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When COVID-19 surged, the hospital resumed non-emergency operations



When COVID-19 surged, the hospital resumed non-emergency operations

Three months ago, the country witnessed COVID-19 patients flooding the New York City intensive care unit, forcing some of its hospitals to turn cafeterias into wards and tents in parking lots.

Hospitals elsewhere are preparing for similar surges: They clean beds, hoard scarce protective equipment, and – voluntarily or under government orders – temporarily cancel non-emergency operations to save space and supplies for coronavirus patients.

In most places, a surge of patients never occurs.

Now, corona virus cases are rocketing nationally and hospitalizations are increasing at an alarming rate. But the response from the hospital is very different.

Most hospitals throughout the country did not cancel elective surgery – nor did government officials request it.

Instead, hospitals say that they are better equipped to deal with crush patients because they have enough protective equipment for their workers and know how to treat coronavirus patients better. They said it would close procedures not important in hospitals based on local risk assessments, but not throughout the system or the state.

Several hospitals have done so, including facilities in South Florida, Phoenix, and Central Valley of California. And in some cases, like in Texas and Mississippi, government officials have ordered hospitals to delay elective surgery.

The hospital’s decision to keep the operating room still partly guided by money. Elective surgery account for most of the hospital income; and American Hospital Assn. estimate that the hospital and the country’s health system lost $ 202.6 billion between March 1 and June 30.

“What we now realize is that shutting down the entire health care system in anticipation of a surge is not the best choice,” said Carmela Coyle, president of the California Hospital Assn. “This will make the health delivery system go bankrupt.”

Association estimate that California hospitals will lose $ 14.6 billion this year, of which $ 4.6 billion has so far been replaced by the federal government.

But some health workers worry that continuing elective surgery amid surges puts them and their patients at risk. For example, some nurses are still being asked to reuse protective devices such as masks and N95 gowns, even though hospitals say they have enough equipment to carry out elective surgery, said Zenei Cortez, president of the United National Nurses union.

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“They continue to put us at risk,” Cortez said. “They continue to look at us as if we are disposable materials.”

Elective surgery, in general, is a procedure that can be postponed without endangering the patient, such as knee replacement and cataract surgery.

Least 33 states and the District of Columbia temporarily banned elective surgery this spring, and most hospitals in states that do not, such as Georgia and California, voluntarily suspend them to ensure they have a bed to accommodate surges of coronavirus patients. U.S. general surgeons, Centers for Disease Control and Prevention and the American College of Surgeons also recommend health facilities to delay non-emergency operations.

The suspension is always meant to be temporary, said Dr. David Hoyt, executive director of the American College of Surgeons. “When this all started, it was just a matter of flooding the system,” he said.

Today, the number of cases has soared after many states have eased orders to stay home and Americans flocked to restaurants, bars and backyards and met with friends and family for graduation parties and Memorial Day celebrations.

Nationally, confirmed COVID-19 cases have reached their peak 3 million. In California, there were many cases, with a 52% jump in the average number of daily cases over the past 14 days, compared to the previous two weeks. Inpatient care has gone up 44%.

Governors, district overseers and city councils have responded by requiring people to wear masks, close bars and restaurants – again – and close the beach on the Fourth July holiday weekend.

But in general, government leaders do not ask hospitals to proactively reduce elective surgery in preparation for surges.

“Our hospital tells us that they feel very strong and competent that they can manage their resources,” said Holly Ward, director of marketing and communications at Arizona Hospital and Healthcare Assn. If they feel the situation guarantees that, “they themselves will delay the operation.”

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In some countries, such as Colorado, public health orders that allow hospitals to continue non-emergency operations in the spring require hospitals to have a protective supply of equipment and extra beds that can be used to treat the influx of COVID-19 patients.

Countries also arrange overflow sites if hospitals run out of rooms. In Maryland, for example, the state uses the Baltimore Convention Center as a field hospital. California last week reactivated four “alternative care site“- including hospitals that are on the verge of closing in the San Francisco Bay Area – to bring COVID-19 patients if the hospital is filled.

But the decision to reduce elective operations in California will not come from the state. This will be made by the district in consultation with the hospital, said Rodger Butler, a spokesman for the California Agency for Health and Human Services.

The question is whether the hospital has a system to meet the surge in COVID-19 patients when it happens, said Glenn Melnick, a professor of health economics at USC.

“To some extent, elective care is good care,” Melnick said, “They provide the services needed. They keep the system running. They provide employment and income.”

In Los Angeles County, more than 2,000 COVID patients are currently hospitalized, according to county data. While that number is projected to rise by several hundred people over the next few weeks, hospitals believe they can accommodate them, said county health services director Christina Ghaly. Meanwhile, the hospital is preparing to bring in additional staff members if needed and inform patients who have scheduled operations that they can be postponed.

“There are more patients with COVID in hospitals than ever before in Los Angeles County during a pandemic,” Ghaly said. “Hospitals are better equipped now to handle the patient’s volume than before.”

Although hospitals do not stop elective surgery, many have not ramped up the full schedule they had before COVID-19. And they say they pick and choose operations based on what happens in their area.

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“We were all COVIDs when we were just starting,” said Joshua Adler, executive vice president for doctor services at UCSF Health. based in UC San Francisco. “We don’t know what we’re dealing with.”

But after a few months treating patients, the hospital has learned how to supply units, how to transfer patients, how to treat other patients simultaneously and how to improve testing, Adler said.

At Scripps Health in San Diego, which has brought more than 230 patients from Imperial County who were hit to the east, the hospital has resumed how many transfers they will receive when confirmed COVID-19 cases increase in their own communities, said Chris Van Gorder, president and CEO of Scripps Health.

A command center established by the hospital system reviews the number of patients and medical supplies and coordinates with regional health officials to learn how the virus spreads. Only patients who need urgent surgery are scheduled, Van Gorder said.

“We only allow our doctors to schedule cases in the next two weeks,” Van Gorder said. “If we see a sudden spike, we have to delay.”

In Central Valley California and in Phoenix, where cases and hospitalizations are soaring, Mercy’s hospital has suspended elective surgery to focus resources on COVID-19 patients.

But other hospitals in the CommonSpirit Health system, which has 137 hospitals in 21 states, did not end elective surgery – as they did in the spring – and treat patients with needs other than COVID, said Marvin O’Quinn, system president. and chief operating officer.

“In many cases their health has deteriorated because they did not get the care they need,” said O ‘Quinn, whose hospital lost nearly $ 1 billion in two months. “It’s not only detrimental to the hospital for not doing such cases; it harms the community. “

This story was produced by Kaiser Health News, which publishes California Healthline, an editorial service that is independent of California Health Care Foundation. KHN is not affiliated with Kaiser Permanente.

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The abolition of fees for teaching Portuguese abroad will not be accepted by parliament, MP says – Observer



The abolition of fees for teaching Portuguese abroad will not be accepted by parliament, MP says - Observer

According to Socialist MP Paulo Pisco, the views of the BE, PCP and PAN on the abolition of fees for teaching Portuguese abroad were voted on Tuesday in a parliamentary committee.

The Committee on Foreign Affairs and Portuguese Communities voted on Tuesday in favor of four projects – from the Left Bloc, the Communist Party of Portugal, “People-Animal-Nature” and “Enough”, which mainly advocate the abolition of fees for teaching Portuguese abroad and free school textbooks.

According to Paulo Pisco, a socialist member of the commission, the opinions of the BE, PKP and PAN were approved, but Chega’s opinion deserved to be abstained from the PS because it contained “xenophobic elements” in its purpose.

The MP had in mind, in particular, the recipients of this teaching, which is currently intended not only for the Portuguese or the descendants of the Portuguese, but also for those who want to learn the Portuguese language, with which Chega allegedly disagrees, according to Paulo Pisco. .


After the approval of these opinions, the abolition of the bribe would be discussed and voted on in the plenary session of the Assembly of the Republic, but Paulo Pisco said that they should not be approved, since the “commitment” of the government is different.

“The government’s obligation is to reduce the burden of the Portuguese” and this will always be determined “in every approved state budget”.

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Portuguese health minister rejects conflict of interest over marriage to president



The health minister said there was no conflict of interest in her marriage to the current chairman of the Order of Dietitians, saying that the trusteeship of that body had been delegated to the Secretary of State for Health Promotion.

Portugal Digital with Lusa

“Honestly, I don’t think it exists. I have no doubt that this Lady Secretary of State will fill this leadership role,” Manuel Pizarro said on Monday (age 26) on the sidelines of the Pharmacist’s Day celebrations in Sintra, in the Lisbon area.

Aware of the possible conflict of interest, Manuel Pizarro explained that he took “the most appropriate measure (…)”, which was to entrust the functions of guardianship of the Order of Nutritionists to Margarida Tavares.”

“(…) Since I took office as a minister, I have been aware that, since professional organizations have an administrative oversight role, (…) there is a risk of conflict of interest, and I have taken the measures that seem to me the most appropriate, which from the very decided at the outset that he would delegate this oversight function over the Order of Nutritionists to the Secretary of State for Health Promotion,” he stressed.

When asked about the reasons why Margarida Tavares’ name still does not appear in the Diário da República, the official said that “it was necessary to wait for the inauguration of the secretaries of state” and then “to organize the whole process of delegation of authority.” .

“It’s even a good chance that there is a Secretary of State for Health Promotion. I think custody of the Order of Dietitians has been well handed over to the Secretary of State for Health Promotion,” he repeated, noting that “he definitely won’t go through the Minister’s order.” [da Saúde]”.

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“If the secretary of state is responsible for this, it should not go through the minister,” he stressed.

Manuel Pizarro’s statements came after news that the government official may have a conflict of interest because he is married to the chairman of the Order of Dietitians, Alexandra Bento.

The Order of Dietitians was created in 2011 with the approval of the current Minister of Health, who at the time served as Secretary of State for Health.

In addition, Alexandra Bento was the only President of the Order of Occupational Health to attend the inauguration of Manuel Pizarro on 10 September.

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Portuguese newspaper criticizes CR7: “Less Ronaldo, more Portugal” | international football



Portuguese newspaper criticizes CR7: "Less Ronaldo, more Portugal" |  international football

The cover of one of the most important sports newspapers in Portugal this Monday drew a critical tone against the greatest player in the history of the country.

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On the eve of the day when the Portuguese national team will play with Spain and draw for reaching the semi-finals of the League of Nations, the daily newspaper “A Bola” printed a photo Cristiano Ronaldo stating that the player had lost influence in the team commanded by Fernando Santos.

“Less Ronaldo, more Portugal,” reads the headline.

The publication reports that the 37-year-old striker could start on the bench and lists some of the positives of his possible absence, such as the buffing of protagonist Bruno Fernandes. See below:

This Tuesday’s cover of A Bola is being printed by Cristiano Ronaldo – Photo: Reproduction

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Cristiano Ronaldo started and assisted in a 4–0 thrashing of the Czech Republic on the last round. He has only scored twice in his last eight caps, both against Switzerland.

Czech Republic 0 x 4 Portugal highlights in UEFA Nations League 2022

For Manchester United in the 2022/23 season, he started in three of the eight games played. In the last of them, against Sheriff from Moldova, in the Europa League, he scored for the first time.

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