npr--2020-03-30--'Challenging Times Are Ahead,' Trump Says Of Extended Social Distancing Guidelines

'Challenging Times Are Ahead , ' Trump Says Of Extended Social Distancing Guidelines President Trump warned Americans on Monday to prepare for more disruption and death as he and other authorities extended mitigation procedures for several more weeks amid the widening coronavirus disaster .
Trump acknowledged on Sunday that his goal for a return to normalcy by Easter wo n't happen , and he extended the federal guidelines for social distancing and mitigation to April 30 .
He said on Monday that the pandemic will take longer than he hoped to abate .
`` Challenging times are ahead for the @ @ @ @ @ @ @ on Monday .
He said that at least another month of social distancing — and the consequences that it has for everyday life and the economy — would be necessary based on modeling that said the peak in fatalities might not arrive for another two weeks .
Public health authorities say that keeping people apart and constraining gatherings of more than 10 people disrupts the spread of the virus .
A smaller infected population reduces the burden on hospitals and medical workers .
Some 14,000 National Guard personnel have been activated to help @ @ @ @ @ @ @ many Americans , the outlines of the disturbance to normal life go much deeper into the year than next month , following orders from governors or lower-level local leaders .
Virginia Gov .
Ralph Northam , a Democrat , issued a `` stay at home '' decree on Monday for the commonwealth that runs until June 10 .
San Francisco Mayor London Breed extended her `` stay safe '' order until May 1 .
The number of cases in the United States continues to climb , nearing 160,000 , with nearly 3,000 deaths @ @ @ @ @ @ @ possible death toll at a scale once unfathomable — Dr. Deborah Birx , the White House 's coronavirus response coordinator , told NBC that in the best case , 200,000 people could die .
Trump said on Monday that Birx and another specialist on the White House coronavirus task force , Dr. Anthony Fauci , showed him estimates that suggested if the U.S. went back to normal with no more countermeasures , as many as 2 million or more Americans could die .
But the precautions have delivered a heavy shock to the @ @ @ @ @ @ @ of work after social distancing and isolation protocols have forced the closure of countless businesses .
Macy 's said on Monday that it 's furloughing some 130,000 workers .
One projection circulating on Monday put the potential nadir for the employment rate at a level worse than that seen during the Great Depression .
Trump has signed legislation aimed at providing around $ 2.2 trillion worth of relief to the paralyzed economy .
He and members of Congress have n't ruled out more legislation along those lines , depending on the way the @ @ @ @ @ @ @ entered 2020 with record debt , and the borrowing associated with this year 's rescue package will be `` mind-boggling , '' as one specialist told NPR .
Trump and congressional leaders have said they need to focus on the current emergency .
Financial markets , at least , have been buoyed by the passage of the relief legislation and the commitments by leaders in Washington — including Fed Chairman Jay Powell — to continue to take whatever measures are necessary to sustain the economy through the crisis .
House Speaker Nancy Pelosi @ @ @ @ @ @ @ she is n't planning to take a coronavirus test even though one of her allies — Rep. Nydia Velazquez , D-N.Y. — has been diagnosed with `` presumed coronavirus infection . ''
Velaszquez attended a bill enrollment ceremony with Pelosi and other members , but Pelosi 's office said on Monday that the speaker had sought advice and been told she 's probably fine .
`` Following the announcement by Chairwoman Velazquez , the speaker today consulted with the attending physician who found her contact to be of low risk and recommended the @ @ @ @ @ @ @ a Pelosi spokesman said in a statement .
The news followed a conference call on which Pelosi said that if Congress does take up another coronavirus relief bill , potentially the fourth , it probably would n't reach the House floor until later in the month .
The House has extended its recess until April 20 .
Trump hailed what he called the valuable contributions made by American industry on Monday and invited a number of company bosses to discuss their production .
Trump also said that a number of companies are producing @ @ @ @ @ @ @ associated with a climbing number of patients .
The latest announcement came from Ford and GE Healthcare , which said on Monday that they 're on track to build 50,000 machines within the next 100 days .
Trump , cognizant that there may be more production now online than America can use , said on Monday that the U.S. would supply surplus machines to Europe .
Italy , France and Spain are the candidates Trump mentioned , plus in the past he has said the United Kingdom also needs ventilators .
It is @ @ @ @ @ @ @ give those nations the equipment or other medical supplies or whether their governments would make arrangements to buy them .

'Challenging Times Are Ahead,' Trump Says Of Extended Social Distancing Guidelines
Enlarge this image toggle caption Tasos Katopodis/Getty Images Tasos Katopodis/Getty Images
Updated at 6:15 p.m. ET
President Trump warned Americans on Monday to prepare for more disruption and death as he and other authorities extended mitigation procedures for several more weeks amid the widening coronavirus disaster.
Trump acknowledged on Sunday that his goal for a return to normalcy by Easter won't happen, and he extended the federal guidelines for social distancing and mitigation to April 30. He said on Monday that the pandemic will take longer than he hoped to abate.
"Challenging times are ahead for the next 30 days," Trump said on Monday.
He said that at least another month of social distancing — and the consequences that it has for everyday life and the economy — would be necessary based on modeling that said the peak in fatalities might not arrive for another two weeks.
Public health authorities say that keeping people apart and constraining gatherings of more than 10 people disrupts the spread of the virus. A smaller infected population reduces the burden on hospitals and medical workers.
Weeks or months of disruptions
Some 14,000 National Guard personnel have been activated to help manage the disaster response.
And for many Americans, the outlines of the disturbance to normal life go much deeper into the year than next month, following orders from governors or lower-level local leaders.
Virginia Gov. Ralph Northam, a Democrat, issued a "stay at home" decree on Monday for the commonwealth that runs until June 10. San Francisco Mayor London Breed extended her "stay safe" order until May 1.
The number of cases in the United States continues to climb, nearing 160,000, with nearly 3,000 deaths.
Public health authorities are framing the possible death toll at a scale once unfathomable — Dr. Deborah Birx, the White House's coronavirus response coordinator, told NBC that in the best case, 200,000 people could die.
Trump said on Monday that Birx and another specialist on the White House coronavirus task force, Dr. Anthony Fauci, showed him estimates that suggested if the U.S. went back to normal with no more countermeasures, as many as 2 million or more Americans could die.
But the precautions have delivered a heavy shock to the economy. Millions of Americans are out of work after social distancing and isolation protocols have forced the closure of countless businesses. Macy's said on Monday that it's furloughing some 130,000 workers.
One projection circulating on Monday put the potential nadir for the employment rate at a level worse than that seen during the Great Depression.
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Trump has signed legislation aimed at providing around $2.2 trillion worth of relief to the paralyzed economy. He and members of Congress haven't ruled out more legislation along those lines, depending on the way the coming weeks unfold.
The United States entered 2020 with record debt, and the borrowing associated with this year's rescue package will be "mind-boggling," as one specialist told NPR. Trump and congressional leaders have said they need to focus on the current emergency.
Financial markets, at least, have been buoyed by the passage of the relief legislation and the commitments by leaders in Washington — including Fed Chairman Jay Powell — to continue to take whatever measures are necessary to sustain the economy through the crisis.
Pelosi won't take test
House Speaker Nancy Pelosi, D-Calif., said on Monday that she isn't planning to take a coronavirus test even though one of her allies — Rep. Nydia Velazquez, D-N.Y. — has been diagnosed with "presumed coronavirus infection."
Velaszquez attended a bill enrollment ceremony with Pelosi and other members, but Pelosi's office said on Monday that the speaker had sought advice and been told she's probably fine.
"Following the announcement by Chairwoman Velazquez, the speaker today consulted with the attending physician who found her contact to be of low risk and recommended the speaker take no particular action," a Pelosi spokesman said in a statement.
The news followed a conference call on which Pelosi said that if Congress does take up another coronavirus relief bill, potentially the fourth, it probably wouldn't reach the House floor until later in the month. The House has extended its recess until April 20.
Trump: more ventilator production
Trump hailed what he called the valuable contributions made by American industry on Monday and invited a number of company bosses to discuss their production.
Trump also said that a number of companies are producing ventilators to try to ameliorate the need associated with a climbing number of patients.
The latest announcement came from Ford and GE Healthcare, which said on Monday that they're on track to build 50,000 machines within the next 100 days.
Trump, cognizant that there may be more production now online than America can use, said on Monday that the U.S. would supply surplus machines to Europe.
Italy, France and Spain are the candidates Trump mentioned, plus in the past he has said the United Kingdom also needs ventilators. It isn't clear whether the U.S. government would give those nations the equipment or other medical supplies or whether their governments would make arrangements to buy them.


npr--2020-03-30--WHO Official Defends Guidance: 'We're Not Seeing' Airborne Transmission

WHO Official Defends Guidance : 'We 're Not Seeing ' Airborne Transmission A World Health Organization official says the evidence so far shows that the virus that causes COVID-19 is primarily transmitted through `` respiratory droplets and contact routes '' — from coughs and sneezes — and does n't seem to linger in the air .
The WHO 's guidance , first published Friday , has been met with some criticism from virus transmission experts .
Dr. Hanan Balkhy , assistant director-general for antimicrobial resistance at the WHO , talked with All Things Considered on Monday about the organization 's @ @ @ @ @ @ @ How much evidence do you need to persuade the WHO to rethink or update or think differently about transmission of COVID-19 ?
We do n't need to be persuaded but we need to have the evidence that it actually is being spread through a specific route that we 're not seeing right now .
... Let me give you a simple example .
We have hospitals that have worked on developing units for COVID patients .
And those patients have coughing , sneezing , in ICUs , they 're scoping them .
If @ @ @ @ @ @ @ we would see cases with no contact before getting ill with that disease .
That 's just one example .
And we 're not seeing that .
I think when you look at the sheer number of positive cases , they 're happening with very clear mixing and mingling .
They 're very close with each other .
... That does not indicate airborne transmission .
So if I hear you correctly , you 're not discounting other studies or other views on this , you 're just saying : Until we have @ @ @ @ @ @ @ and what evidence we do have thus far points to it being mostly spread by droplets , not airborne .
Yes , absolutely .
We do believe that the WHO has to give guidance for the globe .
And I want to reemphasize the situation of the scenarios where you need to do a risk assessment where you would apply airborne isolation because you have specific high-risk areas in your facility that does not allow for proper cleaning , proper hygiene .
I can not put a patient in a negative pressure room @ @ @ @ @ @ @ so I have to apply certain measures based on the scenario that I have at hand .
But the general guidance is that this is transmitted through droplets and contact routes .
The audio version of this interview airs on All Things Considered Monday afternoon .

WHO Official Defends Guidance: 'We're Not Seeing' Airborne Transmission
Enlarge this image toggle caption Fabrice Coffrini/AFP via Getty Images Fabrice Coffrini/AFP via Getty Images
A World Health Organization official says the evidence so far shows that the virus that causes COVID-19 is primarily transmitted through "respiratory droplets and contact routes" — from coughs and sneezes — and doesn't seem to linger in the air.
The WHO's guidance, first published Friday, has been met with some criticism from virus transmission experts.
Dr. Hanan Balkhy, assistant director-general for antimicrobial resistance at the WHO, talked with All Things Considered on Monday about the organization's guidelines. Here is an excerpt.
How much evidence do you need to persuade the WHO to rethink or update or think differently about transmission of COVID-19?
We don't need to be persuaded but we need to have the evidence that it actually is being spread through a specific route that we're not seeing right now. ... Let me give you a simple example. We have hospitals that have worked on developing units for COVID patients. And those patients have coughing, sneezing, in ICUs, they're scoping them.
If we were to have airborne transmission, we would see cases with no contact before getting ill with that disease. That's just one example.
And we're not seeing that. I think when you look at the sheer number of positive cases, they're happening with very clear mixing and mingling. They're very close with each other. ... That does not indicate airborne transmission.
So if I hear you correctly, you're not discounting other studies or other views on this, you're just saying: Until we have solid evidence otherwise, past similar coronaviruses and what evidence we do have thus far points to it being mostly spread by droplets, not airborne.
Yes, absolutely. We do believe that the WHO has to give guidance for the globe. And I want to reemphasize the situation of the scenarios where you need to do a risk assessment where you would apply airborne isolation because you have specific high-risk areas in your facility that does not allow for proper cleaning, proper hygiene. I cannot put a patient in a negative pressure room to do a bronchoscope for example, so I have to apply certain measures based on the scenario that I have at hand. But the general guidance is that this is transmitted through droplets and contact routes.
The audio version of this interview airs on All Things Considered Monday afternoon.


npr--2020-03-30--Van Gogh Painting Stolen After Thieves Apparently Smash Dutch Museum Entrance

A painting by Vincent Van Gogh was stolen early Monday morning from a Dutch museum in what appeared to be a smash-and-grab from the institution 's front entrance .
The painting , an 1884 work titled `` The Parsonage Garden at Nuenen in Spring 1884 , '' had been on loan to the Singer Laren museum near Amsterdam .
It is part of the permanent collection of the Groninger Museum , in the northern part of the country .
Police say the break-in took place at about 3:15 a.m. local time , according to the Dutch news website NL Times @ @ @ @ @ @ @ door at the museum 's entrance , and only took the Van Gogh .
According to CNN , museum director Jan Rudolph de Lorm said at a press conference Monday afternoon , `` I am shocked and unbelievably pissed off , '' continuing : `` It is very bad for the Groninger Museum .
It 's also very bad for Singer . ''
The museum has been closed to the public since earlier this month due to the coronavirus pandemic , but it was initially unclear whether or not its overnight security staff @ @ @ @ @ @ @ to health concerns .
This is not the first time that Van Gogh paintings have been stolen in Holland in recent decades .
In 1991 , thieves managed to make off with 20 pieces from Amsterdam 's Van Gogh Museum which were altogether worth some $ 500 million .
One robber hid in the museum until after closing hours , and then let an accomplice in .
But their plan fell apart about half an hour after the robbery , when a second car the robbers had planned to meet up with got @ @ @ @ @ @ @ their loot , and four men were later arrested and sentenced .
And in 2016 , Italian police recovered two Van Goghs — each reportedly valued at over $ 50 million — in a house south of Naples that allegedly belonged to a drug smuggler .
Those works had been stolen in 2002 , also from the Van Gogh Museum in Amsterdam .
Perhaps coincidentally , the painting taken Monday morning was stolen on Van Gogh 's birthday ; he was born March 30 , 1853 .

Van Gogh Painting Stolen After Thieves Apparently Smash Dutch Museum Entrance
Enlarge this image toggle caption Marc Deville/Gamma-Rapho via Getty Images Marc Deville/Gamma-Rapho via Getty Images
A painting by Vincent van Gogh was stolen early Monday morning from a Dutch museum in what appeared to be a smash-and-grab from the institution's front entrance.
The painting, an 1884 work titled The Parsonage Garden at Nuenen in Spring 1884, had been on loan to the Singer Laren museum near Amsterdam. It is part of the permanent collection of the Groninger Museum, in the northern part of the Netherlands.
Police say the break-in took place at about 3:15 a.m. local time, according to the Dutch news website NL Times. The thieves smashed through the glass door at the museum's entrance and only took the van Gogh.
According to CNN, museum director Jan Rudolph de Lorm said at a news conference Monday afternoon, "I am shocked and unbelievably pissed off," continuing: "It is very bad for the Groninger Museum. It's also very bad for Singer."
The museum has been closed to the public since earlier this month because of the coronavirus pandemic, but it was initially unclear whether its overnight security staff or other measures had been reduced because of health concerns.
This is not the first time that van Gogh paintings have been stolen in the Netherlands in recent decades. In 1991, thieves managed to make off with 20 pieces from Amsterdam's Van Gogh Museum that were altogether worth some $500 million. One robber hid in the museum until after closing hours and then let an accomplice in. But their plan fell apart about half an hour after the robbery, when a second car that the robbers had planned to meet up with got a flat tire. The thieves abandoned their loot, and four men were later arrested and sentenced.
And in 2016, Italian police recovered two van Goghs — each reportedly valued at over $50 million — in a house south of Naples that allegedly belonged to a drug smuggler. Those works had been stolen in 2002, also from the Van Gogh Museum in Amsterdam.
Perhaps coincidentally, the painting taken Monday morning was stolen on van Gogh's birthday; he was born March 30, 1853.


npr--2020-03-30--'The Danish Way Is Working': Prime Minister Hints At A Gradual Reopening For April

'The Danish Way Is Working ' : Prime Minister Hints At A Gradual Reopening For April Denmark 's Prime Minister Mette Frederiksen is expressing cautious optimism that her country will be able to begin a gradual reopening after Easter .
`` The Danish way of doing things is working , '' she said at a press conference on Monday .
Amid the coronavirus outbreak , Denmark was one of the first European countries to announce a full closure of public schools and institutions and to impose strict limits on social gatherings .
It was also one of the first nations @ @ @ @ @ @ @ did on March 14 .
As of Monday , Denmark had 2,555 confirmed cases of COVID-19 infection and 77 deaths .
While the number of patients in intensive care continues to rise , infectious disease expert Kåre Mølbak says `` infection pressure '' — the average number of others infected by each infected person — is now half of what it was in mid-March .
`` The epidemic is in no way over , '' he says , `` but we can see that it is more under control than in other parts @ @ @ @ @ @ @ Denmark done differently ?
Because we can see that there are lots of countries that have acted similarly ... but still have big problems .
My professional opinion is that what has been effective in Denmark is that we acted early . ''
Frederiksen also credits the willingness of Danes to unite in following the rules .
`` Our joint efforts are absolutely crucial , '' she said during her widely broadcast press conference .
In fact , Danes have been so good at self-isolating that doctors have experienced a drastic drop in @ @ @ @ @ @ @ point that the head of the Danish College of General Practitioners is now reminding people with ailments other than the coronavirus that they still can — and should — seek treatment .
While emphasizing the need for a `` gradual '' movement back to business , Frederiksen did not offer many details about how that might look .
She hinted at the possibility of staggered school and work hours , and a continuation of restrictions on gatherings .
She also spoke directly to Denmark 's seniors , saying they would likely need to @ @ @ @ @ @ @ time .
`` We are asking the weakest to be the strongest right now , '' she said .
`` And that is a tough request . ''
Despite the overall optimism of her message , Frederiksen admonished Danes not to take her word as a guarantee , emphasizing the need for continued restraint .
`` If we can see that the numbers begin to rise drastically , if we can see that Danes begin to gather inside and outside — not to keep their distance — then we can not open Denmark @ @ @ @ @ @ @ .
`` In fact , we can end in the opposite situation where we have to tighten the rules even more . ''

'The Danish Way' Is Working: Prime Minister Hints At A Gradual Reopening For April
Enlarge this image toggle caption Philip Davali/Ritzau Scanpix/AFP via Getty Images Philip Davali/Ritzau Scanpix/AFP via Getty Images
Denmark's prime minister, Mette Frederiksen, is expressing cautious optimism that her country will be able to begin a gradual reopening after Easter. "The Danish way of doing things is working," she said at a news conference on Monday.
Amid the coronavirus outbreak, Denmark was one of the first European countries to announce a full closure of public schools and institutions and to impose strict limits on social gatherings. It was also one of the first nations to close its borders, which it did on March 14.
As of Monday, Denmark had 2,555 confirmed cases of COVID-19 infection and 77 deaths.
While the number of patients in intensive care continues to rise, infectious disease expert Kare Molbak says "infection pressure" — the average number of people infected by each infected person — is now half of what it was in mid-March.
"The epidemic is in no way over," he says, "but we can see that it is more under control than in other parts of Europe. So ... what has Denmark done differently? Because we can see that there are lots of countries that have acted similarly ... but still have big problems. My professional opinion is that what has been effective in Denmark is that we acted early."
Frederiksen also credits the willingness of Danes to unite in following the rules.
"Our joint efforts are absolutely crucial," she said during her widely broadcast news conference.
In fact, Danes have been so good at self-isolating that doctors have experienced a drastic drop in calls. It's quiet to the point that the head of the Danish College of General Practitioners is now reminding people with ailments other than the coronavirus that they still can — and should — seek treatment.
While emphasizing the need for a "gradual" movement back to business, Frederiksen did not offer many details about how that might look. She hinted at the possibility of staggered school and work hours and a continuation of restrictions on gatherings.
She also spoke directly to Denmark's seniors, saying they would likely need to take precautions for a longer period of time.
"We are asking the weakest to be the strongest right now," she said. "And that is a tough request."
Despite the overall optimism of her message, Frederiksen admonished Danes not to take her word as a guarantee, emphasizing the need for continued restraint.
"If we can see that the numbers begin to rise drastically, if we can see that Danes begin to gather inside and outside — not to keep their distance — then we cannot open Denmark again after Easter," she warned. "In fact, we can end in the opposite situation where we have to tighten the rules even more."


npr--2020-03-31--A Genetic Test For A Microscopic Problem Came With A Jumbo Price Tag

A Genetic Test For A Microscopic Problem Came With A Jumbo Price Tag Michelle Kuppersmith feels great , works full time and exercises three to four times a week .
So she was surprised when a routine blood test found that her body was making too many platelets , which help control bleeding .
Kuppersmith 's doctor suspected the 32-year-old Manhattanite had a rare blood disorder called essential thrombocythemia , which can lead to blood clots , strokes and , in rare cases , leukemia .
Her doctor suggested a bone marrow biopsy , in which a large needle is @ @ @ @ @ @ @ the spongy tissue at the center of the patient 's hip bone .
Doctors examine the bone marrow under a microscope and analyze the DNA .
The procedure allows doctors to judge a patient 's prognosis and select treatment , if needed .
Kuppersmith had heard the procedure can be intensely painful , so she put it off for months .
The biopsy — performed by a provider in her insurance network , at a hospital in her network ― lasted only a few minutes , and Kuppersmith received relatively good news .
@ @ @ @ @ @ @ marrow confirmed her doctor 's suspicions , it showed that the only treatment she needs , for now , is a daily , low-dose aspirin .
She will check in with her doctor every three to four months to make sure the disease is n't getting worse .
All in all , Kuppersmith felt relieved .
Then she got a notice saying her insurer refused to pay for the genetic analysis , leaving her responsible for a $ 2,400 payment .
The patient : New York resident Michelle Kuppersmith , 32 , who @ @ @ @ @ @ @ Blue Shield .
She works as director of special projects at a Washington-based watchdog group .
Because she was treated in New York , Empire Blue Cross Blue Shield — which covers that region ― handled part of her claim .
The providers : Kuppersmith had her bone marrow removed at the Mount Sinai Ruttenberg Treatment Center in New York City , which sent her biopsy sample to a California lab , Genoptix , for testing .
Medical services : Bone marrow biopsy and molecular profiling , which involves looking for genetic mutations @ @ @ @ @ @ @ diagnostics , which includes a variety of gene-based testing , is undergoing explosive growth , said Gillian Hooker , president of the National Society of Genetic Counselors and vice president of clinical development for Concert Genetics , a health IT company in Nashville , Tennessee .
A report from Concert Genetics , a company that helps clients manage genetic testing , found there are more than 140,000 molecular diagnostic products on the market , with 10 to 15 added each day .
The field is growing so quickly that even doctors are struggling @ @ @ @ @ @ @ said .
Kuppersmith underwent a type of testing known as molecular profiling , which looks for DNA biomarkers to predict whether patients will benefit from new , targeted therapies .
These mutations are n't inherited ; they develop over the course of a patient 's life , Hooker said .
Medicare spending on molecular diagnostics more than doubled from 2016 to 2018 , increasing from $ 493 million to $ 1.1 billion , according to Laboratory Economics , a lab industry newsletter .
Charges range from hundreds to thousands of dollars , depending @ @ @ @ @ @ @ and which billing codes insurers use , Hooker said .
Based on Medicare data , at least 1,500 independent labs perform molecular testing , along with more than 500 hospital-based labs , said Jondavid Klipp , the newsletter 's publisher .
In a fast-evolving field with lots of money at stake , tests that a doctor or lab may regard as state-of-the-art an insurer might view as experimental .
Worse still , many of the commercial labs that perform the novel tests are out-of-network , as was Genoptix .
Stephanie Bywater , chief @ @ @ @ @ @ @ owns Genoptix , said that insurance policies governing approval have not kept up with the rapid pace of scientific advances .
Kuppersmith 's doctor ordered a test that has been available since 2014 and was updated in 2017 , Bywater said .
Although experts agree that molecular diagnostics is an essential part of care for patients like Kuppersmith , doctors and insurance companies may not agree on which specific test is best , said Dr. Gwen Nichols , chief medical officer of the Leukemia & Lymphoma Society .
Tests `` can be performed @ @ @ @ @ @ @ number of different laboratories who charge different amounts , '' Nichols said .
Insurance plans are much more likely to refuse to pay for molecular diagnostics than other lab tests .
Laboratory Economics found Medicare contractors denied almost half of all molecular diagnostics claims over the past five years , compared with 5-10 % of routine lab tests .
With so many insurance plans , so many new tests and so many new companies , it is difficult for a doctor to know which labs are in a patient 's network and which @ @ @ @ @ @ @ .
`` Different providers have contracts with different diagnostic companies , '' which can affect a patient 's out-of-pocket costs , Nichols said .
`` It is incredibly complex and really difficult to determine the best , least expensive path . ''
Kuppersmith said she has always been careful to check that her doctors accept her insurance .
She made sure Mount Sinai was in her insurance network , too .
But it never occurred to her that the biopsy would be sent to an outside lab ― or that it would undergo @ @ @ @ @ @ @ The looming threat of a $ 2,400 bill has caused me , in many ways , more anxiety than the illness ever has . ''
The resolution : Despite making dozens of phone calls , Kuppersmith got nothing but confusing and contradictory answers when she tried to sort out the unexpected charge .
An agent for her insurer told her that her doctor had n't gotten preauthorization for the testing .
But in an email to Kuppersmith , a Genoptix employee told her the insurance company had denied the claim because molecular profiling @ @ @ @ @ @ @ for New York-based Empire Blue Cross Blue Shield , which handled part of Kuppersmith 's claim , said her health plan `` covers medically necessary genetic testing . ''
New York , one of 28 states with laws against surprise billing , requires hospitals to inform patients in writing if their care may include out-of-network providers , said attorney Elisabeth Benjamin , vice president of health initiatives at the Community Service Society , which provides free help with insurance problems .
A spokesperson for Mount Sinai said the hospital complies with that law @ @ @ @ @ @ @ a document in 2018 — nearly one year before her bone marrow biopsy ― and signed it .
Benjamin said that 's not OK , explaining : `` I think a one-year-old , vague form like the one she signed would not comply with the state law — and certainly not the spirit of it . ''
Instead of sending Kuppersmith a bill , Genoptix offered to help her appeal the denied coverage to CareFirst .
At first , Genoptix asked Kuppersmith to designate the company as her personal health care representative .
@ @ @ @ @ @ @ like sweeping legal rights to strangers .
Instead , she wrote an email granting the company permission to negotiate on her behalf .
It was sufficient .
A few days after being contacted by KHN , Kuppersmith 's insurer said it would pay Genoptix at the in-network rate , covering $ 1,200 of the $ 2,400 charge .
Genoptix said it has no plans to bill Kuppersmith for the other half of the charge .
The takeaway : Kuppersmith is relieved her insurer changed its mind about her bill .
But , she @ @ @ @ @ @ @ young , savvy person with a college degree .
There are a lot of people who do n't have the time or wherewithal to do this kind of fighting . ''
Patients should ask their health care providers if any outside contractors will be involved in their care , including pathologists , anesthesiologists , clinical labs or radiologists , experts said .
And check if those involved are in-network .
`` Try your best to ask in advance , '' said Jack Hoadley , a research professor emeritus at Georgetown University .
`` @ @ @ @ @ @ @ about where [ a blood or tissue sample ] is sent ? '
'' Ask , too , if the sample will undergo molecular diagnostics .
Since the testing is still relatively new — and expensive ― most insurers require patients to obtain `` prior authorization , '' or special permission , said Dr. Debra Regier , a medical geneticist at Children 's National Hospital in Washington and an associate with NORD , the National Organization of Rare Diseases .
Getting this permission in advance can prevent many headaches .
Finally , be @ @ @ @ @ @ @ you that some components of your care may be out-of-network .
Tell your provider that you want to be informed on a case-by-case basis when an out-of-network provider is involved and to consent to their participation .
Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills .
Do you have a perplexing medical bill you want to share with us ?
Tell us about it here .

A Genetic Test For A Microscopic Problem Came With A Jumbo Price Tag
Enlarge this image toggle caption Shelby Knowles for KHN Shelby Knowles for KHN
Michelle Kuppersmith feels great, works full time and exercises three to four times a week. So she was surprised when a routine blood test found that her body was making too many platelets, which help control bleeding.
Kuppersmith's doctor suspected the 32-year-old Manhattanite had a rare blood disorder called essential thrombocythemia, which can lead to blood clots, strokes and, in rare cases, leukemia.
Her doctor suggested a bone marrow biopsy, in which a large needle is used to suck out a sample of the spongy tissue at the center of the patient's hip bone.
Doctors examine the bone marrow under a microscope and analyze the DNA. The procedure allows doctors to judge a patient's prognosis and select treatment, if needed. Kuppersmith had heard the procedure can be intensely painful, so she put it off for months.
Share your medical billing story Do you have a medical bill you'd like us to investigate? You can tell us about it and submit it here.
The biopsy — performed by a provider in her insurance network, at a hospital in her network ― lasted only a few minutes, and Kuppersmith received relatively good news.
While a genetic analysis of her bone marrow confirmed her doctor's suspicions, it showed that the only treatment she needs, for now, is a daily, low-dose aspirin. She will check in with her doctor every three to four months to make sure the disease isn't getting worse.
All in all, Kuppersmith felt relieved.
Then she got a notice saying her insurer refused to pay for the genetic analysis, leaving her responsible for a $2,400 payment.
The patient: New York resident Michelle Kuppersmith, 32, who is insured by Maryland-based CareFirst Blue Cross Blue Shield. She works as director of special projects at a Washington-based watchdog group. Because she was treated in New York, Empire Blue Cross Blue Shield — which covers that region ― handled part of her claim.
Total amount owed: $2,400 for out-of-network genetic profiling
The providers: Kuppersmith had her bone marrow removed at the Mount Sinai Ruttenberg Treatment Center in New York City, which sent her biopsy sample to a California lab, Genoptix, for testing.
Medical services: Bone marrow biopsy and molecular profiling, which involves looking for genetic mutations
What gives: The field of molecular diagnostics, which includes a variety of gene-based testing, is undergoing explosive growth, said Gillian Hooker, president of the National Society of Genetic Counselors and vice president of clinical development for Concert Genetics, a health IT company in Nashville, Tennessee.
A report from Concert Genetics, a company that helps clients manage genetic testing, found there are more than 140,000 molecular diagnostic products on the market, with 10 to 15 added each day.
The field is growing so quickly that even doctors are struggling to develop a common vocabulary, Hooker said.
Kuppersmith underwent a type of testing known as molecular profiling, which looks for DNA biomarkers to predict whether patients will benefit from new, targeted therapies. These mutations aren't inherited; they develop over the course of a patient's life, Hooker said.
Medicare spending on molecular diagnostics more than doubled from 2016 to 2018, increasing from $493 million to $1.1 billion, according to Laboratory Economics, a lab industry newsletter.
Charges range from hundreds to thousands of dollars, depending on how many genes are involved — and which billing codes insurers use, Hooker said.
Based on Medicare data, at least 1,500 independent labs perform molecular testing, along with more than 500 hospital-based labs, said Jondavid Klipp, the newsletter's publisher.
In a fast-evolving field with lots of money at stake, tests that a doctor or lab may regard as state-of-the-art an insurer might view as experimental.
Worse still, many of the commercial labs that perform the novel tests are out-of-network, as was Genoptix.
Stephanie Bywater, chief compliance officer at NeoGenomics Laboratories, which owns Genoptix, said that insurance policies governing approval have not kept up with the rapid pace of scientific advances. Kuppersmith's doctor ordered a test that has been available since 2014 and was updated in 2017, Bywater said.
Although experts agree that molecular diagnostics is an essential part of care for patients like Kuppersmith, doctors and insurance companies may not agree on which specific test is best, said Dr. Gwen Nichols, chief medical officer of the Leukemia & Lymphoma Society.
Tests "can be performed a number of different ways by a number of different laboratories who charge different amounts," Nichols said.
Insurance plans are much more likely to refuse to pay for molecular diagnostics than other lab tests. Laboratory Economics found Medicare contractors denied almost half of all molecular diagnostics claims over the past five years, compared with 5-10% of routine lab tests.
With so many insurance plans, so many new tests and so many new companies, it is difficult for a doctor to know which labs are in a patient's network and which specific tests are covered, Nichols said.
"Different providers have contracts with different diagnostic companies," which can affect a patient's out-of-pocket costs, Nichols said. "It is incredibly complex and really difficult to determine the best, least expensive path."
Kuppersmith said she has always been careful to check that her doctors accept her insurance. She made sure Mount Sinai was in her insurance network, too. But it never occurred to her that the biopsy would be sent to an outside lab ― or that it would undergo genetic analysis.
She added: "The looming threat of a $2,400 bill has caused me, in many ways, more anxiety than the illness ever has."
The resolution: Despite making dozens of phone calls, Kuppersmith got nothing but confusing and contradictory answers when she tried to sort out the unexpected charge.
An agent for her insurer told her that her doctor hadn't gotten preauthorization for the testing. But in an email to Kuppersmith, a Genoptix employee told her the insurance company had denied the claim because molecular profiling was viewed as experimental.
A spokesperson for New York-based Empire Blue Cross Blue Shield, which handled part of Kuppersmith's claim, said her health plan "covers medically necessary genetic testing."
New York, one of 28 states with laws against surprise billing, requires hospitals to inform patients in writing if their care may include out-of-network providers, said attorney Elisabeth Benjamin, vice president of health initiatives at the Community Service Society, which provides free help with insurance problems.
A spokesperson for Mount Sinai said the hospital complies with that law, noting that Kuppersmith was given such a document in 2018 — nearly one year before her bone marrow biopsy ― and signed it.
Benjamin said that's not OK, explaining: "I think a one-year-old, vague form like the one she signed would not comply with the state law — and certainly not the spirit of it."
Instead of sending Kuppersmith a bill, Genoptix offered to help her appeal the denied coverage to CareFirst. At first, Genoptix asked Kuppersmith to designate the company as her personal health care representative. She was uncomfortable signing over what sounded like sweeping legal rights to strangers. Instead, she wrote an email granting the company permission to negotiate on her behalf. It was sufficient.
A few days after being contacted by KHN, Kuppersmith's insurer said it would pay Genoptix at the in-network rate, covering $1,200 of the $2,400 charge. Genoptix said it has no plans to bill Kuppersmith for the other half of the charge.
The takeaway: Kuppersmith is relieved her insurer changed its mind about her bill. But, she said: "I'm a relatively young, savvy person with a college degree. There are a lot of people who don't have the time or wherewithal to do this kind of fighting."
Patients should ask their health care providers if any outside contractors will be involved in their care, including pathologists, anesthesiologists, clinical labs or radiologists, experts said. And check if those involved are in-network.
"Try your best to ask in advance," said Jack Hoadley, a research professor emeritus at Georgetown University. "Ask, 'Do I have a choice about where [a blood or tissue sample] is sent?'"
Ask, too, if the sample will undergo molecular diagnostics. Since the testing is still relatively new — and expensive ― most insurers require patients to obtain "prior authorization," or special permission, said Dr. Debra Regier, a medical geneticist at Children's National Hospital in Washington and an associate with NORD, the National Organization of Rare Diseases. Getting this permission in advance can prevent many headaches.
Finally, be wary of signing blanket consent forms telling you that some components of your care may be out-of-network. Tell your provider that you want to be informed on a case-by-case basis when an out-of-network provider is involved and to consent to their participation.
Bill of the Month is a crowdsourced investigation by Kaiser Health News and NPR that dissects and explains medical bills. Do you have a perplexing medical bill you want to share with us? Tell us about it here.


npr--2020-03-31--CDC Director On Models For The Months To Come: 'This Virus Is Going To Be With Us'

CDC Director On Models For The Months To Come : 'This Virus Is Going To Be With Us' When infectious pathogens have threatened the United States , the Centers for Disease Control and Prevention has been front and center .
During the H1N1 flu of 2009 , the Ebola crisis in 2014 , and the mosquito-borne outbreak of Zika in 2015 , the CDC has led the federal response .
Yet the nation 's public health agency , with its distinguished history of successfully fighting scourges such as polio and smallpox , has been conspicuously absent in recent weeks , @ @ @ @ @ @ @ coronavirus soared in the U.S. President Trump has been holding almost daily press conferences at the White House , but the primary health advisers at his side are not from the CDC : Dr. Anthony Fauci directs the National Institute of Allergy and Infectious Diseases , which focuses on biomedical research , and Dr. Deborah Birx is the global AIDS coordinator for the State Department .
The public has heard much less from the CDC director , Dr. Robert Redfield , and the agency , based in Atlanta , has not held a @ @ @ @ @ @ @ Monday , Dr. Redfield agreed to a phone interview with Sam Whitehead , the health reporter at WABE in Atlanta , where he also hosts a coronavirus podcast .
This interview has been edited and condensed for length and clarity .
Has the CDC learned anything new about the virus , such as how contagious it is or how it is transmitted , in recent weeks ?
Let 's take transmission ... this virus does have the ability to transmit far easier than flu .
It 's probably now about three times as @ @ @ @ @ @ @ [ pieces of ] information that we have pretty much confirmed now is that a significant number of individuals that are infected actually remain asymptomatic .
That may be as many as 25 % .
That 's important , because now you have individuals that may not have any symptoms that can contribute to transmission , and we have learned that in fact they do contribute to transmission .
And finally , of those of us that get symptomatic , it appears that we 're shedding significant virus in our oropharyngeal compartment , @ @ @ @ @ @ @ show symptoms .
This helps explain how rapidly this virus continues to spread across the country , because we have asymptomatic transmitters , and we have individuals who are transmitting 48 hours before they become symptomatic .
We know there is asymptomatic spread .
... Are you taking another look at the CDC 's mask recommendations ?
We 're always critically looking at new data and ... there is data from obviously Singapore , Hong Kong and China that looks at the issue and you can look at masks in two ways ... @ @ @ @ @ @ @ or ... if I wear a mask , is it something that protects others , from me ?
Particularly with the new data , that there 's significant asymptomatic transmission , this is being critically re-reviewed , to see if there 's potential additional value for individuals that are infected or individuals that may be asymptomatically infected ... obviously you can see the complexity of that , if you assume that 25 % are asymptomatic the only way you would do it -- if you then sort of went into areas that were @ @ @ @ @ @ @ [ proportion of ] individuals then wearing masks , assuming that they were infected .
I can tell you that the data and this issue of whether it 's going to contribute [ to prevention ] is being aggressively reviewed as we speak .
Coronavirus models the Trump administration has been looking at suggest an initial surge in hospitalizations and deaths in April or May .
But [ after those surges ] 95 % of Americans will still have not been exposed to this virus at all .
To protect that 95 % @ @ @ @ @ @ @ massive testing all over the country to control any renewed spread ?
Most respiratory viruses have a seasonality to them , and it 's reasonable to hypothesize — we 'll have to wait and see — but I think many of us believe as we 're moving into the late spring , early summer season , you 're going to see the transmission decrease , similar to what we see with flu as the virus then moves into the Southern Hemisphere .
We will then have a period of time to continue to @ @ @ @ @ @ @ , there 's a number of states right now that have limited transmission , and so getting back into those states with the public health community for early case definition , isolation , contact tracing , I think this is what we 're going to be doing very aggressively May , June , July — to try to use those standard public health techniques to limit the ability to have wide scale community transmission as we get prepared , most likely , for another wave that we would anticipate in the late fall @ @ @ @ @ @ @ be a substantial portion of Americans that are susceptible .
Hopefully , we 'll aggressively re-embrace some of the mitigation strategies that we have determined had impact , particularly social distancing .
'This is a very powerful weapon' First , I 'd like to thank all the Americans and all the people in our nation that have taken this to heart and really practice aggressive social distancing .
Secondly , for those that are still on the sidelines , I 'd like to tell them , now 's the time to really embrace @ @ @ @ @ @ @ little recommendation on a piece of paper .
This is a very powerful weapon .
This virus can not go from person to person that easily , it needs us to be close .
It needs us to be within six feet .
If we just distance ourselves , this virus ca n't sustain itself , and it will go out .
I 'm reminded about the NBC [ motion graphic ] and it 's now on my Twitter , lining up matches and then lighting the match , and they all light @ @ @ @ @ @ @ match and the fire goes down .
So this social distancing that we 're pushing ... is a powerful weapon , and that will shut this outbreak down sooner than it otherwise would have been shut down .
And as next season comes up , it 's going to be important that we re-embrace that social distancing .
When will the CDC have some kind of public tracking system of every single test result in the country , whether that 's done in a hospital , or by a public or commercial lab @ @ @ @ @ @ @ you to respond .
I think we 're really close .
I mean , we get daily reports from all of the testings coming in .
Obviously , FEMA is the data coordinating center , but I think really strong , integrated data is currently occurring down at the county level , where we 're getting positive tests , and where we 're seeing new clusters , and where we are responding .
One of the critical areas is , of course , long-term care facilities .
We now have over 400 long-term @ @ @ @ @ @ @ now outbreaks .
We 're constantly going into those care facilities trying to limit these outbreaks or obviously trying to prepare other assisted living centers .
At the end of the day , most of us who get this infection will recover .
The majority of people do — probably 98 % , almost 98.5 % , 99 % recover .
The challenge is the older , the vulnerable , the elderly , those with significant medical conditions where this virus has shown a propensity to have a significant mortality .
Once we @ @ @ @ @ @ @ , local public health agencies will need to respond .
What is the CDC 's plan to help with those efforts long-term ?
One thing that I think this coronavirus outbreak has really illustrated , something I 've said since I came into this position , is we should be over investing in public health , over preparing not under preparing .
Can you commit to actual money or personnel to do that work ?
What practically does that help from the CDC look like ?
The CDC provides between 50 % and @ @ @ @ @ @ @ for all state , local , territorial , and tribal health departments .
Clearly with the first supplemental [ coronavirus funding from Congress ] that came , CDC got additional funding ... [ we sent ] close to $ 565 million out to the state and local health departments to begin to let them expand their local capacity .
With the third supplemental , CDC is getting an additional , I think , close to $ 4.4 billion , most of which is going to go out to help .
But it does @ @ @ @ @ @ @ these jobs in a way that individuals want to come and enter the public health workforce .
So , we 're going to continue to try to increase , encourage , and facilitate the local , state , and territorial health departments to have the resources to hire these individuals , as we try to motivate many in the American public to say that this is a great vocation to be part of it .
[ Monday , March 30 ] is actually National Doctors Day , but rather than just thank doctors @ @ @ @ @ @ @ the healthcare workers and all the public health workers , all the first responders .
We have areas in Georgia where we still do n't have confirmed cases , but we ca n't assume that there are n't cases there .
Some of those same counties do n't have robust healthcare systems .
So how does the CDC convince people in counties like that , or officials in counties like that , to take this outbreak seriously ?
We are continuing to try to provide additional resources and guidance .
We will be @ @ @ @ @ @ @ that we 'll have a better eye on where this virus is .
We 'll be working with the state and local health departments to do that .
As we get to a time where we 're able to begin to start to reopen some of the economy , based on data showing that this outbreak is now at a point where that balance can be met ... we have to make sure we do n't then have new , huge community clusters [ in ] these areas that have had very limited @ @ @ @ @ @ @ resources to go in there , and make that early diagnosis of those original cases through the isolation , contact tracing .
'This virus is going to be with us' I do n't think anybody would disagree that for decades , collectively , our nation 's under-invested in public health .
Now , I think people understand that that can really have significant consequences , and now is the time for us to over-invest over-prepare in public health .
This virus is going to be with us .
I 'm hopeful that we @ @ @ @ @ @ @ , and have some time to prepare for the second wave .
I 'm hopeful that the private sector in its ingenuity and working with the government , NIH , will develop a vaccine that ultimately will change the impact of this virus .
But for the next 24 months , you know , we 're all in this together , and the most important thing that we can do is twofold : the American public fully embracing the social distancing that we requested to protect the vulnerable ; and secondly , to @ @ @ @ @ @ @ health , you know , early case identification , isolation , contact tracing , so that this outbreak does not get the upper hand , as it has , unfortunately , in New York City , in northern New Jersey , and now New Orleans .
We 've seen here in Georgia municipalities and counties taking a piecemeal approach to issuing stay-at-home orders or other kinds of prevention measures .
It seems naive to think that people do n't cross city or county lines or even state lines .
What can the CDC @ @ @ @ @ @ @ ?
I think the big thing is that in order to operationalize this , you really do need not only the buy-in of the American public , but you do need the buy-in and guidance of the civil leaders .
We can put out strong sound public health advice to try to motivate people to embrace these .
I think early on , maybe the younger generation may not have embraced them as greatly as the older generation .
My sense now is there 's a greater embracement by really all segments of @ @ @ @ @ @ @ 're young and healthy , you 're likely going to do fine if you get this virus , but we 're trying to protect the vulnerable .
So , I asked people to see the face of their parent or grandparent or their neighbor , or co-worker with diabetes or HIV , or kid trying to enjoy life [ while ] confronting cancer at a young age .
We 're doing it for them .
... it 's a powerful weapon , and from what I 'm seeing is the American public is @ @ @ @ @ @ @ of the fight .
Is it possible to isolate vulnerable populations while allowing other people to let up [ on the social distancing ] ?
Is that something that we can actually do , let people have normal lives while still protecting the most vulnerable among us ?
I think there could be an evolution , and we 're going to say that it 's premature right now .
We want the whole nation to stay all in , as the president announced the other day , to the end of April .
@ @ @ @ @ @ @ data .
It is important that one size does n't fit all , and there are parts of our country that will — when they have the data to know exactly how much virus is in their community — they may be able to make local decisions that begin to allow parts of the economy to open up .
And there 'll be other jurisdictions that the data will say there 's just too much extensive , widespread community transmission for us to do that .
Now , I think you 're going @ @ @ @ @ @ @ be used to find that balance over the next four , six , eight weeks as our nation does come back to work .
The last thing I wanted to say , just to be very clear , I have total confidence that we will get through this .
I have total confidence that we 'll bring this virus down , but the tool that we 're going to do that is this request : for all Americans to really embrace the social distancing that we 've requested .

CDC Director On Models For The Months To Come: 'This Virus Is Going To Be With Us'
Enlarge this image toggle caption Michael Brochstein/Echoes Wire/Barcroft Media via Getty Images Michael Brochstein/Echoes Wire/Barcroft Media via Getty Images
When infectious pathogens have threatened the United States, the Centers for Disease Control and Prevention has been front and center. During the H1N1 flu of 2009, the Ebola crisis in 2014 and the mosquito-borne outbreak of Zika in 2015, the CDC has led the federal response.
Yet the nation's public health agency, with its distinguished history of successfully fighting scourges such as polio and smallpox, has been conspicuously absent in recent weeks as infections and deaths from the new coronavirus soared in the U.S.
President Trump has been holding almost daily press conferences at the White House, but the primary health advisers at his side are not from the CDC. Dr. Anthony Fauci directs the National Institute of Allergy and Infectious Diseases, which focuses on biomedical research, and Dr. Deborah Birx is the global AIDS coordinator for the State Department.
The public has heard much less from the CDC director, Dr. Robert Redfield, and the agency, based in Atlanta, has not held a media briefing since March 9.
On Monday, Redfield agreed to a phone interview with Sam Whitehead, the health reporter at WABE in Atlanta, where he also hosts a coronavirus podcast.
This interview has been edited and condensed for length and clarity.
Has the CDC learned anything new about the virus, such as how contagious it is or how it is transmitted, in recent weeks?
Let's take transmission. ... This virus does have the ability to transmit far easier than flu. It's probably now about three times as infectious as flu.
One of the [pieces of] information that we have pretty much confirmed now is that a significant number of individuals that are infected actually remain asymptomatic. That may be as many as 25%. That's important, because now you have individuals that may not have any symptoms that can contribute to transmission, and we have learned that in fact they do contribute to transmission.
And finally, of those of us that get symptomatic, it appears that we're shedding significant virus in our oropharyngeal compartment, probably up to 48 hours before we show symptoms. This helps explain how rapidly this virus continues to spread across the country, because we have asymptomatic transmitters and we have individuals who are transmitting 48 hours before they become symptomatic.
We know there is asymptomatic spread. ... Are you taking another look at the CDC's mask recommendations?
We're always critically looking at new data and ... there is data from obviously Singapore, Hong Kong and China that looks at the issue and you can look at masks in two ways. ... Is the mask something that protects me or ... if I wear a mask, is it something that protects others, from me?
Particularly with the new data, that there's significant asymptomatic transmission, this is being critically re-reviewed to see if there's potential additional value for individuals that are infected or individuals that may be asymptomatically infected. ... Obviously you can see the complexity of that, if you assume that 25% are asymptomatic, the only way you would do it — if you then sort of went into areas that were high transmission zones and had a significant [proportion of] individuals then wearing masks, assuming that they were infected. I can tell you that the data and this issue of whether it's going to contribute [to prevention] is being aggressively reviewed as we speak.
Coronavirus models the Trump administration has been looking at suggest an initial surge in hospitalizations and deaths in April or May. But [after those surges] 95% of Americans will still have not been exposed to this virus at all. To protect those 95% of Americans, won't we need massive testing all over the country to control any renewed spread?
Most respiratory viruses have a seasonality to them, and it's reasonable to hypothesize — we'll have to wait and see — but I think many of us believe as we're moving into the late spring, early summer season, you're going to see the transmission decrease, similar to what we see with flu as the virus then moves into the Southern Hemisphere. We will then have a period of time to continue to work on countermeasures.
As you know, there's a number of states right now that have limited transmission, and so getting back into those states with the public health community for early case definition, isolation, contact tracing, I think this is what we're going to be doing very aggressively May, June, July — to try to use those standard public health techniques to limit the ability to have wide-scale community transmission as we get prepared, most likely, for another wave that we would anticipate in the late fall, early winter where there will still be a substantial portion of Americans that are susceptible.
Hopefully, we'll aggressively reembrace some of the mitigation strategies that we have determined had impact, particularly social distancing.
"This is a very powerful weapon"
First, I'd like to thank all the Americans and all the people in our nation that have taken this to heart and really practice aggressive social distancing. Secondly, for those that are still on the sidelines, I'd like to tell them now's the time to really embrace this. This is not just a little recommendation on a piece of paper. This is a very powerful weapon.
This virus cannot go from person to person that easily. It needs us to be close. It needs us to be within 6 feet. If we just distance ourselves, this virus can't sustain itself and it will go out. I'm reminded about the NBC [motion graphic] and it's now on my Twitter, lining up matches and then lighting the match, and they all light and then you just take out one match and the fire goes down.
So this social distancing that we're pushing ... is a powerful weapon, and that will shut this outbreak down sooner than it otherwise would have been shut down. And as next season comes up, it's going to be important that we reembrace that social distancing.
When will the CDC have some kind of public tracking system of every single test result in the country, whether that's done in a hospital or by a public or commercial lab? Knowing where these cases are prepares you to respond.
I think we're really close. I mean, we get daily reports from all of the testings coming in. Obviously, FEMA is the data coordinating center, but I think really strong, integrated data is currently occurring down at the county level, where we're getting positive tests, and where we're seeing new clusters, and where we are responding.
One of the critical areas is, of course, long-term-care facilities. We now have over 400 long-term-care facilities in this nation that have now outbreaks. We're constantly going into those care facilities trying to limit these outbreaks or obviously trying to prepare other assisted living centers.
At the end of the day, most of us who get this infection will recover. The majority of people do — probably 98%, almost 98.5%, 99% recover. The challenge is the older, the vulnerable, the elderly, those with significant medical conditions where this virus has shown a propensity to have a significant mortality.
Once we know what the outbreak truly looks like, local public health agencies will need to respond. What is the CDC's plan to help with those efforts long-term?
One thing that I think this coronavirus outbreak has really illustrated, something I've said since I came into this position, is we should be overinvesting in public health, overpreparing not underpreparing.
Can you commit to actual money or personnel to do that work? What, practically, does that help from the CDC look like?
The CDC provides between 50% and 70% of the public health funding for all state, local, territorial and tribal health departments. Clearly with the first supplemental [coronavirus funding from Congress] that came, CDC got additional funding ... [we sent] close to $565 million out to the state and local health departments to begin to let them expand their local capacity. With the third supplemental, CDC is getting an additional, I think, close to $4.4 billion, most of which is going to go out to help.
But it doesn't help if we can't create these jobs in a way that individuals want to come and enter the public health workforce. So we're going to continue to try to increase, encourage and facilitate the local, state and territorial health departments to have the resources to hire these individuals as we try to motivate many in the American public to say that this is a great vocation to be part of it. [March 30] is actually National Doctors Day, but rather than just thank doctors today, I want to thank all the health care workers and all the public health workers, all the first responders.
We have areas in Georgia where we still don't have confirmed cases, but we can't assume that there aren't cases there. Some of those same counties don't have robust health care systems. So how does the CDC convince people in counties like that, or officials in counties like that, to take this outbreak seriously?
We are continuing to try to provide additional resources and guidance. We will be expanding surveillance throughout the United States so that we'll have a better eye on where this virus is. We'll be working with the state and local health departments to do that.
As we get to a time where we're able to begin to start to reopen some of the economy, based on data showing that this outbreak is now at a point where that balance can be met ... we have to make sure we don't then have new, huge community clusters [in] these areas that have had very limited transmission. So we do have the resources to go in there and make that early diagnosis of those original cases through the isolation, contact tracing.
"This virus is going to be with us"
I don't think anybody would disagree that for decades, collectively, our nation's underinvested in public health. Now, I think people understand that that can really have significant consequences, and now is the time for us to overinvest overprepare in public health.
This virus is going to be with us. I'm hopeful that we'll get through this first wave and, and have some time to prepare for the second wave. I'm hopeful that the private sector in its ingenuity and working with the government, NIH, will develop a vaccine that ultimately will change the impact of this virus.
But for the next 24 months, you know, we're all in this together, and the most important thing that we can do is twofold: the American public fully embracing the social distancing that we requested to protect the vulnerable; and secondly, to operationalize the bread and butter of public health — you know, early case identification, isolation, contact tracing — so that this outbreak does not get the upper hand, as it has, unfortunately, in New York City, in northern New Jersey, and now New Orleans.
We've seen here in Georgia municipalities and counties taking a piecemeal approach to issuing stay-at-home orders or other kinds of prevention measures. It seems naive to think that people don't cross city or county lines or even state lines. What can the CDC do to encourage a more unified response?
I think the big thing is that in order to operationalize this, you really do need not only the buy-in of the American public, but you do need the buy-in and guidance of the civil leaders. We can put out strong, sound public health advice to try to motivate people to embrace these.
I think early on, maybe the younger generation may not have embraced them as greatly as the older generation. My sense now is there's a greater embracement by really all segments of society. ... Yes, if you're young and healthy, you're likely going to do fine if you get this virus, but we're trying to protect the vulnerable.
So I asked people to see the face of their parent or grandparent or their neighbor, or co-worker with diabetes or HIV, or kid trying to enjoy life [while] confronting cancer at a young age. We're doing it for them. ... It's a powerful weapon, and from what I'm seeing is the American public is responding. People want to be part of the fight.
Is it possible to isolate vulnerable populations while allowing other people to let up [on the social distancing]? Is that something that we can actually do, let people have normal lives while still protecting the most vulnerable among us?
I think there could be an evolution, and we're going to say that it's premature right now. We want the whole nation to stay all in, as the president announced the other day, to the end of April. We're going to be looking at data.
It is important that one size doesn't fit all, and there are parts of our country that will — when they have the data to know exactly how much virus is in their community — they may be able to make local decisions that begin to allow parts of the economy to open up.
And there'll be other jurisdictions that the data will say there's just too much extensive, widespread community transmission for us to do that. Now, I think you're going to see that analysis and that data be used to find that balance over the next four, six, eight weeks as our nation does come back to work.
The last thing I wanted to say, just to be very clear, I have total confidence that we will get through this. I have total confidence that we'll bring this virus down, but the tool that we're going to do that is this request — for all Americans to really embrace the social distancing that we've requested.
This story is part of NPR's reporting partnership with WABE and Kaiser Health News.


npr--2020-03-31--As Pandemic Spreads, The Developing World Looks Like The Next Target

As Pandemic Spreads , The Developing World Looks Like The Next Target So far , the coronavirus has hit hardest in wealthy countries .
But the pandemic now appears poised to explode in many parts of the developing world — which has far fewer resources to combat the virus .
The virus initially traveled outward from China to places that had the most interaction with China .
These are the richer parts of East Asia — South Korea , Japan , Taiwan , Singapore — along with Europe and the United States .
All these countries had lots of flights @ @ @ @ @ @ @ .
Of the 24 countries with the most coronavirus cases , all but a couple are from the developed world , according to a comprehensive chart maintained by Johns Hopkins University .
But now , several months after the virus first appeared , it appears poised to explode in many lower-income parts of the world — which has far fewer resources to combat the virus .
`` There are a lot of other countries at lower-income levels that already have significant coronavirus outbreaks , '' said Mira Rapp-Hooper of the Council on Foreign @ @ @ @ @ @ @ the overall scope is `` very likely going undetected or under-detected while the pandemic continues to spread in those countries . ''
Analysts caution that it 's impossible to predict with certainty which countries will be hit hardest and which may be able to mount an effective defense .
But a list of vulnerable nations includes countries with huge populations and widespread poverty , such as India , Indonesia , Pakistan , Nigeria and Brazil .
So far , few cases To date , the number of confirmed cases in these countries have @ @ @ @ @ @ @ than 5,000 in Brazil to just over 100 in Nigeria .
However , all these nations have lagged behind wealthier countries in responding to the threat , and their options are far more limited .
In India , the world 's second most populous nation with 1.3 billion people , Prime Minister Narendra Modi imposed a 21-day lockdown last week .
By Sunday , he was on nationwide radio acknowledging the hardships .
`` I would firstly like to seek forgiveness from all my countrymen , '' Modi said .
Impoverished Indians will @ @ @ @ @ @ @ prime minister is this , who has put us into so much trouble . ''
But Modi said there was no other option .
The number of confirmed cases in India has just passed 1,000 , though in the absence of widespread testing the actual number is likely much higher .
The measures imposed in wealthier countries may not be realistic in poorer ones , says Jennifer Nuzzo , an epidemiologist and director of the Outbreak Observatory at Johns Hopkins University 's Center for Health Security .
`` It 's one thing for @ @ @ @ @ @ @ sit at home and telework for weeks or months , '' she says .
`` But it 's another thing to ask people in countries where their sole income may be from going out into the streets and selling things , to tell them to stay home for weeks and months and potentially not earn an income to feed their families . ''
Modi 's moves in India sparked a mass migration , with millions of the urban poor fleeing for their home villages .
`` The last thing you want in these @ @ @ @ @ @ @ of your epidemic , '' she says .
`` I do really worry that when governments announce an intention to implement lockdowns , it winds up scattering cases and it becomes much harder to control when you do n't know where everyone went . ''
Experts say there are no easy , low-cost solutions that poorer countries could adopt .
Like wealthier countries , they need more tests , more protective equipment for doctors and nurses , more hospital beds — and have no clear way to get them .
As many wealthier @ @ @ @ @ @ @ cases , it 's not clear if the U.S. and other developed countries will be able to help orchestrate a strong response , as they have done for previous international health crises , like the 2014 Ebola outbreak in West Africa .
Nuzzo did cite one glimmer of hope .
She was part of a study , published just last October , on how well countries were prepared for a pandemic .
The results did not track strictly along national income levels .
Past experience mattered , she said , citing two examples @ @ @ @ @ @ @ than expected when hit by Ebola in 2014 , Nuzzo says .
The health system functioned , and the disease was brought under control .
`` They were able to contain it quickly and it did n't become the nightmare scenario that we predicted , '' she says .
In East Africa , Uganda and neighboring countries were the first countries ravaged by HIV/AIDS back in the 1980s .
As a result , they 've built public health systems that perform well above what their income levels would suggest , she notes .

As Pandemic Spreads, The Developing World Looks Like The Next Target
Enlarge this image toggle caption Sunday Alamba/AP Sunday Alamba/AP
So far, the coronavirus has hit hardest in wealthy countries. But the pandemic now appears poised to explode in many parts of the developing world — which has far fewer resources to combat the virus.
The virus initially traveled outward from China to places that had the most interaction with China. These are the richer parts of East Asia — South Korea, Japan, Taiwan, Singapore — along with Europe and the United States. All these places had lots of flights, business dealings and tourism with China.
Of the 24 countries with the most coronavirus cases, all but a couple are from the developed world, according to a comprehensive chart maintained by Johns Hopkins University.
But now, several months after the virus first appeared, it appears poised to explode in many lower-income parts of the world — areas that have far fewer resources to combat the virus.
"There are a lot of other countries at lower-income levels that already have significant coronavirus outbreaks," said Mira Rapp-Hooper of the Council on Foreign Relations. Because of limited testing, the overall scope is "very likely going undetected or underdetected while the pandemic continues to spread in those countries."
Analysts caution that it's impossible to predict with certainty which countries will be hit hardest and which may be able to mount an effective defense.
But a list of vulnerable nations includes countries with huge populations and widespread poverty, such as Brazil, India, Indonesia, Nigeria and Pakistan.
So far, few cases
To date, the number of confirmed cases in these countries has been relatively low, ranging from fewer than 5,000 in Brazil to just over 100 in Nigeria.
But all these nations have lagged behind wealthier countries in responding to the threat, and their options are far more limited.
In India, the world's second most populous nation with 1.3 billion people, Prime Minister Narendra Modi imposed a 21-day lockdown last week. By Sunday, he was on nationwide radio acknowledging the hardships.
"I would firstly like to seek forgiveness from all my countrymen," Modi said. Impoverished Indians will "definitely be thinking what kind of prime minister is this, who has put us into so much trouble."
But Modi said there was no other option. The number of confirmed cases in India has just passed 1,000, though in the absence of widespread testing the actual number is likely much higher.
Enlarge this image toggle caption Mahesh Kumar A/AP Mahesh Kumar A/AP
The measures imposed in wealthier countries may not be realistic in poorer ones, says Jennifer Nuzzo, an epidemiologist and director of the Outbreak Observatory at Johns Hopkins University's Center for Health Security.
"It's one thing for us here in the United States to sit at home and telework for weeks or months," she says. "But it's another thing to ask people in countries where their sole income may be from going out into the streets and selling things, to tell them to stay home for weeks and months and potentially not earn an income to feed their families."
Indians head to villages
Modi's moves in India sparked a mass migration, with millions of the urban poor fleeing for their home villages.
Nuzzo sees this as extremely dangerous.
"The last thing you want in these circumstances is to increase the geographic footprint of your epidemic," she says. "I do really worry that when governments announce an intention to implement lockdowns, it winds up scattering cases and it becomes much harder to control when you don't know where everyone went."
Experts say there are no easy, low-cost solutions that poorer countries could adopt. Like wealthier countries, they need more tests, more protective equipment for doctors and nurses, more hospital beds — and have no clear way to get them.
As many wealthier countries struggle to contain their own coronavirus cases, it's not clear if the U.S. and other developed countries will be able to help orchestrate a strong response, as they have done for previous international health crises, like the 2014 Ebola outbreak in West Africa.
Nuzzo did cite one glimmer of hope. She was part of a study, published just last October, on how well countries were prepared for a pandemic. The results did not track strictly along national income levels. Past experience mattered, she said, citing two examples from Africa.
Nigeria did much better than expected when hit by Ebola in 2014, Nuzzo says. The health system functioned, and the disease was brought under control.
"They were able to contain it quickly and it didn't become the nightmare scenario that we predicted," she says.
In East Africa, Uganda and neighboring countries were the first countries ravaged by HIV/AIDS back in the 1980s. As a result, they've built public health systems that perform well above what their income levels would suggest, she notes.
Greg Myre is a national security correspondent. Follow him @gregmyre1.


npr--2020-03-31--Facebook, YouTube Warn Of More Mistakes As Machines Replace Moderators

Facebook , YouTube Warn Of More Mistakes As Machines Replace Moderators Facebook , YouTube and Twitter are relying more heavily on automated systems to flag content that violate their rules , as tech workers were sent home to slow the spread of the coronavirus .
But that shift could mean more mistakes — some posts or videos that should be taken down might stay up , and others might be incorrectly removed .
It comes at a time when the volume of content the platforms have to review is skyrocketing , as they clamp down on misinformation about the pandemic @ @ @ @ @ @ @ years that they want computers to take on more of the work of keeping misinformation , violence and other objectionable content off their platforms .
Now the coronavirus outbreak is accelerating their use of algorithms rather than human reviewers .
`` We 're seeing that play out in real time at a scale that I think a lot of the companies probably did n't expect at all , '' said Graham Brookie , director and managing editor of the Atlantic Council 's Digital Forensic Research Lab .
Facebook CEO Mark Zuckerberg told reporters @ @ @ @ @ @ @ `` we may be a little less effective in the near term while we 're adjusting to this . ''
Twitter and YouTube are also sounding caution about the shift to automated moderation .
`` While we work to ensure our systems are consistent , they can sometimes lack the context that our teams bring , and this may result in us making mistakes , '' Twitter said in a blog post .
It added that no accounts will be permanently suspended based only on the actions of the automated systems .
YouTube @ @ @ @ @ @ @ always as accurate or granular in their analysis of content as human reviewers . ''
It warned that more content may be removed , `` including some videos that may not violate policies . ''
And , it added , it will take longer to review appeals of removed videos .
Facebook , YouTube and Twitter rely on tens of thousands of content moderators to monitor their sites and apps for material that breaks their rules , from spam and nudity to hate speech and violence .
Many moderators are not full-time employees @ @ @ @ @ @ @ work for staffing firms .
Now those workers are being sent home .
But some content moderation can not be done outside the office , for privacy and security reasons .
For the most sensitive categories , including suicide , self-injury , child exploitation and terrorism , Facebook says it 's shifting work from contractors to full-time employees — and is ramping up the number of people working on those areas .
There are also increased demands for moderation as a result of the pandemic .
Facebook says use of its apps , @ @ @ @ @ @ @ .
The platforms are under pressure to keep false information , including dangerous fake health claims , from spreading .
The World Health Organization calls the situation an infodemic , where too much information , both true and false , makes it hard to find trustworthy information .
The tech companies `` are dealing with more information with less staff , '' Brookie said .
`` Which is why you 've seen these decisions to move to more automated systems .
Because frankly , there 's not enough people to look at the @ @ @ @ @ @ @ '' That makes the platforms ' decisions right now even more important , he said .
`` I think that we should all rely on more moderation rather than less moderation , in order to make sure that the vast majority of people are connecting with objective , science-based facts . ''
Some Facebook users raised alarm that automated review was already causing problems .
When they tried to post links to mainstream news sources like The Atlantic and BuzzFeed , they got notifications that Facebook thought the posts were spam .
Facebook @ @ @ @ @ @ @ spam due to a glitch in its automated spam filter .
Zuckerberg denied the problem was related to shifting content moderation from humans to computers .
`` This is a completely separate system on spam , '' he said .
`` This is not about any kind of near-term change , this was just a technical error . ''

Facebook, YouTube Warn Of More Mistakes As Machines Replace Moderators
Enlarge this image toggle caption Glenn Chapman/AFP via Getty Images Glenn Chapman/AFP via Getty Images
Facebook, YouTube and Twitter are relying more heavily on automated systems to flag content that violate their rules, as tech workers were sent home to slow the spread of the coronavirus.
But that shift could mean more mistakes — some posts or videos that should be taken down might stay up, and others might be incorrectly removed. It comes at a time when the volume of content the platforms have to review is skyrocketing, as they clamp down on misinformation about the pandemic.
Tech companies have been saying for years that they want computers to take on more of the work of keeping misinformation, violence and other objectionable content off their platforms. Now the coronavirus outbreak is accelerating their use of algorithms rather than human reviewers.
"We're seeing that play out in real time at a scale that I think a lot of the companies probably didn't expect at all," said Graham Brookie, director and managing editor of the Atlantic Council's Digital Forensic Research Lab.
Facebook CEO Mark Zuckerberg told reporters that automated review of some content means "we may be a little less effective in the near term while we're adjusting to this."
Twitter and YouTube are also sounding caution about the shift to automated moderation.
"While we work to ensure our systems are consistent, they can sometimes lack the context that our teams bring, and this may result in us making mistakes," Twitter said in a blog post. It added that no accounts will be permanently suspended based only on the actions of the automated systems.
YouTube said its automated systems "are not always as accurate or granular in their analysis of content as human reviewers." It warned that more content may be removed, "including some videos that may not violate policies." And, it added, it will take longer to review appeals of removed videos.
Facebook, YouTube and Twitter rely on tens of thousands of content moderators to monitor their sites and apps for material that breaks their rules, from spam and nudity to hate speech and violence. Many moderators are not full-time employees of the companies, but instead are contractors who work for staffing companies.
Now those workers are being sent home. But some content moderation cannot be done outside the office, for privacy and security reasons.
For the most sensitive categories, including suicide, self-injury, child exploitation and terrorism, Facebook says it's shifting work from contractors to full-time employees and it is ramping up the number of people working on those areas.
There are also increased demands for moderation as a result of the pandemic. Facebook says use of its apps, including WhatsApp and Instagram, is surging. The platforms are under pressure to keep false information, including dangerous fake health claims, from spreading.
The World Health Organization calls the situation an infodemic, where too much information, both true and false, makes it hard to find trustworthy information.
The tech companies "are dealing with more information with less staff," Brookie said. "Which is why you've seen these decisions to move to more automated systems. Because frankly, there's not enough people to look at the amount of information that's ongoing."
That makes the platforms' decisions right now even more important, he said. "I think that we should all rely on more moderation rather than less moderation, in order to make sure that the vast majority of people are connecting with objective, science-based facts."
Some Facebook users raised alarm that automated review was already causing problems.
When they tried to post links to mainstream news sources like The Atlantic and BuzzFeed, they got notifications that Facebook thought the posts were spam.
Facebook said the posts were erroneously flagged as spam because of a glitch in its automated spam filter.
Zuckerberg denied that the problem was related to shifting content moderation from humans to computers.
"This is a completely separate system on spam," he said. "This is not about any kind of near-term change, this was just a technical error."


npr--2020-03-31--Toilet Paper Startup Ramps Up And Rolls In Wake Of Coronavirus Pandemic

Toilet Paper Startup Ramps Up And Rolls In Wake Of Coronavirus Pandemic The coronavirus pandemic has led to the panic-buying of one item in particular : toilet paper .
Stores have been rationing the goods , in some cases , doling out as little as one roll apiece .
This sudden demand for what some are calling `` white gold '' is proving a challenge — and an opportunity — for one fledgling family business in a Maine , where the paper industry has seen some hard times .
`` It 's been insane .
I do n't sleep much @ @ @ @ @ @ @ But he 's up , overseeing the early shift anyway .
It 's a busy , industrial scene of forklifts and pallets , and workers hustling from machine to machine , turning out rolls of tissue .
It 's been this way since his toilet paper startup , Tissue Plus , was forced into sudden go-mode .
`` So unfortunately , we were n't quite prepared for this to happen so quickly , '' Cooper says .
`` but we 're doing our best to meet the demand .
We 've been very @ @ @ @ @ @ @ workforce available . ''
Shouting over the din of some proprietary machinery that does something we 're not allowed to describe , Jeff Clement is busy keeping the rolls on the rails .
`` Try to make sure they go in there nice and straight , '' he explains .
`` If they get crooked it 'll mess everything up . ''
Clement spent 30 years working at a nearby mill before it closed in 2014 .
An abundance of skilled paper workers like Clement is one reason Cooper decided to use his @ @ @ @ @ @ @ paper factory in Bangor , Maine , — a small riverside city probably most famous for its association with several Stephen King horror stories , including It .
But the area 's paper-making heritage , coupled with an availability of raw material made sense .
And the product made sense , since it was something people would need every day .
Cooper has been able to take on 20 full-time workers so far .
One of them is Peter Hamel who spent decades at another mill before it closed in 2006 .
Hamel @ @ @ @ @ @ @ a new paper plant nearby , but he 's hopeful .
`` I think we 're gon na make it , '' he says .
`` It 's an opportunity and it 's good for the area , bring employment into the area . ''
And right now , he 's making one of hottest items on the planet .
`` I actually received an inquiry from the country of Iceland yesterday , '' says owner Marc Cooper .
`` Grocery store chains from Florida , distributors from around the country .
The @ @ @ @ @ @ @ '' Right now , Tissue Plus is churning out toilet tissue and paper towels 18 hours a day , but even local demand from individuals , senior centers , stores , and the state prison system is unspooling every roll as fast as the workers can wind them , although Cooper says the company also donates a number of rolls to help homeless shelters and pantries get through the crisis .
Cooper says it 'll take another 15 to 20 workers to get the plant up to its full speed of about 80 @ @ @ @ @ @ @ .
He 's hoping a new online toilet paper subscription service he 's just launched at tissueplus.com , among other ideas , will help fund those jobs .
He 's also planning to donate a portion of the proceeds he raises to helping those hurt by the pandemic .
But new enterprises are notoriously unprofitable .
Cooper says so far , they 've only seen money `` go in one direction '' : out .
But there are signs of a turnaround .
In February , Cooper says Tissue Plus almost broke even @ @ @ @ @ @ @ important paper in the house only increasing , he 's predicting that the company will break even , and maybe even turn a small profit .

Toilet Paper Startup Ramps Up And Rolls In Wake Of Coronavirus Pandemic
Enlarge this image toggle caption Nick Woodward /Maine Public Radio Nick Woodward /Maine Public Radio
The coronavirus pandemic has led to the panic-buying of one item in particular: toilet paper.
Stores have been rationing the goods, in some cases, doling out as little as one roll apiece. This sudden demand for what some are calling "white gold" is proving a challenge — and an opportunity — for one fledgling family business in Maine, where the paper industry has seen some hard times.
"It's been insane. I don't sleep much," says owner Marc Cooper. But he's up, overseeing the early shift anyway. It's a busy, industrial scene of forklifts and pallets, and workers hustling from machine to machine, turning out rolls of tissue. It has been this way since his toilet paper startup, Tissue Plus, was forced into sudden go mode.
Why Do People Hoard Toilet Paper? A Look At Irrational Behaviors In Uncertain Times Why Do People Hoard Toilet Paper? A Look At Irrational Behaviors In Uncertain Times Listen · 7:02 7:02
"So unfortunately, we weren't quite prepared for this to happen so quickly," Cooper says, "but we're doing our best to meet the demand. We've been very fortunate that there's been a good workforce available."
Shouting over the din of some proprietary machinery that does something we're not allowed to describe, employee Jeff Clement is busy keeping the rolls on the rails.
"Try to make sure they go in there nice and straight," he explains. "If they get crooked, it'll mess everything up."
Clement spent 30 years working at a nearby mill before it closed in 2014. An abundance of skilled paper workers like Clement is one reason Cooper decided to use his life savings to launch a new toilet paper factory in Bangor, Maine — a small riverside city probably most famous for its association with several Stephen King horror stories, including as inspiration for the setting of It.
The area's paper-making heritage, coupled with an availability of raw material made sense. And the product made sense, since it was something people would need every day.
Cooper has been able to take on 20 full-time workers so far. One of them is Peter Hamel who spent decades at another mill before it closed in 2006. Hamel says he never thought he would see a new paper plant nearby, but he's hopeful.
"I think we're gonna make it," he says. "It's an opportunity and it's good for the area, [brings] employment into the area."
And right now, he's making one of hottest items on the planet. And Cooper is hearing from all over the world.
"I actually received an inquiry from the country of Iceland yesterday," he says. "Grocery store chains from Florida, distributors from around the country. The demand is insane for toilet paper."
Tissue Plus is churning out toilet tissue and paper towels 18 hours a day, but even local demand from individuals, senior centers, stores and the state prison system is unspooling every roll as fast as the workers can wind them. Cooper says the company also donates a number of rolls to help homeless shelters and pantries get through the crisis.
Cooper says it'll take another 15 to 20 workers to get the plant up to its full speed of about 80 rolls per minute, around the clock.
He's hoping that a new online toilet paper subscription service he has just launched at tissueplus.com, among other ideas, will help fund those jobs. He's also planning to donate some of the money he brings in to helping those hurt by the pandemic.
But new enterprises are notoriously unprofitable. Cooper says so far, they've only seen money "go in one direction": out.
There are signs of a turnaround. In February, Cooper says Tissue Plus almost broke even, and with demand for the most important paper in the house only increasing, he's predicting that the company will break even, and maybe even turn a small profit.