What's the masking policy? That's an important element of accessibility while COVID is still spreading.

Want to read: The Book of Delights: Essays by Ross Gay (ISBN 9781616207922)

via https://www.thisamericanlife.org/692/the-show-of-delights

Ooh, new Sigur Rós album! https://song.link/i/1689744219

I need to remember to listen to them more often, especially when I feel down. It’s so moving and relaxing.

I emailed this message to our county public health officer and my district supervisor.

Subject: Please keep our communities safer from COVID-19

To: Wilma J. Wooten, MD, MPH
Public Health Officer, San Diego Health and Human Services Agency
Wilma.Wooten@sdcounty.ca.gov
https://www.sandiegocounty.gov/content/sdc/hhsa.html

Cc: Chairwoman Nora Vargas
San Diego County Supervisor District 1
District1community@sdcounty.ca.gov
https://www.supervisornoravargas.com

Dear Dr. Wooten and Chairwoman Vargas,

I am writing to express my deep concern about the spread of COVID-19 in healthcare settings due to the lack of mitigations like masking. Nobody should have to worry about getting COVID while seeking care and healthcare workers should not have to fear contracting it at work. We know that COVID is airborne, people can be infectious without showing symptoms, and two-way masking with well-fitting respirators is effective at reducing its spread.

I am at a higher risk myself due to some heart issues. I was incredibly dismayed when I went in for a routine visit to my cardiologist and saw none of the staff were masked. I am particularly concerned for our disabled and immunocompromised community members who have had to be extremely cautious during the ongoing pandemic (and before). Most places in society have become even more hostile to their existence in the rush “back to normal.” Now some of the most important places for them, healthcare settings, are no longer safe for them either.

A conservative count from the US Health and Human Services showed that over 138,000 hospital-acquired COVID infections occurred in the first three months of 2023.¹ We know that COVID infection — no matter how mild — puts people at risk of an array of long-term health issues. I also consider this an equity and racial justice issue since COVID disproportionately impacts BIPOC people.

I know county guidance “strongly recommends” masking in healthcare settings, but that is clearly not sufficient. I believe universal masking in healthcare settings must become a standard part of infection control. I urge you to work towards making that a county mandate. I would also urge for programs to make high-quality respirators readily available to all, along with clearer public health messaging about their effectiveness. Together, these actions will help keep our communities safer from COVID.

Some additional resources:

• Back to the future: Redefining “universal precautions” to include masking for all patient encounters (doi:10.1017/ice.2023.2)
• People’s CDC: Universal Masks and COVID-19 Admission Screening Should be Standard of Care

Thank you for your time and consideration.

Sincerely,
Gregor Morrill
San Diego resident of District 1

★ https://lifeofpablo.com/blog/content-available-in-other-languages

★ https://cleverdevil.club/@jonathan/110551904462894949

★ Still Masking

I kinda laugh when people stereotype California as being super progressive. Sure, it can be progressive in some aspects relative to other states, but that’s a pretty low bar and the state is definitely not a monolith politically.

Recent example: Yesterday, San Diego city council passed a homeless encampment ban in many areas as long as there are shelter beds available. This does nothing to help people transition out of homelessness and gives police more power to harass, cite, and arrest some of our most marginalized people. Like Ken Saragosa said, “The problem is you can’t arrest homelessness out of existence.”

There are far too few shelter beds in the city, so it’s questionable if this can even be enforced anytime soon, though I doubt such technicalities will stop the police. I hope this gets challenged legally and thrown out.

“Divided San Diego City Council passes homeless camping ban”. The San Diego Union-Tribune. June 13, 2023.

Bookmarked: Working around SPF problems delivering to Gmail

Today is the last day to submit a comment telling Medicare/Medicaid that hospitals should protect us from COVID-19! The People's CDC has a quick guide with a template you can easily personalize. Submissions are due by June 9, 2023, 11:59PM Eastern time.

I am concerned about COVID in healthcare settings. I am at higher risk due to heart issues, but we also know that COVID infection — no matter how mild — puts people at risk of long-term health issues (Long COVID). We should not have to worry about getting COVID while receiving healthcare and healthcare workers should not have to fear contracting it at work.

For these reasons, I am writing to strongly urge The Centers for Medicare and Medicaid to include hospital-onset COVID-19 in the Hospital-Acquired Condition (HAC) Reduction Program part of CMS-1785-P.

1. CMS should include COVID in its HAC Reduction Program and require hospitals to report and try to minimize hospital-onset COVID, using layered protections, such as universal mask wearing, universal screening testing, and improved air quality to promote patient and staff safety and health equity.
2. Hospital-onset COVID should be defined as infections diagnosed after 5 days of admission or greater.^1,2 Hospitals should report all hospital-onset COVID cases to CMS, and post these numbers publicly.
3. Additional research is needed to better understand COVID transmission and to improve definitions of hospital-acquired COVID, using whole genome sequencing technologies and serial surveillance testing.^1,3 The CDC currently defines hospital-onset COVID as cases diagnosed after 14 days of hospitalization, which is a huge underestimate. Even 5- or 7-day thresholds to define hospital-acquired COVID underestimate its true incidence.^1,2 Hospitals should be required to report all COVID cases to CMS and the CDC and specify how many days patients have been in the hospital when diagnosed with COVID.

The evidence that informs these suggestions includes:

For only three months of 2023, the CDC tallied nearly 138,000 hospital-onset COVID infections, counting only those that arose after 14 days of hospitalization.⁴

COVID has been one of the top five major causes of death in the US since 2020,^5,6 and many of those deaths were likely due to hospital-acquired COVID, which has a 5-10% mortality rate.^7,8 This is significantly higher than several of the other infections CMS includes in its HAC Reduction Program. Catheter-Associated Urinary Tract Infection has a mortality rate of 2.3%,⁹ Surgical Site Infections for Abdominal Hysterectomy and Colon Procedures have a mortality rate of 3%,¹⁰ and Clostridioides-difficile (C. diff) infection has a mortality rate of 7.9%.¹¹ Thus, hospital-onset COVID is well worth preventing.

Nearly 40% of all US residents are concerned about COVID outbreaks.¹² Preventing COVID in the hospital is an equity issue. People of color continue to suffer high rates of COVID deaths.¹³ Half of health workers go to work with COVID symptoms,¹⁴ amid huge health worker shortages. CMS needs to protect both patients and health workers.

Even when community transmission is low, healthcare settings are the most likely place where people getting care for COVID could encounter vulnerable patients who could be harmed by COVID. Covid outbreaks are already happening in hospitals that ditched masks.¹⁵ If your hospital roommate has COVID, you have a 4 in 10 chance of catching it from them.¹⁶ No one should go to the hospital for a heart attack, an elective surgery, or to deliver a baby and catch COVID.

In spite of these facts, hospital administrators lobbied public health departments to end COVID protections in healthcare.¹⁷ Vulnerable patients can still become severely ill or die from COVID. Anyone can get Long COVID, which disables over 4 million people in the United States.^18,19 Hospitals should be protecting us from COVID when we are in their care. But hospitals are in a “crushing” financial crisis.²⁰ They lose money when they have to cancel procedures when patients test positive for COVID. We are concerned that hospitals are putting profits over patient safety.

Please protect vulnerable patients, prevent health worker shortages, and promote health equity by requiring hospitals to protect patients from hospital-acquired COVID.

References

1. Lumley SF, Constantinides B, Sanderson N, et al. Epidemiological data and genome sequencing reveals that nosocomial transmission of SARS-CoV-2 is underestimated and mostly mediated by a small number of highly infectious individuals. J Infect. 2021;83(4):473-482. doi:10.1016/j.jinf.2021.07.034
2. Wu Y, Kang L, Guo Z, Liu J, Liu M, Liang W. Incubation Period of COVID-19 Caused by Unique SARS-CoV-2 Strains: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(8):e2228008. doi:10.1001/jamanetworkopen.2022.28008
3. Rhee C, Baker MA, Klompas M. Prevention of SARS-CoV-2 and respiratory viral infections in healthcare settings: current and emerging concepts. Curr Opin Infect Dis. 2022;35(4):353-362. doi:10.1097/QCO.0000000000000839
4. U.S. Department of Health and Human Services. COVID-19 Reported Patient Impact and Hospital Capacity by State Timeseries (RAW). HealthData.gov. Accessed May 21, 2023. https://healthdata.gov/Hospital/COVID-19-Reported-Patient-Impact-and-Hospital-Capa/g62h-syeh
5. COVID-19 was third leading cause of death in the United States in both 2020 and 2021. National Institutes of Health (NIH). Published July 5, 2022. Accessed October 13, 2022. https://www.nih.gov/news-events/news-releases/covid-19-was-third-leading-cause-death-united-states-both-2020-2021
6. McPhillips D. Covid-19 was the fourth leading cause of death in 2022, CDC data shows. CNN. https://www.cnn.com/2023/05/04/health/covid-fourth-leading-cause-of-death/index.html. Published May 4, 2023. Accessed May 21, 2023.
7. Otter JA, Newsholme W, Snell LB, et al. Evaluation of clinical harm associated with Omicron hospital-onset COVID-19 infection. J Infect. 2023;86(1):66-117. doi:10.1016/j.jinf.2022.10.029
8. Cook AD Henrietta. Hundreds die of COVID after catching virus while in hospital. The Age. https://12ft.io/proxy?&q=https%3A%2F%2Fwww.theage.com.au%2Fnational%2Fvictoria%2Fhundreds-die-of-covid-after-catching-virus-while-in-hospital-20230330-p5cwjx.html. Published March 30, 2023. Accessed May 21, 2023.
9. Centers for Disease Control and Prevention. Guideline for Prevention of Catheter-Associated Urinary Tract Infections (2009). Infection Control. Published March 28, 2019. Accessed May 21, 2023. https://www.cdc.gov/infectioncontrol/guidelines/cauti/background.html
10. Lantana Consulting Group, Centers for Disease Control and Prevention. American College of Surgeons–Centers for Disease Control and Prevention (ACS-CDC) Harmonized Procedure Specific Surgical Site Infection (SSI) Outcome Measure Technical Report. Centers for Disease Control and Prevention; 2021. Accessed May 21, 2023. https://qualitynet.cms.gov/files/627bad867c89c50016b44266?filename=2021_SSI_MeasTechRpt_v1.0.pdf
11. Yu H, Alfred T, Nguyen JL, Zhou J, Olsen MA. Incidence, Attributable Mortality, and Healthcare and Out-of-Pocket Costs of Clostridioides difficile Infection in US Medicare Advantage Enrollees. Clin Infect Dis Off Publ Infect Dis Soc Am. 2023;76(3):e1476-e1483. doi:10.1093/cid/ciac467
12. Civiqs. Coronavirus: Outbreak concern. Accessed May 21, 2023. https://civiqs.com/results/coronavirus_concern?uncertainty=true&annotations=true&zoomIn=true
13. Lundberg DJ, Wrigley-Field E, Cho A, et al. COVID-19 Mortality by Race and Ethnicity in US Metropolitan and Nonmetropolitan Areas, March 2020 to February 2022. JAMA Netw Open. 2023;6(5):e2311098. doi:10.1001/jamanetworkopen.2023.11098
14. Linsenmeyer K, Mohr D, Gupta K, Doshi S, Gifford AL, Charness ME. Sickness presenteeism in healthcare workers during the coronavirus disease 2019 (COVID-19) pandemic: An observational cohort study. Infect Control Hosp Epidemiol. Published online 2023:1-4. doi:10.1017/ice.2023.47
15. Lee BY. Bay Area Hospital Reinstitutes Face Mask Mandate After Covid-19 Outbreak. Forbes. Published online April 22, 2023. Accessed May 22, 2023. https://www.forbes.com/sites/brucelee/2023/04/22/bay-area-hospital-reinstitutes-face-mask-mandate-after-covid-19-outbreak/
16. Karan A, Klompas M, Tucker R, Baker M, Vaidya V, Rhee C. The Risk of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Transmission from Patients With Undiagnosed Coronavirus Disease 2019 (COVID-19) to Roommates in a Large Academic Medical Center. Clin Infect Dis. 2022;74(6):1097-1100. doi:10.1093/cid/ciab564
17. Lazar K. Health groups call on Mass. to keep mask mandates in health care settings - The Boston Globe. The Boston Globe. https://www.bostonglobe.com/2023/04/05/metro/health-groups-call-mass-keep-mask-mandates-health-care-settings/. Published April 5, 2023. Accessed May 21, 2023.
18. Centers for Disease Control and Prevention. Long COVID - Household Pulse Survey. Published February 21, 2023. Accessed March 6, 2023. https://www.cdc.gov/nchs/covid19/pulse/long-covid.htm
19. Bach K. New Data Shows Long Covid is Keeping as Many as 4 Million People Out of Work. Brookings. Published August 24, 2022. Accessed October 13, 2022. https://www.brookings.edu/research/new-data-shows-long-covid-is-keeping-as-many-as-4-million-people-out-of-work/
20. Thomas N. Congress can take action to help healthcare deal with “crushing” financial challenges, AHA urges. Published online October 25, 2022. Accessed May 21, 2023. https://www.beckershospitalreview.com/finance/congress-can-take-action-to-help-healthcare-deal-with-crushing-financial-challenges-aha-urges.html

This comment is for:
Document ID: CMS-2023-0057-0003
Federal Register Number: 2023-07389
Agency: Centers for Medicare & Medicaid Services
Parent Agency: U.S. Department of Health & Human Services

I was at my cardiologist today for a routine check-up and did not see a single person masked. I saw three nurses/staff behind the desk and four patients in the waiting area. The other patients all appeared to be ages 60+. Neither of the people who saw me in the patient room were masked. Again, this was in a cardiologist’s office at the hospital.

If I look exhausted, it’s because I am. I feel so alone.

Currently reading: Live Wire by Harlan Coben (ISBN 9780525952060)

★ https://zeroes.ca/@maleve/110438444466147947

Currently reading: Funny in Farsi by Firoozeh Dumas (ISBN 9780307430991)

Finished reading: Lovestar by Andri Snær Magnason (ISBN 9781609804268)

We should not have to worry about getting COVID while receiving healthcare and workers should not have to fear contracting it at work. We know that COVID is airborne, people can be infectious without showing symptoms, and two-way masking is effective at reducing its spread.

The People’s CDC has some great resources and action materials. Check out their website, specifically “Keep Healthcare Safe” under the “Actions” menu. You can contact your governor, county health officials, and healthcare executives to tell them they should make masking the new infection control standard for healthcare.

In the meantime, please continue masking indoors and in crowded outdoor spaces. This is an act of love and reciprocal care. We are interdependent and there is no individualizing of risk during these times.

Art credit: @schmutzparty on Twitter who said to “take, share, and distribute widely.” A high resolution version is also available.

My sleep schedule has been, uhh, erratic and poor for a while. Last week was particularly exhausting, but I started to reset over the weekend.

Small wins this week: I’ve been in bed reading (not on my phone!) by 11pm the last two nights. Feels good!

But do they bring all the boys to the yard?