News, July 25th

COVID-19 means development setbacks for Mongolia: a UN Resident Coordinator’s blog

Mongolia has recorded very few cases of COVID-19, less than 300 as on date, despite its more than 4,000-kilometer porous border with China. However, the country faces a major economic impact from the pandemic, says Tapan Mishra, the UN Resident Coordinator in Mongolia.

The general picture of the COVID-19 situation in Mongolia is very positive. The Government of Mongolia closed all educational institutions including kindergartens, schools, and universities at the beginning of the year. It also introduced strict measures on social distancing, such as a ban on public gatherings, limiting public transportation, closing public spaces such as gyms, and making the wearing of masks in public compulsory. Travel has been very limited, including a complete ban on any international travel by road, rail, or air.

Mongolia has been very vulnerable to the pandemic, not only because of its physical proximity to China and Russia including close links and dependence for economic interests, but also due to its own inadequate health care system.

Despite these challenges, there has been no local transmission reported (cases have been limited to patients importing the virus), and I would say that the leadership of the country has dealt well with the pandemic.

Another factor that has helped in making Mongolia’s response a success story, is that the citizens of the country have diligently complied with the government’s directives and regulations. The requirements to wear masks, ensure good hygiene, such as frequent hand-washing, and physical distancing, have been seriously adhered to. Even during the Tsagaan Sar, the Mongolian Lunar New Year in February, they complied with government orders, and did not even visit their extended families and elders, which is a tradition for Mongolian families.

Several UN agencies are physically present in Mongolia, with more providing support from outside. In response to the COVID-19 crisis, the UN bodies came together under the leadership of the office of the Resident Coordinator, and we have been following the World Health Organization’s response plan, and the UN’s humanitarian and socio-economic response plans. This has involved setting up a socio-economic task force and identifying the needs and priorities of the most vulnerable people in Mongolian society.

The UN Country Team has utilized well the $1 Million UN Secretary-General’s COVID-19 Response and Recovery MPTF (multi-partner trust fund) allocation, for supporting the Government of Mongolia in improving the national testing capacity and have more supplies of personal protective equipment. We have been also supporting development of the digital learning curriculum to enhance the quality of online learning, as children have not been able to go to school for around six months.

We stand ready to support the Government in every possible way, from their health, humanitarian, and socio-economic response plans, to their longer-term economic recovery.

We do not know the full impact the pandemic is having yet, but we know it is significant. For instance, in the first quarter of 2020, the economy contracted by 10.7 per cent, and government revenue fell by 8.6 per cent year on year, whilst expenditure went up 19.3 per cent.

Mongolia has a large amount of debt, which means that there is an increased risk of defaulting on debt. According to the IMF, GDP is also expected to fall sharply to minus one per cent this year, down from 5.3 per cent in 2019.

To bolster the economy, the Government approved economic stimulus packages, worth over 10 percent of GDP, which included several measures to support vulnerable groups, including cash benefits; mortgages, consumer and business loan repayments were deferred; and the mortgage rate was reduced.

Unfortunately, it is highly likely that the pandemic will set back the progress we have been making in Mongolia. The Government took early, effective action against the spread of COVID-19, but the increased borrowing, amid an economy hit by reduced exports, means that it will be difficulty to recover from the socio-economic impacts of the crisis.

In collaboration with the IMF, World Bank, and other partners, we are conducting detailed studies to look at the real impacts, but we are also working with the Government of Mongolia to ensure that the recovery plans do not leave anyone behind.

I only hope that donors provide the funding that is needed to support the most vulnerable people in Mongolia and help to ensure that the post-pandemic recovery benefits all members of society.

France to test travelers from 16 COVID-19 high-risk countries

Starting from Aug. 1, France will impose COVID-19 tests on travelers arriving from 16 “red zone” countries where the coronavirus circulates rapidly, Prime Minister Jean Castex announced on Friday (July 24).

The French government planned “to reinforce sanitary security on borders” due to the high risk of epidemic resurgence, said Castex when visiting Charles-de-Gaulle airport in the north of Paris.

The 16 countries are the United States, Brazil, India, Algeria, Bahrain, Israel, South Africa, Kuwait, Qatar, the United Arab Emirates, Oman, Panama, Peru, Serbia, Turkey, and Madagascar.

The French border is closed to these countries. Therefore, the measure will only be applied to French citizens who live in these countries or travelers from these countries who have an established residence in France, Castex told reporters.

“We know that in a number of these countries, there is no testing strategy and that access to tests is difficult, so we have decided to generalize tests on arrival,” he said.

For Spain, the French border remains open but discussions between the two countries are underway to limit the traffic flow as much as possible, Castex added.

“Concerning the situation in Catalonia, which is witnessing deteriorated sanitary indicators, we strongly recommend French citizens to avoid going there until the health situation improves,” said the prime minister.

In France, “the viral circulation is clearly increasing with R (reproduction rate) at 1.3 and a daily number of new cases over 1,000,” warned the country’s Health Ministry.

“We have thus erased a good part of the progress that we had made in the first weeks of deconfinement,” it added.

As of Friday, France had registered 180,528 COVID-19 cases, including a single-day increase of 1,130, up from 1,062 a day before. Meanwhile, 30,192 people lost their lives to the virus, including 10 new deaths registered in the last 24 hours, showed the ministry data.

Since May 9 when the government started easing restrictive rules, 581 clusters have been identified, 215 of them still active. Eleven new clusters were detected in the past 24 hours.

Hurricane Hanna roars towards Covid-crippled Texas

Texas, already struggling with a surge in coronavirus cases, was bracing Saturday after storm Hanna strengthened into the first Atlantic hurricane of 2020, with meteorologists warning of heavy rain, storm surge and potentially life-threatening flash flooding.

The Category 1 storm, with wind speeds of around 75 miles per hour (120 kilometers per hour), strengthened to a hurricane overnight and is expected to make landfall by afternoon or early evening, the National Hurricane Center (NHC) said.

It could bring storm surge of up to five feet and as many as 18 inches of rain to parts of south Texas, the NHC said, warning of dangerous flash flooding.

Hanna was about 100 miles east south-east of Corpus Christi, Texas, at 7am local time (1200 GMT), and was moving west at about nine miles per hour, an NHC advisory said.

Expected to make a slight turn later in the day, it “should make landfall along the Texas coast within the hurricane warning area this afternoon or early this evening,” the advisory continued.

Storm warnings were already in effect along Texas’s Gulf Coast early on Saturday. In Corpus Christi, officials closed libraries and museums as the city braced for the storm, local media reported.

Hanna will roar ashore as Texas is already facing a huge surge in coronavirus infections, with officials instituting a state-wide mask mandate to try to curb the spread of the disease.

Iran vows to lodge complaint against U.S. fighter jets for “harassment” of passenger plane

The Civil Aviation Organization of Iran announced on Friday that it will lodge a complaint with the International Civil Aviation Organization (ICAO) over “harassment” of its passenger plane by two U.S. fighter jets over the Syrian airspace on Thursday.

In a statement, the Civil Aviation Organization of Iran urged the ICAO to immediately address the issue, which, it said, is “a clear violation of the international law and the aviation standards and regulations,” Press TV reported.

On Thursday evening, two U.S. fighter jets came close to an Iranian Beirut-bound passenger plane over Syrian airspace, which forced the pilot of Iran’s Mahan Air to change altitude to avoid collision, according to Iran’s state TV.

The Iranian plane had to dive and make a quick landing at the Beirut airport after U.S. warplanes blocked its passage, it said.

The Mahan Air aircraft, with over 150 passengers on board, was later landed safely in the Lebanese capital, but the incident caused the injury of several passengers, Iran’s state TV reported.

The plane flew back to Tehran after refueling.

Iranian Vice-President for Legal Affairs Laya Joneidi said on Friday that the “harassment of the passenger plane in a third country is a blatant violation of aviation security, and a breach of the freedom of the air for civil flights.”

The U.S. government is responsible for the fighter jets’ dangerous maneuvering, and Iran can legally pursue the issue at the ICAO and at the International Court of Justice, Joneidi was quoted as saying by Press TV.

Also, Iran’s Minister of Roads and Urban Development Mohammad Eslami described the U.S. jets’ move as an “act of terrorism.”

“Our passenger plane was moving at the international commercial flight route and corridor, and the American fighter jets’ threatening move was unlawful and inhumane,” said Eslami.

“The ICAO is expected to issue a statement against this inhumane move by the United States,” the Iranian minister said.

Besides, the Iranian Foreign Ministry announced that Iran will “take necessary political and legal measures” over the incident.

The incident is the first of its kind in Syria but it adds to the tensions between the U.S. and Iran, which have soared since 2018 when the U.S. President Donald Trump pulled Washington out of the landmark Iranian nuclear deal and reimposed unilateral sanctions against the energy and financial sectors of the Islamic republic.

Pepcid-COVID study raised red flags weeks after $21M grant

Two months after the Trump administration awarded 21 million to study whether a common heartburn drug was effective against COVID-19, government health officials raised serious concerns about patient safety and scientific integrity, according to internal documents obtained by The Associated Press.

The US Department of Health and Human Services outlined a long list of concerns in a June 8 letter, concluding there was a high probability that the companies doing the research would fail to honor the terms of the deal to assess famotidine, the active ingredient in Pepcid, as a coronavirus treatment.

The AP reported on Thursday that the contract with Florida-based Alchem Laboratories and its subcontractor, Northwell Health in New York, was the subject of ridicule by some government scientists who did not think the Pepcid study merited millions of federal research dollars.

A federal whistle blower, Dr Rick Bright, cited the contract as a key example of what he called unethical conduct by agency leadership in deciding how to spend taxpayer dollars to combat the coronavirus.

Despite the problems, the HHS office spearheading the federal response to the coronavirus crisis has not cancelled the contract. Northwell, the state’s largest health care provider, told AP earlier this week that the famotidine trial has been paused indefinitely because of a shortage of new COVID-19 patients in New York.

In the four-page cure notice, HHS raised a litany of red flags about the Pepcid trial, which delivers a large dose of famotidine intravenously to patients in the study. Among them: a lack of adequate documentation of good clinical practices related to ensuring patient safety.

HHS’s letter also said the researchers failed to implement a system to track harm to patients, lacked an independent data monitor to ensure the integrity of the trial’s findings and failed to provide government scientists overseeing the contract with proper Food and Drug Administration documentation.

These are very serious concerns and are most shocking in the lack of attention to possible safety risks for what is a very high dose of famotidine, far above the FDA-approved dosing parameters for its currently-approved uses, said Aaron Kesselheim, a Harvard Medical School professor who reviewed the HHS letter for the AP.

It would be unethical to run any clinical trial without a plan for tracking adverse events experienced by patients, he said, so that it can inform the decision about whether any benefits of the drug being studied that might be identified in the trial outweigh any risks. An HHS spokesperson did not immediately respond to a request seeking comment on the letters.

James Talton, Alchem’s president and CEO, in a June 19 response to the letter, told HHS that frequent changes in standards of care for patients required a redesign of the trial.

On April 14, the Trump administration signed the contract to test famotidine in COVID-19 patients in New York despite a lack of published data or studies to suggest heavy doses would be safe or effective against the novel coronavirus.

When government scientists learned of the hastily produced proposal to spend millions in federal funding on the research, they considered it laughable, according to Bright’s whistleblower complaint.

But the June letter from HHS would indicate that the trial was plagued by poor management from the start.

The manner in which the clinical trial has been conducted by the Alchem/Northwell team does not meet the standards specified (in) the contract and suggests a high probability that Alchem will be unable to meet the terms of the contract, the letter stated, noting that its purpose was to communicate the government’s concerns.

Robert Kaplan, a Stanford University medical professor and former associate director of the National Institutes of Health, said when HHS sends a cure notice about a clinical trial, it is a fairly serious step by the agency in voicing concerns that had been reached through consensus internally.

The (HHS) boards have the responsibility to stop the trial if there is a safety concern. They can also stop the trial for futility if it is unlikely to produce a significant benefit.

Critics, including Bright, who opposed funding the trial while director at HHS’ Biomedical Advanced Research and Development Authority, said the Pepcid project underscores the Trump administration’s disregard for science and anti-corruption rules – rules meant to protect taxpayer dollars from going to political cronies or funding projects that aren’t based on more rigorous science.

The government had very little data on which to base a funding decision about Pepcid and COVID-19, critics say; there was no high-grade research on famotidine’s coronavirus-fighting potential to underpin a clinical trial involving hundreds of patients.

Bright filed a complaint accusing a senior administration health official of rushing the deal through without the scientific oversight necessary for such a large federal award.

Alchem’s Talton outlined in his response to HHS how his company and Northwell had addressed the concerns.

The companies agreed to assign an independent medical monitor to audit all of the data produced by the trial, according to Talton.

The clinical trial is currently suspended, Talton wrote. I urge BARDA to continue the studies related to famotidine as a treatment for COVID-19 under (the contract).

Rapid City nursing homes with 13 coronavirus deaths have recent history of infection violations

Two Rapid City nursing homes with significant COVID-19 outbreaks are some of the worst-ranked facilities in the state and have a history of infection control violations, public records show.

Avantara Saint Cloud has seen 45 of 49 residents — or 92% — contract the virus as of Thursday, said Tatiana Johnson, regional director of operations at Legacy Healthcare, which operates the nursing homes. Eight of those residents have died while 32 have already recovered. Nineteen of 21 staff members infected with the virus have recovered.

At Avantara Arrowhead, 45 of 68 residents, or 66%, have had the virus. Five have died while 19 are recovered. Twenty-four staff members tested positive for the virus and 10 have recovered.

Both facilities have a history of infection control violations related to staff not following proper procedures for cleaning, disinfecting, hand washing, glove wearing and making sure residents are cleaned properly.

The most recent violation was found when the Department of Health inspected Arrowhead on June 9, after 15 residents and nine employees had already contracted the virus.

The inspector found staff failed to properly clean and disinfect shared equipment, insulin injection devices and the unit for residents who tested positive for the virus or were exposed but tested negative. A logbook said the unit had been cleaned nine out of nine mornings, two out of eight afternoon shifts, and none of the evening shifts. Staff also wore their N-95 masks outside of the building and then stored them in a paper bag inside their cars, which would have exposed them to heat.

“All residents are at risk for adverse effects related to failure to maintain an infection prevention and control program,” Arrowhead wrote in its plan of correction, which involved random audits and educating staff on proper cleaning, disinfecting and mask storage.

DOH spokesman Derrick Haskins said visits on July 14 and this week showed Arrowhead had addressed these issues.

An experienced certified nursing assistant who works at Saint Cloud says her facility could have better prepared for the pandemic.

“Things could have been done better from the beginning,” said the woman, who contracted COVID-19 and passed it on to relatives.

Saint Cloud is the fourth-lowest ranked of South Dakota’s 104 long-term care facilities that participate in Medicare and Medicaid. It also has Medicare’s lowest possible overall and health inspection ratings of “much below average.”

Arrowhead is the lowest-ranked facility in the state. It’s also the only one labeled a Special Focus Facility, which means it’s subject to frequent inspections and possible Medicare/Medicaid termination due to “a history of persistent poor quality of care.”

Arrowhead was designated a Special Focus Facility in August 2019 and is inspected every six months, Haskins said. Johnson said Arrowhead has graduated the program and is expected to be taken off the list.

“Avantara Saint Cloud and Avantara Arrowhead and their heroic staff have been on the front lines fighting against this unforgiving virus, protecting our residents, who are among some of the most vulnerable in our community,” she said.

Johnson said the nursing homes are unsure how the virus first entered their facilities but have and continue to take “full precautionary measures” based on guidance from the DOH, CDC, and Centers for Medicare and Medicaid.

The CNA was granted anonymity for this story because she fears retaliation for speaking out. The Journal has seen a photo of the woman in personal protective gear and a document confirming her job title and place of work.

The woman began working at Saint Cloud this year but has been a CNA for more than two decades. She said the nursing home has taken some steps to prevent the virus: no visitors are allowed, there have been at least four mass testing’s, and staff have their temperatures taken daily and wear personal protective equipment.

She said the first mass testing was in late May or early June and it took a week to learn the results. It turned out that one staff member — who was asymptomatic and continued to work — and two residents were positive. She said she’s not sure who provided the equipment, but it was Saint Cloud’s medical staff that did the testing.

Saint Cloud had a few cases at a time until late June or early July when “all of a sudden it was boom, boom, boom … it was all over the building,” the CNA said.

She said staff wore loose-fitting surgical masks until N-95 masks arrived on July 6 after about 20 residents were already infected. She said the facility still needs more masks so they can change them more often.

Staff who clean and disinfect areas need to do a better job, the CNA said. For example, she said rooms aren’t properly disinfected when a resident is moved to a different area after contracting the virus.

The CNA said she knows three staff members who had high temperatures when they arrived at work, but instead of leaving they took their temperature again after 30 minutes and wrote down the new, lower one. She said staff who miss work because they develop symptoms, or a confirmed case of the virus have to use their saved paid time off.

She said Saint Cloud’s residents are “very susceptible” to the virus and since they all have Alzheimer’s or other forms of dementia many do not understand the pandemic and continue walking into the hallways and each other’s rooms.

The CNA said she’s considering looking for work elsewhere even though she is well paid.

“Is that money worth my health? No.” ​

Legacy Healthcare operates Arrowhead, Saint Cloud and 16 other long-term care facilities in South Dakota, according to its website. They are owned by Cascade Capital Group and both for-profit companies are based in a Chicago suburb. Legacy Healthcare operates 52 facilities, mostly in Illinois and South Dakota but also in Montana and Utah.

Cascade says it bought 16 of its South Dakota facilities in July 2019. The nursing homes were previously operated by Skyline Health Care.

Legacy took over “a struggling operator who had previous issues with clinical results and public health violations resulting in subpar Medicare ratings,” Johnson said. “While this posed some challenges at first, our selfless staff have been instrumental in improving many different facets of the facilities, which has created many positive results in the last year.”

Arrowhead was labeled a Special Focus Facility a month after Legacy took over and all but one of the inspections reviewed by the Journal occurred after Legacy became the operator. The company’s South Dakota facilities range from low-ranking ones like Arrowhead and Saint Cloud to ones rated by Medicare as “much above average.”

Johnson said Arrowhead and Saint Cloud have worked to prevent the virus by not allowing visitors, stopping group meals and activities, and following masking and social distancing when possible. She said staff are screened for symptoms each day and have proper Personal Protective Equipment. Both nursing homes voluntarily mass tested all residents and staff with help from local and state health departments, Johnson added.

Haskins said the department has been holding weekly calls, providing Personal Protective Equipment, and conducted 18,598 mass tests of staff and residents at long-term care facilities. The facilities are also conducting random testing of staff and residents each week.

During the pandemic, the DOH has conducted 145 infection control inspections at all 104 South Dakota long-term care facilities that use Medicare and Medicaid, Haskins said. The department does an extra inspection and provides daily check-ins facilities after a resident develops the virus.

Nursing homes that are part of Medicare and Medicaid programs are inspected once a year for re-certification and more often if there is a complaint or they are a Special Focus Facility, according to Medicare’s “Nursing Home Compare” website. The inspections are conducted by trained inspectors and at least one nurse with the South Dakota Department of Health on behalf of the federal government.

The inspectors note any violations and the facility must explain how they will correct them within a certain amount of time, Haskins said. Medicare then gives ratings for health inspections, staffing and quality of resident care by using a five-star system ranging from “much below average” to “much above average.” Those three ratings are used to determine the overall rating.

Medicare gave Saint Cloud its lowest ranking — one star or “much below average” — for its overall and health inspection ratings during its September 2019 annual inspection. It was ranked average for staffing and above average for quality of resident care.

Saint Cloud, which used to be called Bella Vista, was fined $19,321 after being cited for 14 health violations. South Dakota facilities have an average of 3.5 health deficiencies while U.S. ones have an average of 8.2, Medicare says.

One infection prevention issue was a dirty salon/spa area, including dirty toilets. Inspectors saw a staff member fail to properly clean a different shower area. Some staff members did not follow proper hand/glove hygiene for themselves and sanitation for residents while cleaning residents after they went to the bathroom.

Saint Cloud said it re-educated staff on disinfecting these areas, hand/glove hygiene, bathroom hygiene and infection control.

DOH staff inspected Saint Cloud in March 2020 after a complaint about resident safety related to falls and infection control but found the facility was following all rules. They inspected the facility in April and on June 17 and found it was following infection procedure and was prepared for the coronavirus pandemic.

Arrowhead, which used to be called Meadowbrook, specializes in caring for people in need of medical and rehabilitative treatment. It has no Medicare rankings due to its Special Focus Facility status.

Inspections show that Arrowhead has yo-yoed in its preparedness for infections and the coronavirus since March.

DOH staff found Arrowhead was following infection and coronavirus protocols during a visit this week and on July 14, Haskins said. Those visits came after staff found the facility wasn’t following infection rules during the June 9 visit.

Federal inspectors previously found the facility implemented COVID-19 practices and was following infection control regulations during an April 23 visit, Haskins said. But that visit came after a March 12 visit in which inspectors found the facility was not meeting professional or infection standards.

Inspectors found some staff failed to properly care for incontinent patients and follow medical procedures. They also found some staff failed to properly disinfect a whirlpool tub and follow hand hygiene and glove use rules, including while caring for a patient with a contagious infection.

The inspectors also found Arrowhead was violating a South Dakota law that says new employees must be evaluated for vaccines and contagious diseases within 14 days of being hired.

Arrowhead said it would remedy the problems in the April 23 and June 9 inspections by educating staff and conducting audits.

But those weren’t the first time the facility had violations it said would be remedied through training and audits. DOH staff also found violations — including infection control ones related to hand/glove hygiene and disinfection — during inspections in January, September, and December 2019.

Arrowhead was fined $6,805 in January 2019 after inspectors found 13 health deficiencies.

Published by jim

Curator of things...

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