Public Posts

When the storm passes
and the roads are tamed,
and we are the survivors
of a collective shipwreck.

With a weeping heart
and a blessed destiny 
we will feel happy
just for being alive.

And we will hug
the first stranger
and praise the luck 
of not having lost a friend.

And then we'll remember
everything we lost
And all at once we will learn
all we had not learned before

We will no longer be envious 
because we have all suffered
We will no longer be lazy
And will be more compassionate 

What belongs to all will be worth more 
than that never achieved
We will be more generous
and much more committed 

We will understand how fragile
it means to be alive.
We will sweat empathy
for who is and who has left.

We will miss the old man
asking for a dollar in the market
we didn't know his name
although he was next to us

And perhaps the poor old man
was your God in disguise.
You never asked for his name
because you were in a hurry.

And everything will be a miracle
And everything will be legacy.
And life will be respected,
the life we have won.

When the storm passes
I ask God, full of sadness 
to return us to be better
as he had dreamed we would be.

Translation of Alexis Valdés  poem "Esperanza" (Hope) written in Spanish in March 2020 about the humanitarian crisis brought "by the Coronavirus and the "hope" of how we will feel when the "Storm Passes" ("Cuando pase la tormenta"  -  Esperanza)

Alexis Valdés is a Cuban composer, singer, musician and poet residing in Miami. Translated by CP

- A historical view of Mothers day
- Remote Learning - The Class Divide: Remote Learning at 2 Schools, Private and Public
- Covid-19 - The Risks - Know Them - Avoid Them .
- If 80% of Americans Wore Masks, COVID-19 Infections Would Plummet, New Study Says 

Seattle photographers trade Zoom calls for a zoom lens .......... Read more

This pandemic is going to have ramifications that unfold for years to come that we won’t be able to predict. But my money is, for sure, on all of us leveling up on our germophobe meters. This New York Times cough simulation burned itself into my brain when I saw it, while I’m trying desperately to erase the knowledge that speaking alone creates enough droplets to lead to potential exposure. (I’m dragging you all down with me!)

All right, on to my attempts to summarize years-worth of news that was somehow crammed into one week. Buckle up!

President Donald Trump released a three-phase plan that leans heavily on the idea that reopening the country should not be based on a one-size-fits-all mentality. Hot spots would keep their shutdown measures in place, while areas in the country that haven’t been hit could start slowly getting back to normal.

The guidance was quickly dismissed by critics as “vague and inconsistent.” And considering that governors are the final authority on when shelter-in-place orders are lifted (which Trump acknowledged, after previously drawing an outcry over claims that he alone would make that decision), it may not make a huge impact on what happens next.

Trump also announced his panel of advisers who will help him reopen the country — something that came as a surprise to some of the people he named. One of the first bits of advice to come from the business leaders? The United States is woefully behind in the amount of testing it needs to do to reopen the country. Meanwhile, conversations between Trump and his panel don’t have to be made public because only “formal outside advisory committees” fall under the transparency law requirements.

As Josh Gerstein, from Politico, notes: Notably, the White House avoided the term “committee” in its announcement.

Speaking of testing, saliva tests based on the 23andMe model are being touted as the answer to the country’s testing woes. But I think I’ve heard that promise before.

WHO became a new target in Trump’s efforts to shift blame from his own administration’s missteps in the early days of the crisis. After a few days of speculation, Trump announced he wants to cut funding for the international organization, going against the State Department’s advice that the move would be “ceding ground” to China.

Predictably, since the country is in the midst of a pandemic, the decision drew swift condemnation from Trump’s critics and the medical community. And though WHO’s response may not have been pitch-perfect, experts say, the organization consistently treated the contagion as the threat it was far earlier than some nations did.

Although Trump’s decision was based on his criticism of WHO’s early response to the current crisis, the funding cuts would be felt far beyond the organization’s efforts to fight COVID-19.

As all that was going on, many people were wondering where the CDC — once the preeminent disease-fighting body — has been in this current fight. The agency won high praise for its work helping fight AIDS, Ebola and Zika, and played a major role in eradicating smallpox, as well as the near-elimination of polio. But funding cuts beneath the Trump administration have rendered it a “nonentity.”

In an ironic twist of fate, the pandemic could shape Trump’s health care legacy into one that looks a lot like his opponents’ dream scenario. The administration has greenlighted plans that pump billions of government money into the health care system to help offset costs, including a taxpayer-generated fund for hospitals to use to cover patients’ care. (Ahem, does that sound familiar?) Anxiety is rippling through some conservative circles that Trump might oversee historic new levels of federal health spending.

In contrast to all that, though, Trump’s continued disdain for the health law could also hamper the administration’s response to the crisis.

And hospitals say that $100 billion pot allocated in the $2.2 trillion stimulus package is not only taking far too long to distribute, but also is woefully inadequate.

Thursday marked another deadliest-day record, with the death count rising by 4,591 in the span of 24 hours. Meanwhile, New York this week started counting “probable” COVID-19-related deaths, which sent its totals soaring past 10,000. The change highlights one of the issues with getting an accurate count of the nation’s losses. Not only are COVID-19 cases widely considered undercounted because of a lack of tests, some states are counting them using different criteria (while remaining adamant that their strategy is best).

There’s also been a worrisome spike in at-home deaths, which makes some experts think we’re just seeing the tip of the iceberg in the death toll.

In a nod to the fact that the coronavirus knows no state boundaries, governors in different regions are forming partnerships to create plans to reopen their states in the coming months. The coalitions so far: the Northeastern corridor, the West Coast trio of Washington, Oregon and California, and seven Midwestern states.

While the partnerships are in their early days, it seems the plans will rely heavily on testing and a slow rollout that takes into account more vulnerable populations.

As the general shutdown effort enters its second month, though, tensions are simmering to a boiling point for some. Protesters, driven by economic and civil liberty concerns took to the streets this week to demand governors lift specific shutdown orders. But even as they voiced complaints, cases started to spike in the very states that hadn’t seen the need to shelter in place.

And those of us who have been social distancing laughed a little nervously (without humor) at a new study that suggests it could be needed until 2022. For what it’s worth, that seemed like a worst-case-scenario projection that didn’t account for a possible vaccine or increased capacity in hospitals.

It’s so rare these days that I get to talk about good news, but today is the day! There are hopeful signs coming out of a study on Gilead’s antiviral remdesivir, the drug that’s been a front-runner since the early days of the crisis. But, a warning: The good news comes with a huge helping of salt in that there was no control group used in the study, so the patients might have been getting better on their own.

Meanwhile, studies are going forward on a drug that calms the immune system, targeting the deadly “cytokine storms” that seem to be at the root of younger patients’ deaths. But fears remain that suppressing a patient’s immune system in the midst of a battle against the virus could backfire.

While the global science community has dropped everything to race for a cure, the scattershot, all-hands-on-deck method might actually be doing more harm than good, with researchers working at cross-purposes, duplicating efforts and failing to communicate outside of their realm.

Speaking of hopeful signs, there’s also a lot of movement with Moderna’s development of a vaccine. The company is set to get an infusion of cash and expand its trials with hopes that something can get pushed to the public far earlier than the original 12- to 18-month timeframe. Even Dr. Anthony Fauci (who has been on the extra-cautious side) has said that he thinks it might be possible to have a safe and effective vaccine as early as mid- to late winter.

In the meantime, some observers wonder if the general immune boost that comes with an old TB vaccine might help bridge the gap during the long wait for a coronavirus vaccine.

And, so far, the big names in the anti-vaccination movement have not changed their tunes, even as many in the country are looking to a vaccine as the one true exit strategy from the pandemic.

In a man-our-health-system-is-complicated moment, UnitedHealth Group is actually reporting an increase in profits during the pandemic. That’s because the extra coronavirus costs have been offset by the cancellations of other procedures.

Hospitals and states where the virus has not yet struck are growing ever more frustrated with FEMA “redirecting” (or “poaching,” for the more critically inclined) equipment it needs to brace for any potential surges. Over the past few weeks, the federal government’s response to equipment distribution has been blasted as somehow too chaotic and too controlling at the same time, which seems to be a real feat.

In another attempt to address some of the shortages in hot spots, the Trump administration announced a voluntary exchange program, in which hospitals in “cold spots” send their unused ventilators to places in need.

And all this demand is driving up costs across the board. A protective mask that used to cost $0.38 now rings up for $5.75. Isolation gowns went from $0.25 to $5. (You get the picture.)

If you expected quick, bipartisan action (haha!) out of Congress during these high-stakes times, you might have to take off the rose-colored glasses. The small-business fund allocated through the $2.2 trillion stimulus package ran out this week, and even in the face of overwhelming requests, Congress can’t seem to shake the shackles of partisan disputes.

Meanwhile, a staggering 22 million Americans have filed for unemployment in the past four weeks, sending the country into an economic nosedive that is drawing apt comparisons to the Great Depression. Images of lines of cars miles long might be our generation’s bread-line pictures, with food banks struggling to deal with the onslaught of needy Americans.

Experts say the stress from the pandemic revealed underlying vulnerabilities that suggest the booming economy might not have been all that strong to begin with. “We built an economy with no shock absorbers,” said Joseph Stiglitz, a Nobel Prize-winning economist.

Meanwhile, whatever details shake out about the reopening of the economy, one thing is certain: It will be fragile, partial and slow.

We know that health care workers represent a high number of coronavirus cases, but a new CDC report puts hard (though still undercounted) numbers on it: As of April 9, 9,282 health care professionals had contracted the virus and at least 27 had died from it.

On that note, KHN and The Guardian are documenting the lives of U.S. workers who succumbed during the crisis. If you have a story to share, please contact us here.

With each passing day, scientists are learning more about the coronavirus. Some news from this week includes a link between obesity and severe cases, as well as good news for asthma patients.

And as the coronavirus upends some ironclad medical traditions, doctors talk about what they wished they’d known about how the illness presents a month ago.

In an extremely grim snapshot of the devastation that’s hitting nursing homes across the country, an investigation following an anonymous tip found a makeshift morgue in one New Jersey facility that was housing 17 bodies.

I hate to leave you on that terrible note, so have a picture of three extremely adorable KHN dogs that will surely brighten your day, if only a little. Have a restful and safe weekend!

"Of course the different numbers cause people from the variety of factions to respond differently; “it’s working” or “see this is overblown” or “big numbers are alarmist.”" 

Making Sense of the Various Coronavirus Death Toll Projections || by Andy Slavitt, former head of the Centers for Medicare and Medicaid Services   https://twitter.com/ASlavitt   .......Read more 

The coronavirus stimulus package Congress rushed out last week to help the nation’s hospitals and health care networks hands the industry billions of dollars in windfall subsidies and other spending that has little to do with defeating the COVID-19 pandemic.

The $2 trillion legislation, which President Donald Trump signed Friday, includes more than $100 billion in emergency funds to compensate hospitals and other health care providers for lost revenue and other costs associated with COVID-19. The measure also calls for spending up to $16 billion to replenish the nation’s depleted stockpile of medical gear, such as ventilators, medicines and personal protective equipment, or PPE.

But health care businesses will get billions of dollars in additional funding not directly related to the pandemic, in some cases because Congress agreed to reverse scheduled cuts in the rates paid by Medicaid and Medicare, which the federal government had tried for years to impose.

“Anything that could tangentially be related to the crisis lobbyists tried to get stuffed in this bill ― particularly health-care-related items,” said Steve Ellis, vice president of Taxpayers for Common Sense, a nonpartisan watchdog group. While the stimulus package is “not as big” a “Christmas tree” as some other bills, Ellis said, “I’m sure we’ll find a few baubles and gifts along the way.”

Hospitals have won widespread praise as their doctors and other medical staffs labor under perilous conditions, including shortages of protective gear. And, perhaps not surprisingly, the industry emerged as a big winner in the stimulus negotiations. Not only can hospitals draw on the $100 billion fund to stem their losses and cover other costs, but they will also see a boost in one stream of revenue as Congress overturned some planned rate cuts.

More than 3,000 hospitals that treat outsize numbers of Medicaid or uninsured patients, for instance, will share in an $8 billion windfall through the stimulus provision that reverses cuts in their Medicaid payments for 2020 and 2021.

Separately, hospitals will rake in at least $3 billion more because of a temporary suspension of a 2% cut in Medicare fees, according to the Federation of American Hospitals, which represents more than 1,000 for-profit hospitals and health systems. The infusion of cash also benefits doctors, nursing homes, home health companies and others.

“That’s welcome news during this time of crisis,” said Joanne Cunningham, executive director of the Partnership for Quality Home Healthcare.

Also tucked into the stimulus: a rollback of planned rate cuts to clinical laboratories and some medical equipment suppliers.

At this stage, it is unclear how much these measures will add to the COVID-19 tab ― or if far more stimulus would be required for the health care industry to rebound.

Take the 2% rate cut known as “the sequester.” The Office of Management and Budget expected it would save Medicare $16.2 billion in fiscal 2021. But the stimulus bill rescinds that rate cut from May 1 through the end of this year. As part of the legislation, Congress said it would, in effect, recoup the payments later by adding another year to the sequester. Whether lawmakers will follow through on that is anyone’s guess.

Anders Gilberg, senior vice president of government affairs for the Medical Group Management Association (MGMA), expects the sequester relief to translate to a “huge” financial boost for more than 15,000 medical practices his group represents.

“This would never have been done under any other circumstances,” Gilberg said. “The situation was recognized as dire.”

Dr. Patrice Harris, president of the American Medical Association, said the stimulus offers “needed financial relief to hard-hit workers, health systems and physician practices. At this critical moment, physician practices need significant financial support to sustain themselves and continue to meet the health care needs of all Americans during this time.”

Similarly, American Hospital Association CEO Rick Pollack called the legislation “an important first step forward. But, he added, “more will need to be done to deal with the unprecedented challenge of this virus.”

In a nod to clinical laboratories, which have helped bail out the federal government’s early failure to supply enough COVID-19 tests, the stimulus delayed planned rate cuts in 2021 likely to amount to tens of millions of dollars in revenue. Medicare officials have been at odds with the lab industry for years over rates for lab tests.

While other health care interests praised the bill, the laboratory trade association said it comes up short.

Just before the Senate passed the stimulus bill Wednesday, American Clinical Laboratory Association President Julie Khani slammed Congress for not designating funding to support labs. She said labs were in “an untenable situation, absorbing growing, uncompensated costs for testing specimens with no assurance that they will be appropriately or fairly reimbursed for all the tests they are performing.”

She added a not-so-veiled threat, saying: “If Congress fails to designate essential emergency funding for clinical laboratories to support our efforts, labs will be soon be forced to make difficult decisions about whether they can keep building the [testing] capacity our nation needs.”

The lab association, in a statement to Kaiser Health News, said labs have absorbed “staggering” Medicare reimbursement cuts of as much as 30% for many common tests in recent years.

In public securities filings this year, lab giants Quest Diagnostics Inc. and Laboratory Corp of America Holdings, known as LabCorp, reported they expected rate cuts in 2020 totaling more than $150 million. LabCorp said it supported the views of the lab association. Quest did not respond to a request for comment.

While labs processing COVID-19 tests missed out on direct funding, they could be eligible for some of the $100 billion allocated for hospitals and other providers to cover their losses, congressional aides said.

And the stimulus measure states that even in the event a lab is out-of-network, health plans are expected to pay the price it sets — as long as the lab publishes that price online — or negotiate with the lab.

Given that laws in some states ban surprise billing in particular, this provision seems to favor the labs, said Katie Keith, a Georgetown University law professor and health policy expert. “No one just lets the provider set the price,” she said.

The lab association disputes that, saying that many health plans are expected to pay them less than the $51.50 government recommended for a COVID-19 test.

Just how the $100 billion in health care funding will be distributed and how much oversight will occur is another unknown.

Health and Human Services Secretary Alex Azar has the authority to decide how long the emergency provisions remain in effect. Tracking all that money will be a challenge as well.

Ellis, the taxpayer advocate, noted that no government agency “is ready to handle the rush of extra funding.” He said that the stimulus grants extra resources to inspector general offices to monitor spending.

“There will be waste, there will be abuse,” he said. “It’s about exposing and rooting it out.”

The HHS Office of Inspector General expects to receive $4 million to support this oversight, according to spokesman Donald White.

Some groups aren’t waiting to compete over the $100 billion. The MGMA sent a letter March 27 to Azar and the Centers for Medicare & Medicaid Services chief Seema Verma asking for more direct help. Gilberg noted that some medical practices, such as doctors who perform colonoscopies, have not been able to continue their work.

“Doctors and physician practices are having a lot of trouble right now,” Gilberg said. “They are literally shut down, and they are having financial troubles. Their operations have come to a full halt.”

KHN correspondents Rachana Pradhan and Emmarie Huetteman contributed to this report.

A high-ranking federal official in late February warned that the United States needed to plan for not having enough personal protective equipment for medical workers as they began to battle the novel coronavirus, according to internal emails obtained by Kaiser Health News.

The messages provide a sharp contrast to President Donald Trump’s statements at the time that the threat the coronavirus posed to the American public remained “very low.” In fact, concerns were already mounting, the emails show, that medical workers and first responders would not have enough masks, gloves, face shields and other supplies, known as PPE, to protect themselves against infection when treating COVID-19 patients.

The emails, part of a lengthy chain titled “Red Dawn Breaking Bad,” includes senior officials across the Department of Veterans Affairs, the State Department, the Department of Homeland Security and the Department of Health and Human Services, as well as outside academics and some state health officials. KHN obtained the correspondence through a public records request in King County, Washington, where officials struggled as the virus set upon a nursing home in the Seattle area, eventually killing 37 people. It was the scene of the first major outbreak in the nation.

“We should plan assuming we won’t have enough PPE — so need to change the battlefield and how we envision or even define the front lines,” Dr. Carter Mecher, a physician and senior medical adviser at the Department of Veterans Affairs, wrote on Feb. 25. It would be weeks before front-line health workers would take to social media with the hashtag #GetMePPE and before health systems would appeal to the public to donate protective gear.

In the email, Mecher said confirmed-positive patients should be categorized under two groups with different care models for each: those with mild symptoms should be encouraged to stay home under self-isolation, while more serious patients should go to hospital emergency rooms.

“The demand is rising and there is no guarantee that we can continue with the supply since the supply-chain has been disrupted,” Eva Lee, director of the Center for Operations Research in Medicine and HealthCare at Georgia Tech and a former health scientist at the Atlanta VA Medical Center, wrote that same day citing shortages of personal protective equipment and medical supplies. “I do not know if we have enough resources to protect all frontline providers.”

Reached on Saturday, Lee said she isn’t sure who saw the message trail but “what I want is that we take action because at the end of the day we need to save patients and health care workers.”

Mecher, also reached Saturday, said the emails were an “an informal group of us who have known each other for years exchanging information.” He said concerns aired at the time on medical protective gear were top of mind for most people in health care. More than 35 people were on the email chain, many of them high-ranking government officials.

The same day Mecher and others raised the concern in the messages, Trump made remarks to a business roundtable group in New Delhi, India.

“We think we’re in very good shape in the United States,” he said, noting that the U.S. closed the borders to some areas. “Let’s just say we’re fortunate so far.  And we think it’s going to remain that way.”

The White House declined to comment. In a statement, VA press secretary Christina Mandreucci said, “All VA facilities are equipped with essential items and supplies to handle additional coronavirus cases, and the department is continually monitoring the status of those items to ensure a robust supply chain.”

Doctors and other front-line medical workers in the weeks since have escalated concerns about shortages of medical gear, voicing alarm about the need to protect themselves, their families and patients against COVID-19, which as of Saturday evening had sickened more than 121,000 in the United States and killed at least 2,000.

As Mecher and others sent emails about growing PPE concerns, HHS Secretary Alex Azar testified to lawmakers that the U.S. had 30 million N95 respirator masks stockpiled but needed 300 million to combat the outbreak. Some senior U.S. government officials were also warning the public to not buy masks for themselves to conserve the supply for health care providers.

U.S. Surgeon General Jerome Adams tweeted on Feb. 29: “Seriously people – STOP BUYING MASKS!  They are NOT effective in preventing general public from catching #Coronavirus, but if healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!”

Still, on Feb. 27, the FDA in a statement said that officials were not aware of widespread shortages of equipment.

“We are aware of reports from CDC and other U.S. partners of increased ordering of a range of human medical products through distributors as some healthcare facilities in the U.S. are preparing for potential needs if the outbreak becomes severe,” the agency said.

Simultaneously, Trump downplayed the risk of the novel coronavirus to the American public even though the Centers for Disease Control and Prevention was warning it was only a matter of time before it would spread across the country. On Feb. 29, the CDC also updated its strategies for health workers to optimize supplies of N95 masks.

An HHS spokesperson said Saturday the department has been in “an all-out effort to mobilize America’s capacity” for personal protective equipment and other supplies, including allowing the use of industrial N95 respirators in health care settings and awarding contracts to several private manufacturers to buy roughly 600 million masks over the next 18 months.

“Health care supply chains are private-sector-driven,” the spokesperson said. “The federal role is to support that work, coordinate information across the industry and with state or local agencies if needed during emergencies, and drive manufacturing demand as best we can.”

The emails from King County officials and others in Washington state also show growing concern about the exposure of health care workers to the virus, as well as a view into local officials’ attempts to get help from the CDC.

In one instance, local medical leaders were alarmed that paramedics and other emergency personnel were possibly exposed after encountering confirmed-positive patients at the Life Care Center of Kirkland, the Seattle-area nursing home where roughly three dozen people have died because of the virus.

“We are having a very serious challenge related to hospital exposures and impact on the health care system,” Dr. Jeff Duchin, the public health officer for Seattle and King County, wrote in a different email to CDC officials March 1. Duchin pleaded for a field team to test exposed health care workers and additional support.

Duchin’s email came hours after a physician at UW Medicine wrote about being “very concerned” about exposed workers at multiple hospitals and their attempts to isolate infected workers.

“I suspect that we will not be able to follow current CDC [recommendations] for exposed HCWs [health care workers] either,” wrote Dr. John Lynch, medical director of employee health for Harborview Medical Center and associate professor of Medicine and Allergy and Infectious Diseases at the University of Washington. “As you migh [sic] imagine, I am very concerned about the hospitals at this point.”

Those concerns have been underscored with an unusual weekend statement from Dr. Patrice Harris, president of the American Medical Association, which represents doctors, calling on Saturday for more coordination of needed medical supplies.

“At this critical moment, a unified effort is urgently needed to identify gaps in the supply of and lack of access to PPE necessary to fight COVID-19,” the statement says. “Physicians stand ready to provide urgent medical care on the front lines in a pandemic crisis. But their need for protective gear is equally urgent and necessary.”

"From normal life to this hell in a week”: A man on losing his partner to the Coronavirus.
 https://www.washingtonpost.com/people/eli-saslow/

"Close down group meals for seniors. Cancel social gatherings."

The directive, from the Illinois Department on Aging, sent shock waves through senior service organizations late last week.

Overnight, Area Agencies on Aging had to figure out how to help people in their homes instead of at sites where they mingle and get various types of assistance.

This is the new reality as the COVID-19 virus barrels into communities across America. Older adults — the demographic group most at risk of dying if they become ill ― are being warned against going out and risking contagion. And programs that serve this population are struggling to ensure that seniors who live in the community, especially those who are sick and frail, aren’t neglected.

This vulnerable population far outstrips a group that has received more attention: older adults in nursing homes. In the U.S., only 1.4 million seniors reside in these institutions; by contrast, about 47 million older adults are aging in place. An additional 812,000 seniors make their homes at assisted living facilities.

While some of these seniors are relatively healthy, a significant portion of them are not. Outside of nursing homes, 15% of America’s 65-and-older population (more than 7 million seniors) is frail, a condition that greatly reduces their ability to cope with even minor medical setbacks. Sixty percent have at least two chronic conditions, such as heart disease, lung disease or diabetes, that raise the chance that the coronavirus could kill them.

But the virus is far from the only threat older adults face. The specter of hunger and malnutrition looms, as sites serving group meals shut down and seniors are unable or afraid to go out and shop for groceries. An estimated 5.5 million older adults were considered “food insecure” — without consistent access to sufficient healthy food ― even before this crisis.

As the health care system becomes preoccupied with the new coronavirus, non-urgent doctors’ visits are being canceled. Older adults who otherwise might have had chronic illness checkups may now deteriorate at home, unnoticed. If they don’t go out, their mobility could become compromised — a risk for decline.

Furthermore, if older adults stop seeing people regularly, isolation and loneliness could set in, generating stress and undermining their ability to cope. And if paid companions and home health aides become ill, quarantined or unable to work because they need to care for children whose schools have closed, older adults could be left without needed care.

Yet government agencies have not issued detailed guidance about how to protect these at-risk seniors amid the threat of the COVID-19 virus.

“I’m very disappointed and surprised at the lack of focus by the CDC in specifically addressing the needs of these high-risk patients,” said Dr. Carla Perissinotto, associate chief for geriatrics clinical programs at the University of California-San Francisco, referring to the Centers for Disease Control and Protection.

In this vacuum, programs that serve vulnerable seniors are scrambling to adjust and minimize potential damage.

Meals on Wheels America CEO Ellie Hollander said “we have grave concerns” as senior centers and group dining sites serving hot meals to millions of at-risk older adults close. “The demand for home-delivered meals is going to increase exponentially,” she predicted.

That presents a host of challenges. How will transportation be arranged, and who will deliver the meals? About two-thirds of the volunteers that Meals on Wheels depends on are age 60 or older ― the age group now being told to limit contact with other people as much as possible.

In suburban Cook County just outside Chicago, AgeOptions, an Area Agency on Aging that serves 172,000 older adults, on Thursday shuttered 36 dining sites, 21 memory cafes for people with dementia and their caregivers, and programs at 30 libraries after the Illinois Department on Aging recommended that all such gatherings be suspended.

Older adults who depend on a hot breakfast, lunch or dinner “were met at their cars with packaged meals” and sent home instead of having a chance to sit with friends and socialize, said Diane Slezak, AgeOptions president. The agency is scrambling to figure out how to provide meals for pickup or bring them to people’s homes.

With Mather, another Illinois organization focused on seniors, AgeOptions plans to expand “Telephone Topics” — a call-in program featuring group discussions, lectures, meditation classes and live performances — for seniors now confined at home and at risk of social isolation.

In New York City, Mount Sinai at Home every day serves about 1,200 older adults who are homebound with serious illnesses and disabilities — an extraordinarily vulnerable group. A major concern is what will happen to clients if home care workers become sick with the coronavirus, are quarantined or are unable to show up for work because they have to care for family members, said Dr. Linda DeCherrie, Mount Sinai at Home’s clinical director and a professor of geriatrics at Mount Sinai Health System.

With that in mind, DeCherrie and her colleagues are checking with every patient on the program’s roster, evaluating how much help the person is getting and asking whether they know someone ― a son or daughter, a friend, a neighbor — who could step in if aides become unavailable. “We want to have those names and contact information ready,” she said.

If caregivers aren’t available, these frail, homebound patients could deteriorate rapidly. “We don’t want to take them to the hospital, if at all possible,” DeCherrie said. “The hospitals are going to be full and we don’t want to expose them to that environment.”

In San Francisco, UCSF’s Care at Home program serves about 400 similarly vulnerable older adults. “Testing [for the coronavirus] is even more of a problem for people who are homebound,” said Perissinotto, who oversees the program. And adequate protective equipment ― gloves, gowns, masks, eye shields — is extremely difficult to find for home-based providers, Perissinotto said, a concern voiced by other experts as well.

To the extent possible, UCSF program staff are trying to do video visits so they can assess whether patients are symptomatic ― feverish or coughing — before going out to their homes. But some patients don’t have the technology that makes that possible or aren’t comfortable using it. And others, with cognitive impairments who don’t have family at home, may not be able to respond appropriately.

At UCSF’s general medicine clinic, nonessential medical visits have been canceled. “I have a lot of older patients with chronic pain or diabetes who otherwise would come in for three-month visits,” said Dr. Anna Chodos, a geriatrician and assistant professor of medicine who practices in the clinic. “Now, I’m talking to them over the phone.”

“I’m less worried about people who can answer the phone and report on what they’re doing,” she said. “But I have a lot of older patients who are living alone with mild dementia, serious hearing issues and mobility impairments who can’t work their phones.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.