Friday Stats and More

Friday Stats and More

At this point, according to the Centers for Disease Control’s COVID-19 cases in the United State website, which the FEHBlog tracks, the number of confirmed cases topped one million on Wednesday and the number of confirmed deaths topped 60,000 on Thursday. Interestingly, the case fatality rate (deaths over cases) has remained between 5 and 6% for the last fourteen days after jumping from 2% on April 1 to 5% on April 17. The case fatality rate (“CFR”) should drop as the number of confirmed cases increases due to antibiotic testing. The American Spectator observes

To put this in perspective: Last winter 250,000 people tested positive for the flu. 25,000 died. If these numbers are right, the CFR for the flu is 10 percent … but that can’t be right.

And, in fact, it isn’t. The Centers for Disease Control and Prevention (CDC) estimates that, although only 250,000 people tested positive for the flu last year, 39 million people actually got it. Generally only those who are older or otherwise unhealthy, or those who have a severe case, go to the doctor and get tested for the flu; everyone else just takes Motrin and Tylenol and stays home. This drives up the CFR dramatically.

Also check out the CDC’s weekly COVIDView.

The Boston Globe’s STAT offers a pessimistic view of the COVID-19 emergency over time. If the STAT’s view is correct, then we have experienced no progress in medical care since 1918-1919 when the flu decimated the world. The FEHBlog has confidence in our healthcare system to pull us through this crisis.

America’s Health Insurance Plans discusses the steps that health insurers take to expand coverage in the face of the COVID-19 emergency. Health benefits did not exist in 1918-19.

For those interested, the American Medical Association reviews advocacy efforts for its membership during the crisis.

The Harvard Business Review called the FEHBlog’s attention to

Kanter’s Law: that everything can look like a failure in the middle. Unexpected obstacles and difficult predicaments can arise in the middle of any human and organizational endeavor. Give up, and by definition it’s a failure. Persist, pivot, and persevere, and there’s hope for finding another successful path.

In closing Happy Law Day. ” Law Day is held on May 1st every year to celebrate the role of law in our society and to cultivate a deeper understanding of the legal profession.”

The Law Day 2020 theme is “Your Vote, Your Voice, Our Democracy: The 19th Amendment at 100.” In 2019-2020, the United States is commemorating the centennial of the transformative constitutional amendment that guaranteed the right of citizens to vote would not be denied or abridged by the United States or any state on account of sex. American women fought for, and won, the vote through their voice and action.

Friday Stats and More

Here are the Centers for Disease Control’s top line COVID-19 statistics for the past four weeks:

4/34/104/174/24
Confirmed Cases239,279459,165661,712862,648
Confirmed Deaths5,44216,57028,82343,451
Deaths over Cases2.27%3.61%4.36%5.04%

Don’t forget to check out the CDC’s weekly COVIDView which comes out on Fridays. The COVIDView is more encouraging reading than the bare statistics.

A new study in Health Affairs estimates “that a single symptomatic COVID-19 infection would cost a median of $3,045 in direct medical costs.”

Fierce Healthcare reports that CIGNA studied “care utilization among their commercial group and individual plan members between January and March across seven [serious] conditions and found decreases in hospitalizations across the board.”

[The lead researcher] said the team was surprised by the size of these decreases and that they were found across all seven conditions, because going without treatment for these conditions can have serious consequences.

[A research team physician] added that providers can help encourage patients to seek care in these situations by developing a care plan with those at high risk for certain conditions and having open conversations that affirm they should seek care in an emergency situation even if they should stay home otherwise.

It’s a crazy time.

Friday Stats and More

Here are the latest four weeks from the CDC’s COVID-19 Cases in the U.S. website:

Covid-193-274-34-104-17
Cases85,356239,279459,165661,712
Deaths12465,44216,57028,823
Cases / Deaths1.46%2.27%3.61%4.36%

This week the CDC began to include deaths probably caused by COVID-19 in its death count. The FEHBlog will stick with confirmed COVID-19 deaths. The probable COVID-19 death count today was 4,226. The CDC’s number close out at 4 pm on the day before the report.

Today the CDC added demographic data to its Cases in U.S. website. The FEHBlog was surprised to find that in almost 75% of the COVID-19 cases, race/ethnicity was not specified. The majority of cases are found in the 18 to 64 age range. The CDC’s statistics do not provide a gender breakdown.

The CDC also released its weekly COVIDView report. 680,000 COVID-19 lab tests were conducted in the week ended April 11. (The CDC’s weekly summaries customarily are a week behind the release date.)

Here’s a link to the President’s three phase guidelines on reopening our country that were issued yesterday. According to the Fierce Healthcare report, Dr. Deborah Birx from the CDC explains that before entering phase one, states and cities “must see data that shows a sustained decline in influenza-like illness, as well as positive COVID-19 cases with persistent testing, for a minimum of 14-days.”

Friday Stats and More

So the FEHBlog was wrong in promoting the fact that the COVID-19 death rate was stable for two days this week. After the period of stability the death rate rose from 3.23% to 3.61%. In other words, the plateau has not yet been reached. Here are the CDC Cases in U.S. Stats for the four Fridays:

COVID-193/203/274/34/10
Cases10,44285,356239,279459,165
Deaths15012465,44216,570
Deaths over Cases1.44%1.46%2.37%3.61%

Please note that the CDC numbers close at 4 pm on the previous day. The much loved John Hancock COVID-19 site is simply too much for the FEHBlog to handle.

Today, the CDC released its latest COVIDView and its final FluView for the 2019-20 flu season. Thanks heavens for small miracles.

The FEHBlog was overjoyed by a sentence from the following HHS press release that the FEHBlog has placed in bold print:

The Trump Administration is committed to ensuring that Americans are protected against financial obstacles that might prevent them from getting the testing and treatment they need from COVID-19.As announced in early April, a portion of the $100 billion Provider Relief Fund will be used to reimburse healthcare providers, at Medicare rates, for COVID-related treatment of the uninsured.
As a condition, providers are obligated to abstain from “balance billing” any patient for COVID-related treatment.
The Families First Coronavirus Response Act requires private insurers to cover an insurance plan member’s cost-sharing payments for COVID-19 testing. President Trump has also secured commitments from private insurers, including Humana, Cigna, UnitedHealth Group, and the Blue Cross Blue Shield system to waive cost-sharing payments for treatment related to COVID-19 for plan members.

Here’s the rub. How will health plans know that a particular provider is barred from balance billing for COVID-19 care?

It is admirable that UnitedHealthGroup is helping HHS promptly distribute this CARES Act funding to providers.

Person using a laptop

Thursday Miscellany

As the FEHBlog discussed COVID-19 death rates yesterday, it’s only meet and right to post STAT’s story which seeks to put COVID-19 death projections into perspective.

On the flip side, STAT reports on Pfizer’s decision to accelerate by three months human testing on a potential treatment for COVID-19 and local WTOP news reports on COVID-19 vaccine development efforts by a company in the Maryland suburbs of D.C., Novovax. Best of luck.

Healthleaders Media discusses a Guidehouse study finding

A major factor hampering the financial situation for rural providers is the migration of patients to care options outside of the community, with over 75% of patients bypassing local hospitals to receive care elsewhere. These levels are much higher compared to the outmigration patterns of suburban and urban patients.

More than 350 rural hospitals [one in four], accounting for $8.3 billion in total patient revenue, are at the greatest financial risk of closure, according to Guidehouse. The five states most likely to be impacted by hospital closures include Tennessee, Oklahoma, Mississippi, Alabama, and Kansas, according to the analysis.

Guidehouse adds that “Of these hospitals, 81%, or 287 hospitals, are considered highly essential to the health and economic well-being of their communities.” What is really troubling about this study is that it was conducted before the COVID-19 emergency which must be exacerbating these financial problems.

The Centers for Medicare and Medicaid Services today issued additional guidance loosening the regulatory reins on healthcare providers so that “so that hospitals, clinics, and other healthcare facilities can boost their frontline medical staffs” necessary to treat COVID-19 patients and others. Among other steps,

Doctors can now directly care for patients at rural hospitals, across state lines if necessary, via phone, radio, or online communication, without having to be physically present. Remotely located physicians, coordinating with nurse practitioners at rural facilities, will provide staffs at such facilities additional flexibility to meet the needs of their patients.

Similarly, the HHS Office for Civil Rights which enforces the HIPAA Privacy and Security Rules promised not to impose HIPAA penalties on good faith rule violations that occur at COVID-19 testing sites.

Drug Channels offers an interesting take on the CMS actuary’s recent healthcare spending projections for the U.S. Adam Fein observes that ” The coronavirus is upending our healthcare system and putting enormous pressure on hospitals. Despite increased costs of treatment, I expect that spending [that CMS estimated before the COVID-19 emergency] will be lower than the CMS projections.”

On the technology front, the federal government’s cybersecurity authorities released a detailed alert on a variety of cyberscams that have arisen during the COVID-19 emergency.

Midweek update

As you know, the FEHBlog tracks the daily COVID-19 cases in the U.S. posted by the Centers for Disease Control. Here are the statistics for this week so far:

COVID 19 Statistics4/54/64/74/8
Cases304,826330,891374,329395,011
Deaths7,6168,91012,06412,754
Deaths over Cases2.50%2.69%3.22%3.23%

We tragically have experienced more COVID-19 deaths so far this week than the approximately 3,000 Americans who died at Pearl Harbor (or on September 11). However, the relatively high death rate (particularly compared to the flu) was flat for the past two days. We will see on Friday whether this encouraging trend continues.

The flattening occurred because the number of deaths stopped increasing proportionally faster than the number of cases. The more rapidly increasing number of COVID-19 cases must be due at least in part to the expansion of COVID-19 testing as discussed in this Healthcare Dive article and this HHS announcement that licensed pharmacists now are authorized to order COVID-19 tests.

Fierce Healthcare reports on the development of a new COVID-19 portal called “The National Response Portal that will provide vital information to healthcare providers, policymakers and the general public as a ‘one-stop-shop’ for all health data related to COVID-19, which is caused by the novel coronavirus, according to the organizations.” The new portal is gathering information now and is expected to go live next week.

It’s World Health Day

The World Health Organization has declared today World Health Day appropriately honoring nurses and midwives. U.S. HHS Secretary Alex Azar commented

“This year’s theme for World Health Day, ‘Celebrating Nurses and Midwives,’ is also an important reminder of the work being done by frontline healthcare workers every day, around the world, to save lives. Preparing for and responding to outbreaks that can cross borders is one of the most important contributions we can make to support our healthcare workers, and we applaud the heroic work they have been doing to battle the global pandemic

The FEHBlog heartily agrees. Now, how about some Tuesday Tidbits?

  • Yesterday, as Health Payer Intelligence reports, the Centers for Medicare and Medicaid Services “finalized its Medicare Advantage and Part D rates, including finalizing the disputed Medicare Advantage end-stage renal disease (ESRD) payment rule without changes.” HPI adds that CMS anticipates a slight uptick (1.66 percent) in revenue as a result of the new rate announcement, based on its changes to the reimbursement methodologies for Medicare Advantage organizations, PACE organizations, and Part D sponsors. The uptick does not account for the adjustments related to the underlying coding trend, which CMS anticipates will bump most risk scores by around 3.56 percent.” In the FEHBlog’s view, the extension of Medicare Advantage coverage to beneficiaries under age 65 with end stage renal disease could be disruptive to Medicare Advantage rates.
  • The Centers for Disease Control released yesterday a report on “Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020.” Here’s the summary

What is already known about this topic?

Data from China suggest that pediatric coronavirus disease 2019 (COVID-19) cases might be less severe than cases in adults and that children (persons aged <18 years) might experience different symptoms than adults.

What is added by this report?

In this preliminary description of pediatric U.S. COVID-19 cases, relatively few children with COVID-19 are hospitalized, and fewer children than adults experience fever, cough, or shortness of breath. Severe outcomes have been reported in children, including three deaths.

What are the implications for public health practice?

Pediatric COVID-19 patients might not have fever or cough. Social distancing and everyday preventive behaviors remain important for all age groups because patients with less serious illness and those without symptoms likely play an important role in disease transmission.

  • TechCrunch brings us up to date another potential COVID-19 vaccine is entering phase 1 human trials with Food and Drug Administration approval. This vaccine is being developed by Inovio Pharmaceuticals with financial backing from the Bill and Melinda Gates Foundation. Best of luck to Inovio and the other developers.
  • A friend of the FEHBlog found this online edited transcript of NYC pulmonologist David Price’s chat and Q&A on COVID-19 discussed in yesterday’s FEHBlog. Check it out.

CDC COVIDView

The Centers for Disease Control has started to issue weekly COVIDView reports similar to the FluView reports that the agency issues during flu season.

This CDC report provides a weekly summary and interpretation of key indicators being adapted to track the COVID-19 pandemic in the United States. This includes information related to COVID-19 outpatient visits, emergency department visits, hospitalizations and deaths, as well as laboratory data.

These reports are as of one week behind the issuance date so the first COVIDView is as for the week of March 28, 2020.

COVIDView helpfully supplements the CDC’s Summary of Cases in the U.S. website which is updated daily, including weekends.

New CDC Guidance

NPR reports that

President Trump said Friday the Centers for Disease Control and Prevention now recommends that people wear cloth or fabric face coverings, which can be made at home, when entering public spaces such as grocery stores and public transit stations. It is mainly to prevent those people who have the virus — and might not know it — from spreading the infection to others.

The guidelines do not give many details about coverings beyond: “cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.” * * * And the mask need not be professional-grade to offer some benefit. In fact, officials say it probably shouldn’t be: The CDC recommends constructing your own cloth mask.

The New York Times provides guidance on how to make your own mask. The FEHBlog can’t think of a more fun activity for the weekend.

Thursday Miscellany

Healthcare Dive helpfully reviews the benefit improvements that large health insurers have made in response to the COVID-19 emergency.

Hospitals say that’s not enough, and are calling on the biggest payers to follow actions taken by Congress and CMS to help resolve cash flow issues, by accelerating payments or opting into releasing interim periodic payments. The American Hospital Association also is urging payers to eliminate administrative burdens such as prior authorizations.

The more things change, the more they stay the same.

Beckers Hospital Review reports that “Peak demand for hospital resources due to COVID-19 is expected by mid-April in the U.S., according to an analysis from the University of Washington’s Institute for Health Metrics and Evaluation in Seattle.” The report provides an expect peak demand date for each State in the Union and DC.

The HHS Office for Civil Rights which enforces the HIPAA Privacy and Security Rules loosened another Privacy Act provision for the duration of the COVID-19 emergency —

As a matter of enforcement discretion, effective immediately, the HHS Office for Civil Rights (OCR) will exercise its enforcement discretion and will not impose potential penalties for violations of certain provisions of the HIPAA Privacy Rule against covered health care providers or their business associates for uses and disclosures of protected health information by business associates for public health and health oversight activities during the COVID-19 nationwide public health emergency.

Although this is really inside the Beltway, the FEHBlog, as a lawyer, finds it noteworthy to relate that, according to Govexec.com, the Office of Management and Budget “is not directing agencies to extend the amount of time alloted for public feedback on regulation changes during the coronavirus outbreak, despite calls from [House Democrat] lawmakers to do so.”

Finally, the FEHBlog notes that according to the Boston Globe’s Stat News, rumblings about masking the American public continue.


In a draft document obtained by STAT, the CDC recommended that the public use homemade face coverings when in public, reserving higher-grade protective equipment like N95 masks for hospitals and health care workers, who have faced severe shortages in personal protective equipment as the coronavirus pandemic has accelerated through the United States.

Such face coverings, according to the draft guidance, would not be intended to protect the wearer, but rather prevent the wearer from unknowingly spreading the disease when in public. Individuals should wear face coverings in public settings like grocery stores, the guidance said. Children under the age of 2 and people experiencing trouble breathing would be excluded from the mask guidelines.