7347 Lisa Clawson, Encompass Health | (209) 404-9876

CONNECT WITH US (877) 442-6437 35

|

HANGERCLINIC.COM

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Q

&

A

A and B, though not necessarily for Part D. Q. I have been receiving health care through Medicaid. Will I lose this coverage when I become eligible for Medicare?

A: Eligibility for Medicaid depends entirely on your income, according to the rules of your state. If you still qualify for Medicaid when you become eligible for Medicare, you’ll have both at the same time.

Q: What is the difference between Medicare and Medicaid?

A: Medicare is a federal health insurance program for people age 65 and over and younger people who qualify due to disability. Medicaid, a state-run program, provides health coverage for people with low incomes.

Q: Can I get help to pay for my prescription drugs if my income is low?

A: Yes. You can apply to the Extra Help program, which provides Medicare Part D prescription drug coverage at low or reduced cost for people with incomes under a certain level.

Q: What are the basic rights and responsibilities of people with Medicare?

A: No matter what type of Medicare coverage you have, you have certain rights and responsibilities.

You have a right to: • • • • • 37

Be treated fairly and not experience discrimination Have access to doctors and hospitals Get emergency and urgently needed care when you need it Know what Medicare will and will not cover Appeal certain decisions about your coverage or payment

Understanding Medicare Coverage With Sean R. Harrison •

File complaints about your care • Have your personal information kept private

ple, if you’re unconscious in the emergency room — you are not responsible for paying the bill.

Q: Will my Medicare Part D preQ. Is my doctor required to file scription drug plan notify me if my Medicare claims or do I file its list of covered drugs (formulary) changes? them with Medicare directly?

A: In most situations, doctors and A: Your drug plan is required other providers that accept Medi- to notify you of changes in its care are required by law to subcoverage and costs in specific mit claims to Medicare. Medicare circumstances. providers (for example, hospitals, skilled nursing facilities, home Q. My doctor told me he doesn’t health agencies and physicians accept assignment. Can you exwho accept assignment) are replain what this means? quired by law to submit directly to A: A doctor who doesn’t accept Medicare any claims for covered assignment can charge you up services that they have provided to 15 percent more for a medto Medicare patients. ical service than a doctor who accepts assignment. If you’re However, there are situations in enrolled in the original Medicare which you may be asked to pay program, it’s important to ask a physician who does not accept any doctor you see whether he or assignment and then submit your she accepts “assignment” — beown claim for reimbursement to fore you receive care — because Medicare, using form CMS-1490S. this can have an impact on what you pay.

Q: What does it mean when doctors “opt out” of Medicare?

A doctor who accepts assignA: If you go to a doctor who has ment has agreed to accept the opted out of Medicare, you are Medicare-approved amount as responsible for the full bill. The full payment for any covered servast majority of doctors choose to vice provided to a Medicare paparticipate in Medicare, but some tient. The doctor sends the whole do opt out. Opted-out doctors bill to Medicare. Medicare pays cannot bill Medicare for treating the 80 percent of the cost that it you, and you cannot claim rechas decided is appropriate for the ompense from Medicare either, so service, and you are responsible you end up paying the full cost of for the remaining 20 percent. whatever the doctor charges.

A doctor who doesn’t accept assignment can charge up to 15 If you go to a doctor who’s opted percent above the Medicare-apout, he or she should ask you to proved amount for a service. You sign a form, which is essentially are responsible for the additional a private contract between the charge, on top of your regular two of you, in which you agree to 20 percent share of the cost. pay the entire bill out of your own The doctor is supposed to subpocket. mit your claim to Medicare, but you may have to pay the doctor However, if an opted-out docat the time of service and then tor does not get you to sign this claim reimbursement from Mediagreement or if you’re in no care. position to sign one — for exam-

HEALTH & FITNESS

Nutrition, Exercise & Healthy Living Tips for Amputees

Vitamin D

What you need to know The ongoing coronavirus pandemic has some looking for ways to keep their immune systems in tip-top shape, and there’s evidence that the supplement vitamin D can help with exactly that. But should you take it? And what about its effect on COVID-19?

“It’s important to keep in mind that there are no clinical studies that show the effectiveness of vitamin D or any other supplements or vitamins to treat coronavirus,” Dr. John Whyte, the chief medical officer of the health care website WebMD. A study was performed to find out if vitamin C helped reduce or prevent to common cold.

There didn’t seem to be much risk reduction (40 percent reduction in the vitamin D group and 42 percent in the placebo group). So it certainly would be a stretch to say that vitamin D can prevent or treat COVID-19 based on the current data available.

That aside, medical professionals already know that vitamin D helps to strengthen bones, and that the supplement also regulates cellular function throughout the body.

With respect to the immune system, vitamin D is known to participate in the activation of certain types of white blood cells which fight infections.

Because vitamin D plays such an essential role in immune health, low levels can weaken our defenses and increase susceptibility to illnesses, like colds

and flu.

There is so much bad information out there about what to take or what to do to protect yourself from this virus that people are ingesting harmful things into their bodies. Keep it simple.

About 40 percent of Americans are vitamin D deficient and with the seemingly endless stay-athome orders in some states, and with that people are staying inside more than normal (vitamin D levels can be influenced by sun exposure.) Given that many of us are inside, and under stay at home orders, it could be worthwhile to consider taking vitamin D supplements.

The nutrient can be found in fish, such as salmon, as well as dairy products, such as milk. He recommended 600 to 800 international units of vitamin D each day, a level common in many multivitamins. But be warned against “megadoses,” as too much is not a good thing and can cause problems.

Vitamin D helps regulate the immune system Vitamin D supplementation helps boost your immune system by stimulating naturally occurring antimicrobial peptides, which protect the body by destroying invading microbes.8 These antimicrobial peptides live in immune cells throughout the body, including cells lining the upper and lower respiratory tract. There, they are able to directly fight off viruses and bacteria that cause common immune and respiratory infections like colds and flu.

Why is vitamin D important?

Although vitamin D is called a “vitamin” (i.e., a required nutrient obtained from the diet), it is not truly a vitamin. It acts more like a hormone since the body can synthesize it from cholesterol after the skin is exposed to UVB rays from the sun. Vitamin D is estimated to be involved in the regulation of up to 2000 genes—that’s a lot of input into the critical processes happening in every cell throughout the

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Q&

A

With Sean R. Harrison

Understanding Medicare Coverage If you have Medigap insurance, all policies cover Part B’s 20 percent copays in full or in part. Two policies (F and G) cover excess charges from doctors who don’t accept assignment.

state department of insurance.

— Read Full Answer

Note that these rules apply only to the original Medicare program. If you’re enrolled in a Medicare Advantage plan, such as an HMO or PPO, you pay the specific copays for doctors’ services that your plan requires.

Q: Is there anyone I can go to for personal help in choosing a Medicare plan or to resolve other issues with Medicare — even if I have to pay for assistance?

A: You don’t have to pay to get personal help with Medicare issues. Your state health insurance assistance program (SHIP) provides this service free of charge.

Q. Can I be denied Medicare coverage, or asked to pay more, because of my current health problems or preexisting medical conditions?

A: No. Medicare does not discriminate between people in poor or good health.

Q: Whom do I contact to report 90 to 98% certified organic ingrediMedicare fraud? ents, with intention to heal. We make A: The office of Medicare’s herbal infusions in an olive oil base inspector general investigates to ensure excellent skin absorption Medicare fraud and welcomes tip-offs from Medicare beneficia- and delivery of potent healing beneries. fits. A Product I personally use.

Current and past health problems don’t bar anybody from Medicare coverage or cause anybody to pay higher premiums or copays than somebody who is in perfect health.

Medicare is often confusing because its rules affect different people in different circumstances. Hopefully this Q&A offers some practical and comprehensive information to help you navigate the program according to your own situation.

However, if you have advanced kidney failure (known as end-stage renal disease or ESRD) you cannot enroll in a Medicare Advantage plan. Nonetheless, you can still get the appropriate treatment — regular dialysis or a kidney transplant — through the original Medicare program. Also, if you develop ESRD while enrolled in a Medicare Advantage plan, you can remain in it.

Q. How do I find an insurance company that is approved to sell Medicare supplemental plans (Medigap) in my area?

A: You can find a complete list online on Medicare’s website. Or you can call Medicare’s help line or your

Made by hand in small batches with

Vitamin D

What you need to know

entire body! Consequently, this vital nutrient has been linked to almost every health condition under the sun, from bone and muscle health, to brain health, You can find more information pregnancy, immune activity, carand more details on this subject diovascular functions and more. at AARP Medicare Question and In contrast, vitamin D deficiency Answer Tool can lead to significant health consequences, and it’s estimatFor a PDF with Medicare infored that 42% of American adults mation please visit: https:// are deficient. Below are some www.medicare.gov/sites/deof the many aspects of health fault/files/2018-07/11386_which vitamin D has been shown medicare-questions-answered. to impact. pdf Vitamin D benefits and the consequences of deficiency When many people think about vitamin D, they likely think about their bones. Vitamin D 40

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Amp Life Talk Radio Listen on Spreaker.com

is known for helping to balance minerals like calcium, phosphorus, sodium, and magnesium for healthy bone formation and mineralization. Although vitamin D plays a significant role in skeletal health, its benefits go well beyond bone health to all parts of the body. Because of the abundant presence of these minerals, along with vitamin D receptors in the body, vitamin D’s benefits are vast, directly and indirectly influencing countless physiological functions. For example, vitamin D can act as an antioxidant, regulate immune activity, support cardiovascular health, modulate blood sugar balance, regulate neurotransmitter synthesis and more.

Vitamin D from food, supplementation, or sun exposure, is originally in an inactive form. It must shuttle first through the liver, to become 25(OH) vitamin D, and then to the kidney, to become biologically active 1,25(OH)2 vitamin D. Once biologically active, vitamin D travels to organs throughout the body. Because vitamin D receptors are found in most organs in the body (e.g. intestines, pancreas, kidney, lungs, thyroid, etc.), vitamin D affects their health and functions. Below are some of the organ systems that benefit from vitamin D, and the negative consequences of vitamin D deficiency in select health conditions.

Vitamin D and musculoskeletal health Vitamin D supports the normal structure and function of bones and muscles. Historically, the consequences of chronic vitamin D deficiency have been on full display in cases of rickets, a skeletal disorder that results in weakening and distortion of bone growth in children without food sources of vitamin D and low sun exposure. Vitamin D deficiency also affects adults, as evidenced by an increased risk in certain types of fractures and forms of muscles weakness.

HEALTH Vitamin D and brain and nervous system Vitamin D substantially affects the brain and nervous systems. Studies have shown that supplemental vitamin D may enhance mood during the winter season when vitamin D synthesis from the sun is extremely low. In addition, research suggests that low vitamin D levels may be associated with increased sleepiness and sleep difficulties.

&

FITNESS

information check out “Don’t Forget Vitamin D this Cold and Flu Season”.

Vitamin D and cardiovascular health

In addition to the respiratory system, research shows that vitamin D plays a role in the health Vitamin D and pregnancy of the cardiovascular sysGrowing evidence also suptem as well, helping to ports the benefits of vitamin reduce the risk of variD during pregnancy. Recent ous complications of the studies have found that during heart and blood vessels. pregnancy, vitamin D may For example, researchers reduce the risk of many pregreported that daily vitanancy complications. min D supplementation using a wide range of Vitamin D and immunity doses (i.e. 600 IU, 2,000 and respiration IU, 4,000 IU) decreased Since vitamin D plays a role in stiffness of specific blood regulating the immune system, vessels after only eight it may also have a positive weeks, compared to plainfluence on immune-related cebo. Even more comconditions such as acute and pelling, the influence of chronic respiratory complicavitamin D was observed tions and may help to diminin a dose-response relaish their symptoms when they tionship, meaning that as occur. For example, adequate more vitamin D was takamounts of vitamin D during en, more improvement in childhood and adulthood have blood vessel structure was been shown to decrease the observed.1 risk of the exacerbation of chronic respiratory issues and their symptoms. Studies have also shown that pregnant women taking 4,400 IU of 1 Everything You Need to Know About vitamin D per day may reduce Vitamin D the risk of respiratory issues in their newborn to threeyear-old children, compared to pregnant women who took just 400 IU per day. Self-reported incidences of seasonal respiratory complications have shown to be significantly lower in women taking 800 IU per day 42 compared to placebo. For more

Transcripts from Amp Life Talk Radio - The Podcast INTRO - Welcome to Amp Life Talk Radio - The Podcast Living with limb loss can be challenging. You have questions, concerns, and can feel alone in the process. I’m Sean Harrison, a certified peer visitor for the Amputee Coalition and the host of this show, I be will your guide as you go through this process.

Having someone along with you as you become acquainted to living with limb loss is why I am here.

Empowering Amputees to Reach Their Full Potential through Communication, Education, & Inspiration.

Amp Life Talk Radio is a talk show for amputees and those affected by limb-loss. If you’re an amputee I want you to know you’re not alone.

HOOK It is normal to have strong emotional or physical reactions following a distressing event. On most occasions though, these reactions subside as part of the body’s natural healing and recovery process. Family members who experience a shared distressing event often become closer and appreciate each other more.

A traumatic experience is any event in life that causes a threat to our safety and potentially places our own life or the lives of others at risk. As a result, a person experiences high levels of emotional, psychological, and physical distress that temporarily disrupts their ability to function normally in day-today life.

Examples of potentially traumatic experiences include natural disasters such as a brushfire or flood, experiencing violence in the community, having a serious car accident, or being assaulted.

SEGMENT ONE Reactions to trauma In a family, each member will react to the traumatic event in their own way.

If family members don’t understand each other’s experience, then misunderstandings, communication breakdowns and other problems can result.

Even if you cannot understand exactly what another member is going through, being aware of common reactions and their effect on family life can help everyone cope better in the long run.

Examples of common reactions 43 to trauma are:

ShowNotes • • • • • • •

feeling as if you are in a state of ‘high alert’ and are ‘on watch’ for anything else that might happen feeling emotionally numb, as if in a state of ‘shock’ becoming emotional and upset feeling extremely fatigued and tired feeling very stressed and/or anxious being very protective of others including family and friends not wanting to leave a particular place for fear of ‘what might happen’.

Also, it is important to remember that despite the above traumatic reactions, many families look back and see that crises have actually helped them to become closer and stronger. However, don’t hesitate to seek professional help if you are uncertain or think your family is struggling to recover.

SEGMENT TWO Family life following the event Every family is different but, generally speaking, common changes to family life soon after the event include: • Parents may fear for each other’s safety and the safety of their children away from home.

• Family members may experience nightmares or upsetting dreams about the event.

• Fear of another distressing expe-

• •

•

• • •

•

rience happening may affect family life.

• Anger at whoever is believed to have caused the event can often flow on to the affected loved one or the family in general.

• Family members may feel overwhelmed by insecurity or lack of control, or at the thought of having so much to do.

• Family members may not know how to talk to each other. Each person is struggling to understand what has happened and how they feel about it. If talking makes people upset, they will often avoid it.

• Impatience, misunderstandings, arguments over small things and withdrawal from each other can all impact on family life and relationships.

Disruption to family relationships Family relationships can also be affected by a traumatic event – for example, parents may feel unsure about how to help their children after the crisis.

Communication breaks down as each family member struggles in their own way to come to terms with what has happened.

Children don’t want to go to school.

Parents don’t want to go to work.

Household schedules tend to lapse – for example, chores are missed, regular mealtimes are disrupted or recreation is neglected.

The usual arrangements for household responsibilities change.

Children may cook meals for a time, parents may feel unable to do tasks, or children may not want to be alone.

Family life – weeks or months later Family relationships may change weeks or even months after the event. Because time has passed, family members sometimes don’t realize how changes are directly linked to the event.

Every family is different but, generally speaking, common changes in the weeks or months after the event include: • Family members may become short-tempered or irritable with

• • • • • • • •

each other, which can lead to arguments and friction.

They may lose interest in activities or perform less well at work or school.

Children may be clingy, grizzly, demanding or naughty.

Teenagers may become argumentative, demanding or rebellious.

Individuals may feel neglected and misunderstood.

Some family members may work so hard to help loved ones, they neglect to look after themselves.

Individual family members may feel less attached or involved with one another.

Parents may experience emotional or sexual problems in their relationship.

Everyone feels exhausted and wants support, but cannot give much in return.

Family life – years later Sometimes, the response to a distressing or frightening event may take a long time to show. In some cases, it may take years for problems to surface. This can happen if the person is very busy helping others or dealing with related issues, such as insurance, rebuilding, relocation, legal processes or financial problems. When things have returned to normal, their reactions may show up.

Every family is different but, generally speaking, changes to family dynamics can include: • The experience may be relived when faced with a new crisis.

• Problems may seem worse than they are and be more difficult to handle.

• Changes to family life that occurred in the days, weeks or months after the event may become permanent habits.

• Family members may cope differently with reminders of the event.

Some may want to commemorate the anniversary or revisit the scene of the event, while others may want to forget about it.

• Conflict in coping styles can lead to arguments and misunderstandings if the family members aren’t sensitive to each other’s needs.

SEGMENT THREE People react differently to trauma It is important to remember that it is normal for people to respond in different ways to distressing events. However, sometimes people’s responses can clash. One person may withdraw and need time to themselves, while the other needs company and wants to talk about it. Although this can

seem quite confusing at times, giving a person the necessary space to work through their own reaction can be extremely helpful.

With families, common reactions may include: • strong feelings – include anxiety, fear, sadness, guilt, anger, vulnerability, helplessness or hopelessness. These feelings will not just apply to the event, but to many other previously normal areas of life as well • physical symptoms – include headache, nausea, stomach ache, insomnia, broken sleep, bad dreams, changed appetite, sweating and trembling, aches and pains, or a worsening of pre-existing medical conditions • thinking is affected – include difficulties with concentrating or thinking clearly, short-term memory problems, difficulty planning or making decisions, inability to absorb information, recurring thoughts of the traumatic event, thinking about other past tragedies, pessimistic thoughts or an inability to make decisions • behavior changes – include a drop in work or school performance, turning to changed eating patterns, using drugs or alcohol, being unable to rest or keep still, lack of motivation to do anything, increased aggressiveness or engaging in self-destructive or self-harming activities.

SEGMENT FOUR Helpful strategies for recovery from trauma Some things you can do to reduce complications and support family recovery include: • Remember that recovery takes time. Prepare the family members to go through a period of stress and cut back on unnecessary demands to conserve everyone’s energy.

• Don’t just focus on the problems.

Make free time to be together and relax, or else the stress will not subside.

• Keep communicating. Make sure each family member lets the others know what is going on for them and how to help them.

• Plan regular time out and maintain activities you enjoyed before – even if you don’t much feel like it. You probably will enjoy yourself if you make the effort. Enjoyment and relaxation rebuild emotional energy.

• Keep track of your family’s progress in recovery and what has

•

been achieved. Don’t just keep thinking about what is still to be done.

Stay positive and encouraging, even if at times, everyone needs to talk about their fears and worries. Remind yourself that families get through the hard times and are often stronger.

TAKE CALLS ( 1 - MINUTE PER CALL ) LIMIT TO 10 MAX. CONCLUSION Seeking help from a health professional Traumatic stress can cause very strong reactions in some people and may become chronic (ongoing).

You should seek professional help if you: • are unable to handle the intense feelings or physical sensations • don’t have normal feelings, but continue to feel numb and empty • feel that you are not beginning to return to normal after three or four weeks • continue to have physical stress symptoms • continue to have disturbed sleep or nightmares • deliberately try to avoid anything that reminds you of the traumatic experience • have no one you can share your feelings with • find that relationships with family and friends are suffering • are becoming accident-prone and using more alcohol or drugs • cannot return to work or manage responsibilities • keep reliving the traumatic experience • feel very much on edge and can be easily startled.

WRAP-UP I would like to thank everyone for tuning into another episode of Amp Life Talk Radio a show for amputees and by an amputee. I hope you found the information shared tonight useful.

Please leave me a comment on our Facebook Page: Amp Life Talk Radio good or bad. Remember the show is every Wednesday at 5:30 PM, the “LIVE” call-in show Toll-Free Line is (888) 979-9334, Goto http://amplifetalkradio.co You can listen to each episode at amplifetalkradio.com - The is “LIVE” weekly on Wednesday at 5:30 PM on Spreaker.com and Facebook Live.

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INFLUENZA (FLU) Cleaning to Prevent the Flu Cleaning to Prevent the Flu

48 hours

How long can the flu virus live on objects, such as doorknobs and tables?

The flu virus can “live” on some surfaces for up to 48 hours. Routine cleaning of surfaces may reduce the spread of flu.

What kills flu viruses?

Flu viruses are killed by heat above 167° F [75° C]. Common household cleaning products can also kill the flu virus, including products containing: • chlorine • hydrogen peroxide • detergents (soap) • iodophors (iodine-based antiseptics) • alcohols

How should a caregiver handle a sick person’s tissues or other items?

Make sure to wash your hands after touching the sick person. Also wash after handling their tissues or laundry.

For more information call CDC info at 1-800-CDC-INFO (232-4636) or go to www.cdc.gov/flu.

PUBLIC SERVICE ANNOUNCEMENT U.S. Department of Health and Human Services Centers for Disease Control and Prevention 45

CS 290778-A/2018

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