'Two Medical Systems, Two Pandemic Responses' diff viewer (6/7)

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Two Medical Systems, Two Pandemic Responses	Two Medical Systems, Two Pandemic Responses
2020-06-17 04:15:23 UTC	2020-06-17 14:52:41 UTC (about 11 hours later)
After lamenting in a recent Canada Letter about my inability to find an expert who could offer an informed comparison of how the medical systems in Canada and the United States were responding to the coronavirus pandemic, I soon heard from Professor Peter Berman.	After lamenting in a recent Canada Letter about my inability to find an expert who could offer an informed comparison of how the medical systems in Canada and the United States were responding to the coronavirus pandemic, I soon heard from Professor Peter Berman.
He is particularly well placed for such an assessment, after spending 25 years teaching at Harvard, most recently as a professor of global health systems and economics at the T.H. Chan School of Public Health. Professor Berman is now based in Vancouver as the director of the school of population and public health at the University of British Columbia’s medical school.	He is particularly well placed for such an assessment, after spending 25 years teaching at Harvard, most recently as a professor of global health systems and economics at the T.H. Chan School of Public Health. Professor Berman is now based in Vancouver as the director of the school of population and public health at the University of British Columbia’s medical school.
I’ll begin the comparison with some numbers. Massachusetts, the previous home of Professor Berman, has a population of 6.8 million and British Columbia has slightly over 5 million residents. But the toll of the pandemic on the two areas has been significantly different. As off Friday afternoon in Massachusetts, there have been more than 62,000 reported cases and 3,562 deaths, or 52 fatalities for every 100,000 people. In B.C., there have been just 2,112 reported cases and 111 deaths or just two victims for every 100,000 residents.	I’ll begin the comparison with some numbers. Massachusetts, the previous home of Professor Berman, has a population of 6.8 million and British Columbia has slightly over 5 million residents. But the toll of the pandemic on the two areas has been significantly different. As off Friday afternoon in Massachusetts, there have been more than 62,000 reported cases and 3,562 deaths, or 52 fatalities for every 100,000 people. In B.C., there have been just 2,112 reported cases and 111 deaths or just two victims for every 100,000 residents.
Professor Berman cautioned that those numbers reflect a wide variety of factors outside the medical system like the demographic makeup of different cities and regions.	Professor Berman cautioned that those numbers reflect a wide variety of factors outside the medical system like the demographic makeup of different cities and regions.
But he noted that near his old office at Harvard “there must be thousands of the world’s best hospital beds and there are three top international top hospitals within a couple blocks.” So with resources like that, why is there such a great disparity with British Columbia?	But he noted that near his old office at Harvard “there must be thousands of the world’s best hospital beds and there are three top international top hospitals within a couple blocks.” So with resources like that, why is there such a great disparity with British Columbia?
Part of the answer, for Professor Berman, can be found in how hospitals are funded and managed by the public health care systems of Canadian provinces.	Part of the answer, for Professor Berman, can be found in how hospitals are funded and managed by the public health care systems of Canadian provinces.
“The kind of system we have in Canada — and I think in British Columbia we have a pretty well-run version of it — allows the public health authorities to essentially commandeer the hospital system. It’s a command and control thing, it’s not a coordination thing,” he said.	“The kind of system we have in Canada — and I think in British Columbia we have a pretty well-run version of it — allows the public health authorities to essentially commandeer the hospital system. It’s a command and control thing, it’s not a coordination thing,” he said.
In the United States, Professor Berman said, hospitals are largely private institutions without any overall control.	In the United States, Professor Berman said, hospitals are largely private institutions without any overall control.
The effect of having these different systems plays out in many ways.	The effect of having these different systems plays out in many ways.
“In British Columbia, the province just said: ‘We need to get ready for this, we need to free up 30 percent of the hospital beds,’” Professor Berman said. “And they instructed the health authorities to do it.”	“In British Columbia, the province just said: ‘We need to get ready for this, we need to free up 30 percent of the hospital beds,’” Professor Berman said. “And they instructed the health authorities to do it.”
But in Massachusetts, he said, not only was there no one to tell hospitals to clear out beds, the economics of the system work against such steps.	But in Massachusetts, he said, not only was there no one to tell hospitals to clear out beds, the economics of the system work against such steps.
“If you have a private hospital where all the beds are paid for by patients and by insurance, when you have an empty bed, you have no revenue,” Professor Berman said. “So there’s a strong incentive for the hospital managers, especially in trying economic times, to be reluctant to cooperate. And then you end up with this kind of panicky atmosphere that has been happening in the U.S. where people are saying: ‘We don’t have enough beds, we don’t have enough this, we don’t have enough that.’”	“If you have a private hospital where all the beds are paid for by patients and by insurance, when you have an empty bed, you have no revenue,” Professor Berman said. “So there’s a strong incentive for the hospital managers, especially in trying economic times, to be reluctant to cooperate. And then you end up with this kind of panicky atmosphere that has been happening in the U.S. where people are saying: ‘We don’t have enough beds, we don’t have enough this, we don’t have enough that.’”
By contrast, Canadian hospitals have fixed funding. The number of full or empty beds has no effect on their budgets.	By contrast, Canadian hospitals have fixed funding. The number of full or empty beds has no effect on their budgets.
The structure in the United States leads to other problems. Few American hospital administrators got together to do things like moving medical supplies and patients around between their institutions, Professor Berman said.	The structure in the United States leads to other problems. Few American hospital administrators got together to do things like moving medical supplies and patients around between their institutions, Professor Berman said.
“They have a strong disincentive not to do that and in addition there is no one who can make them do that without a pretty heavy duty expression of police powers of the state, which we haven’t really seen happening,” he said.	“They have a strong disincentive not to do that and in addition there is no one who can make them do that without a pretty heavy duty expression of police powers of the state, which we haven’t really seen happening,” he said.
Professor Berman also noted that while the American system has vast medical and scientific expertise, there’s little national coordination. Instead, responsibility has been fractured among a variety of long established agencies like the Centers for Disease Control, the National Institutes of Health and the coronavirus task force established by President Trump.	Professor Berman also noted that while the American system has vast medical and scientific expertise, there’s little national coordination. Instead, responsibility has been fractured among a variety of long established agencies like the Centers for Disease Control, the National Institutes of Health and the coronavirus task force established by President Trump.
“So you see these different agencies being brought in to weigh in with their opinions without any sense of who’s really the spokesperson,” he said. In Canada however, “at a national level, Theresa Tam is doing that and then at the provincial level, we have people like Bonnie Henry doing that. I think in the U.S., no one’s been allowed to do that.”	“So you see these different agencies being brought in to weigh in with their opinions without any sense of who’s really the spokesperson,” he said. In Canada however, “at a national level, Theresa Tam is doing that and then at the provincial level, we have people like Bonnie Henry doing that. I think in the U.S., no one’s been allowed to do that.”
Updated June 16, 2020	Updated June 16, 2020
	The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.	The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.	So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.	Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.	A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.	The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.	Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.	States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.	Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)	If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.	Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.	The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.	If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.	If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
None of this means that Canada’s approach to the crisis and the structure of its medical system is perfect. Among other things, Professor Berman said that Canada’s health systems, which effectively treat doctors as private contractors, sometimes leads to disconnections between primary health care and the hospital systems. He also said that the country has been slow to push testing for the virus out into communities.	None of this means that Canada’s approach to the crisis and the structure of its medical system is perfect. Among other things, Professor Berman said that Canada’s health systems, which effectively treat doctors as private contractors, sometimes leads to disconnections between primary health care and the hospital systems. He also said that the country has been slow to push testing for the virus out into communities.
But none of that has led to the sort of response he’s seeing back in the United States.	But none of that has led to the sort of response he’s seeing back in the United States.
“I’m a health economist,” Professor Berman said. “So the argument is always given in the United States that we have a lot of innovation, the system is very efficient and so on. But this is the other side of the argument.”	“I’m a health economist,” Professor Berman said. “So the argument is always given in the United States that we have a lot of innovation, the system is very efficient and so on. But this is the other side of the argument.”
Partly fulfilling a campaign promise and in the week of Nova Scotia’s shooting tragedy, Prime Minister Justin Trudeau announced a ban on about 1,500 military style weapons on Friday. Legislation to buy back the estimated 100,000 such semiautomatic rifles in Canada and to introduce other gun restrictions is in the works.	Partly fulfilling a campaign promise and in the week of Nova Scotia’s shooting tragedy, Prime Minister Justin Trudeau announced a ban on about 1,500 military style weapons on Friday. Legislation to buy back the estimated 100,000 such semiautomatic rifles in Canada and to introduce other gun restrictions is in the works.
At a time of enormous turmoil and uncertainty for professional sports, the National Women’s Hockey League announced a new franchise in Toronto, its first outside of the United States.	At a time of enormous turmoil and uncertainty for professional sports, the National Women’s Hockey League announced a new franchise in Toronto, its first outside of the United States.
Among the Canadians lost to the coronavirus is Bertha Laforest, a nun at a convent in Quebec where 36 of the 47 nuns became infected.	Among the Canadians lost to the coronavirus is Bertha Laforest, a nun at a convent in Quebec where 36 of the 47 nuns became infected.