Long-term complications of COVID-19 signals billions in healthcare costs ahead

By Caroline Humer, Nick Brown and Emilio Parodi

NEW YORK (Reuters) – Late in March, Laura Gross, 72, was recovering from gall bladder surgery in her Fort Lee, New Jersey, home when she became sick again.

Her throat, head and eyes hurt, her muscles and joints ached and she felt like she was in a fog. Her diagnosis was COVID-19. Four months later, these symptoms remain.

Gross sees a primary care doctor and specialists including a cardiologist, pulmonologist, endocrinologist, neurologist, and gastroenterologist.

“I’ve had a headache since April. I’ve never stopped running a low-grade temperature,” she said.

Studies of COVID-19 patients keep uncovering new complications associated with the disease.

With mounting evidence that some COVID-19 survivors face months, or possibly years, of debilitating complications, healthcare experts are beginning to study possible long-term costs.

Bruce Lee of the City University of New York (CUNY) Public School of Health estimated that if 20% of the U.S. population contracts the virus, the one-year post-hospitalization costs would be at least $50 billion, before factoring in longer-term care for lingering health problems. Without a vaccine, if 80% of the population became infected, that cost would balloon to $204 billion.

Some countries hit hard by the new coronavirus – including the United States, Britain and Italy – are considering whether these long-term effects can be considered a “post-COVID syndrome,” according to Reuters interviews with about a dozen doctors and health economists.

Some U.S. and Italian hospitals have created centers devoted to the care of these patients and are standardizing follow-up measures.

Britain’s Department of Health and the U.S. Centers for Disease Control and Prevention are each leading national studies of COVID-19’s long-term impacts. An international panel of doctors will suggest standards for mid- and long-term care of recovered patients to the World Health Organization (WHO) in August.

YEARS BEFORE THE COST IS KNOWN

More than 17 million people have been infected by the new coronavirus worldwide, about a quarter of them in the United States.

Healthcare experts say it will be years before the costs for those who have recovered can be fully calculated, not unlike the slow recognition of HIV, or the health impacts to first responders of the Sept. 11, 2001 attacks on the World Trade Center in New York.

They stem from COVID-19’s toll on multiple organs, including heart, lung and kidney damage that will likely require costly care, such as regular scans and ultrasounds, as well as neurological deficits that are not yet fully understood.

A JAMA Cardiology study found that in one group of COVID-19 patients in Germany aged 45 to 53, more than 75% suffered from heart inflammation, raising the possibility of future heart failure.

A Kidney International study found that over a third of COVID-19 patients in a New York medical system developed acute kidney injury, and nearly 15% required dialysis.

Dr. Marco Rizzi in Bergamo, Italy, an early epicenter of the pandemic, said the Giovanni XXIII Hospital has seen close to 600 COVID-19 patients for follow-up. About 30% have lung issues, 10% have neurological problems, 10% have heart issues and about 9% have lingering motor skill problems. He co-chairs the WHO panel that will recommend long-term follow-up for patients.

“On a global level, nobody knows how many will still need checks and treatment in three months, six months, a year,” Rizzi said, adding that even those with mild COVID-19 “may have consequences in the future.”

Milan’s San Raffaele Hospital has seen more than 1,000 COVID-19 patients for follow-up. While major cardiology problems there were few, about 30% to 40% of patients have neurological problems and at least half suffer from respiratory conditions, according to Dr. Moreno Tresoldi.

Some of these long-term effects have only recently emerged, too soon for health economists to study medical claims and make accurate estimates of costs.

In Britain and Italy, those costs would be borne by their respective governments, which have committed to funding COVID-19 treatments but have offered few details on how much may be needed.

In the United States, more than half of the population is covered by private health insurers, an industry that is just beginning to estimate the cost of COVID-19.

CUNY’s Lee estimated the average one-year cost of a U.S. COVID-19 patient after they have been discharged from the hospital at $4,000, largely due to the lingering issues from acute respiratory distress syndrome (ARDS), which affects some 40% of patients, and sepsis.

The estimate spans patients who had been hospitalized with moderate illness to the most severe cases, but does not include other potential complications, such as heart and kidney damage.

Even those who do not require hospitalization have average one-year costs after their initial illness of $1,000, Lee estimated.

‘HARD JUST TO GET UP’

Extra costs from lingering effects of COVID-19 could mean higher health insurance premiums in the United States. Some health plans have already raised 2021 premiums on comprehensive coverage by up to 8% due to COVID-19, according to the Kaiser Family Foundation.

Anne McKee, 61, a retired psychologist who lives in Knoxville, Tennessee and Atlanta, had multiple sclerosis and asthma when she became infected nearly five months ago. She is still struggling to catch her breath.

“On good days, I can do a couple loads of laundry, but the last several days, it’s been hard just to get up and get a drink from the kitchen,” she said.

She has spent more than $5,000 on appointments, tests and prescription drugs during that time. Her insurance has paid more than $15,000 including $240 for a telehealth appointment and $455 for a lung scan.

“Many of the issues that arise from having a severe contraction of a disease could be 3, 5, 20 years down the road,” said Dale Hall, Managing Director of Research with the Society of Actuaries.

To understand the costs, U.S. actuaries compare insurance records of coronavirus patients against people with a similar health profile but no COVID-19, and follow them for years.

The United Kingdom aims to track the health of 10,000 hospitalized COVID-19 patients over the first 12 months after being discharged and potentially as long as 25 years. Scientists running the study see the potential for defining a long-term COVID-19 syndrome, as they found with Ebola survivors in Africa.

“Many people, we believe will have scarring in the lungs and fatigue … and perhaps vascular damage to the brain, perhaps, psychological distress as well,” said Professor Calum Semple from the University of Liverpool.

Margaret O’Hara, 50, who works at a Birmingham hospital is one of many COVID-19 patients who will not be included in the study because she had mild symptoms and was not hospitalized. But recurring health issues, including extreme shortness of breath, has kept her out of work.

O’Hara worries patients like her are not going to be included in the country’s long-term cost planning.

“We’re going to need … expensive follow-up for quite a long time,” she said.

(Reporting by Caroline Humer and Nick Brown in New York; Emilio Parodi in Milan and Alistair Smout in London; editing by Michele Gershberg and Bill Berkrot)

Fauci to testify before U.S. House COVID-19 panel after being blocked by White House

By David Morgan

WASHINGTON (Reuters) – Dr. Anthony Fauci, the top U.S. infectious disease expert, will testify on Friday before a coronavirus subcommittee in Congress, weeks after President Donald Trump’s administration first refused to let him address the panel.

Fauci’s testimony comes at the end of a week when the pandemic’s tragic toll on the country has become far clearer. The United States on Wednesday experienced its 150,000th death from the disease — more than any other country — and data on Thursday showing a deep economic plunge.

Democrats said the Trump administration initially prevented Fauci from testifying to the panel by saying he was unavailable for the entire month of July and relented only after House Majority Whip James Clyburn wrote to Vice President Mike Pence.

A veteran of six Republican and Democratic administrations, Fauci has become the most familiar face of the administration’s coronavirus task force.

This week, Trump, who has often bristled against scientists’ advice on responding to the pandemic, bemoaned the degree to which Fauci is admired, saying “nobody likes me. It can only be my personality.”

U.S. Centers for Disease Control and Prevention Director Dr. Robert Redfield and Admiral Brett Giroir, assistant secretary at the Department of Health and Human Services, are also scheduled to testify before the Select Subcommittee on the Coronavirus Crisis.

Headed by Clyburn, the subcommittee was created this year to monitor the trillions of dollars approved by Congress to help the United States weather the health and economic impacts of the COVID-19 pandemic.

Earlier this week, Trump retweeted a post accusing Fauci and Democrats of suppressing the use of the drug hydroxychloroquine to treat the new coronavirus that included a link to a video of a group discounting the need for face masks amid the pandemic. The tweet was removed by social media companies.

(Reporting by David Morgan; Editing by Scott Malone and David Gregorio)

U.S. CDC reports 4,024,492 coronavirus cases

(Reuters) – The U.S. Centers for Disease Control and Prevention (CDC) on Friday reported 4,024,492 cases of the coronavirus, an increase of 72,219 cases from its previous count, and said that the number of deaths had risen by 1,113 to 143,868.

The CDC reported its tally of cases of the respiratory illness known as COVID-19, caused by the new coronavirus, as of 4 pm ET on July 23 versus its previous report a day earlier.

The CDC figures do not necessarily reflect cases reported by individual states.

(Reporting by Vishwadha Chander in Bengaluru; Editing by Devika Syamnath)

Why COVID-19 is killing U.S. diabetes patients at alarming rates

By Chad Terhune, Deborah J. Nelson and Robin Respaut

(Reuters) – Devon Brumfield could hear her father gasping for breath on the phone.

Darrell Cager Sr., 64, had diabetes. So his youngest daughter urged him to seek care. The next day, he collapsed and died in his New Orleans home.

The daughter soon learned the cause: acute respiratory distress from COVID-19. His death certificate noted diabetes as an underlying condition. Brumfield, who lives in Texas and also has type 2 diabetes, is “terrified” she could be next.

“I’m thinking, Lord, this could happen to me,” she said of her father’s death in late March.

She has good reason to fear. As U.S. outbreaks surge, a new government study shows that nearly 40% of people who have died with COVID-19 had diabetes.

Among deaths of those under 65, half had the chronic condition. The U.S. Centers for Disease Control and Prevention analyzed more than 10,000 deaths in 15 states and New York City from February to May.

Jonathan Wortham, a CDC epidemiologist who led the study, called the findings “extremely striking,” with serious implications for those with diabetes and their loved ones.

A separate Reuters survey of states found a similarly high rate of diabetes among people dying from COVID-19 in 12 states and the District of Columbia.

Ten states, including California, Arizona and Michigan, said they weren’t yet reporting diabetes and other underlying conditions, and the rest did not respond – rendering an incomplete picture for policymakers and clinicians struggling to protect those most at-risk.

America’s mortality rates from diabetes have been climbing since 2009 and exceed most other industrialized nations. Blacks and Latinos suffer from diabetes at higher rates than whites and have disproportionately suffered from COVID-19.

“Diabetes was already a slow-moving pandemic. Now COVID-19 has crashed through like a fast-moving wave,” said Elbert Huang, a professor of medicine and director of the University of Chicago’s Center for Chronic Disease Research and Policy.

Keeping diabetes under control – among the best defenses against COVID-19 – has become difficult as the pandemic disrupts medical care, exercise and healthy eating routines.

The high price of insulin has also forced some people to keep working – risking virus exposure – to afford the essential medicine. And as the country grapples with an economic crisis, millions of Americans have lost their jobs and their employer-sponsored health insurance.

Much of this could have been anticipated and addressed with a more comprehensive, national response, said A. Enrique Caballero, a Harvard Medical School endocrinologist and diabetes researcher.

Top health officials should have done more to emphasize the threat to people with diabetes and assuage their fears of hospital visits, he said, while also focusing more on helping patients manage their condition at home.

Policymakers had ample warning that COVID-19 posed a high risk for diabetes patients. In 2003, during the coronavirus outbreak known as SARS, or Severe Acute Respiratory Syndrome, more than 20% of people who died had diabetes.

In 2009, during the H1N1 flu pandemic, patients with diabetes faced triple the risk of hospitalization.

Most recently in 2012, when the coronavirus Middle East Respiratory Syndrome, or MERS, emerged, one study found 60% of patients who entered intensive care or died had diabetes.

The COVID-19 pandemic, however, has unearthed previously unknown complications because it has lasted longer and infected many more people than earlier coronavirus epidemics, said Charles S. Dela Cruz, a Yale University physician-scientist and Director of the Center of Pulmonary Infection Research and Treatment.

Doctors warn that the coronavirus pandemic may indirectly lead to a spike in diabetes-related complications – more emergency-room visits, amputations, vision loss, kidney disease and dialysis.

“My fear is we will see a tsunami of problems once this is over,” said Andrew Boulton, president of the International Diabetes Federation and a medical professor at the University of Manchester in England.

‘ONE BIG PUZZLE’

Researchers have scrambled for months to unravel the connections between diabetes and the coronavirus, uncovering an array of vulnerabilities.

The virus targets the heart, lung and kidneys, organs already weakened in many diabetes patients. COVID-19 also kills more people who are elderly, obese or have high blood pressure, many of whom also have diabetes, studies show.

On the microscopic level, high glucose and lipid counts in diabetes patients can trigger a “cytokine storm,” when the immune system overreacts, attacking the body. Damaged endothelial cells, which provide a protective lining in blood vessels, can lead to inflammation as white blood cells rush to attack the virus and may cause lethal clots to form, emerging research suggests.

“It’s all one big puzzle,” said Yale’s Dela Cruz. “It’s all interrelated.”

Many of their vulnerabilities can be traced to high blood sugar, which can weaken the immune system or damage vital organs. COVID-19 appears not only to thrive in a high-sugar environment but to exacerbate it. Recent evidence suggests the virus may trigger new cases of diabetes.

David Thrasher, a pulmonologist in Montgomery, Alabama, said up to half of COVID-19 patients in his local hospital ICU have diabetes. “They are often my most challenging patients,” he said, and the immune system response may be a big reason why.

‘DIABETES BELT’

The pandemic has ripped through several southern states with some of the nation’s highest diabetes rates. A Reuters examination of state data found that nearly 40% of COVID-19 deaths were people with diabetes in Alabama, Louisiana, Mississippi, North Carolina, South Carolina and West Virginia. Much of this area lies within what the CDC calls the “diabetes belt.”

Alabama has the highest percentage of adults with diabetes at 13.2%, or more than 550,000 people, CDC data show. Diabetes patients accounted for 38% of the state’s COVID-related deaths through June, officials said. Karen Landers, Alabama’s assistant state health officer, said she is particularly heartbroken at the deaths of diabetes patients in their 30s and 40s.

Medical professionals in these states say they struggle to keep patients’ diabetes under control when regular in-person appointments are canceled or limited because of the pandemic.

Sarah Hunter Frazer, a nurse practitioner at the Medical Outreach Ministries clinic for low-income residents in Montgomery, Alabama, said diabetes is common among her COVID-19 patients. With clinic visits on hold, she stays in touch by phone or video chat. If a problem persists, she insists on an outdoors, face-to-face meeting. “We meet them under a shade tree behind the clinic,” Frazer said.

In similar fashion, doctors at the University of North Carolina stepped up their use of telemedicine to reach at-risk rural patients. Despite those efforts, John Buse, a physician and director of the university’s diabetes center, said he’s certain some foot ulcers and dangerously high blood sugars are being missed because people avoid health facilities for fear of the virus.

‘UNDER CONTROL’

Many diabetes patients with severe or deadly cases of COVID-19 were in good health before contracting the virus.

Clark Osojnicki, 56, of Stillwater, Minnesota, had heard early warnings about the risks of the coronavirus for people with diabetes, said his wife, Kris Osojnicki. But the couple didn’t think the admonitions applied to him because his glucose levels were in a healthy range.

“He was incredibly active,” she said.

On a Sunday in mid-March, Osojnicki jogged alongside his border collie, Sonic, on an agility course for dogs inside a suburban Minneapolis gym. Three days later, Osojnicki developed a fever, then body aches, a cough and shortness of breath. He was soon in the hospital, on a ventilator. Clark, a financial systems analyst, died April 6 from a blood clot in the lungs.

Osojnicki is among 255 recorded deaths in Minnesota of people with COVID-19 and diabetes mentioned on their death certificate as of mid-July, according to state data. The records describe people who died as young as 34.

WORKING FOR INSULIN

For years, the skyrocketing cost of insulin has fueled much of the national outrage over drug prices. Early in the pandemic, the American Diabetes Association asked states to eliminate out-of-pocket costs for insulin and other glucose-lowering medications through state-regulated insurance plans.

But no state has fully followed that advice, the ADA said. Vermont suspended deductibles for preventive medications, like insulin, starting in July. Other states ordered insurers to make prescription refills more available but didn’t address cost.

Robert Washington, 68, knew his diabetes put him at risk from COVID-19. When his employer, Gila River’s Lone Butte Casino in Chandler, Arizona, reopened in May, he decided to keep working as a security guard so he could afford insulin.

Washington’s supervisors had assured him he could patrol alone in a golf cart, said his daughter, Lina. But once back at work, he was stationed at the entrance, where long lines of gamblers waited, most without masks, Robert told his daughter.

“He was terrified at what he saw,” Lina said.

He tested positive for the virus in late May and was admitted to the hospital days later. He died from complications of COVID-19 on June 11, his daughter said.

A week after Washington’s death, the casino again closed as COVID-19 cases exploded in the state. The casino did not respond to a request for comment.

“It’s hard to accept he is gone. I have to stop myself from wanting to call him,” said Lina, a sports anchor and reporter at a Sacramento, California, TV station. “A lot of these deaths were in some way preventable.”

(Reporting by Chad Terhune, Deborah J. Nelson and Robin Respaut; Editing by Brian Thevenot)

Lung radiation shows promise for COVID-19 pneumonia; smoking raises risks

By Nancy Lapid

(Reuters) – The following is a brief roundup of some of the latest scientific studies on the novel coronavirus and efforts to find treatments and vaccines for COVID-19, the illness caused by the virus.

Lung radiation may hasten COVID-19 pneumonia recovery

A low dose of radiation to the lungs of COVID-19 pneumonia patients can help them recover more quickly, a small study suggests. Doctors at Emory University in Atlanta treated 10 such patients with lung radiation and compared them to 10 patients of similar ages who received usual care, without radiation. With radiation, the average time to significant improvement was three days, compared to 12 days in the control group.

Other potential effects included a shorter average time to hospital discharge (12 days with radiation versus 20 days without it) and a lower risk of mechanical ventilation (10% with radiation versus 40% without it). But those two differences were too small to rule out the possibility they were due to chance, the researchers found.

The radiation group was “a little older, a little sicker, and their lungs were a little more damaged … but despite that we saw a strong signal of efficacy,” Emory’s Dr. Mohammad Khan told Reuters.

Khan noted that in the radiation group, COVID-19 medications were withheld before and after the treatment, so the results reflect the effect of the radiation alone.

“Radiotherapy,” Khan said, “can reduce the inflammation in the lungs of COVID-19 patients and reduce the cytokines that are causing the inflammation.” Cytokines are proteins made by the immune system. The results on the first five patients have been accepted for publication by the journal Cancer.

The results on all 10 were posted on Tuesday ahead of peer review on the website medRxiv. The researchers have launched a randomized controlled trial of the treatment and expect to eventually include multiple centers.

Smoking may boost severe COVID-19 risk among young adults

Close to one third of young U.S. adults appear to have an elevated risk for severe COVID-19, with smoking their strongest risk factor, according to survey data.

Researchers looked at data from more than 8,000 participants, ages 18 to 25, in the nationally representative National Health Interview Survey for 2016 to 2018. They also looked at participants’ medical conditions identified by the U.S. Centers for Disease Control and Prevention as making people of any age “medically vulnerable” to severe illness from the coronavirus.

Among these are diabetes, heart disease, immune problems, smoking, poorly controlled HIV or AIDS, and respiratory diseases. Overall, 32% of the young adults surveyed were seen as medically vulnerable to severe COVID-19. Among non-smoking young adults, however, only 16% were seen as medically vulnerable.

“Efforts to reduce smoking and e-cigarette use among young adults would likely reduce their medical vulnerability to severe illness,” the researchers said on Monday in the study published in the Journal of Adolescent Health. “Our analysis suggests that risk from smoking and e-cigarette use is highest among young adults who are male, white, and lower income and who are fully or partially uninsured.”

Coronavirus may rarely pass through placenta

It is unclear whether the coronavirus can pass through the womb from mother to fetus.

On Tuesday, doctors in France reported a very rare case that suggests transmission through the placenta may be possible. In the journal Nature Communications, they described a baby born prematurely to a mother with COVID-19. They found the virus in placental tissue as well as in the mother’s and baby’s blood, which suggests that trans-placental transmission of the novel coronavirus virus may be possible, although further studies are needed. Both mother and baby recovered well.

Marian Knight, a professor of maternal and child population health at Oxford University, said the case should not be a major worry for pregnant women. Among the many thousands of babies born to mothers infected with the virus, only around 1% to 2% have been reported to also have had a positive test, Knight said.

Promising results from early trial of new vaccine

Moderna Inc’s experimental vaccine for COVID-19, mRNA-1273, was safe and provoked immune responses in all 45 healthy volunteers in a first-in-humans phase 1 study, researchers reported on Tuesday in the New England Journal of Medicine. Volunteers who got two doses of the vaccine had levels of virus-killing antibodies that exceeded the average levels seen in recovered COVID-19 patients.

Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, whose researchers developed Moderna’s vaccine candidate, called the results good news. Fauci noted that the study found no serious adverse events and the vaccine produced “reasonably high” levels of virus-killing or neutralizing antibodies.

“If your vaccine can induce a response comparable with natural infection, that’s a winner,” Fauci told Reuters. “That’s why we’re very pleased by the results.” A phase 2 trial testing the vaccine’s efficacy in a larger group started in May.

A much larger phase 3 trial to confirm efficacy and identify rare side effects will begin this month, ultimately including 30,000 participants. Separately, early-stage human trial data on a vaccine being developed by AstraZeneca and Oxford University will be published on July 20, the Lancet medical journal said on Wednesday.

(Reporting by Nancy Lapid, Kate Kelland and Julie Steenhuysen; Editing by Will Dunham)

Trump willing to consider more aid to reopen schools, Kudlow says

WASHINGTON (Reuters) – U.S. President Donald Trump is willing to consider additional aid to re-open schools, White House economic adviser Larry Kudlow said on Monday.

“The president has said that he’s open to suggestions about additional funding if it appears that would be necessary in certain states and localities, so he will look at that,” Kudlow told reporters outside the White House.

Trump has been pushing for schools to re-open for the beginning of the school year in the fall, even while the coronavirus surges in states across the country.

Last week, Trump attacked the Centers for Disease Control and Prevention for school reopening guidelines that he said were too expensive and impractical.

The Trump administration has argued that schools must re-open in order to get the battered economy back on track, but critics have questioned whether it can be done safely.

(Reporting by Lisa Lambert and Makini Brice; Editing by Chizu Nomiyama and Richard Chang)

New U.S. health crisis looms as patients without COVID-19 delay care

By Sharon Bernstein

(Reuters) – A Texas man who waited until his brain tumor was softball-sized; a baby who suffered an ear infection for six days; a heart patient who died: The resurgence of COVID-19 is creating another health crisis as hospitals fill and patients are fearful or unable to get non-emergency care.

With U.S. coronavirus infections reaching new heights, doctors and hospitals say they are also seeing sharp declines in patients seeking routine medical care and screenings – and a rise in those who have delayed care for so long they are far sicker than they otherwise would be.

“I had one lady who had delayed for five days coming in with abdominal pain that was getting worse and worse,” said Dr. Diana Fite, who practices emergency medicine in Houston. “When she finally came in, she had a ruptured appendix.”

After the pandemic was declared a national emergency in March, many states banned non-essential medical procedures, and the number of patients seeking care for other ailments took a nosedive. Hospitals and medical practices were hit hard financially.

Emergency department use dropped by 42% during the first 10 weeks of the pandemic despite a rise in patients presenting with symptoms of the coronavirus, data from the U.S. Centers for Disease Control and Prevention show. In the same period, patients seeking care for heart attacks dropped by 23% and stroke care by 20%.

As the initial outbreak leveled off in the weeks that followed, healthcare experts planned to handle primary care differently should infections rise again, making sure minor procedures like cancer screenings were still allowed and assuring patients that hospitals and clinics were safe.

But the recent surge in cases has swamped hospitals in many states, including Texas, Arizona, Florida and parts of California.

CANCER MORTALITY RATES

Texas has again banned many non-emergency procedures, though cancer surgeries are still allowed, and a hospital in California’s San Joaquin Valley for several days admitted only COVID-19 patients.

Patients without COVID-19 – either out of fear, confusion or because of difficulty in obtaining the care they need – are again staying home.

The result is a healthcare crisis in the making, said Austin oncologist Dr. Debra Patt, who said she expects mortality rates from cancer to skyrocket in the years after the pandemic because patients have delayed their care.

“They’re scared to go in the hospital unless they absolutely have to,” said Patt. “And even when the patients are willing, it’s hard to get things done.”

Patt in recent days treated a man who waited to come in for headaches and dizziness until he had lost 35 pounds and had a softball-sized tumor in his head.

Fite, who is president of the Texas Medical Association, cared for a baby whose parents waited six days before bringing him in with a severe ear infection.

Patt said screening mammograms are down by 90% in Austin, where she specializes in breast cancer and serves as executive vice president of Texas Oncology. That means some tumors will be missed, and women who develop aggressive cancers might not know about it until the disease is more advanced and more likely to be deadly.

“It’s an impact we will see on cancer survival for years to come,” she said.

Dr. David Fleeger, a colorectal surgeon in Austin and a past president of the Texas Medical Association, said he has had numerous patients cancel colonoscopies in recent days.

“The delays in colonoscopies that are occurring right now ultimately will lead to more cancers and more deaths,” he said.

‘IN A HOLDING PATTERN’

Patt’s patient Helen Knost had to put off surgery for breast cancer in early spring because it was considered non-emergency in Texas and barred at the time, and she was treated instead with the medication Tamoxifen.

“It’s very strange to know you have cancer and you’re just hanging out with it, just in a holding pattern,” said Knost, who did ultimately undergo successful surgery.

In California, doctors at the 150-bed Adventist Lodi Memorial Hospital in the San Joaquin Valley were determined that a second surge in coronavirus cases would not bring a repeat of the pandemic’s early days, when emergency room visits dropped in half. Emergency medical technicians also reported a 45% rise in the number of heart patients who died before they could be brought to the hospital.

Hospital CEO Daniel Wolcott led a campaign to inform the community that the medical center was open and safe, even speaking to people about it in the grocery store.

But with new COVID-19 cases swamping the hospital, sickening nearly 30 staff members and forcing it to divert non-coronavirus cases to other facilities for several days, Wolcott fears that again patients with heart conditions and other illnesses will stay away.

“We won’t know for years how many people lost their lives or lost good years of their lives for fear of coronavirus,” he said.

(Reporting by Sharon Bernstein in Sacramento, California; editing by Bill Tarrant and Cynthia Osterman)

U.S. sets one-day record with more than 60,500 COVID cases; Americans divided

By Lisa Shumaker and Omar Younis

(Reuters) – More than 60,500 new COVID-19 infections were reported across the United States on Thursday, according to a Reuters tally, setting a one-day record as weary Americans were told to take new precautions and the pandemic becomes increasingly politicized.

The total represents a slight rise from Wednesday, when there were 60,000 new cases, and marks the largest one-day increase by any country since the pandemic emerged in China last year.

As infections rose in 41 of the 50 states over the last two weeks, Americans have become increasingly divided on issues such as the reopening of schools and businesses. Orders by governors and local leaders mandating face masks have become particularly divisive.

“It’s just disheartening because the selfishness of (not wearing a mask) versus the selflessness of my staff and the people in this hospital who are putting themselves at risk, and I got COVID from this,” said Dr. Andrew Pastewski, ICU medical director at Jackson South Medical Center in Miami.

“You know, we’re putting ourselves at risk and other people aren’t willing to do anything and in fact go the other way and be aggressive to promote the disease. It’s really, it’s really hard,” he said.

Stephanie Porta, 41, a lifelong Orlando, Florida, resident, said only about half the shoppers at her grocery store wore masks, though that was more than she saw two weeks ago.

“They’re trying to make everything seem normal, when it’s not. People are dying, people are getting sick. It’s insane,” she said.

Florida on Thursday announced nearly 9,000 new cases and 120 new coronavirus deaths, a record daily increase in lives lost. Governor Ron DeSantis called the rising cases a “blip” and urged residents not to be afraid.

“I know we’ve had a lot of different blips,” DeSantis said. “We’re now at a higher blip than where we were in May and the beginning of June.”

Florida is one of the few states that does not disclose the number of hospitalized COVID patients. But more than four dozen Florida hospitals reported their intensive care units reached full capacity earlier this week.

In Texas a group of bar owners sued Governor Greg Abbott, a Republican, saying his June 26 order closing them down violates the state constitution, the Dallas Morning News reported.

Dr. Robert Redfield, director of the U.S. Centers for Disease Control and Prevention, said Thursday that keeping schools closed would be a greater risk to children’s health than reopening them.

California and Texas, the two most populous states, announced record increases in COVID deaths on Wednesday.

California has seen cases and hospitalizations surge, even though it imposed one of the strictest lockdowns. After several lawmakers and staffers at the state Capitol in Sacramento were infected, lawmakers said the legislature would not return from summer break until July 27.

Riverside University Health System, east of Los Angeles, expanded its 44-bed intensive care unit after it filled up with patients.

“It’s been very consistent every day in the last couple of weeks. Every day has been like a full moon,” Riverside emergency room physician Stephanie Loe said, referring to doctors’ beliefs that a full moon brings more patients to the emergency room.

Governors in California, Florida and Texas have either ruled out forced business closures and quarantines or called them a last resort. But Los Angeles Mayor Eric Garcetti warned he would impose a new stay-at-home order in two weeks if the latest surge did not ease.

The rise in infections also weighed on the stock market Thursday on fears of new lockdowns, which would take a toll on the economic recovery. The Dow <.DJI> and the S&P 500 <.SPX> ended down about 1%.

(Reporting by Omar Younis in Los Angeles, Rich McKay in Atlanta and Sharon Bernstein in Sacramento, California; Additional reporting by Lucia Mutikani in Washington and Maria Caspani and Sinead Carew in New York; Writing by Lisa Shumaker and Dan Whitcomb; Editing by Cynthia Osterman, Daniel Wallis and Leslie Adler)

New U.S. CDC school reopening guidelines promised after Trump complains

By Doina Chiacu and Daphne Psaledakis

WASHINGTON (Reuters) – The U.S. Centers for Disease Control and Prevention plans to issue new guidelines for reopening schools, Vice President Mike Pence said on Wednesday, after President Donald Trump criticized the agency’s recommendations as too expensive and impractical.

Trump, a Republican who is seeking re-election in November, accused Democrats of wanting to keep schools shut for political reasons and threatened to cut off federal funding to schools that do not reopen, despite a surge in coronavirus cases.

“I disagree with @CDCgov on their very tough & expensive guidelines for opening schools. While they want them open, they are asking schools to do very impractical things. I will be meeting with them!!!” Trump said on Twitter.

Flanked by top administration health and education officials, Pence said the CDC next week will issue a “new set of tools … to give more clarity on the guidance going forward.

“The president said today we just don’t want the guidance to be too tough,” Pence said at a White House coronavirus task force briefing at the Department of Education.

CDC Director Robert Redfield stressed that agency guidelines were not requirements.

“It would be personally very disappointing to me, and I know my agency, if we saw that individuals were using these guidelines as a rationale for not reopening our schools,” Redfield said.

White House spokeswoman Kayleigh McEnany told reporters the White House did not pressure the CDC to revise its recommendations.

The CDC has made a number of recommendations for schools, including testing for COVID-19, dividing students into small groups, serving packaged lunches in classrooms instead of cafeterias, and minimizing sharing of school supplies.

It has advised that seats be spaced at least six feet apart and that sneeze guards and partitions be put in place when social distancing is not possible.

Administration officials said local leaders would tailor their decisions on how schools reopen.

“Ultimately it’s not a matter of if schools should reopen, it’s simply a matter of how. They must fully open,” Education Secretary Betsy DeVos said.

States are responsible for primary and secondary education under the U.S. Constitution, but some have been holding off on deciding when and how to open schools, concerned about the resurgence of coronavirus across the country.

The U.S. outbreak has crossed the 3 million mark in confirmed cases, with a death toll of 131,336, according to a Reuters tally.

“The Dems think it would be bad for them politically if U.S. schools open before the November Election, but is important for the children & families. May cut off funding if not open!” Trump said on Twitter.

Acknowledging that the lion’s share of school funding comes from states, Pence said that the administration would work with Congress to look for ways “to give states a strong incentive and encouragement to get kids back to school.”

“It’s time for us to get our kids back to school,” he said.

The federal government provides some supplementary funding for schools, including through congressional appropriations. With Democrats controlling the House of Representatives, any effort to curtail funding is sure to face roadblocks.

McEnany said Trump is “looking at potential redirecting (of funding) to make sure it goes to the student and it is most likely tied to the student and not to a district where schools are closed.”

Labor Secretary Eugene Scalia said school re-openings were necessary for the U.S. economic recovery. Business and conservative groups have said parents need to get back to work.

On Tuesday, Trump said he would pressure state governors to open schools in the fall.

However, the surge in U.S. cases has raised concerns about the increased risk of children spreading the virus to vulnerable adults at home as well as to older teachers and school staff.

New York Governor Andrew Cuomo said the federal government has no authority on schools and his state will announce its reopening plans in the first week of August.

In neighboring New Jersey, Governor Phil Murphy said he planned to reopen state schools in the fall, but reserved the right to “tweak that if it means saving lives.”

(Reporting by Doina Chiacu; Additional reporting by Jeff Mason; Editing by Bernadette Baum, Jonathan Oatis and Sonya Hepinstall)

Trump says ‘may cut off funding’ if U.S. schools do not open

By Doina Chiacu

WASHINGTON (Reuters) – U.S. President Donald Trump on Wednesday threatened to cut off funding to schools that do not open in the fall and criticized a federal health agency’s guidelines for reopening schools as “very tough & expensive.”

The Republican president, who is seeking re-election in November, accused Democrats of wanting to keep schools shut for political reasons, despite a surge in coronavirus cases across the country.

“The Dems think it would be bad for them politically if U.S. schools open before the November Election, but is important for the children & families. May cut off funding if not open!” Trump said on Twitter, pointing to schools reopening in some European countries with no problems.

It was not clear what specific federal aid the Republican president had in mind. States are responsible for primary and secondary education under the U.S. Constitution, but the federal government provides some supplementary funding.

Trump also took aim at the U.S. Centers for Disease Control and Prevention, the nation’s health protection agency whose director sits on the White House coronavirus task force.

“I disagree with @CDCgov on their very tough & expensive guidelines for opening schools. While they want them open, they are asking schools to do very impractical things. I will be meeting with them!!!” Trump said in a separate Twitter post.

The White House did not elaborate on which CDC guidelines Trump took issue with.

The CDC has recommended a number of considerations for schools, including testing, dividing students into small groups, serving packaged lunches in classrooms instead of cafeterias, and minimizing sharing of school supplies. It advised sneeze guards and partitions be put in place when social distancing is not possible, and that seats be spaced at least six feet apart.

“It’s time for us to get our kids back to school,” Vice President Mike Pence said after a White House coronavirus task force meeting at the Department of Education on Wednesday.

Pence said the CDC plans to issue new guidelines on schools and stressed the agency’s guidelines were not meant to replace local school considerations and decision-making.

On Tuesday, Trump held meetings about school re-openings at the White House and said he would pressure state governors to open schools in the fall.

New York Governor Andrew Cuomo retorted on Wednesday that the federal government has no authority on schools and his state will announce reopening plans in the first week of August.

Business and conservative groups have urged reopening schools safely as important to getting parents back to work and reviving the U.S. economy.

Educators say socialization and other benefits such as school food programs are critically important. Experts have also shown online learning exacerbates the divide between poorer and more wealthy Americans, who have greater access to technology.

The alarming surge in cases in the United States, however, has raised concerns about the increased risk of spread of the virus by children to vulnerable adults at home as well as to older teachers and school staff.

New Jersey Governor Phil Murphy said on Wednesday he planned to reopen state schools in the fall, but reserved the right to “tweak that if it means saving lives.”

In Los Angeles, the top public health official said the planned reopening of primary and secondary schools in the fall is at risk. “Every single school district at this point needs to have plans in place to continue distance learning for 100% of the time,” Public Health Director Barbara Ferrer told officials in a private conference call reported by the Los Angeles Times.

(Reporting by Doina Chiacu; Editing by Bernadette Baum and Jonathan Oatis)