Today’s Class: Impeccable Timing 101

June 15th, 2020 by Tom Lynch

No one will ever accuse the Republican Party of being overburdened with sensitivity. In two stick-in-the-eye moves just oozing with impeccable timing, the Grand Old Party is telling the world just what it can do with its Black Lives Matter folderol.

First, the GOP’s unquestioned leader, President Donald Trump, like a too long cooped up horse, has decided to resume his rallies, which for him seem to be better than crack cocaine. This week in Tulsa Oklahoma he and as many of his followers as campaign officials can cram into the 19,000-seat BOK Center will gather for a couple of hours of The Best Of Trump as if the COVID-19 pandemic had never happened, neither masks nor social distancing required. Reminds me of Ebenezer Scrooge discussing innovative methods to “decrease the surplus population.”

In the first of his two impeccable timing decisions, Mr. Trump announced he would hold his Tulsa rally on 19 June, known as Juneteenth, the date on which in 1865, the last of the South’s slaves were notified of their freedom under the Emancipation Proclamation. It would take until the following December and the 13th Amendment to officially abolish slavery in America.

Juneteenth is recognized as a state holiday or ceremonial holiday in 47 states and the District of Columbia (what are you waiting for Hawaii, North Dakota, and South Dakota?) and is the oldest celebration marking the end of slavery, dating from 1866.

According to the Associated Press, Trump was unaware of Juneteenth, let alone the significance of it to the Black community, when he announced his rally’s date. Consequently, he did not anticipate the blowback he would get. But get it he did. Even from his own supporters.  In a rare instance of backing down, he moved the rally to the next day, the 20th, still in Tulsa at the BOK Center.

But in America’s Black consciousness, Tulsa is known for a lot more than Juneteenth, as significant as that is. On another day in June, the 1st June day of 1921, Tulsa was the site of the worst race massacre in American history.

The day before, police had arrested a young black man by the name of Dick Rowland for allegedly attacking a white woman in a Tulsa elevator. Soon after Rowland’s arrest, rumors began to spread about a group of whites planning a lynching party. To protect Rowland, African American World War 1 veterans surrounded the jail holding him. There was a standoff with a mob of whites. Somebody fired a shot, and a firefight ensued. The much larger white mob pushed the black vets all the way to Greenwood, Tulsa’s black section.

Greenwood was the wealthiest black neighborhood in the country. Oil had made it rich. Racism was about to destroy it. Over the course of the day, 6,000 homes and businesses and 36 square city blocks were turned to ash. Pilots of two airplanes dropped turpentine bombs on buildings, instantly igniting them. Three hundred African Americans were slaughtered, most thrown into mass graves. Not a soul was ever prosecuted for anything. Then Tulsa, population 100,000, swept it all under the rug. Two generations later nobody knew a thing about it. It was never taught in schools, no books were written, no oral history passed down. It was as if it never happened.

Tulsa’s current mayor, G. T. Bynum, wants to take the rug up to see what’s hiding under it. He’s committed to investigating what happened and determining accountability. He thinks he’s found a couple of the mass graves and is having them excavated. The goal is to at least identify as many victims as possible through DNA analysis.

For the people of Tulsa, especially the black people of Tulsa, this is a deep, open, festering wound, and next Saturday Donald Trump will come riding into town on his big, very white horse to preach the gospel of Trump to 19,000 of his followers. It’ll be an interesting day.

There is one more incident of impeccable timing.

The Republican National Covention had been scheduled for North Carolina, but because North Carolina’s Democratic Governor Roy Cooper, concerned about the spread of COVID-19, would not guarantee a full house for the late August event, the Republican party has moved most of the convention to Jacksonville, Florida. The Coronation of Mr. Trump is set for the night of 27 August.

And, you guessed it, there is a black history story about 27 August and Jacksonville. It is known as Ax Handle Saturday.

The year is 1960 and the Jacksonville Youth Council of the National Association for the Advancement of Colored People (NAACP) is holding peaceful lunch counter sit-ins. Peaceful demonstrations. A group of outraged whites taking exception to this level of daring, begin spitting on the demonstrators and calling them names no one should ever be called. Then ax handles, mercifully without ax heads, suddenly appear along with baseball bats, and the demonstrators begin to get hit. Things go downhill from there. When it is all over dozens of young African Americans would be wounded in various ways. On a brighter note, nobody died, but that was probably blind luck.

To give you an idea of racial relations in Jacksonville at the time, a year earlier, in 1959, the year before Ax Handle Saturday, Nathan Bedford Forrest High School opened in Jacksonville, celebrating the memory of a Confederate General and the first Grand Dragon of the Ku Klux Klan.

The 60th anniversary of Ax Handle Saturday will be celebrated on 27 August in a park about a mile away from the convention at about the same time the balloons come down. Impeccable timing.

 

 

Racial Justice: If Not Now, When?

June 8th, 2020 by Tom Lynch

Since the nonchalant murder of George Floyd our nation has galvanized behind the cause of equal justice for all. We have moved past the chaos of the first day or two to a too-loud-to-be-ignored-any-longer chorus peacefully demanding systemic changes in race relations. Now, the question of the moment is: What will come of this? After all, we’ve had demonstrations and protests when abominations like this have happened before. And afterwards, after the thoughts and prayers stuff, life goes on. Is this going to be any different? Personally, I think it will be.

Why? Let me tell you a story.

It is 31 January 1968. In Vietnam, it’s the most important holiday of the year, the Tet Lunar New Year. In years past, this seven to nine day holiday has been the occasion for an informal cease fire between North and South warring forces. But not this year. Since the previous autumn, the North Vietnamese military commander General Vo Nguyen Giap has been secretly caching weapons, ammunition and Viet Cong troops throughout the country. In late autumn 1967, in a brilliant move of military misdirection, Giap has North Vietnamese regular army regiments attack U.S. strategically placed Firebases in the highlands of central Vietnam. The ferocious  battle of Khe Sang is an example. As U.S. commanders concentrate on repulsing these attacks, Giap prepares to spring the Tet trap.

And in the early morning hours of 31 January, 70,000 Viet Cong troops attack all over the country.

The Tet Offensive takes South Vietnamese and American commanders and politicians completely by surprise, shocks the U.S. public and begins the slow erosion of public support for the war. The fiercest fighting happens in the city of Hue, the ancient capital of Vietnam. The Viet Cong capture Hue and hold it until they are finally driven out on 24 February by American forces. During the time they hold the city, the Viet Cong exact a terrible price. They go house to house arresting all people thought to be South Vietnamese sympathizers, including a convent full of Catholic Nuns. They massacre them all and throw them into mass graves. Five thousand people.

In three to four weeks, Giap’s forces are resoundingly defeated. He has spread them too thin. The Tet Offensive will prove to be a military disaster for the North, but, more important, it will become its biggest strategic victory. American and South Vietnamese politicians now realize the contest will be longer and much more deadly than they have anticipated, the mood of the American people begins to shift, and U.S. army Killed In Action increases to 500 per week.

And then, twenty days after the recapture of Hue, comes the most horrific and gruesome stain on America’s character during the entire war: The My Lai Massacre.

It is 16 March, and at the village of My Lai an American nerve-frayed platoon of the Americal Division under the command of 1st Lieutenant William Calley massacres hundreds of innocent civilians – men, women and children – as they run from their huts. Then they round up the rest of the village, line them up along a large ditch and shoot them all. According to Vietnamese records, they slaughter 547 people that day (the U.S. admits to only 304).

Calley had been ordered by his Company Commander, Captain Ernest Medina, to enter My Lai and kill the Viet Cong that Army Intelligence thought were hiding there among the civilian population. But there are no Viet Cong at My Lai that day. The Platoon troops don’t care. They kill everyone. And Calley, their commanding officer, stands by and watches. He does nothing to stop it.

Afterwards, Calley’s commanders in the Americal’s 11th Infantry Brigade will cover up the massacre by simply saying there wasn’t one. But the truth eventually comes out when American reporter Seymour Hersh breaks the story a year later (for which he will win a Pulitzer Prize). Calley is court-martialled, found guilty and sentenced to life in prison. President Nixon will reduce the sentence to three years and allow Calley to serve it by house arrest at Fort Benning, Georgia. The army also charges fourteen other people up and down the chain of command. All either have their charges dismissed or are acquitted at trial. Everyone seems to live happily ever after, even Calley, who doesn’t publicly admit any regret until 41 years later.

Why am I writing this? For two reasons. First, because the quality of leadership matters. All the leadership, top to bottom,  surrounding the My Lai massacre was horridly bad leadership, and, in the eyes of the public, leadership in many of America’s police departments is of a similar calibre. It is seen as suspect, at best, and despotic, at worst. Second, because the Tet Offensive and the My Lai massacre galvanized the American public into creating a movement that eventually became too powerful for politicians to resist and led to the end of the Vietnam war, a war that killed more than 50,000 Americans and millions of Vietnamese.

Today, we are in a similar situation of urgent morality. For hundreds of years, black children have been raised to fear whites, especially white police. “Don’t talk back, keep your hands on the steering wheel at all times, and never ever reach for anything.” Driving While Black is not fake news. The selection and training of police recruits continues to perpetuate this fundamental character flaw in the soul of America.

At the very least, what will reduce the worst in policing and increase the best is a thoroughly reimagined system of selecting and training new police officers. “Protect and serve” begins with empathy, actually seeing the people one is sworn to serve; actually listening to better understand them and their needs.

After My Lai, the army rebuilt its officer training programs. The Code of Military Justice and the Geneva Convention were given more attention. As we moved to an All-Volunteer Army, the selection criteria were rethought and enhanced. We have seen the benefit of that in our military’s improved conduct in Iraq and Afganistan. That kind of retooled selection and training has not happened in police academies. What has happened is more training in crowd control, more buying of military quality weaponry and a perpetuation of an us versus them mentality. These have been on stark display since the killing of George Floyd.

To change this will require sustained, dedicated and empathic leadership, which I’m guessing will not be coming from 1600 Pennsylvania Avenue, at least not in the immediate future. But the growing and forceful muilticultural demands for equal justice as vividly  demonstrated recently on the streets of America is a start, a start that urgently needs a finish.

More About The Moderna Vaccine Results

May 22nd, 2020 by Tom Lynch

Scientists and Wall Street analysts are now beginning to peal the onion of Moderna’s announcement about its Phase One Trial results in which it reported its vaccine candidate had produced antibodies in eight of the study’s 45 participants. Following the announcement, Moderna’s shares rose nearly 30%. A profitable day, indeed.

On Tuesday, I wrote it was way too early to get excited based on this teeny tiny study. Since then, it’s nice to see that Evercore ISI’s Umer Raffat, an analyist Institutional Investor called a Rising Star of Wall Street Research, has added context and perspective. Early Tuesday, Raffat sent a 78-page slide deck to his clients explaining why, while possibly encouraging, Moderna’s announcement  and Monday conference call should not give anyone a serious sense of hope until a lot more work is done and a lot more is known about this particular Phase One Trial.

Getting into the science weeds, Raffat focused his analysis on antibodies and T-Cells.

First, the antibodies. Raffat thinks the most impressive thing about Moderna’s data release concerns “binding” antibodies. These are antibodies that attach to SARS-CoV-2, the virus that causes COVID-19. The concern with Moderna’s announcement is that what’s really important for an effective vaccine is its ability to generate “neutralizing” antibodies that actually prevent the virus from infecting healthy cells, and Moderna provided no information about neutralizing antibodies except to say its neutralizing antibodies “were at or above convalescent serum” collected from people who recovered from COVID-19. Studies have shown that people who have recovered from COVID-19 can generate a wide range of neutralizing-antibodies in their convalescent serum. So, it is unclear just how comparable Moderna’s convalescent serum samples were to samples taken from the trial participants.

The FDA will have to determine what level of neutralizing antibodies are required for an approved vaccine. The Agency has already said that when convalescent serum is used to treat COVID-19 patients the neutralizing antibodies should be high, whatever that means.

Another issue with Moderna’s mRNA-1273 vaccine rests with T-Cells. The level of T-Cell generation is an indicator of the degree to which the immune system is attacking COVID-19. Moderna’s announcement and subsequent call did not address this. Some researchers have shown that a high level of T-Cell generation, even without high levels of neutralizing antibodies, have been found in people who have recovered from COVID-19, leading to speculation that T-Cell generation may be very important for any successful vaccine. However, when asked about this during the conference call, Moderna’s Chief Medical Officer, Tal Zaks, M.D., Ph.D., said  “You would expect that based on the fundamental scientific principles of how an mRNA vaccine works because it teaches the body’s own cells to make the protein from within the cell.”

One last point – The study participants numbered 45. Eight produced binding antibodies. Only four were sampled for neutralizing antibodies. Four.

As I wrote earlier this week, Moderna has made it to the one yard line. Ninety-nine to go.

 

 

The Continuing Saga Of COVID-19 In Long Term Care Facilities And New Research

May 21st, 2020 by Tom Lynch

We have written about the ongoing death spiral in LTCFs four times – herehere, here, and here.

We’ve done this, because for three months authorities have known that LTCF’s were lethal hot spots, the most lethal in the country, actually. And to this day the federal government has devoted nothing more than lip service to it. Don’t believe me? Read on.

Last Thursday, OSHA issued COVID-19 Guidelines, not Requirements, for nursing homes. The Guidelines recommend screening residents and staff for symptoms, keeping everyone six feet apart and creating alternatives to group activities. I challenge anyone to read the Guidelines and find the word, “must.” OSHA has become the quintessential paper tiger. Remember, it only took three months to produce these groundbreaking recommendations.

And it is now exactly one month since CMS Administrator Seema Verma, to much ballyhoo, announced new COVID-19 reporting requirements for nursing homes. Specifically, CMS was requiring:

…nursing homes to inform residents, their families and representatives of COVID-19 cases in their facilities. In addition, as part of President Trump’s Opening Up America, CMS will now require nursing homes to report cases of COVID-19 directly to the Centers for Disease Control and Prevention (CDC).  This information must be reported in accordance with existing privacy regulations and statute. This measure augments longstanding requirements for reporting infectious disease to State and local health departments. Finally, CMS will also require nursing homes to fully cooperate with CDC surveillance efforts around COVID-19 spread.

So, how has that worked out? Keep in mind that, as reported by the New York Times, “While just 11 percent of the country’s cases have occurred in long-term care facilities, deaths related to Covid-19 in these facilities account for more than a third of the country’s pandemic fatalities.” As of 9 May, the Times reported the death toll in Long Term Care Facilitites (LTCF) was 28,100. Those are the ones we know of.

Unfortunately, that number is probably low, because we are still waiting for the CMS reporting requirement to produce anything. And now, it appears CMS’s plan has changed. On 14 May, one week ago, Administrator Verma said data from LTCFs would not be posted on the CDC website. Rather, it will be reported by the end of this month somewhere on Medicare’s website Nursing Home Compare.

Nursing Home Compare is exactly what the name suggests. It is a site where, by inputting a zip code, one can compare what Medicare calls Health Deficiencies in specific nursing homes within the relative geography chosen. It includes a humongously large database containing a number of datasets devoted to health deficiencies. This may be the place one would search for nursing home data regarding COVID-19. But we won’t know that until “the end of this month.” Maybe.

We shall see.

By the way, Verma’s announcement of one month ago began with this:

Today, under the leadership of President Trump, the Centers for Medicare & Medicaid Services (CMS) announced new regulatory requirements that will require nursing homes to inform residents, their families and representatives of COVID-19 cases in their facilities.

“Leadership.” Really?

Research on what is most effective to stop COVID-19 transmission

Two new research papers look into the effectiveness of the measures governments have either required or recommended for slowing the spread of the virus.

The first, Strong Social Distancing Measures In The United States Reduced The COVID-19 Growth Rate, published in Health Affairs on 14 May, investigated the efficacy of four social distancing policies taken by most state and local governments: Shelter-in-place orders (SIPOs), public school closures, bans on large social gatherings, and closures of entertainment-related businesses. Specifically, the researchers were trying to estimate the relationship between social distancing policies and the exponential growth rate of confirmed COVID-19 cases using an event-study regression with multiple treatments.

There were surprising results.

First, from the Paper:

Adoption of government-imposed social distancing measures reduced the daily growth rate by 5.4 percentage points after 1–5 days, 6.8 after 6–10 days, 8.2 after 11–15 days, and 9.1 after 16–20 days. Holding the amount of voluntary social distancing constant, these results imply 10 times greater spread by April 27 without SIPOs (10 million cases) and more than 35 times greater spread without any of the four measures (35 million). Our paper illustrates the potential danger of exponential spread in the absence of interventions,…

Second, only two of the policies produced statistically significant impacts on the growth rate at the 95% confidence level: SIPOs and the closures of entertainment-related businesses.

In contrast, the researchers found no evidence that bans on large social gatherings or school closures influenced the growth rate. That is not to say there was no influence on the growth rate due to these measures, just that whatever influence was there, it was not statistically significant.

The school closure finding is important as school boards and college trustees ponder whether to reopen in the fall. Yesterday, Boston College, where I spent some of my youth, announced that the campus would be open for classes for the fall semester.

The second PaperFace Masks Against COVID-19: An Evidence Review, “synthesized the relevant literature to inform multiple areas: 1) transmission characteristics of COVID-19, 2) filtering characteristics and efficacy of masks, 3) estimated population impacts of widespread community mask use, and 4) sociological considerations for policies concerning mask-wearing.”

The verdict of the researchers: “The preponderance of evidence indicates that mask wearing reduces the transmissibility per contact by reducing transmission of infected droplets in both laboratory and clinical contexts. Public mask wearing is most effective at stopping spread of the virus when compliance is high. The decreased transmissibility could substantially reduce the death toll and economic impact while the cost of the intervention is low.” In otherwords, masks work.

This paper carried the following supplemental tidbit:

While the focus of this article is on preventing the spread of COVID-19 disease through public mask wearing, many countries face concurrent epidemics of contagious respiratory diseases like tuberculosis and influenza. Tuberculosis kills 1.5 million people globally per year, and in 2018, 10 million people fell ill. Face covering has been shown to also reduce the transmission of tuberculosis. Similarly, influenza transmission in the community declined by 44% in Hong Kong after the implementation of changes in population behaviors, including social distancing and increased mask wearing, enforced in most stores, during the COVID-19 outbreak.
This could be important when one considers that an effective vaccine for tuberculosis exists: the Bacillus Calmette-Guérin vaccine. It isn’t usually given to infants in the U.S., because the disease isn’t a widespread problem here. However, when we eventually have a vaccine for COVID-19, we’re going to have to face the fact that getting it to people around the world is not going to be easy.
And, God help us, we’ll also have to deal with the anti-vax cult living among us here at home.

 

COVID-19: Two Updates

May 19th, 2020 by Tom Lynch

Who pays?

The last question asked in our question-filled Post of 13 May was the same as the first question asked, namely: Who’s the guy at the end of the line left holding the bill for COVID-19 workers’ compensation claim costs?

Right now, as we have written here, each state is addressing this in its own way; fifty different plans for one national crisis.Thus far, workers’ compensation is the pot out of which, in one way or another, claims are addressed. Employers do not like this.

Employers of essential workers haven’t wanted to scream too loudly about being the last in line guy, what with so many of their  workers falling ill, even dying, every day. That kind of crass insensitivity would be bad for business. But inwardly, they have to be nervous about getting stuck with the check, the cost of which, as we have documented here, could be enormous.

Employers have already taken a high hard one to the side of the head with the complete and utter devastation COVID-19 has done to their economic well being, and the requirement to pay the workers’ compensation claims which are going to avalanche over the top of them is something with which they strongly disagree. For what it’s worth, I think they have a point.

Back at the state capitals, I would venture, governors don’t really care where the money comes from, just as long as it’s not coming out of their state treasuries.

And throughout history, insurers have resisted paying for occupational disease claims. Witness the 20-year fight to avoid paying the costs of pneumoconiosis, which resulted in the Federal Coal Mine Health and Safety Act of 1969, amended four years later by the Black Lung benefits Act, which created the Black Lung Disability Trust Fund.

So, if the states don’t pay and if insurers don’t pay and if employers don’t pay, who is left?

Brothers and sisters, the federal government is left, which is another way of saying we are left. We will all share the risk and share the costs. If you cannot bring yourself to believe that, you haven’t been paying attention.

In fact, a model exists: The September 11th Victim Compensation Fund, which:

…provides compensation to individuals (or a personal representative of a deceased individual) who were present at the World Trade Center or the surrounding New York City exposure zone; the Pentagon crash site; and the Shanksville, Pennsylvania crash site, at some point between September 11, 2001, and May 30, 2002, and who have since been diagnosed with a 9/11-related illness.  The VCF is not limited to first responders.  Compensation is also available to those who worked or volunteered in construction, clean-up, and debris removal; as well as people who lived, worked, or went to school in the exposure zone.

The wheels are already in motion. Last week, a bipartisan group in the House unveiled the Pandemic Heroes Compensation Act, a plan to compensate essential workers who fall sick or die from COVID-19. The Act is modeled on the September 11th Victim Compensation Act.

Senate democrats are also proposing legislation. Like everything else in D.C. these days, the road from here to eventual victim compensation will be tortuous, but I cannot see any other way of paying for this national catastrophe other than with a national program. Can you?

The Moderna results

For a number of years, I chaired the Board of a BIOTECH pre-clinical Contract Research Organization (CRO). We took compounds, whose makers hoped would become the next blockbuster drugs, and tested them in mice, rats, guinea pigs, rabbits, pigs and non-human primates (that’s right, monkeys). In the biotech business, everyone knows everyone else, and we certainly knew a lot of scientists trying to develop vaccines.

Yesterday, the Boston pharmaceutical company Moderna reported a vaccine it was developing for COVID-19 produced antibodies in humans. In vaccine development, this is the beginning of a Phase One trial, and its purpose is to confirm the vaccine is not toxic. Moderna’s Phase One trial is composed of 45 participants, eight of whom  Moderna says produced the antibodies. We know nothing of the other 37.

While encouraging, you won’t find respected scientists getting too excited yet. They know what Moderna has done is to take the ball out of the end zone and reach the one yard line. Nintey-nine to go.

Two things are exciting, however. First, Moderna was able to get to this point at light speed. What Moderna did in about 70 days usually takes three to four years. That is over the moon fast, but the other ninety-nine yards are going to be increasingly more arduous. Second, there are more than 100 other groups around the world, both pharmaceutical and academic, who are also going hell bent for leather to develop the vaccine that will eradicate COVID-19. Although I have every confidence one of these groups, maybe Moderna,  will cross the goal line at the other end of the field, it will take a miracle on the order of the Raising of Lazarus for this to happen before mid to late 2021.

Until then: Constant vigilance. Complacency will kill you. Really. Please keep this in mind as all the beaches and parks open this coming Memorial Day weekend. It will be highly tempting to revert to former form.

 

Important COVID-19 Workers’ Compensation Questions

May 13th, 2020 by Tom Lynch

Economic chickens are coming home to roost all over America. Except for the one percenters, and I may be wrong about them, everyone is feeling it, the pain. Biomedical devastation is leading us to places we have never imagined, let alone seen. In the quiet little room called workers’ compensation where I have sat for some number of years, there are questions that are going to need answering. Let’s look at a few of them.

But first, a little background. A week ago we wrote about a recent National Council on Workers’ Compensation (NCCI) analysis of workers’ compensation cost projections due to COVID-19. NCCI’s analysis projected a best case scenario, in which loss costs increase $2 billion, and a worst case scenario, in which they increase $81.5 billion, or 250% more than current total loss costs. Willis Towers Watson also released a scenario-based analysis that suggested pretty much the same thing.

On 8 April, the California State Assembly Insurance Committee asked the the California Workers’ Compensation Insurance Rating Bureau (WCIRB) to project loss costs if conclusive (rebuttable) presumptions were provided to front line workers, something Governor Gavin Newsom actually did through Executive Order one month later, so the “if” became a “done.” Later in April, the WCIRB released the requested report and concluded:

…the cost estimates in this Research Brief are presented as a range of potential impacts based on varying assumptions of the number of COVID-19 claims filed. On this basis, the WCIRB estimates that the annual cost of COVID-19 claims on ECI (Essential Critical Infrastructure) workers under a conclusive presumption ranges from $2.2 billion to $33.6 billion with an approximate mid-range estimate of $11.2 billion, or 61% of the annual estimated cost of the total workers’ compensation system prior to the impact of the pandemic.

Note two things. First, for perspective, if California were a country, it would have the fifth largest GDP in the world. Second, regardless, the WCIRB’s best case scenario is $.2 billion more than NCCI’s best case scenario for all 38 states where it provides ratemaking services.

Clearly, whatever scenario happens, workers’ compensation losses are going to be cataclysmic.

So, about those questions:

  1. Who’s going to pay for all of this? In normal times, the answer is obvious: Employers and insurers (when losses exceed an employer’s liability). But if we know one thing for sure, these are not normal times. So, who takes the hit?
  2. What about secondary chronic conditions the virus has been shown to cause in some people? Many survivors of SARS (Severe Acute Respiratory Syndrome) suffered crippling ailments for more than a decade. We’re already seeing COVID-19 survivors come home from hospital with severe, possibly persistent, chronic conditions. Are these conditions covered by the initial claim? I can see the plaintiff’s attorney now. “Your Honor, but for the COVID-19 occupational disease, poor John here would never have immediately lost kidney function requiring dialysis three times per week, and would be the picture of health.”
  3. How will COVID-19 claims impact experience modification, which affects an employer’s premium for three years? It is only logical that if loss costs increase by billions in one year, an employer of essential workers, say a hospital, will see its experience modification factor take off like a SpaceX rocket. That is a recipe for economic doom and disaster beyond what we’re already seeing.
  4. What happens when an essential worker who has contracted COVID-19 and filed a claim infects other family members, or the neighbor next door, for that matter? Would they be covered by the claim, or by health insurance if they happen to have it? Keep in mind, job losses due to COVID-19 are now in excess of 20.6 million. Many have lost not only a job, they have also lost the health insurance the job provided. The Kaiser Family Foundation has said, “26.8M would become uninsured after losing job-based coverage during the coronavirus if they don’t enroll in other coverage.” Consequently, this question is very important, because workers’ compensation health care is totally free, unlike employer-based and nearly all other insurance options that all come with deductibles and co-pays.

Meanwhile, back at the California Workers’ Compensation Insurance Rating Bureau, the organization has submitted a proposed rule to deal with number 2, above. It wants to exclude COVID-19 loss costs from the calculation of experience modification. Specifically, the proposed rule says:

Claims directly arising from a diagnosis of Coronavirus disease 2019 (COVID-19), reported with a catastrophe Number 12 pursuant to the Uniform Statistical Reporting Plan, shall not be reflected in the computation of the experience modification.

The proposed rule would also reclassify workers now working remotely from home as clerical – 8810, which is the lowest premium rate possible.

Let’s suppose for just a moment that the WCIRB’s proposed rule is approved, and California’s employers are off the hook with respect to experience modification. This presents another question: Will other states do the same? All of them? Some of them? None? Whatever happens, it seems to me we need a nationally consistent approach. Wouldn’t you agree?

Finally, this all leads back to the first question: Who’s the guy at the end of the line left holding the bill for COVID-19 claim costs?

How Are States Handling Workers’ Compensation During COVID-19?

May 11th, 2020 by Tom Lynch

Last week we wrote about Governor Gavin Newsom’s Executive Order implementing a workers’ compensation rebuttable presumption for all essential workers who contract COVID-19 in California.

To review, a rebuttable presumption means an essential worker who contracts COVID-19 does not have to prove work-relatedness. The burden is on the employer to prove the disease was not caused by work.

Writing that other states have also taken action, I noted those actions varied widely across the country. But the monumentality of COVID-19 requires more on this topic. Just what are other states doing? Specifically.

Thirty-nine have either done nothing or have legislation pending. That is, they have taken no action via Executive Order, as Newsom did, or have yet to enact legislation. The District of Columbia is also in this group. Neither, have any of these states declared COVID-19 an occupational disease, although it obviously can be one.

The other 12 states have taken the following actions:

Akaska: On 9 April, Alaska Governor Mike Dunleavy signed legislation declaring a rebuttable presumption for first responders and other health care workers.

Arkansas: On 21 April Governor Asa Hutchinson issued an Executive Order creating a rebuttable presumption for first responders, other health care workers and National Guard personnel assigned to COVID-19 duties.

Florida: The state published a Memorandum saying first responders and health care workers “would be eligible for workers’ compensation benefits under Florida law.” Given the torment COVID-19 is causing throughout society, this is pretty wimpy, don’t you think?

Illinois: On 16 April, Governor J. B. Pritzker issued an Executive Order declaring a rebuttable presumption for first responders and other health care workers. Then, under intense pressure from the business and insurance communities, Pritzker, whose family owns the Hyatt hotel chain, rescinded the order. Obviously, a stand-up guy. So, I guess you could say Illinois now belongs in the camp of the other 38 states that have done nothing.

Kentucky: On 9 April, Governor Andy Beshear issued an Executive Order similar to Newsom’s, creating a rebuttable presumption for all essential workers who contract COVID-19. The business community isn’t happy, but, unlike Pritzker, Beshear has not changed his position.

Michigan: On 30 March, the Workers’ Disability Compensation Agency declared an Emergency Rule creating a rebuttable presumption for all First Response Employees, a term, as Michigan defines it, that includes just about everyone in health care.

Minnesota: On 7 April, Governor Tim Walz signed legislation establishing a rebuttable presumption for first responders, health care workers, correctional officers and child care workers.

Missouri: The Department of Labor and Industrial Relations issued an emergency rule, effective 22 April, declaring a rebuttable presumption for first responders, but, not, perplexingly, for other health care workers exposed to COVID-19. First responders are defined as “a law enforcement officer, firefighter or an emergency medical technician (EMT).”

New Mexico: On 23 April Governor Michelle Lujan Grisham issued an Executive Order creating a rebuttable presumption for state-employed first responders and volunteers to the health care system fighting the disease. Private sector employees are not covered.

North Dakota: On 25 March, Governor Doug Burgum issued an Executive Order creating a rebuttable presumption for all first responders and health care workers. On 16 April, he issued another one to cover funeral directors.

Utah: On 22 April, enacted legislation creating a rebuttable presumption for all first responders.

Washington: On 5 March, Governor Jay Inslee issued an Executive Order  creating a rebuttable presumption for first responders and other health care workers. The order also applies if the workers are merely quarantined.

The majority of states not listed here have some kind of legislation filed awaiting legislative action. But as anyone who has ever wandered the halls of a state capital watching the sausage being made knows, it doesn’t mean a thing until the Governor in the corner office signs it.

Time is wasting.

 

Pandemics: Are We Smart Enough To Learn From Them?

May 8th, 2020 by Tom Lynch

“As the world becomes more of a global village, infectious disease could by natural transmission become more threatening in the United States. Here monitoring is lax because of a mistaken belief that the threat of infectious disease has been almost wiped out by antibiotics.” American Medical Association conference on infectious disease, 2001, from Norman F. Cantor, In the wake of the plague, 2001, Harper Collins.

Pandemics and the Roman Empire: From glory to gory

History’s first pandemic, the Antonine Plague, struck in AD 165 at the height of the Roman empire, the time Edward Gibbon described as when “the condition of the human race was most happy and prosperous.” Nobody knew, but the Roman Climate Optimum (RCO) was approaching its end. The RCO was an extremely propitious climatological period (BC 400 – AD 250) that allowed the empire to keep all its ~70 million people well fed and relatively healthy, which led to the development of the greatest army the world had ever seen, and would not see again for more than a thousand years. The Antonine Plague, named for the family of Emperor Pius Antoninus, killed at least seven million of the empire’s people, more than 10% of the population.

The greatest physician of the age was Galen (born AD 129). He treated and cured a number of distinguished Romans and extensively documented the spread of the disease in his masterpiece, The Method of Medicine. He said, “Hippocrates showed the path; I made it passable.” Galen didn’t know what caused the Antonine Plague, but he did know that it spread quickly in densely packed pockets of humanity and less quickly when people stayed away from each other.

The Roman Empire survived the Antonine Plague, its imperial fibers frayed, but not broken. The empire recovered its strength. Relative good health returned. Until AD 249, that is, when the Plague of Cyprian ambushed the empire. The Plague, named for the Christian Bishop from Carthage whose writings document the event, was probably smallpox. The Plague of Cyprian lasted 20 years and, at its height, killed about 5,000 people per day in Rome.

Once again, the empire recovered, but now it was weaker with reduced resources. Moreover, the RCO was steadily ending and climate was beginning to turn unfavorable. Egypt, the empire’s breadbasket, began to experience drought, something that had never happened during the RCO. This time, the empire dissolved into anarchy and saw the emergence of the “barracks emperors,” who righted the ship of state once more – for a time. But now, disease was always just over the horizon.

In AD 378, the Roman army suffered its worst defeat ever at Adrianople where 20,000 soldiers were killed, a terrible loss of life, but tiny compared to plague deaths. In 410, the Visigoths sacked the city, the first time an enemy army had ever been inside the the Roman walls. Rome was heading inexorably toward its ruin.

In AD 541, the Justinian Plague landed the knockout punch for the Roman Empire. This greatest of pandemics, until then, anyway, was the pandemic of yersinia pestis, the agent that causes bubonic plague, and it lingered off and on for 200 years. That was when Rome descended into a high-end, Byzantine rump state, its former glory a distant memory. Roman records show the city inhabited by one million people during the time of Marcus Aurelius in AD 165, now housed about 20,000. The world would not see another million person city until London at the end of the 17th century.

Where did all the disease come from? Until the Antonine Plague, Rome had never been struck on such a grand scale. Today, experts believe it hitched a ride with people who travelled more and more in a vast empire. For example, the Justinian Plague is thought to have originated in China, making its way to Rome through trade. Just like today.

The Romans didn’t have the scientifically designed medical therapies to combat infectious disease. But even then mitigation efforts were aimed at running from the disease, creating separation, wherever it manifested. For example, in AD 452 Attila the Hun was plundering all of Italy on his way to Rome, whose soldiers were powerless against him. But then, confounding the Romans, he stopped, decamped and headed for the high ground of the Alps. Why? To get away from the anopheles mosquito. Malaria was suddenly killing his men and his horses. Which proves germs were better at killing than soldiers.

The Black Death of the Middle Ages

In the 14th century, bubonic plague (and probably anthrax, too) struck again causing the greatest pandemic the world has ever seen. The population of England was reduced by ~50% and did not recover until about 1800.

At that time, Edward III, King of England, Wales and one-third of France, was poised to add Spain to his conquests by marrying his 15-year-old daughter, Princess Joan, to Spain’s Prince Pedro. The marriage would change the face of Europe and give Edward control over most of the continent. The year was 1348, and bubonic plague struck as Joan and her large entourage were crossing the channel. They landed at Bordeaux, where the plague was suddenly and viciously cutting down the population leaving bodies stacked in the streets. The stench was terrible. People dealt with it by walking around covering their noses with handkerchiefs drenched in perfume. The 14th century’s version of face masks.

The welcoming committee advised the Princess and her party to get far away from the plague. But the English thought they knew better and settled into Chateau de l’Ombriere, overlooking the Mediterranean and dead smack in the middle of the disease. Within weeks, they were all dead except for one English minister who brought the news back to Edward.

And so the bite of a flea altered the course of history.

The Spanish Flu of 1918/1919

And in the early 20th century we were visited by the Spanish Flu, which carried off 50 million souls worldwide. We told the story of the Spanish Flu here, early in our waltz with COVID-19.

Americans then did what Americans are doing now: they kept apart, stayed home to avoid contact, and wore masks when they moved around in society. At least most of them did, just as most are doing now.

Those Americans had to wait 20 years for a vaccine that only 40% of us now take, and thousands still die every year from the flu.

Conclusion

You may say, “Why is this history, interesting though it may be, even being mentioned? Here in 2020, we’re 2,000 years removed from ancient Rome; 650 years from the death of Princess Joan, and the Spanish Flu was 100 years ago. Why bring this stuff up now?” After all, the combination of more energy, more food, sanitary reform, germ theory, antibiotics and all around jet-propelled science have led to a population boom unlike anything else in the history of the planet. People are living longer and better. So, why look to ancient history in the midst of COVID-19?

Social distancing is nothing new. Throughout history, when societies were confronted with infectious disease on a grand scale, people tried to evacuate the area. Some of them could, most could not. They had no knowledge of the value of hand washing, and hand shaking was as common then as it is now, or at least as it was ten weeks ago, so disease transmittal was rampant.

But beyond all that, although blind luck and more than a little mismanagement contributed to the decline and fall of Rome, infectious disease and climatological degradation were the driving forces. And the Romans were blindsided by both. In the Black Death period, aristocratic hubris and tremendous poverty throughout the population’s underbelly led to death on a massive scale. During the Spanish Flu, many in the U.S. ignored warnings and directives to be “socially distant.” Many chose not to mask in public. Many protested government edicts to contain the spread of the disease. And many died.

Here, during COVID-19, we’ve had:

  • Gross mismanagement from the top, as well as in some of the states;
  • Aristocratic hubris on a massive scale;
  • Profound economic inequality and, consequently, disease in large sections of our urban communities; and,
  • Misguided protesters who endanger themselves and others as they gather together clamoring for the freedom to do just that.

Science and our seeming societal sophistication have led many of us, too many, to believe we actually can plant cut flowers and watch our garden grow.

In the words of that great American philosopher, Pogo, “We have met the enemy, and he is us.”

More COVID-19 Quick Takes

May 7th, 2020 by Tom Lynch

Workers’ compensation and the disease

COVID-19 is presenting some interesting and perplexing issues for workers’ compensation. Among them are:

  1. Claims adjusters and Nurse Case Managers are far more familiar with injury claims than disease claims. Occupational disease claims are fuzzy, and work-relatedness is often difficult to determine. A broken arm on the shop floor is ever so much more cut and dried. Yesterday, Governor Gavin Newsom made this moot for California by signing an Executive Order that will make it easier for essential workers who contract COVID-19 to obtain workers’ compensations benefits. His order is in effect for 60 days and is retroactive to 19 March. Note Bene – his order establishes a rebuttable presumption and covers all workers deemed essential during the crisis; e.g., grocery workers, among others, as well as first responders and all health care workers. A rebuttable presumption means an essential worker who contracts COVID-19 does not have to prove work-relatedness. The burden is on the employer to prove the disease could not have been caused by work. California is one of a number of states that have taken action addressing workers’ compensation coverage for essential workers.
  2. But not all states have taken action in the same way. In fact, approaches vary considerably. Two issues treated differently among the states are: first, whether to establish a rebuttable presumption as described above; and, second, just who is essential. Some states say that while a number of occupations have been determined to be “essential” during COVID-19 (see Grocery Workers, above), only first responders and health care workers are essential enough to qualify for workers’ compensation if they come down with the disease. Labor unions say this is an issue of fairness, but since when has workers’ compensation been equally fair in all states? Consider loss of function awards, which vary tremendously across the nation.
  3. NCCI has jumped into the COVID 19 what if debate and projected various loss cost scenarios for the workers’ compensation insurance industry. All scenarios show increased losses, and some of the them are downright grim. In the worst case, 50% of all workers are infected and 60% of all claims are paid, in which case losses increase $81.5 billion, or 250% more than current total loss costs. Ouch! In the best case NCCI presents, there is no rebuttable presumption, only first responders and health care workers are eligible for workers’ compensation benefits, only 5% of them become infected, and only 60% of the claims are paid, which results in an increase in loss costs of $2 billion. The best case scenario is is not going to happen. See 1, above.
  4. And what about the poor employers and insurers who are going to foot the bill? Specifically, what about experience modification? One can almost say COVID-19 comes under the heading: An Act Of God. But the claims are going to be paid, so how does a confused insurer account for that in  the premium it’s going to drop on the head of John Q. Employer with a loud and painful thud?

Update on Long Term Care Facilities

I’ve addressed LTCFs here, here  and here, pointing out that there is no coordinated national reporting of LTCF COVID-19 cases or deaths. “One would think this cries out for federal data tracking conducted in a consistent manner across the nation.” Doesn’t seem to have happened yet.

The logical entity to track this is the Centers for Disease Control and Prevention (CDC), and maybe it is. But, then again, maybe it isn’t, because it won’t say. Yesterday, two Senate Democrats — Ron Wyden of Oregon and Bob Casey of Pennsylvania — called on the Trump administration to close this gap and commit to a timeline to release the information.

“There have been no signs that the Trump administration has an effective plan to address the tragedy that is taking place in America’s nursing homes,” they said in a joint statement.

It’s logical to assume that a disproportionate number of deaths would occur in LTCFs. The vulnerable elderly, many, perhaps most, with a number of comorbid underlying conditions, are packed together and present a breeding ground for the virus. Early on, this should have been apparent to the CDC. Why its talented scientists didn’t dive into this from Day 1 is beyond me.

We’ll continue to follow this.

Are We Learning From History, Or Repeating It?

Throughout history, infectious diseases have crippled societies. They have stymied progress and, in the best cases delayed, in the worst reversed, economic development and prosperity.

How have societies handled infectious disease pandemics throughout history, and are our actions in the midst of COVID-19 any better?

It’s true that our science puts us a quantum leap ahead of historical societies in terms of searching for therapies and a vaccine. Oh, the vaccine will happen, but between now and then are we dealing with our current infectious disease problem better than our ancestors?

Actually, no. Societies have long known that when a killing disease strikes on a grand scale the best thing to do is stay far away from other people. Quite literally, head for the hills. Trouble was, that wasn’t always possible due to urban densities and economic privation. Today, densely packed areas, especially cities, are the immediate hot spots, the poor and African Americans are disproportionately infected, and our mitigation efforts are the same as time immemorial.

Tomorrow, we’ll take a look at the history of pandemics, their societal effects and how we can learn from them as we move through and, we fervently hope, leave behind the scourge of COVID-19.

 

 

And Now For Something Completely New And Different: May Day!

May 1st, 2020 by Tom Lynch

“When the pandemic is over, our society will need to stop and think about who is essential and why should the delivery truck driver earn a tiny fraction of what is paid to the Executive Vice President for Interactive Synergy & Proactive Metrics?” ― Garrison Keillor

Boy, do we need a break. This dystopian, abnormal new normal is wearing us down.  Yesterday’s little broo-ha-ha in the Michigan Capital with wackadoodle white gunslingers roaming the gallery illustrates the point.

So, today we’ll take a break from all things COVID and bring you a touch of history. Stay with me, now.

First, a plug. For many years, Garrison Keillor has published The Writer’s Almanac, a refreshing and informative daily dollop of history and poetry that somehow finds its way to the inbox every morning. If you’re not a subscriber (it’s free), you will thank me if you become one. Today’s Writer’s Almanac told the story of May Day, all the way back to the 3rd century BC. Everyone thinks they know all about May Day, but maybe everyone should give that a rethink, especially when everyone reads about the Puritans’ views on the subject.

Here, from The Writer’s Almanac, is the story of May Day.

Today is May Day. Even though spring officially begins in March, today is the day that celebrates the height of spring, a day of spring festivities and celebrations. It is also a day to honor laborers.

Like many of our modern holidays, May Day has its roots in ancient, pagan celebrations.

Beginning in the third century B.C. in Rome, the festival Floralia, for the goddess Flora, was held in the days around May Day, April 28th to May 3rd. Flora was a goddess of flowers and fertility, and the festival was held to please her so that she protected flowers and other blossoming plants. There was a circus and theater performances, there were prostitutes and naked dancers, and a sacrifice to the goddess. Deer and goats were let loose to symbolize fertility, and beans and lupines were scattered for the same reason. Romans usually wore white tunics, but during Floralia, they got to wear bright colors.

In the Celtic British Isles, May Day was celebrated as the festival of Beltane, or Bealtaine or Bealtuinn — Bel was the Celtic god of light, and taine or tuinne meant fire. It was the summer half of the year — a time when the sun set later, when the earth and animals were fertile. Beltane lasted from sundown the night before to sundown on the first of May. On the eve of Beltane, people lit bonfires to Bel to call back the sun. People jumped over the fires to purify themselves, and they blessed their animals by taking them between bonfires before leading them to their summer pastures the next day. It was a day to walk around the property lines and assess your land for the summer season, to mend fences. Women washed their faces with the spring dew so that they would stay beautiful, and there was dancing, tournaments, parades, feasting, and general revelry. There were lots of flowers — men walked around the fires with rowan branches to keep evil spirits at bay, and May trees, or Maypoles, were set up covered in rowan or hawthorn flowers as a blessing. People danced around the Maypole, seen to be a phallic symbol to promote fertility, and villages would compete with each other to see who could produce the tallest maypole. Young couples went off into the forest to spend the night together and came back the next day with flowers to spread through the village. A young woman was crowned May Queen, and she would ride naked on horseback through the village.

Many of these celebrations continued as late as the 17th century — the Puritans were not too pleased, especially since so many young women went off into the woods and came back pregnant. Maypoles were made illegal in 1644.

Since the Puritans discouraged May Day, it was never a major holiday in America. In the late 19th century, May Day was chosen as the date for International Workers’ Day by the Socialists and Communists of the Second International to commemorate those who were hanged after the Haymarket Square riot, which occurred in Chicago in early May of 1886.