COVID Vaccines Appear Safe and Effective, but Key Questions Remain

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The recent rollout of two newly authorized COVID-19 vaccines is a bright ray of hope at the pandemic’s darkest hour.

We now have a path that can lead us to happier times — even as we watch and suffer from the horrible onslaught of new infections, hospitalizations and deaths that mark the end of this regrettable year.

Health care workers and nursing home residents have already begun to get shots in the first phase of the rollout. Vaccinations should start to be available to the general public sometime in the first few months of next year.

The two vaccines — one developed by Pfizer and BioNTech, the other by Moderna — use the same novel genetic approach. Their development in under a year, shattering all records, is a marvel of science. It’s also a cause for concern for millions of Americans who fear the uncertainty of an unknown technology.

The clinical trial data for the Pfizer and Moderna vaccines show that when both shots of the dual-injection immunization are taken, three weeks to a month apart, they are about 95% effective — at least at preventing severe COVID illness.

However, “a vaccine that remains in the vial is 0% effective no matter what the data show,” says Dr. Walter Orenstein, a professor of infectious diseases at the Emory University School of Medicine in Atlanta and associate director of the Emory Vaccine Center.

Hence, the imperative of persuading millions of people, across racial, cultural, religious, political and generational lines, to get immunized when a vaccine becomes available to them. A survey published this month showed 45% of respondents are taking a wait-and-see approach to vaccination.

Because the vaccines were developed under duress as the coronavirus exacted its deadly toll, the premium was on speed — “warp speed.” So although the number of people in the trials is as large as or larger than in previous vaccine trials, some key questions won’t be answered until millions more are vaccinated.

For example, we don’t know to what extent the vaccines will keep us from transmitting or contracting the virus — though the protection from potentially fatal illness they are likely to confer is in itself something of a miracle.

We don’t know whether irreversible side effects might emerge, or who is at higher risk from them. And we don’t know whether we’ll need to get vaccinated every year, every three years, or never again.

These unknowns add to the challenges faced by the federal government, local health authorities, medical professionals and private sector entities as they seek to persuade people across the broadest possible swath of the population to get a vaccine.

Skepticism resides in many quarters, including among African Americans, many of whom have a long-standing mistrust of the medical world; the vocal “anti-vaxxers”; and people of all stripes with perfectly understandable doubts. Not to mention communities with language barriers and immigrants without documents — more than 2 million strong in California — who may fear coming forward.

Here are answers to some questions you might be asking yourself about the new vaccines:

Q: How can I be sure they’re safe?

There’s no ironclad guarantee. But the federal Food and Drug Administration, in authorizing the Moderna and Pfizer vaccines, determined that their benefits outweighed their risks.

The side effects observed in trial participants were common to other vaccines: pain at the injection site, fatigue, headache, muscle pain and chills. “Those are minor side effects, and the benefit is not dying from this disease,” says Dr. George Rutherford, a professor of epidemiology at the University of California-San Francisco.

Saturday, the Centers for Disease Control and Prevention reported six cases of anaphylactic allergic reaction in the first 272,000 people who got the Pfizer vaccine outside the clinical trials. This has led the CDC to recommend that people receiving the vaccine be observed for up to 30 minutes afterward.

It’s possible other unexpected adverse effects could pop up down the road. “The chances are low, but they are not zero,” says Orenstein. There’s not enough data yet to know if the vaccines pose an elevated risk to pregnant or lactating women, for example, or to immunocompromised people, such as those with HIV. And we know very little about the effects in children, who were not in the initial trials and for whom the vaccines are not authorized.

Q: Why should my family and I take it?

First of all, because you will protect yourselves from the possibility of severe illness or even death. Also, by getting vaccinated you will be doing your part to achieve a vaccination rate high enough to end the pandemic. Nobody knows exactly what percentage of the population needs to get inoculated for that to happen, but infectious disease experts put the number somewhere between 60% and 70% — perhaps even a little higher. Think of it as a civic duty to get your shots.

Q: So, when can I get mine?

It depends on your health status, age and work. In the first phase, already underway, health care workers and nursing home residents are getting vaccinated. The 40 million Moderna and Pfizer doses expected to be available by year’s end should immunize most of them.

Next in line are people 75 and older and essential workers in various public-facing jobs. They will be followed by people ages 65-74 and those under 65 with certain medical conditions that put them at high risk. Enough vaccine could be available for the rest of the population by late spring, but summer or even fall is more likely. Already, some distribution bottlenecks have developed.

On the bright side, two other vaccines — one from Johnson & Johnson, the other from AstraZeneca and Oxford University — could win FDA authorization early next year, significantly increasing the supply.

Q: Once I’m vaccinated, can I finally stop wearing a mask and physical distancing?

No. Especially not early on, before a lot of people have been vaccinated. One reason for that is self-protection. The Moderna and Pfizer vaccines are 95% effective, but that means you still have a 5% chance of falling ill if you are exposed to someone who hasn’t been vaccinated — or who has been but is still transmitting the virus.

Another reason is to protect others, since you could be the one shedding virus despite the vaccination.

Q: I’ve already had COVID-19, so I don’t need the vaccine, right?

We don’t know for sure how long exposure to the virus protects you from reinfection. Protection probably lasts at least a few months, but public health experts say it’s a good idea to get vaccinated when your turn comes up — especially if it’s been many months since you tested positive.

There’s been some talk among health officials of pushing those who’ve been infected in the last 90 days or so toward the back of the line, to ensure adequate supply for those who might be at higher risk.

Q: How long before our lives get back to normal?

“If everything goes well, next Thanksgiving might be near normal, and we might be getting close to that by the summer,” says Dr. William Schaffner, a professor of infectious diseases at the Vanderbilt University School of Medicine in Nashville, Tennessee. ”But there would have to be substantial acceptance of the vaccine and data showing the virus moving in a downward direction.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

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.

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Medicare Open Enrollment Is Complicated. Here’s How to Get Good Advice.

If you’ve been watching TV lately, you may have seen actor Danny Glover or Joe Namath, the 77-year-old NFL legend, urging you to call an 800 number to get fabulous extra benefits from Medicare.

There are plenty of other Medicare ads, too, many set against a red-white-and-blue background meant to suggest officialdom — though if you stand about a foot from the television screen, you might see the fine print saying they are not endorsed by any government agency.

Rather, they are health insurance agents aggressively vying for a piece of a lucrative market.

This is what Medicare’s annual enrollment period has come to. Beneficiaries — people who are 65 or older, or with long-term disabilities — have until Dec. 7 to join, switch or drop health or drug plans, which take effect Jan. 1. By switching plans, they can potentially save money or get benefits not ordinarily provided by the federal insurance program.

For all its complexity and nearly endless options, Medicare fundamentally boils down to two choices: traditional fee-for-service or the managed care approach of Medicare Advantage.

The right choice for you depends on your financial wherewithal and current health status, and on future health scenarios that are often difficult to foresee and unpleasant to contemplate.

Costs and benefits among the multitude of competing Medicare plans vary widely, and the maze of rules and other details can be overwhelming. Indeed, information overload is part of the reason a majority of the more than 60 million people on Medicare, including over 6 million in California, do not comparison-shop or switch to more suitable plans.

“I’ve been doing it for 33 years and my head still spins,” says Jill Selby, corporate vice president of strategic initiatives and product development at SCAN, a Long Beach nonprofit that is one of California’s largest purveyors of Medicare managed care, known as Medicare Advantage. “It’s definitely a college course.”

Which explains why airwaves and mailboxes are jammed with all that promotional material from people offering to help you pass the course.

Many are touting Medicare Advantage, which is administered by private health insurers. It might save you money, but not necessarily, and research suggests that, in some cases, it costs the government more than administering traditional Medicare.

But the hard marketing is not necessarily a sign of bad faith. Licensed insurance agents want the nice commission they get when they sign somebody up, but they can also provide valuable information on the bewildering nuances of Medicare.

Industry insiders and outside experts agree most people should not navigate Medicare alone. “It’s just too complicated for the average individual,” says Mark Diel, chief executive officer of California Coverage and Health Initiatives, a statewide association of local outreach and health care enrollment organizations.

However, if you decide to consult with an insurance agent, keep your antenna up. Ask people you trust to recommend agents, or try eHealth or another established online brokerage. Vet any agent you choose by asking questions on the phone.

“Be careful if you feel like the insurance agent is pushing you to make a decision,” says Andrew Shea, senior vice president of marketing at eHealth. And if in doubt, don’t hesitate to get a second opinion, Shea counsels.

You can also talk to a Medicare counselor through one of the State Health Insurance Assistance Programs, which are present in every state. Find your state’s SHIP at www.shiptacenter.org.

Medicare & You, a comprehensive handbook, is worth reading. Download it at the official Medicare website, www.medicare.gov.

The website offers a deep dive into all aspects of Medicare. If you type in your ZIP code, you can see and compare all the Medicare Advantage plans, supplemental insurance plans, known as Medigap, and stand-alone drug (Part D) plans.

The site also shows you quality ratings of the plans, on a five-star scale. And it will display your drug costs under each plan if you type in all your prescriptions. Explore the website before you talk to an insurance agent.

California Coverage and Health Initiatives can refer you to licensed insurance agents who will provide local advice and enrollment assistance. Call 833-720-2244. Its members specialize in helping people who are eligible for both Medicare and Medicaid, the health insurance program for low-income people.

These so-called dual eligibles — nearly 1.5 million in California and about 12 million nationwide — get additional benefits, and in some cases they don’t have to pay Medicare’s monthly medical (Part B) premium, which will be $148.50 in 2021 for most beneficiaries, but higher for people above certain income thresholds.

If you choose traditional Medicare, consider a Medigap supplement if you can afford it. Without it, you’re liable for 20% of your physician and outpatient costs and a hefty hospital deductible, with no cap on how much you pay out of your own pocket. If you need prescription drugs, you’ll probably want a Part D plan.

Medicare Advantage, by contrast, is a one-stop shop. It usually includes a drug benefit in addition to other Medicare benefits, with cost sharing for services and prescriptions that varies from plan to plan. Medicare Advantage plans typically have low to no premiums — aside from the Part B premium that most people pay in either version of Medicare. And they increasingly offer additional benefits, including vision, dental, transportation, meal deliveries and even coverage while traveling abroad.

Beware of the risks, however.

Yes, the traditional Medicare route is generally more expensive upfront if you want to be fully covered. That’s because you pay a monthly premium for a Medigap policy, which can cost $200 or more. Add to that the premium for Part D, estimated to average $41 a month in 2021, according to KFF. (KHN is an editorially independent program of KFF.)

However, Medigap policies will often protect you against large medical bills if you need lots of care.

In some cases, Medicare Advantage could end up being more expensive if you get seriously ill or injured, because copays can quickly add up. They are typically capped each year, but can still cost you thousands of dollars. Advantage plans also typically have more limited provider networks, and the extra benefits they offer can be subject to restrictions.

Over one-third of Medicare beneficiaries nationally are enrolled in Advantage plans. In California, about 40% are.

The main appeal of traditional Medicare is that it doesn’t have the rules and restrictions of managed care.

Dr. Mark Kalish, a retired psychiatrist in San Diego, says he opted for traditional fee-for-service with Medigap and Part D because he didn’t want a “mother may I” plan.

“I’m 69 years old, so heart attacks happen; cancer happens. I want to be able to pick my own doctor and go where I want,” Kalish says. “I’ve done well, so the money isn’t an issue for me.”

Be aware that if you don’t join a Medigap plan during a six-month open enrollment period that begins when you enroll in Medicare Part B, you could be denied coverage for a preexisting condition if you try to buy one later.

There are a few exceptions to that in federal law, and four states — New York, Massachusetts, Maine, Connecticut — require continuous or yearly access to Medigap coverage regardless of health status.

Make sure you understand the rules and exceptions that apply to you.

Indeed, that is an excellent rule of thumb for all Medicare beneficiaries. Read up and talk to insurance agents and Medicare counselors. Talk to friends, family members, your doctor, your health plan — and other health plans.

When it comes to Medicare, says Erin Trish, associate director of the University of Southern California’s Schaeffer Center for Health Policy and Economics, “it takes a village.”



This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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.

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It’s Open Enrollment. Here’s What You Need to Know

California’s annual health insurance enrollment season for individuals and families kicks off this week against a dramatic backdrop: the hotly contested presidential election; a pandemic raging out of control in much of the U.S.; and, on Nov. 10, a Supreme Court hearing of a case that could end the Affordable Care Act and strand millions without coverage.

The massive unemployment caused by the pandemic has already stripped employer-based health insurance from millions nationwide and induced severe financial anxiety as families struggle to pay rent and buy food.

One question hovering over enrollment for 2021 health plans is whether the large-scale loss of medical coverage will generate a surge of sign-ups, or if more pressing financial worries for many people will push insurance lower down their priority list.

“People have so many things to deal with: They’ve lost jobs, they’ve lost a lot of income, and in California they’re also facing fires. I don’t think health insurance has been top of mind for people,” says Cheryl Fish-Parcham, director of access initiatives at Families USA, a consumer health care advocacy organization.

But Peter Lee, executive director of Covered California, the state’s ACA marketplace, is confident it will match the 40% increase in new sign-ups it had for 2020 coverage.

“It is clear that COVID is on Californians’ minds,” he says. “You cannot have COVID on your mind without also having coverage on your mind.”

A Supreme Court decision on the future of the ACA probably won’t come until well into next year, and it is unlikely to affect your 2021 coverage. “So people should feel confident in looking for a health plan,” says Sara Collins, vice president for health care coverage and access at the Commonwealth Fund.

If you are 65 or older, you probably qualify for Medicare, the federal program for seniors, which is entirely separate from the ACA exchanges and broader individual market. Open enrollment for the private Medicare Advantage plans and Part D drug plans is also underway and ends Dec. 7. Insurance agents can usually help you with Medicare, and you can get advice by calling 1-800-434-0222.

If you are under 65, live in the Golden State and want to buy insurance for you and your family, start with Covered California. It’s the only place you can get federal and state assistance to cover some or all of your premiums.

The enrollment period for Covered California, and for the individual market outside the exchange, started Nov. 1 and runs through Jan. 31. In states whose exchanges are operated by the federal government, the enrollment window shuts Dec. 15.

If you lost coverage and need it for the month of December this year, you can still get it through Covered California if you sign up by Nov. 30. For regular annual coverage that starts Jan. 1, you must sign up by Dec. 15. If you miss that deadline, you can still get coverage starting Feb. 1 if you enroll by the final Jan. 31 deadline.

Many people leave money on the table because they aren’t aware of the financial assistance or think they earn too much to qualify. But you don’t need to be poor to get aid.

The federal subsidies, which are tax credits typically provided in the form of reduced monthly premiums, are available to individuals with annual income up to about $51,000 and a family of four with income up to nearly $105,000.

California has supplemented the federal aid with state-funded assistance that extends further into the middle class: up to around $76,500 for an individual and $157,000 for a family of four.

If you log on to Covered California’s website, www.coveredca.com, you can check how much financial help you qualify for and compare health plans. Or, an insurance agent or certified enroller can do the legwork work for you — at no charge. You can find one on the website. You can also call Covered California directly at 800-300-1506.

If your income is below 138% of the federal poverty level, you will probably qualify for Medi-Cal, the government insurance program for people of limited means. The Covered California website — or an enroller — will let you know if you do and walk you through signing up. You can also contact your county’s Medi-Cal office. If you don’t qualify for Medi-Cal, your children might, because the income threshold is higher for them.

If you are looking for exchange-sponsored coverage, click the “shop and compare” tab on the Covered California website, which takes you to a screen that asks your age, income, ZIP code and family size and shows the health plans available, their premiums and your aid amount.

The website also provides quality ratings of the participating health plans. And you can check for plans that have your doctors in their networks — though, as the website warns, that information is not always up to date.

Comparison shopping on the website is straightforward, because at each of the four levels of coverage — bronze, silver, gold and platinum — benefits are uniform from insurer to insurer. So once you’ve decided which metal tier is best for you, you only need to think about the price and whether your providers are in the network.

If you have a Covered California health plan already, shop around rather than automatically renew the one you’re in. “The best deal last year is not necessarily the best deal this year,” says Anthony Wright, executive director of Health Access California.

Covered California announced a 0.5% average statewide premium increase last month, but actual rate changes vary across the state and among carriers.

Anthem Blue Cross, for example, will hike rates by a statewide average of 6%, and the Oscar Health Plan of California by 7.6%, while Blue Shield of California will cut rates by an average of 2.4% and the L.A. Care Health Plan by 4.6%.

If you switch to the lowest-cost plan in your current metal tier, you could reduce your premium by as much as 7.4%, according to Covered California.

Keep in mind that the lowest premium, a bronze plan, is not necessarily the wisest — or cheapest — choice.

Tom Freker, a Huntington Beach insurance agent, counsels people not to buy bronze, because its higher deductibles and coinsurance rates could cost more than a higher-premium plan if you fall ill or have a serious accident.

Freker recommends you enroll in Covered California rather than the off-exchange market, even if you don’t initially qualify for aid. That’s because if your income drops and you report it to the exchange, you might then qualify and get a break on premiums for the rest of the year or a tax credit the following April, he says.

If your income rises during the year you also should report it, so your monthly premium subsidy is reduced, helping you avoid a potentially hefty tax bill come April.

Your initial aid amount, if you qualify, will be based on your projected 2021 income. In this period of pandemic-driven furloughs, slashed hours and job loss, that might be difficult to predict.

Maria Weston, a massage therapist in Long Beach, said her income has fluctuated week to week since the pandemic started and is down about 50% overall.

Her priority for 2021 was to find a less expensive option, so she switched to a cheaper silver plan last month (current enrollees were allowed to make their health plan choices starting Oct. 1).

Weston’s new health plan will save her nearly $1,700 a year on premiums. “I could put that in my retirement account — or eat,” she says. “One of the two.”



This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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.

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¿Estás internado? Todavía puedes votar en gran parte del país

Johnathon Talamantes se rompió la cadera en un accidente de auto el 22 de octubre y se sometió a una cirugía cinco días después en un hospital público cerca del centro de Los Angeles.

Talamantes tendrá que estar en el hospital del condado de LA USC Medical Center hasta pasadas las elecciones, algo que le preocupaba antes de la cirugía.

“Una de las primeras cosas que le pregunté a mi enfermera esa mañana fue: ‘Oh, ¿cómo voy a votar?’”, contó Talamantes, de 30 años, el día antes de la operación.

Primero le pidió a su mamá que buscara la boleta electoral que había recibido tiempo antes, como todos los votantes registrados de California para esta elección.

Pero el personal de LAC + USC le dio otra opción: podían ayudarlo a obtener una boleta de emergencia y emitir su voto sin tener que levantarse de la cama. Entonces Talamantes le dijo a su mamá que no se molestara.

“No quiero que ella venga aquí, por las restricciones de COVID”, dijo.

La ley de California protege los derechos de los votantes que se encuentran en el hospital u otras instalaciones de atención, o confinados en sus hogares. Les permite obtener ayuda de cualquier persona que elijan, que no sea un empleador o un representante sindical, y emitir un voto de emergencia.

Al menos otros 37 estados permiten la votación de emergencia por razones médicas, según la Conferencia Nacional de Legislaturas Estatales. Pero las prácticas varían.

En algunos, solo los miembros de la familia pueden ayudar a los pacientes hospitalizados a votar desde el hospital.

En California, Nueva York y varios otros estados, los empleados y voluntarios del hospital pueden ayudar a un paciente a completar una solicitud de boleta de emergencia. Pueden recoger la boleta del paciente y enviarla a la oficina electoral o depositarla en un buzón oficial.

Por el contrario, en Carolina del Norte, que un trabajador de salud ayude a un paciente a votar es un delito.

En 18 estados, la ley permite que las juntas electorales locales envíen representantes directamente a las cabeceras de los pacientes, aunque seis de esos estados cancelaron ese servicio este otoño debido a la pandemia de COVID-19, dijo el doctor Kelly Wong, fundadora de Patient Voting, un organización no partidista dedicada a aumentar la participación entre los votantes registrados hospitalizados inesperadamente durante la época de las elecciones.

El sitio web del grupo tiene un mapa interactivo de los Estados Unidos con información estado por estado sobre la votación en el hospital. También permite a los pacientes verificar si están registrados para votar.

Wong, residente de la sala de emergencias del Hospital de Rhode Island en Providence, recordó que cuando era estudiante de medicina y trabajaba en una sala de emergencias, los pacientes que estaban a punto de ser ingresados ​​en el hospital le decían: “No puedo estar internado, tengo que cuidar a mi perro o atender a mi abuela”. Luego, durante las elecciones de 2016, escuchó: “No puedo quedarme. Tengo que ir a votar”.

“Eso realmente me llamó la atención”, dijo Wong. Investigó y descubrió que los pacientes podían votar en el hospital mediante una boleta de emergencia, algo que ninguno de sus compañeros de trabajo sabía. “Nuestros pacientes no saben esto. Debería ser nuestro trabajo decírselo”, dijo.

Algunos hospitales han estado ayudando a los pacientes a votar en las elecciones principales durante dos décadas o más, como parte de una tendencia en la industria de la atención médica hacia el compromiso cívico.

Las clínicas comunitarias registran a los votantes en sus salas de espera o en campañas de registro público. En un número cada vez mayor de salas de emergencia, los pacientes y sus familias tienen la oportunidad de registrarse. Muchos hospitales, incluido LAC + USC, tendrán unidades de votación móviles este año, abiertas a los miembros del personal, a los pacientes que están lo suficientemente bien para caminar y a sus familias.

Estos esfuerzos tienen como telón de fondo el papel protagónico de la atención médica en el acalorado drama político de la nación: COVID-19 se ha convertido en un tema principal de la campaña presidencial, mientras que la Corte Suprema de los Estados Unidos, más conservadora desde esta semana, se prepara para escuchar un caso, una semana después de las elecciones, que podría ser la sentencia de muerte para la Ley del Cuidado de Salud a Bajo Precio (ACA).

La pandemia ha hecho que la votación para los pacientes internados sea un desafío debido a las estrictas restricciones en los hospitales y a los muchos empleados que han sido despedidos, cesanteados o que trabajan desde la casa. Y un aumento significativo en la votación adelatanda y el uso de boletas por correo en muchos estados puede reducir la cantidad de pacientes que necesitan ayuda.

“La mayoría de nuestros pacientes, espero, ya habrán votado, porque eso aliviará el estrés; para ellos, es una cosa menos de qué preocuparse”, dijo Camille Camello, directora asociada de servicios de voluntariado en las casi 900 camas del Cedars-Sinai Medical Center en Los Angeles, que tiene un programa para ayudar a los pacientes hospitalizados a votar. Dijo que, en elecciones pasadas, más de 200 pacientes solicitaron boletas.

En LAC + USC, los administradores han intentado asegurarse de que los pacientes sepan que pueden obtener ayuda para votar. Hay carteles en los espacios comunes y el personal está repartiendo volantes con información sobre las votaciones a cada paciente que ingresa, dijo Gabriela Hernández, directora de servicios voluntarios del hospital.

Hernández dijo que ella y unos 25 voluntarios han estado visitando las distintas unidades durante el último mes, preguntando a los pacientes si quieren ayuda para votar.

Los pacientes que dicen que sí reciben solicitudes de boleta de emergencia, que el hospital ha estado enviando al área de registro de votos condado del condado de Los Ángeles para verificación. Las solicitudes de boleta seguirán estando disponibles para los pacientes hasta la mañana del día de las elecciones.

Hernández y su equipo recogerán las boletas y las distribuirán a los pacientes, luego las devolverán al registro antes de las 8 pm, fecha límite el día de las elecciones.

Otros hospitales tienen una agenda más apretada.

En St. Jude Medical Center en Fullerton, California, el personal del hospital está preguntando a los pacientes el lunes 2 de noviembre si quieren asistencia para votar y les traerán boletas el día de las elecciones, dijo Gian Santos, gerente de servicios voluntarios en el hospital. En las elecciones de 2016, solo unos siete u ocho pacientes votaron de esa manera, agregó Santos.

El Hospital St. Joseph en Orange, California, planea hacer todo -solicitudes y boletas- el mismo día de las elecciones.

Para los grandes hospitales, la votación de pacientes hospitalizados puede ser una tarea enorme. Las personas a menudo necesitan asistencia en varios idiomas y los hospitales suelen contratar servicios de traducción.

Muchos hospitales reciben pacientes de numerosos condados y de otros estados.

El Hospital Lenox Hill en Manhattan planea ayudar hasta a 200 pacientes de nueve condados en el estado de Nueva York y tres en Nueva Jersey, dijo Erin Smith, enfermera especializada en obstetricia que, junto con su colega Lisa Schavrien, está liderando el esfuerzo.

El hospital asignará uno o dos “corredores” a cada una de las 12 juntas electorales del condado, dijo Smith. Para ella, hacer que los pacientes vulnerables puedan ejercer su derecho al voto merece el esfuerzo.

“Si no los ayudamos, ¿cuántas miles de personas no van a votar en las elecciones porque sufrieron un accidente automovilístico, tuvieron apendicitis, o una cirugía cerebral inesperada?”, se preguntó Smith.

“Si no lo hacemos en el hospital, es como negarles el voto a los votantes”.

Esta historia de KHN fue publicada primero en California Healthline, un servicio de la California Health Care Foundation.

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.

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Hospitalized? You Can Still Vote in Most Parts of the Country

Johnathon Talamantes, of South-Central Los Angeles, broke his hip in a car accident on Oct. 22 and underwent surgery five days later at a public hospital near downtown.

His post-op recovery will keep him in the hospital, L.A. County+USC Medical Center, beyond Election Day, and as he prepared himself for the surgery, he wondered what that would mean.

“One of the first things I asked my nurse this morning was, ‘Oh, how am I going to vote?’” Talamantes, 30, said from his hospital bed the day before the operation.

He initially thought of asking his mom to rummage through a pile of papers at the home he shares with her and bring him the mail-in ballot that he, like all registered California voters, received for this election.

But then staffers at LAC+USC told him about another option: They could help him get an emergency ballot and cast his vote without having to get out of bed. So Talamantes told his mom not to bother.

“I don’t want her coming down here, because of the COVID restrictions,” he said.

California law protects the rights of voters who are in the hospital or other care facilities, or confined at home. It allows them to get help from anyone they choose — other than an employer or a union representative — and to cast an emergency ballot.

At least 37 other states allow emergency voting for medical reasons, according to the National Conference of State Legislatures. But practices vary.

In some states, only family members can assist hospitalized patients with voting from the hospital.

In California, New York and several other states, hospital employees and volunteers can help a patient complete an emergency ballot application. They can pick up the ballot for the patient and deliver the finished ballot back to the election office or deposit it in an official drop box.

In North Carolina, by contrast, it is a felony for a health care worker to assist a patient with voting.

In 18 states, the law allows local election boards to send representatives directly to patients’ bedsides, though six of those states have canceled that service this fall because of the COVID-19 pandemic, said Dr. Kelly Wong, founder of Patient Voting, a nonpartisan organization dedicated to increasing turnout among registered voters unexpectedly hospitalized around election time.

The group’s website features an interactive map of the United States with state-by-state information on voting while in the hospital. It also allows patients to check whether they are registered to vote.

Wong, an emergency room resident at Rhode Island Hospital in Providence, recalled that when she was a medical student working in an ER, patients who were about to be admitted to the hospital would tell her, “‘I can’t be admitted; I have let the dogs out, or I’m the sole caretaker of my grandmother.’” Then during the election of 2016, she heard, “‘I can’t stay. I have to go vote.’”

“That really caught my attention,” Wong said. She did research and learned patients could vote in the hospital using an emergency ballot — something none of her co-workers knew. “Our patients don’t know this, she said. “It should be our job to tell them.”

Some U.S. hospitals have been assisting patients with voting in major elections for two decades or more, part of a broader tendency in the health care industry toward civic engagement.

Community clinics register voters in their waiting rooms or at public registration drives. In an increasing number of ERs, patients and their families are offered the chance to register. Many hospitals, including LAC+USC, this year will have mobile voting units on-site, open to staff members, patients who are well enough to walk, and their families.

These efforts come against the backdrop of health care’s starring role in the nation’s heated political drama: COVID-19 has become a top presidential campaign issue, while the U.S. Supreme Court, its conservative majority fortified this week, prepares to hear a case — one week after the election — that could be the death knell for the Affordable Care Act.

The pandemic has made inpatient voting a challenge because of tight restrictions at hospitals and the many employees furloughed, laid off or working at home. And a significant increase in early voting and the use of mail-in ballots in many states may reduce the number of patients who need help.

“The majority of our patients, I am hoping, will have voted already, because that will alleviate the stress — for them, it’s one less thing to worry about,” said Camille Camello, associate director of volunteer services at the nearly 900-bed Cedars-Sinai Medical Center in Los Angeles, which has a program to help inpatients vote. In past elections, she said, over 200 patients have requested ballots.

At LAC+USC, administrators have been trying to ensure patients know they can get help voting. Posters line the walls of common spaces and staffers are handing out flyers with voting information to every patient who is admitted, said Gabriela Hernandez, the hospital’s director of volunteer services.

Hernandez said she and about 25 volunteers have been walking the halls in the inpatient units of the hospital for the past month, asking patients if they want help voting.

Patients who say yes get emergency ballot applications, which the hospital has been sending to the L.A. County Registrar-Recorder for verification. The ballot applications will continue to be made available to patients up to the morning of Election Day.

Hernandez and her team will collect the ballots and distribute them to patients, then return them to the registrar before the 8 p.m. deadline on Election Day.

Other hospitals have a more collapsed timeline.

At St. Jude Medical Center in Fullerton, California, hospital staffers will start asking patients Monday if they want voting assistance and bring them ballots on Election Day, said Gian Santos, manager of volunteer services at the hospital. In the 2016 election, only about seven or eight patients voted that way, Santos said.

St. Joseph Hospital in Orange, California, plans to do everything — applications and ballots — on Election Day.

For big hospitals, inpatient voting can be a massive undertaking. People often require assistance in multiple languages, and the hospitals frequently contract with translation services to accommodate them.

Many hospitals receive patients from numerous counties — and across state lines.

Lenox Hill Hospital in Manhattan plans to assist as many as 200 patients from nine counties in New York state and three in New Jersey, said Erin Smith, an obstetrical nurse navigator who, along with fellow OB nurse navigator Lisa Schavrien, is leading the effort.

The hospital will assign one or two “runners” to each of the 12 county election boards, Smith said. For her, enabling vulnerable patients to exercise their right to vote is worth the effort.

“If we’re not helping them do it, how many thousands of people are not voting in elections because they were in a car accident, because they had appendicitis, because they had unexpected brain surgery?” Smith asked.

“If we’re not making it happen in the hospital, it kind of feels to me like voter suppression.”



This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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.

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Telemedicine or In-Person Visit? Pros and Cons

As COVID-19 took hold in March, U.S. doctors limited in-person appointments — and many patients avoided them — for fear of infection. The result was a huge increase in the volume of remote medical and behavioral health visits.

Doctors, hospitals and mental health providers across the country reported a 50- to 175-fold rise in the number of virtual visits, according to a report released in May by the consulting firm McKinsey & Co.

The COVID-fueled surge has tapered off as patients venture back to doctors’ offices. But medical professionals and health experts predict that when the pandemic is over, telehealth will still play a much larger role than before.

Studies show patient satisfaction with telehealth is high. And for physicians who previously were skeptical of remote care, necessity has been the mother of invention.

“There are still a few doubting Thomases, but now that we’ve run our practices this way for three months, people have learned that it’s pretty useful,” says Dr. Joseph Kvedar, president of the American Telemedicine Association and a practicing dermatologist who teaches at Harvard Medical School in Boston.

For patients, the advantages of telemedicine are clear: You typically can get an appointment sooner, in the safety of your own home or workplace, saving time and money on gas and parking — in some cases, even avoiding a loss in wages for missing work.

James Wolfrom, a 69-year-old retired postal executive in San Francisco, has had mostly virtual health care appointments since the pandemic started. He particularly appreciates the video visits.

“It’s just like I’m in the room with the doctor, with all of the benefits and none of the disadvantages of having to haul my body over to the facility,” says Wolfrom, who has Type 2 diabetes. “Even after the pandemic, I’m going to prefer doing the video conferencing over having to go there.”

Telemedicine also provides care for people in rural areas who live far from medical facilities.

The growth of virtual care has been facilitated by Medicare rule changes for the COVID-19 emergency, including one that reimburses doctors for telemedicine at the same rate as in-person care for an expanded list of services. State regulators and commercial health plans also loosened their telehealth policies.

In California, the Department of Managed Health Care, which regulates health plans covering the vast majority of the state’s insured residents, requires commercial plans and most Medi-Cal managed care plans during the pandemic to pay providers for telehealth at parity with regular appointments and limit cost sharing by patients to no more than what they would pay for in-person visits. Starting Jan. 1, a state law — AB-744 — will make that permanent for commercial plans.

Five other states — Delaware, Georgia, Hawaii, Minnesota and New Mexico — have pay-parity laws already in effect, according to Mei Wa Kwong, executive director of the Center for Connected Health Policy. Washington state has one that also will begin Jan. 1.

If you are planning a telehealth appointment, be sure to ask your health plan if it is covered and how much the copay or coinsurance will be. The appointment may be through your in-network provider or a telehealth company your insurer contracts with, such as Teladoc, Doctor On Demand or MD Live.

You can also contact one of those companies directly for a medical consultation if you don’t have insurance, and pay between $75 and $82 for a regular doctor visit.

If you are one of the 13 million Californians enrolled in Medi-Cal, the state’s Medicaid program, you can get telehealth services at little to no cost.

Large medical offices and health systems usually have their own telemedicine platforms. In other cases, your provider may use a publicly available platform such as FaceTime, Skype or Zoom. Either way, you will need access to a laptop, tablet or smartphone — though, for a phone conversation, a landline or simple cellphone will suffice.

Smartphones with good cameras can be particularly useful in telemedicine because high-resolution photos can help doctors see certain medical problems more clearly. For example, a photo from a good smartphone camera usually provides enough detail for a dermatologist to determine whether a mole requires further attention, Kvedar said.

Relatively inexpensive apps and at-home tools enable you to measure your own blood pressure, pulse rate, oxygen saturation level and blood sugar. It’s a good idea to monitor your vitals and have the numbers ready before you start a virtual visit.

Be aware that a remote visit is not right for every situation. In the case of serious injury, severe chest pain or a drug overdose, for example, you should call 911 or get to the ER as quickly as possible.

Virtual visits also are not recommended in other cases for which the doctor needs to lay hands on you.

Wolfrom has had only a few in-person health visits this year, one of them with a podiatrist who checks his feet every six to 12 months for diabetes-related neuropathy. “That can only be done when you are in the room and the podiatrist is touching and feeling your feet,” Wolfrom says.

Face-to-face visits are generally better for young children. Kids often require vaccinations, and it’s easier for doctors to monitor their growth and development in person, says Dr. Dan Vostrejs, a pediatrician at Santa Clara Valley Medical Center in San Jose.

In general, telemedicine is effective in cases that would typically send you to an urgent care clinic, such as minor injuries or flu-like symptoms, including fever, cough and sore throat.

It is also increasingly used for post-surgical follow-ups. Telemedicine can be a godsend for geriatric or disabled patients with reduced mobility. And it’s a no-brainer for mental health care, which is mostly talking anyway.

Among the top telehealth adopters are medical specialists who treat chronic illnesses such as diabetes, hypertension, cardiovascular disease and asthma, says Dr. Peter Alperin, a San Francisco internist and vice president of product at Doximity, a kind of LinkedIn for medical professionals.

Providers can monitor patients’ vitals remotely and discuss lab results, diet, medications and any symptoms in a video chat or a phone conversation. “If you happen to see something that’s awry, you can bring them into your office,” Alperin says, adding it’s “a better form of triage.”

But telemedicine has some serious disadvantages. For one thing, the less formal setting can allow some routine medical practices to slip through the cracks.

In the second quarter of this year, blood pressure was recorded in 70% of doctor office visits compared with about 10% of telemedicine visits, according to a study published early this month.

Elsa Pearson, a resident of Dedham, Massachusetts, had a medical appointment scheduled in March, which was switched to a telephone call because of the pandemic-induced lockdown.

“It was honestly the most efficient appointment I’ve had in my life,” says Pearson, 30. But, “I must admit, without the push of having the labs right there when you leave the appointment, I’ve yet to get them done.”

Perhaps the biggest pitfall in telehealth is the loss of a more intimate and valuable doctor-patient relationship.

In a recent essay, Dr. Paul Hyman, a Maine physician, reflected on the times when an unexpected discovery during an in-person examination had possibly saved a patient’s life: “A discovery of an irregular mole, a soft tissue mass, or a new murmur — I do not forget these cases, and I do not think the patients do either.”



This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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.

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This story can be republished for free (details).

Wildfires Provide Another Reason to Mask Up

If you have declined to wear a face mask during the COVID-19 crisis, you might want to reconsider, as the smoke from over 300 wildfires chokes people across central and Northern California.

But you are going to have to think a little more about what kind of mask is best.

The fires have spewed toxic substances far and wide, raining ash across the region and leaving an acrid brownish-gray haze. Air quality in much of the Bay Area was the worst in the world for a few days last week. And fire season is only just beginning.

The biggest health risk: tiny particles, less than 2.5 microns in diameter, that make up 80% of wildfire smoke. They can enter the bloodstream through the lungs, damaging the airways and the heart. The risks are greatest for the old and very young, and those with preexisting heart and lung conditions.

The best defense against the smoke is simply to stay inside. “If you don’t have to go out, don’t go out,” says Dr. Mary Prunicki, director of air pollution and health research at Stanford University’s Sean N. Parker Center for Asthma and Allergy Research. She advises keeping doors and windows shut and using an air purification device to filter out the smoke particles.

And refrain from strenuous exercise. “You have permission to be a couch potato,” says Anthony Wexler, director of the Air Quality Research Center at the University of California-Davis.

If you must be outside for any extended period, you should cover your face — and that’s where the convergence of COVID-19 and wildfires poses challenges, though not insurmountable ones.

The relatively loose-fitting cloth face coverings and blue surgical-style masks that many of us wear in public to prevent spreading the coronavirus are not particularly useful against smoke, though they can provide some protection, research has shown. Cloth masks reduced airborne particles by 57%, according to one study. Another study showed that surgical and homemade masks reduced particle concentrations fourfold and threefold, respectively.

That compares with a hundredfold reduction by N95 filtering facepiece respirators, commonly known as N95s. The number 95 signifies that they filter out 95% of particles.

“The N95s are great, if you can get your hands on one,” says Wexler.

And therein lies the rub. Huge demand for N95 masks among health care workers on the front lines of COVID-19 led to supply constraints in the spring that continue this summer.

“We are extremely concerned about the availability of N95 masks,” says Gail Blanchard-Saiger, vice president of labor and employment at the California Hospital Association. Administrators at one hospital recently told her they had not received a single shipment of N95s since March. Another said their hospital had 350,000 N95s on back order and were lucky to get 200 a month.

I conducted a (very unscientific) survey of my own, calling four hardware stores and five medical supply stores in Southern California, where I live, to ask if they carried N95s. None of the hardware stores and only two of the medical supply stores did.

If you do get hold of some N95s, be aware that they work properly only with a tight fit against your skin, providing a seal that minimizes leakage. They will likely be too big for children, and if you have facial hair it will interfere with the fit.

The tight fit of a properly functioning N95 means it is uncomfortable, “so you’re not going to wear it a really long time, because it’s going to be really annoying,” Wexler says.

If you have a chronic respiratory condition such as asthma or COPD, check with your doctor before wearing a mask.

Gina Spadafori, a West Sacramento resident who’s had asthma all her life, bought a box of N95s during the Camp Fire in late 2018 and had one left this month when her neighborhood was engulfed by smoke from a multitude of wildfires burning in the region.

She put it on before she went out to check on her goats and chickens one recent morning. “I still immediately got tightness in my chest and some problems breathing,” says Spadafori, 62. “So I can imagine that going out to the barn without it would have been a pretty bad mistake.”

Given the importance of conserving masks during the pandemic, it’s OK to reuse N95s, says Dr. Nicholas Kenyon, division chief of pulmonary, critical care, and sleep medicine at UC Davis Health. “If they are not soiled and wet, and they are still intact, you can use them for several days, hopefully to get through this.”

If you can’t get hold of N95s, don’t fret. You have other options. One is a kind of alternative N95, known as the KN95, which is abundantly available. Eight of the nine stores I called had them in stock.

The KN95s, produced mainly by Chinese manufacturers, are meant to filter out 95% of airborne particles, like the N95s. But beware: They do not always perform as advertised. The Food and Drug Administration rescinded its emergency authorization for some KN95 brands after a study this year found they did not meet the 95% target.

The Centers for Disease Control and Prevention website provides filtration efficiency reports on a large number of N95 and KN95 respirators.

You might also consider insertable PM2.5 filters, designed to fit inside cloth or surgical masks. You can buy them online; they are abundant and inexpensive. The downside is that it may be difficult to get a tight fit, so there could be leakage.

They are “not as good as the real thing, but way better than nothing,” says Wexler.

If you want to go Darth Vader, and a bit more upscale, check out elastomeric respirators — tight-fitting rubber or silicone masks that come with filtration cartridges and offer protection at least equivalent to an N95 and, in some cases, better.

They also have exhalation valves, which makes it easier to breathe. But here’s the problem with that: You expel respiratory droplets. Great for coping with smoke, but potentially risky for those you encounter in the midst of a pandemic. Like the N95s, their tight fit can make them hard to wear for long periods of time — especially in high heat.

Whatever you decide, one thing seems inescapable: With a society rendered germophobic by the pandemic and with wildfires an ever-increasing threat, masks are fast becoming an indispensable part of our wardrobe.

“I think this is the new normal for the 21st century,” says Dr. Richard Jackson, a professor emeritus at UCLA’s Fielding School of Public Health and former head of California’s Department of Public Health under Gov. Arnold Schwarzenegger. “You keep flashlight batteries in your house, and you keep good quality masks.”


This KHN story first published on California Healthline, a service of the California Health Care Foundation.

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.

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This story can be republished for free (details).

Puedes ver a amigos y familiares durante la pandemia, pero sigue estas reglas

Después de un encierro prolongado, anhelando un día en la playa o una noche en la ciudad —y atraídos por el alivio de las restricciones justo cuando llegan las cálidas temperaturas— muchas personas han salido corriendo de los confines del hogar. ¿Quién puede culparlos?

Pero Houston, y San Antonio, Phoenix, Miami y Los Angeles… tenemos un problema.

COVID-19 se está disparando en Texas, Arizona, Florida, California y otros estados, obligando a los funcionarios, una vez más, a cerrar bares, gimnasios y las áreas internas de los restaurantes.

Esto no significa que no podamos pasar tiempo con las personas que más queremos. Nuestra salud mental es demasiado importante para no hacerlo.

Puedes expandir tu burbuja social más allá de la casa, si prestas atención a las conocidas pautas de salud y, además, tomas precauciones adicionales: limita el número de personas que vas a ver, y usa una máscara si la única opción es estar dentro de la casa, o si no puedes estar a menos de 6 pies (dos metros) de distancia al aire libre.

Desinfecta las sillas y mesas, y lávate las manos, antes y después de la reunión. Si van a celebrar con comida y bebida, es mejor que todos los involucrados traigan la suya, ya que compartirla puede aumentar el riesgo de infección.

Arthur Reingold, profesor de epidemiología en la Escuela de Salud Pública de la Universidad de California-Berkeley, y su esposa, epidemióloga de los Centros para el Control y Prevención de Enfermedades (CDC), han comenzado a verse con otra pareja de su edad, que tiene un patio amplio.

“Nos hacen entrar por la parte de atrás; no por la casa”, explica Reingold, de 71 años. “Nos sentamos en sillas que están a unos buenos 10 ó 12 pies de distancia entre sí, y charlamos. Traemos nuestra comida, y ellos tienen la suya”.

Y no usan máscaras. “Personalmente creo que el riesgo en esa situación, incluso sin máscara, es bastante mínimo”, dice Reingold. “Pero si alguien quisiera hacer lo mismo, y usar una máscara, me parecería razonable”.

Y ya que estamos con el tema de las máscaras, por favor recuerda que no te hacen inmune a la infección. “Tus ojos son parte del esquema respiratorio. Puedes infectarte a través de ellos muy fácilmente”, señala George Rutherford, profesor de epidemiología en la UC-San Francisco. Si eres vulnerable, o simplemente quieres tener más cuidado, considera el uso de un protector facial o de gafas protectoras.

La mayoría de nosotros nos hemos preguntado cuándo se puede considerar que una reunión es demasiado grande. Es imposible dar una respuesta exacta; pero cuanto más pequeña, mejor. Y ten en cuenta que no existe el riesgo cero.

En los Estados Unidos en su conjunto, el promedio de la tasa de infección es actualmente de entre el 1% y el 2%, lo que significa que una o dos personas de un grupo de 100 se infectarán, dice la doctora Yvonne Maldonado, pediatra especializada en enfermedades infecciosas de la Escuela de Medicina de la Universidad de Stanford.

Sin embargo, estos porcentajes no aplican necesariamente a cualquier entorno, señala Maldonado. Y recuerda que una reunión en un área donde la tasa de COVID-19 está aumentando, o ya es alta, es más peligrosa que una del mismo tamaño en un lugar donde no lo es. Así que mantente informado sobre el estado de la pandemia en tu área.

Desconfía incluso de los amigos que conoces y a quienes les tienes gran afecto desde hace mucho tiempo.

Puede parecer cruel, pero necesitas saber algo sobre el comportamiento y el paradero reciente de cualquier persona con la que te vas a ver. No seas tímido a la hora de preguntar dónde y con quién han estado en las últimas semanas. Si son amigos lo suficientemente cercanos, entenderán por qué lo preguntas.

Un gráfico de la Texas Medical Association, que generó controversia en Twitter en los últimos días, enumeraba una serie de actividades, clasificadas por riesgo, de menor a mayor. Entre los comportamientos más riesgosos: ir a un bar, a un cine o a cualquier otro lugar lleno de gente. Y comer en un buffet. Podrías hacer preguntas basadas en esa lista, o una similar, para determinar si es seguro visitar a alguien.

Respecto a los encuentros para jugar de tus hijos, los expertos en salud pública dicen que se deben aplicar las mismas precauciones de seguridad que en las reuniones de adultos.

“Los niños pueden jugar juntos, especialmente si sus familias han estado distanciadas socialmente, las actividades no implican contacto físico y pueden participar en las actividades con suficiente espacio”, explica Maldonado.

Otra pregunta, siempre en mi mente, es si resulta arriesgado dejar entrar a un plomero, a un electricista o a otro servicio de reparaciones en la casa. Yo he pospuesto las reparaciones de la casa por varios meses debido a mi incertidumbre al respecto.

Hice esa pregunta a los expertos en salud pública que entrevisté para esta columna, y me dieron la misma respuesta: mientras todos usen máscaras y se mantengan a una distancia saludable, la visita no debería representar una amenaza significativa. Pero se le debe preguntar al profesional qué precauciones tomó en las visitas a otros hogares. Si trabaja para una compañía, revisa sus políticas para los empleados que van de casa en casa.

Como tengo dos perros grandes, también me he preguntado si podrían ser potenciales propagadores del virus, no a través de sus gotas respiratorias, sino porque el virus podría aterrizar en su piel.

Cuando salgo a pasear con ellos por la noche y veo a los vecinos con sus mascotas, normalmente mantenemos nuestra distancia, aunque de vez en cuando alguien quiere acariciar a uno de mis perros, y he estado tentado de acariciar a los suyos, pero me he frenado.

Los expertos dicen que no debería preocuparme. Teóricamente es posible contagiarse del virus a través de un perro si alguien acaba de estornudar sobre él, pero ése es un escenario poco probable. El dueño del perro representa un riesgo mayor.

Para quienes hemos echado de menos un mayor contacto humano, tal vez sea una grata sorpresa que algunos expertos en salud pública piensen que puede ser seguro abrazar a las personas (no a los dueños de perros que no conoces) si sigues ciertas pautas: hazlo al aire libre; usa una máscara; apunten sus rostros en direcciones opuestas;  evita el contacto entre tu cara y el cuerpo de la otra persona; sé breve y lávate las manos después.

Shannon Albers, residente de Sacramento, de 35 años, dice que empezó a abrazar a la gente de nuevo después de leer una historia sobre cómo hacerlo de forma segura en The New York Times.

“Después de 89 días finalmente pude abrazar a mi mamá y ella se puso a llorar”, recordó Albers. “Estábamos paradas cerca de la entrada de la casa y le dije: ‘¿Quieres un abrazo?’ Inmediatamente se apretó la máscara y vino hacia mí, y yo le dije: ‘Espera, mamá’. Hay reglas”.

Los enfermos crónicos y las personas mayores pueden no querer arriesgarse, dijo Reingold de la UC-Berkeley. “Pero si estás tomando cervezas con alguien en una habitación llena de gente, no creo que un abrazo marque la diferencia, francamente”.

Esta historia de KHN fue publicada por primera vez en California Healthline, un servicio de la California Health Care Foundation.

You Can See Friends and Relatives During the Pandemic Surge — But Do It Carefully

Cooped up too long, yearning for a day at the beach or a night on the town — and enticed by the easing of restrictions just as the warm weather arrived — many people have bolted from the confines of home. And who can blame them?

But Houston — and San Antonio and Phoenix and Miami and Los Angeles — we have a problem.

COVID-19 is spiking in Texas, Arizona, Florida, California and other states, forcing officials once again to shut down bars, gyms and the indoor-dining sections of restaurants.

But that does not mean we can’t spend time with the important people in our lives. Our mental health is too important to avoid them.

You can expand your social bubble beyond the household — if you heed now-familiar health guidelines and even take extra precautions: Limit the number of people you see at one time, and wear a mask if meeting indoors is the only feasible option or if you can’t stay at least 6 feet from one another outdoors. Disinfect chairs and tables, and wash your hands, before and after the visit. If food and drink are on the agenda, it’s best for all involved to bring their own, since sharing can raise the risk of infection.

Arthur Reingold, a professor of epidemiology at the University of California-Berkeley’s School of Public Health, and his wife, an epidemiologist for the Centers for Disease Control and Prevention, have begun spending time with another couple around their age who have a large patio. “They have us go around the back; they don’t have us go through the house,” says Reingold, 71. “We sit on chairs that are a good 10 to 12 feet away from each other, and we talk. We bring our food, and they bring their food.”

And they don’t wear masks. “I personally believe the risk from that situation, even without a mask, is pretty minimal,” Reingold says. “But if people wanted to try to do that and wear a mask, I don’t think that would be unreasonable.”

And while we are on the topic of masks, please remember they don’t make you impervious to infection. “Your eyes are part of the respiratory tree. You can get infected through them very easily,” says George Rutherford, a professor of epidemiology at UC-San Francisco. If you are medically vulnerable, or just want to be extra careful, consider wearing a face shield or goggles.

Most of us have wrestled with the question of how big a gathering is too big. It’s impossible to give an exact answer, but the smaller the better. And keep in mind there is no such thing as zero risk.

In the U.S. as a whole, the average infection rate is currently about 1% to 2%, which means one or two people in a group of 100 would typically be infected, says Dr. Yvonne Maldonado, a pediatrician specializing in infectious diseases at Stanford University’s School of Medicine. In any individual setting, however, these percentages don’t necessarily apply, she says. And a gathering in an area where the COVID-19 rate is surging — or already high — is more dangerous than one of the same size in a place where it’s not. So stay informed about the status of the pandemic in your area.

Be wary even of friends you’ve known and loved a long time. That may sound callous, but you need to know something about the behavior and recent whereabouts of anyone with whom you plan to visit. Don’t be shy about asking where and with whom they have been in recent weeks. If they are a close enough friend for you to want to see them, they should understand why you are asking.

A chart from the Texas Medical Association that generated controversy on Twitter in recent days listed numerous activities, ranked from lowest to highest risk. Among the riskiest behaviors: going to a bar, a movie theater or any other crowded venue — and eating at a buffet. You could ask questions based on that list, or a similar one, to determine if it’s safe to visit with someone.

With regard to play dates for your children, public health experts say you should apply the same safety precautions as for adult get-togethers. “Children can play together, especially if their families have been socially distancing, the activities do not involve physical contact, and they can engage in the activities with sufficient physical spacing,” says Stanford’s Maldonado.

Another question, never far from my mind, is whether it’s risky to let a plumber or electrician or handyman into the house. I’ve put off needed house repairs for several months because of my uncertainty about it.

I put the question to the public health experts I interviewed for this column, and they agreed: As long as you both wear masks and stay a healthy distance apart, the visit should not pose a significant threat. But ask the person what precautions he took on visits to other homes. If he works for a company, check its policies for employees who go from home to home.

Shannon Albers is hugging loved ones again – with certain COVID-inspired modifications. “After 89 days I finally got to hug my mom, and she started crying,” Albers recalls.

Because I have two large dogs, I have also wondered whether they could be potential virus spreaders — not through their respiratory droplets, but because the virus might land on their fur. When I’m out walking them in the evening and see neighbors with their canines, we usually keep our distance, but once in a while somebody wants to pet one of my dogs, and I’ve been tempted to pet theirs — but have resisted.

My experts say I shouldn’t worry. It is theoretically possible to catch the virus off a dog if somebody just sneezed on it, but that’s an unlikely scenario. The dog’s owner poses a bigger risk.

For those of us who have craved more human contact, it may come as a welcome surprise that some public health experts think it can be safe to hug people (though not dog owners you don’t know) if you follow certain guidelines: Do it outdoors; wear a mask; point your faces in opposite directions; avoid contact between your face and the other person’s body; keep it brief and wash your hands afterward.

Shannon Albers, a 35-year-old resident of Sacramento, says she started hugging people again after reading a story about how to do it safely in The New York Times.

“After 89 days I finally got to hug my mom, and she started crying,” Albers recalls. “We were standing on the driveway, and I said, ‘Do you want a hug?’ She immediately tightened her mask and started coming down the driveway, and I said, ‘Wait, Mom. There’s rules.’”

Chronically ill and elderly people may not want to risk it, says UC-Berkeley’s Reingold. “But if you are out drinking beers with somebody in a crowded room, I’m not sure the hug makes a difference, frankly.”


This KHN story first published on California Healthline, a service of the California Health Care Foundation.