vox--2020-09-18--The pandemic forced mental health care to change for the better

Share All sharing options for : How the pandemic forced mental health care to change for the better When the Covid-19 pandemic forced Pari Baker , a clinical social worker and therapist in rural Bath County , Virginia , to switch to seeing clients over video in April , she wasn ’ t sure how it would go .
She ’ d never worked with clients that way before ; the small hospital in the Allegheny Mountains where she works didn ’ t offer it .
But after she started seeing her clients online , bad weather and transportation snafus @ @ @ @ @ @ @ rates for appointments plummeted .
She also got new clients living in the surrounding communities , which have historically been underserved by mental health care .
“ So many barriers to treatment ... we just blew through them because of telehealth , ” Baker says .
“ The majority of the new clients had never had mental health services at all before.
” She noticed her long-standing clients would relax a bit more in their own spaces .
“ It was really eye-opening to see how much people benefited from being in a @ @ @ @ @ @ @ , ” Baker says .
They weren ’ t worried about exiting her office and awkwardly seeing someone they knew in the waiting room .
Telehealth , in a way , felt more confidential .
Now , she says , “ I can ’ t imagine going back .
I think that would be really devastating , and really doing a disservice to our people.
” For years , the tools to conduct mental health care remotely have existed .
But there were extreme disincentives for providers and clients alike to use them @ @ @ @ @ @ @ teletherapy services under most circumstances , and with private insurance and Medicaid , it was a crapshoot .
Some plans paid for it , others paid at rates less than in-person sessions , meaning a therapist would either have to charge their clients more or take a pay cut .
With the pandemic , the insurers and government programs largely relented : Many therapists are now being paid in full for teletherapy .
Other obstacles have fallen away too .
Therapists have to be licensed in every state they see clients in , @ @ @ @ @ @ @ , temporarily , for people across state lines .
“ I definitely think it ’ s expanded the number of people who are able to be seen , ” says Katie Gordon , a North Dakota-based psychologist .
She can see clients who are based in nearby Minnesota , even though she isn ’ t licensed to practice there .
“ It would be a shame if we returned back to the way things were , ” she says .
The pandemic has given mental health care a much-needed kick forward into the @ @ @ @ @ @ @ a chance to reflect not just on how the world is changing in response to the current crisis but also how it ought to change .
It ’ s clear in talking to clinicians and mental health care access experts that the pandemic-induced changes should become permanent .
Teletherapy should become a regular option for care , offered alongside in-person sessions , and covered by insurance .
But they also say these changes are just the beginning .
To truly meet the needs of the present , we ’ re going to need @ @ @ @ @ @ @ new mental health care platforms , more equitable access to technology , and a delicate mix of software and a human touch .
“ The status quo wasn ’ t ethical , ” Jessica Schleider , a psychologist who runs the Lab for Scalable Mental Health at Stony Brook University , says .
It kept too many people out of the mental health services they needed .
“ We can ’ t go back to it.
” Here ’ s how to go forward .
New therapy options were desperately needed before the @ @ @ @ @ @ @ mental health care in the US .
One is the high and growing demand for it .
In 2019 , according to data from the Substance Abuse and Mental Health Services Administration , 16.5 million adults said they felt like they needed mental health treatment or counseling but didn ’ t get it .
Forty percent of these Americans said the reason they didn ’ t get care was that they couldn ’ t afford it .
With the stress of the pandemic , the mental health needs of the country have likely @ @ @ @ @ @ @ percent of Americans reported recent symptoms of anxiety and depression in an August survey by the Centers for Disease Control and Prevention .
For comparison , in the first three months of 2019 , just 11 percent of Americans reported these symptoms on a similar survey .
The second fact is that there ’ s a dire mental health care provider shortage that ’ s forecast to grow in the coming decades , as demand for mental health services continues to outstrip supply .
The National Center for Health Workforce Analysis estimates that @ @ @ @ @ @ @ shortages of psychiatrists , clinical counseling and school psychologists , marriage and family therapists , school counselors , and mental health and substance abuse social workers that number in the tens of thousands .
That ’ s the future , but the present situation is dire too .
“ One in three counties don ’ t have a single licensed clinical psychologist , ” says Stephen Schueller , who studies how mental health care can be provided over the internet at the University of California Irvine .
What ’ s more , the @ @ @ @ @ @ @ 2018 survey found that in urban counties , there are 33.2 psychologists for every 100,000 people .
In rural counties , there are only 9.1 psychologists per 100,000 .
So there ’ s a great and growing need for mental health care that ’ s being unmet .
Yet the professionals trained to care for those needs are thin in number , and will struggle to keep up with demand .
Increased teletherapy can address these problems — but only to a small extent .
It can help clinicians find new clients in @ @ @ @ @ @ @ cover people who previously couldn ’ t travel for an appointment .
“ If we are able to make teletherapy more broadly available for the long term , we ’ re going to start serving people who are desperately in need of good mental health services who are currently unable to see providers , ” Jill Holm-Denoma , a professor of clinical psychology at the University of Denver , says .
“ I think that ’ s huge.
” Even with the expansion of teletherapy , it ’ s important to note that @ @ @ @ @ @ @ the pandemic .
Some college students , who received mental health care on campus , lost access when campuses shut down .
Schleider has also conducted a survey ( not yet published ) of those who use mental health services in the Stony Brook University community , finding “ more than 60 percent lost some or all access to those services , ” she says .
“ And the numbers for minoritized individuals were especially bad.
” ( This happened despite the university ’ s counseling center going virtual in March . )
@ @ @ @ @ @ @ teletherapy can be expanded , it will likely help people .
Studies have found that switching to teletherapy doesn ’ t come at the cost of efficacy — which is infuriating when you consider how private insurance and the government have failed to pay for teletherapy .
The hesitance was likely due to status quo bias .
“ Therapist training instilled in us that ‘ in-person is better ’ and that you need to have that face-to-face interaction for therapeutic change to occur , ” Schleider says .
“ The data doesn ’ @ @ @ @ @ @ @ seemingly effective , therapists like it , and it ’ s often more convenient for the clients .
“ Just this morning , I heard from a client who said , ‘ I ’ ll stay in therapy a lot longer now that I don ’ t have to commute an hour on either side of it , ’ ” Holm-Denoma says .
While teletherapy has meant first-time or easier access for many people , there are instances where an in-office visit is still needed .
“ In my clinic , we ’ @ @ @ @ @ @ @ don ’ t feel like they ’ re in a safe home environment , ” Holm-Denoma says .
“ They ’ re wanting to talk maybe about domestic violence .
If they come to my office , it ’ s pretty safe for them to talk candidly .
If they ’ re in their own home , like hiding in their closet trying to tell me what ’ s happening , it actually might be more dangerous for them , right ?
So there are certain problems for which teletherapy is not practical @ @ @ @ @ @ @ even smart.
” Baker , in her practice in rural Virginia , has found that teletherapy can also be tricky for kids seeking privacy from their parents .
“ If they ’ re having trouble with a parent , ” Baker says , “ and that parent has come into the room , how am I going to know that ?
To protect them and be able to , you know , change the subject really quickly before it becomes an issue with the parent ?
” There are also some issues with @ @ @ @ @ @ @ to be worked out .
Right now , there ’ s a push to make it easier to conduct teletherapy across state lines .
Currently , 15 states are part of a pact to grant practicing reciprocity for teletherapy across state lines , and 11 more have legislation pending to join .
There are , though , more considerations here .
Sometimes , a therapist needs to call local authorities if a client is in an emergency .
“ If you ’ re not in the same state with somebody , how do @ @ @ @ @ @ @ they ’ re in danger ?
” says psychotherapist Bedford Palmer II .
“ That ’ s kind of the main issue there.
” There ’ s no one clear solution for this .
“ I hear a lot of clinicians raise it as a concern , but I actually think it ’ s an easy issue to solve , ” Holm-Denoma says .
“ Most telemedicine laws indicate that you need to start each session by confirming the client ’ s physical location .
Assuming you have that information , if you @ @ @ @ @ @ @ either quickly Google the emergency phone number for first responders in the client ’ s location or call 911 and ask to be transferred to the 911 dispatch location for which your client is located.
” ( She also mentions the same challenges arise in large states .
“ If I am a licensed psychologist in California who lives in San Diego , I could be conducting telehealth with a client who is north of San Francisco , ” she says . )
Ideally , Schleider adds , “ there needs to be @ @ @ @ @ @ @ well-considered plan for how therapists are expected to deal with such situations.
” If clinics expand teletherapy , many people may still struggle to access it We can ’ t rely on teletherapy alone to solve the mental health care crisis .
Ideally , when in-person visits become safe again nationwide , they ’ ll be offered alongside teletherapy options .
But roadblocks to doing this remain .
A huge one : 21 million Americans still don ’ t have access to broadband internet , as Vox ’ s Emily Stewart recently explained @ @ @ @ @ @ @ ” to greater access , says Palmer , is “ making sure people have access to the internet as a right instead of just being something that ’ s a luxury.
” What teletherapy and expanded internet options can ’ t solve : the clinician shortage .
Teletherapy may allow some clinicians to see more clients , but there ’ s only so much to squeeze out of the current mental health care workforce .
“ The challenge is we ’ re still relying on trained professionals , ” says Adrian Aguilera , @ @ @ @ @ @ @ to use technology to face unmet mental health care needs , particularly for low-income and ethnic communities .
“ There ’ s a lot of need , but there ’ s also not enough trained professionals to provide care to address all that need.
” Baker says her volume of clients has “ never been higher.
” But her profession ’ s high burnout rate is never too far from her mind .
“ If you ’ re trying to take on more and more people just to make sure that nobody is @ @ @ @ @ @ @ that ’ s at a sacrifice of something , and most of the time it ’ s the therapist , ” she says .
To fill the provider shortage gap , Aguilera and his colleagues are trying to find new ways to use technology .
One promising solution is using text messaging support to supplement in-person therapy sessions .
“ We ’ ve developed an automated text messaging intervention for folks that are in therapy for depression , ” Aguilera says .
“ People are getting messages throughout the week while they are @ @ @ @ @ @ @ them through their therapy “ homework , ” and practice what they learned with the clinician .
“ The idea is to utilize automated texting to help encourage people to actually practice these things , ” he says .
So far , he finds this type of text engagement leads to people staying in treatment twice as long .
But this approach , too , doesn ’ t completely solve the problem of provider shortages .
It just takes some of the follow-up work off the shoulders of providers .
“ We need @ @ @ @ @ @ @ versus personal contact , ” Aguilera says .
Another promising approach to finding that balance is to use peer support groups .
These are non-clinicians trained to give support to other people in treatment , and research finds potential in them to help supplement therapy .
“ There ’ s a couple of apps that have tried that approach , although I ’ m not sure they have gotten a ton of traction , ” Aguilera says .
There ’ s still room for innovation here .
In her Lab for Scalable Mental @ @ @ @ @ @ @ her colleagues are trying to innovate , trying to find short or computer-based mental health care interventions that have maximum impact .
She ’ s trying to determine : What ’ s the smallest dose of therapy you can give a person for maximum impact ?
“ It ’ s not about how long can we keep this person here , it ’ s about what ’ s the least we can give them and still be useful , ” she says .
In pilot studies , she found bite-size sessions of therapy @ @ @ @ @ @ @ with anxiety and depression .
Her lab ’ s website has several programs that anyone can use for free .
She ’ s been pleasantly surprised by who is finding them .
Black and Indigenous kids of color , she says , and LGBTQ+ and non-cisgender minority youth have been flocking to these programs .
“ It seems that when this alternative route is offered , the people who are least likely to access even teletherapy are able to access something , ” she says .
It ’ s not exactly “ if @ @ @ @ @ @ @ , ” Schleider says .
Her lab has advertised these programs on Reddit and Instagram .
But she ’ s been heartened when she looks at user feedback on her programs .
“ A lot of people are saying , like , ‘ My parents don ’ t believe in mental health ; they wouldn ’ t have gotten me treatment if I had asked them , ’ ” she says .
How to build on the success of teletherapy The expansion of teletherapy is a rare bright spot in America during the @ @ @ @ @ @ @ insurers need to do much , much more .
For instance , there ’ s a lot of innovation and diversity in mental health care approaches right now — a slew of mental health apps ( of varying quality , evidence base , and profit motive ) — and more options for different types of care ( even though the number of providers isn ’ t growing with them ) .
For a consumer seeking care , the glut of options might be overwhelming and confusing .
Because of this , the public @ @ @ @ @ @ @ When might an app or therapy workbook be enough to deal with a mental health stressor ?
When is it time to see someone , either in person or via webcam ?
In crisis , people can always call the National Suicide Hotline ( 800-273-8255 ) or text Text HOME to 741741 for a text-based crisis hotline .
But short of a crisis , the landscape of options grows varied and confusing .
If clinicians are able to work across state lines , the options grow even more .
( Websites like Psychology @ @ @ @ @ @ @ . )
It ’ s not clear what the ideal triage layer is , or should be .
But overall , the public could benefit from greater education about mental health care , what services different providers give , and how to find them .
Meanwhile , it ’ s clear that the pandemic-induced expansions to telehealth coverage should remain in place after the pandemic , but it ’ s unclear if they will .
States or the federal government would need to enact legislation to mandate teletherapy be covered and paid for @ @ @ @ @ @ @ “ Congressional action would be the most direct path ” to universal teletherapy coverage , says Jacob C. Warren , who studies health disparities at Mercer University School of Medicine .
“ If done state-by-state , the states in which it might be needed the most may not take the action.
” When states were given the option of expanding Medicare along with the Affordable Care Act , some of the states with the highest health care needs declined .
“ I ’ m hopeful that the temporary coverage put in place for @ @ @ @ @ @ @ , ” he says .
“ It has opened people ’ s eyes to the power of home-based teletherapy.
” But congressional action alone wouldn ’ t be enough to bolster the future of mental health care .
“ Telehealth is not going to be able to solve the mental health crisis in America , ” Baker says .
“ It ’ s just not .
But I think it ’ s a huge step in the right direction.
” Help keep Vox free for all Millions turn to Vox each month to @ @ @ @ @ @ @ news , from the coronavirus crisis to a racial reckoning to what is , quite possibly , the most consequential presidential election of our lifetimes .
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Share All sharing options for: How the pandemic forced mental health care to change for the better
When the Covid-19 pandemic forced Pari Baker, a clinical social worker and therapist in rural Bath County, Virginia, to switch to seeing clients over video in April, she wasn’t sure how it would go. She’d never worked with clients that way before; the small hospital in the Allegheny Mountains where she works didn’t offer it.
But after she started seeing her clients online, bad weather and transportation snafus were suddenly no longer issues. No-show rates for appointments plummeted. She also got new clients living in the surrounding communities, which have historically been underserved by mental health care.
“So many barriers to treatment ... we just blew through them because of telehealth,” Baker says. “The majority of the new clients had never had mental health services at all before.”
She noticed her long-standing clients would relax a bit more in their own spaces. “It was really eye-opening to see how much people benefited from being in a space that was really comfortable for them,” Baker says. They weren’t worried about exiting her office and awkwardly seeing someone they knew in the waiting room. Telehealth, in a way, felt more confidential.
Now, she says, “I can’t imagine going back. I think that would be really devastating, and really doing a disservice to our people.”
For years, the tools to conduct mental health care remotely have existed. But there were extreme disincentives for providers and clients alike to use them. Medicare didn’t pay for teletherapy services under most circumstances, and with private insurance and Medicaid, it was a crapshoot. Some plans paid for it, others paid at rates less than in-person sessions, meaning a therapist would either have to charge their clients more or take a pay cut.
With the pandemic, the insurers and government programs largely relented: Many therapists are now being paid in full for teletherapy.
Other obstacles have fallen away too. Therapists have to be licensed in every state they see clients in, but now many therapists can offer teletherapy, temporarily, for people across state lines.
“I definitely think it’s expanded the number of people who are able to be seen,” says Katie Gordon, a North Dakota-based psychologist. She can see clients who are based in nearby Minnesota, even though she isn’t licensed to practice there. “It would be a shame if we returned back to the way things were,” she says.
The pandemic has given mental health care a much-needed kick forward into the 21st century. It’s also a chance to reflect not just on how the world is changing in response to the current crisis but also how it ought to change.
It’s clear in talking to clinicians and mental health care access experts that the pandemic-induced changes should become permanent. Teletherapy should become a regular option for care, offered alongside in-person sessions, and covered by insurance.
But they also say these changes are just the beginning. To truly meet the needs of the present, we’re going to need more technological innovation, new science, new mental health care platforms, more equitable access to technology, and a delicate mix of software and a human touch.
“The status quo wasn’t ethical,” Jessica Schleider, a psychologist who runs the Lab for Scalable Mental Health at Stony Brook University, says. It kept too many people out of the mental health services they needed. “We can’t go back to it.”
Here’s how to go forward.
New therapy options were desperately needed before the pandemic
Two facts overshadow all discussions of mental health care in the US.
One is the high and growing demand for it. In 2019, according to data from the Substance Abuse and Mental Health Services Administration, 16.5 million adults said they felt like they needed mental health treatment or counseling but didn’t get it. Forty percent of these Americans said the reason they didn’t get care was that they couldn’t afford it.
With the stress of the pandemic, the mental health needs of the country have likely only grown. Nationally, around 31 percent of Americans reported recent symptoms of anxiety and depression in an August survey by the Centers for Disease Control and Prevention. For comparison, in the first three months of 2019, just 11 percent of Americans reported these symptoms on a similar survey.
The second fact is that there’s a dire mental health care provider shortage that’s forecast to grow in the coming decades, as demand for mental health services continues to outstrip supply. The National Center for Health Workforce Analysis estimates that, by 2025, there will be shortages of psychiatrists, clinical counseling and school psychologists, marriage and family therapists, school counselors, and mental health and substance abuse social workers that number in the tens of thousands.
That’s the future, but the present situation is dire too. “One in three counties don’t have a single licensed clinical psychologist,” says Stephen Schueller, who studies how mental health care can be provided over the internet at the University of California Irvine. What’s more, the low supply is unevenly distributed. A 2018 survey found that in urban counties, there are 33.2 psychologists for every 100,000 people. In rural counties, there are only 9.1 psychologists per 100,000.
So there’s a great and growing need for mental health care that’s being unmet. Yet the professionals trained to care for those needs are thin in number, and will struggle to keep up with demand.
Increased teletherapy can address these problems — but only to a small extent. It can help clinicians find new clients in underserved areas and expand their practices to cover people who previously couldn’t travel for an appointment. “If we are able to make teletherapy more broadly available for the long term, we’re going to start serving people who are desperately in need of good mental health services who are currently unable to see providers,” Jill Holm-Denoma, a professor of clinical psychology at the University of Denver, says. “I think that’s huge.”
Even with the expansion of teletherapy, it’s important to note that many have lost access to care during the pandemic. Some college students, who received mental health care on campus, lost access when campuses shut down. Schleider has also conducted a survey (not yet published) of those who use mental health services in the Stony Brook University community, finding “more than 60 percent lost some or all access to those services,” she says. “And the numbers for minoritized individuals were especially bad.” (This happened despite the university’s counseling center going virtual in March.)
The good news here is that where teletherapy can be expanded, it will likely help people. Studies have found that switching to teletherapy doesn’t come at the cost of efficacy — which is infuriating when you consider how private insurance and the government have failed to pay for teletherapy. The hesitance was likely due to status quo bias. “Therapist training instilled in us that ‘in-person is better’ and that you need to have that face-to-face interaction for therapeutic change to occur,” Schleider says. “The data doesn’t support that.”
So teletherapy is seemingly effective, therapists like it, and it’s often more convenient for the clients. “Just this morning, I heard from a client who said, ‘I’ll stay in therapy a lot longer now that I don’t have to commute an hour on either side of it,’” Holm-Denoma says.
Teletherapy can’t replace all in-person sessions
While teletherapy has meant first-time or easier access for many people, there are instances where an in-office visit is still needed.
“In my clinic, we’ve had a couple of people who don’t feel like they’re in a safe home environment,” Holm-Denoma says. “They’re wanting to talk maybe about domestic violence. If they come to my office, it’s pretty safe for them to talk candidly. If they’re in their own home, like hiding in their closet trying to tell me what’s happening, it actually might be more dangerous for them, right? So there are certain problems for which teletherapy is not practical, and it’s maybe not even smart.”
Baker, in her practice in rural Virginia, has found that teletherapy can also be tricky for kids seeking privacy from their parents. “If they’re having trouble with a parent,” Baker says, “and that parent has come into the room, how am I going to know that? To protect them and be able to, you know, change the subject really quickly before it becomes an issue with the parent?”
There are also some issues with teletherapy and client safety that still need to be worked out.
Right now, there’s a push to make it easier to conduct teletherapy across state lines. Currently, 15 states are part of a pact to grant practicing reciprocity for teletherapy across state lines, and 11 more have legislation pending to join. There are, though, more considerations here. Sometimes, a therapist needs to call local authorities if a client is in an emergency. “If you’re not in the same state with somebody, how do you work with the local authorities when they’re in danger?” says psychotherapist Bedford Palmer II. “That’s kind of the main issue there.”
There’s no one clear solution for this.
“I hear a lot of clinicians raise it as a concern, but I actually think it’s an easy issue to solve,” Holm-Denoma says. “Most telemedicine laws indicate that you need to start each session by confirming the client’s physical location. Assuming you have that information, if you have imminent safety concerns, you can either quickly Google the emergency phone number for first responders in the client’s location or call 911 and ask to be transferred to the 911 dispatch location for which your client is located.” (She also mentions the same challenges arise in large states. “If I am a licensed psychologist in California who lives in San Diego, I could be conducting telehealth with a client who is north of San Francisco,” she says.)
Ideally, Schleider adds, “there needs to be a clear set of guidelines and a well-considered plan for how therapists are expected to deal with such situations.”
If clinics expand teletherapy, many people may still struggle to access it
We can’t rely on teletherapy alone to solve the mental health care crisis.
Ideally, when in-person visits become safe again nationwide, they’ll be offered alongside teletherapy options. But roadblocks to doing this remain. A huge one: 21 million Americans still don’t have access to broadband internet, as Vox’s Emily Stewart recently explained.
“One of the big pieces” to greater access, says Palmer, is “making sure people have access to the internet as a right instead of just being something that’s a luxury.”
What teletherapy and expanded internet options can’t solve: the clinician shortage. Teletherapy may allow some clinicians to see more clients, but there’s only so much to squeeze out of the current mental health care workforce.
“The challenge is we’re still relying on trained professionals,” says Adrian Aguilera, a UC Berkeley researcher who studies how to use technology to face unmet mental health care needs, particularly for low-income and ethnic communities. “There’s a lot of need, but there’s also not enough trained professionals to provide care to address all that need.”
Baker says her volume of clients has “never been higher.” But her profession’s high burnout rate is never too far from her mind. “If you’re trying to take on more and more people just to make sure that nobody is going without the help they need, that’s at a sacrifice of something, and most of the time it’s the therapist,” she says.
To fill the provider shortage gap, Aguilera and his colleagues are trying to find new ways to use technology.
One promising solution is using text messaging support to supplement in-person therapy sessions. “We’ve developed an automated text messaging intervention for folks that are in therapy for depression,” Aguilera says. “People are getting messages throughout the week while they are in treatment.” The text messages help them through their therapy “homework,” and practice what they learned with the clinician. “The idea is to utilize automated texting to help encourage people to actually practice these things,” he says.
So far, he finds this type of text engagement leads to people staying in treatment twice as long. But this approach, too, doesn’t completely solve the problem of provider shortages. It just takes some of the follow-up work off the shoulders of providers.
“We need to find the right balance of automation versus personal contact,” Aguilera says.
Another promising approach to finding that balance is to use peer support groups. These are non-clinicians trained to give support to other people in treatment, and research finds potential in them to help supplement therapy. “There’s a couple of apps that have tried that approach, although I’m not sure they have gotten a ton of traction,” Aguilera says. There’s still room for innovation here.
In her Lab for Scalable Mental Health at Stony Brook, Schleider and her colleagues are trying to innovate, trying to find short or computer-based mental health care interventions that have maximum impact. She’s trying to determine: What’s the smallest dose of therapy you can give a person for maximum impact? “It’s not about how long can we keep this person here, it’s about what’s the least we can give them and still be useful,” she says.
In pilot studies, she found bite-size sessions of therapy can make an impact on teens dealing with anxiety and depression.
Her lab’s website has several programs that anyone can use for free. She’s been pleasantly surprised by who is finding them. Black and Indigenous kids of color, she says, and LGBTQ+ and non-cisgender minority youth have been flocking to these programs. “It seems that when this alternative route is offered, the people who are least likely to access even teletherapy are able to access something,” she says.
It’s not exactly “if you build it, they will come,” Schleider says. Her lab has advertised these programs on Reddit and Instagram. But she’s been heartened when she looks at user feedback on her programs. “A lot of people are saying, like, ‘My parents don’t believe in mental health; they wouldn’t have gotten me treatment if I had asked them,’” she says.
How to build on the success of teletherapy
The expansion of teletherapy is a rare bright spot in America during the pandemic. But mental health authorities and insurers need to do much, much more.
For instance, there’s a lot of innovation and diversity in mental health care approaches right now — a slew of mental health apps (of varying quality, evidence base, and profit motive) — and more options for different types of care (even though the number of providers isn’t growing with them). For a consumer seeking care, the glut of options might be overwhelming and confusing.
Because of this, the public needs something of a triage layer: When might an app or therapy workbook be enough to deal with a mental health stressor? When is it time to see someone, either in person or via webcam? In crisis, people can always call the National Suicide Hotline (800-273-8255) or text Text HOME to 741741 for a text-based crisis hotline. But short of a crisis, the landscape of options grows varied and confusing. If clinicians are able to work across state lines, the options grow even more. (Websites like Psychology Today can help you find a therapist.)
It’s not clear what the ideal triage layer is, or should be. But overall, the public could benefit from greater education about mental health care, what services different providers give, and how to find them.
Meanwhile, it’s clear that the pandemic-induced expansions to telehealth coverage should remain in place after the pandemic, but it’s unclear if they will. States or the federal government would need to enact legislation to mandate teletherapy be covered and paid for by insurance and Medicare and Medicaid.
“Congressional action would be the most direct path” to universal teletherapy coverage, says Jacob C. Warren, who studies health disparities at Mercer University School of Medicine. “If done state-by-state, the states in which it might be needed the most may not take the action.” When states were given the option of expanding Medicare along with the Affordable Care Act, some of the states with the highest health care needs declined. “I’m hopeful that the temporary coverage put in place for Covid will be a catalyst for this,” he says. “It has opened people’s eyes to the power of home-based teletherapy.”
But congressional action alone wouldn’t be enough to bolster the future of mental health care.
“Telehealth is not going to be able to solve the mental health crisis in America,” Baker says. “It’s just not. But I think it’s a huge step in the right direction.”


vox--2020-09-18--The new Covid-19 case surge in Europe, explained

VIENNA — “ I have never seen an emergency room so crowded with very , very sick patients , ” recalls Annalisa Malara , a doctor at Codogno Hospital in Lombardy , Italy .
“ We were literally overwhelmed by the number.
” That was late February , when Malara diagnosed Italy ’ s first case of locally transmitted Covid-19 .
An emotionally wrenching marathon of hospital shifts followed .
Malara felt like she was constantly scrambling — to get enough oxygen to keep patients alive , to arrange transfers to other hospitals , to try and sleep so she @ @ @ @ @ @ @ to watch patients die , ” she said .
“ It ’ s something that I think I can ’ t forget — I will never forget.
” More recently , Codogno Hospital has been Covid-19-free .
But with case counts rising across the country and the continent again , Malara worries about a return to tragedy .
Last week , she spent hours on the phone with colleagues to check on the status of their intensive care units .
The situation was stable — though no one was sure how long that @ @ @ @ @ @ @ scared , ” she confessed .
Only six months after Italy ’ s coronavirus crisis became a warning to the West about how quickly the virus could strain even the best-resourced health systems in the world , the World Health Organization warned Thursday of a “ very serious situation ” unfolding again across Europe , as weekly cases surpassed those reported during the first peak of the pandemic in March .
This “ should serve as a wake-up call for all of us , ” Dr. Hans Kluge , the WHO regional director @ @ @ @ @ @ @ country level , the situation is no more reassuring .
Italian officials are once again reporting around 1,500 new infections each day .
That ’ s not yet anywhere near the last peak of 6,500 — but it ’ s a significant rise from 200 in early July .
France and Spain , currently the hardest-hit countries in the region , are tracking an onslaught of cases even worse than their springtime peaks .
On September 7 , Spain became the first European country to count half a million total cases — more @ @ @ @ @ @ @ two weeks prior .
Days later , France recorded a jump of 10,000 new cases in one day .
In Austria , between late April and mid-June , cases stayed below 100 for weeks , then gradually rose , with 768 reported on September 16 .
Even Germany , an oft-cited example of coronavirus response excellence in Europe , has slowly seen its daily case count edge up , with nearly 2,000 infections — a doubling from August 1 .
Yet one can almost forget there ’ s a pandemic going on in @ @ @ @ @ @ @ in Vienna , where Covid-19 infections are rising so fast Germany just declared the city a high-risk hot spot , restaurants in my neighborhood are full of maskless people practically sitting elbow-to-elbow , kids are back in school and on the playgrounds , and opera season has reopened .
This disjuncture — between the rapidly rising case counts and relatively relaxed social life — has left some confused , and others complacent .
When I showed up at a small garden brunch on Saturday , the hosts said they ’ d wondered whether @ @ @ @ @ @ @ neighbors would think of the gathering — after they heard the news that morning that Austria had just recorded more than 800 new daily infections .
Meanwhile , a 20-something university student told me that the coronavirus now feels like old news to her peers .
Part of the confusion has to do with the fact that the current phase in Europe — despite how bad it looks according to case numbers alone — has a different dynamic from the first .
And that ’ s not only because Covid-19-related hospitalizations and deaths @ @ @ @ @ @ @ as they did in the spring .
This new dynamic is hard to see when you consider case counts or even hospitalizations alone .
“ Even more than in March and April , we need to use [ all the data ] to paint a picture that ’ s complex and balanced , ” said Edouard Mathieu , the Paris-based data manager of Oxford University ’ s Our World in Data project .
Indeed , Europe ’ s latest coronavirus chapter is a much more nuanced story than the previous one — but @ @ @ @ @ @ @ : a looming and very real risk of exponentially growing cases , leading to thousands of unnecessary deaths and the threat of new lockdowns .
Why cases alone can ’ t tell us about Europe ’ s new Covid-19 surge There are a few important caveats to keep in mind when examining Europe ’ s surging coronavirus case count .
The biggest one : You can ’ t “ take the numbers today and place them on top of the earlier curve and assume it ’ s the same thing , ” Flavia @ @ @ @ @ @ @ National Institute of Health , told Vox .
Official case numbers are always an artifact of how testing is being done — and how testing is done has changed dramatically over the course of the pandemic .
“ Most cases we were seeing at the beginning were clearly symptomatic , because the indication was to test only symptomatic people , ” Riccardo said .
“ Generally people were asked to stay home until they had more severe symptoms .
That ’ s the opposite of what ’ s happening now.
” That broadening @ @ @ @ @ @ @ , along with an increased capacity to swab , has meant many more tests are being done , and more cases documented .
In mid-March , German officials performed roughly 20,000 tests per day , according to Our World in Data .
Now the number is a staggering 150,000 .
By the end of May , France and Spain were doing 37,000 and 44,000 daily tests , respectively ; France now does 144,000 tests per day and Spain , 89,000 .
This suggests two things : During the first wave of the pandemic @ @ @ @ @ @ @ of the coronavirus infections in the population , so the real peak in the spring was much higher than the official graphs suggested .
“ We probably measured something like less than 10 percent of what happened , ” Mathieu said .
Second , the recent surge looks relatively large compared to the spring spike — but in reality , it ’ s probably smaller .
Still , the expansion in testing alone can ’ t fully explain the current case uptick , at least not in every country .
That ’ s @ @ @ @ @ @ @ — becomes useful .
The test-per-case ratio tracks exactly what it sounds like : the number of tests being done divided by the confirmed cases .
When the number drops too low it means an epidemic is likely out of control , since officials can no longer keep up with the demand for testing and see where new pockets of disease are spreading .
That ’ s what ’ s happening now in Europe — most notably Spain , Italy , and France — where cases are rising faster than can be explained @ @ @ @ @ @ @ For example , back in June , Spanish officials did 130 tests for every confirmed case .
As of September 12 , that number had dropped to only nine tests per case .
In Austria , the number of tests per confirmed case has fallen from 250 in early June to 20 .
A similar decline in the UK is proving to be worrisome .
There , reports of an explosion in testing wait times and delays in people getting notified of positive results have sparked rumors of another lockdown .
Hospitalizations and @ @ @ @ @ @ @ at a slower rate than before But there ’ s another aspect to the data we have to consider in order to understand the trends in Europe : how quickly infections , hospitalizations , and deaths are rising .
Today , they are generally increasing at a much slower rate than in the spring ( you can see that more clearly when you plot the data on a logarithmic scale ) .
While this is good news , the trends are still worrisome .
Let ’ s focus on hospitalizations for a moment @ @ @ @ @ @ @ an intermediate step between rising cases and increased mortality .
They can also signal the extent to which a health care system is strained and , when they start rising , provide a warning that more resources need to be marshaled quickly .
Earlier in the pandemic , there was a two-week lag between an uptick in cases and a rise in hospitalizations , said Maria DeJoseph Van Kerkhove , the World Health Organization ’ s Covid-19 technical lead .
And when hospitals became crowded with Covid-19 patients , that was followed by @ @ @ @ @ @ @ , for most of the summer , the surging Covid-19 caseload in European countries wasn ’ t accompanied by that growth in hospitalizations or deaths — a trend many attributed to the shift in transmission from mainly older to younger groups .
“ Across Europe , there were a number of outbreaks in social settings — nightclubs , restaurants , and social gatherings , ” Van Kerkhove told Vox .
The median age of cases dropped .
So even though cases overall grew , hospitalizations and deaths were down — and that makes @ @ @ @ @ @ @ to experience mild or symptom-free infections .
Covid-19 demographics are changing again — shifting back into older populations .
In France , for example , 4 percent of tests performed on people age 60 and older are now positive — a doubling from two weeks ago .
By September 10 , there was a 44 percent increase in the proportion of people over age 75 who have been diagnosed with the virus compared to the previous week .
In Italy , the median age of cases went down from nearly 60 in February @ @ @ @ @ @ @ .
It ’ s back up to 40 — and Riccardo thinks it ’ ll rise again as outbreaks move from social settings like nightclubs into households again .
So it has taken time for hospitalizations and deaths to start rising again — but they are now in France and Spain , Van Kerkhove said .
Mathieu walked me through the situation in France , which he ’ s been tracking .
In July , cases started increasing in a way that couldn ’ t be explained by testing alone — albeit slowly @ @ @ @ @ @ @ every 3.5 days , like in March .
A rise in hospitalizations didn ’ t follow immediately .
It ’ s become clear that was because younger people were catching the virus .
By mid-August , “ the virus started to affect older people , and then a few weeks later , hospitalizations have started to increase , ” said Mathieu .
By September 10 , the French public health ministry reported that new Covid-19 hospitalizations were growing in all but one region of the country .
“ Now we are starting to @ @ @ @ @ @ @ .
In late July , there were 10 Covid-19 deaths per day .
Now , there are 30 .
“ This whole process took almost two months instead of [ several ] weeks.
” The exact same trend is playing out now in Spain , he added .
“ In March , the number of deaths was doubling every two to three days in Spain , ” he said .
“ The current rate is much slower — deaths are doubling on average every two weeks.
” But they ’ re still doubling @ @ @ @ @ @ @ more slowly this time , it ’ s still exponential growth that could require more lockdowns There ’ s one last factor to consider in the slowing Covid-19 death rate — and it ’ s good news .
Doctors are better at diagnosing and treating the disease than they were at the start of the pandemic , so patients are more likely to survive .
“ Governments like to congratulate themselves because they are not seeing the level of hospitalizations and deaths as we saw at peak — and the reason for that @ @ @ @ @ @ @ still burning in the same way , ” said Lawrence Gostin , a Georgetown University global expert .
“ We ’ re catching it earlier and treating it better .
So you see lower death rates because of earlier detection , better treatment , and elderly and vulnerable were either exposed and died or they learned the lesson and are staying away.
” These treatments include cheap and readily available drugs like dexamethasone and hydrocortisone , which can cut the risk of dying in very sick patients by a third .
While that @ @ @ @ @ @ @ start to rise and resources to deal with patients — drugs , personal protective equipment , beds , staff — don ’ t grow fast enough to meet demand , “ your fatality rate will increase again , ” Devi Sridhar , professor and chair of Global Public Health at the University of Edinburgh , warned .
And that ’ s when the specter of lockdowns starts reappearing .
“ If you see hospitals filling up and ICU beds full , [ politicians will ] have no choice but to implement some kind @ @ @ @ @ @ @ system to collapse , ” Sridhar added .
“ You can ’ t have people dying in hospital doorways because they can ’ t get access to oxygen.
” Sridhar wasn ’ t at all surprised that Israel just imposed a new lockdown , or that Madrid — where doctors are calling the situation “ March in slow motion ” — is also resorting to lockdown measures .
She also predicts there will be more to come for Europe — that we ’ ll “ pay for summer holidays with winter lockdowns.
” @ @ @ @ @ @ @ lift restrictions as soon as possible , ” she said .
“ What ’ s happened is a muddling of economic and health objectives — we ’ re not doing either properly.
” Mathieu finds this frustrating since it was so predictable .
It ’ s “ exactly what happened the first time : People failed to think in terms of exponential growth.
” During phase one of the pandemic , coronavirus outbreaks proliferated exponentially , meaning an uptick in cases that appeared slow at first rapidly accelerated , outstripping countries ’ abilities @ @ @ @ @ @ @ to use the only instrument they had to deal with unchecked Covid-19 spread — one that didn ’ t require an exponential increase in doctors or hospital beds , Mathieu pointed out : the lockdown .
This time , the growth is happening even more slowly — we have an even better warning .
Yet , Mathieu said , “ There ’ s a weird benchmark thing going on where some people think there ’ s a threshold of terribleness and as long as we ’ re under that threshold , we shouldn @ @ @ @ @ @ @ even though it ’ s still exponential growth .
Take France , for example .
While the country ’ s death rate is nowhere near the last peak , when 1,000 people were dying each day from Covid-19 , “ 30 could soon be 50 or 100 .
And that ’ s dangerous for a mathematical reason ... exponential growth.
” If hospitalizations in France keep increasing exponentially at the current rate of 30 percent per week , for example , it ’ ll take only eight weeks to reach April levels again @ @ @ @ @ @ @ is going up exponentially in France — hospitalizations , ICU admissions , death — even though for now the absolute numbers are still very low.
” “ We need to strike a balance , ” he added , “ between telling people it ’ s not the same thing [ as the first coronavirus peak ] , it ’ s not as bad , it ’ s slower — but we should do something about it.
” Oliver Johnson , a professor of information theory and the director of the Institute for Statistical @ @ @ @ @ @ @ is also worried that people have already forgotten about exponential growth .
“ Two , three weeks ago , [ people were saying ] it ’ s just cases .
Now , people are saying it ’ s just hospitalizations .
And it ’ s like okay , well — what ’ s the next stage after that ?
” Now we ’ re heading into winter , when social distancing is more challenging and people are more likely to gather indoors , where the virus has a much better chance of spreading @ @ @ @ @ @ @ these kinds of viruses spread better when it ’ s cold .
And if you start counting even to Christmas , it starts to look quite scary , ” Johnson added .
“ My worry is that it ’ s a long winter.
” Help keep Vox free for all Millions turn to Vox each month to understand what ’ s happening in the news , from the coronavirus crisis to a racial reckoning to what is , quite possibly , the most consequential presidential election of our lifetimes .
Our mission has @ @ @ @ @ @ @ in this moment : to empower you through understanding .
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VIENNA — “I have never seen an emergency room so crowded with very, very sick patients,” recalls Annalisa Malara, a doctor at Codogno Hospital in Lombardy, Italy. “We were literally overwhelmed by the number.”
That was late February, when Malara diagnosed Italy’s first case of locally transmitted Covid-19. An emotionally wrenching marathon of hospital shifts followed. Malara felt like she was constantly scrambling — to get enough oxygen to keep patients alive, to arrange transfers to other hospitals, to try and sleep so she could keep going. “We had to watch patients die,” she said. “It’s something that I think I can’t forget — I will never forget.”
More recently, Codogno Hospital has been Covid-19-free. But with case counts rising across the country and the continent again, Malara worries about a return to tragedy. Last week, she spent hours on the phone with colleagues to check on the status of their intensive care units. The situation was stable — though no one was sure how long that would last. “Everyone is very scared,” she confessed.
Only six months after Italy’s coronavirus crisis became a warning to the West about how quickly the virus could strain even the best-resourced health systems in the world, the World Health Organization warned Thursday of a “very serious situation” unfolding again across the agency’s European region, as weekly cases surpassed those reported during the first peak of the pandemic in March. This “should serve as a wake-up call for all of us,” Dr. Hans Kluge, the WHO regional director for Europe, said.
At the country level, the situation is no more reassuring. Italian officials are once again reporting around 1,500 new infections each day. That’s not yet anywhere near the last peak of 6,500 — but it’s a significant rise from 200 in early July. France and Spain, currently the hardest-hit countries in the region, are tracking an onslaught of cases even worse than their springtime peaks. On September 7, Spain became the first European country to count half a million total cases — more than 100,000 of them diagnosed in the two weeks prior. Days later, France recorded a jump of 10,000 new cases in one day. In Austria, between late April and mid-June, cases stayed below 100 for weeks, then gradually rose, with 768 reported on September 16.
Even Germany, an oft-cited example of coronavirus response excellence in Europe, has slowly seen its daily case count edge up, with nearly 2,000 infections — a doubling from August 1.
Yet one can almost forget there’s a pandemic going on in many parts of the continent.
Here in Vienna, where Covid-19 infections are rising so fast Germany just declared the city a high-risk hot spot, restaurants in my neighborhood are full of maskless people practically sitting elbow-to-elbow, kids are back in school and on the playgrounds, and opera season has reopened.
This disjuncture — between the rapidly rising case counts and relatively relaxed social life — has left some confused, and others complacent. When I showed up at a small garden brunch on Saturday, the hosts said they’d wondered whether they should cancel — worrying what their neighbors would think of the gathering — after they heard the news that morning that Austria had just recorded more than 800 new daily infections. Meanwhile, a 20-something university student told me that the coronavirus now feels like old news to her peers.
Part of the confusion has to do with the fact that the current phase in Europe — despite how bad it looks according to case numbers alone — has a different dynamic from the first. And that’s not only because Covid-19-related hospitalizations and deaths aren’t rising nearly as quickly as they did in the spring. This new dynamic is hard to see when you consider case counts or even hospitalizations alone.
“Even more than in March and April, we need to use [all the data] to paint a picture that’s complex and balanced,” said Edouard Mathieu, the Paris-based data manager of Oxford University’s Our World in Data project. Indeed, Europe’s latest coronavirus chapter is a much more nuanced story than the previous one — but it ultimately ends in the same place: a looming and very real risk of exponentially growing cases, leading to thousands of unnecessary deaths and the threat of new lockdowns.
Why cases alone can’t tell us about Europe’s new Covid-19 surge
There are a few important caveats to keep in mind when examining Europe’s surging coronavirus case count. The biggest one: You can’t “take the numbers today and place them on top of the earlier curve and assume it’s the same thing,” Flavia Riccardo, a researcher at the Italian National Institute of Health, told Vox.
Official case numbers are always an artifact of how testing is being done — and how testing is done has changed dramatically over the course of the pandemic. “Most cases we were seeing at the beginning were clearly symptomatic, because the indication was to test only symptomatic people,” Riccardo said. “Generally people were asked to stay home until they had more severe symptoms. That’s the opposite of what’s happening now.”
That broadening of the testing criteria for the coronavirus, along with an increased capacity to swab, has meant many more tests are being done, and more cases documented. In mid-March, German officials performed roughly 20,000 tests per day, according to Our World in Data. Now the number is a staggering 150,000. By the end of May, France and Spain were doing 37,000 and 44,000 daily tests, respectively; France now does 144,000 tests per day and Spain, 89,000.
This suggests two things: During the first wave of the pandemic, health officials only captured a fraction of the coronavirus infections in the population, so the real peak in the spring was much higher than the official graphs suggested. “We probably measured something like less than 10 percent of what happened,” Mathieu said. Second, the recent surge looks relatively large compared to the spring spike — but in reality, it’s probably smaller.
Still, the expansion in testing alone can’t fully explain the current case uptick, at least not in every country. That’s where another metric — test per case — becomes useful.
The test-per-case ratio tracks exactly what it sounds like: the number of tests being done divided by the confirmed cases. When the number drops too low it means an epidemic is likely out of control, since officials can no longer keep up with the demand for testing and see where new pockets of disease are spreading.
That’s what’s happening now in Europe — most notably Spain, Italy, and France — where cases are rising faster than can be explained by the increase in testing alone.
For example, back in June, Spanish officials did 130 tests for every confirmed case. As of September 12, that number had dropped to only nine tests per case. In Austria, the number of tests per confirmed case has fallen from 250 in early June to 20. A similar decline in the UK is proving to be worrisome. There, reports of an explosion in testing wait times and delays in people getting notified of positive results have sparked rumors of another lockdown.
Hospitalizations and deaths in Europe are rising — just at a slower rate than before
But there’s another aspect to the data we have to consider in order to understand the trends in Europe: how quickly infections, hospitalizations, and deaths are rising. Today, they are generally increasing at a much slower rate than in the spring (you can see that more clearly when you plot the data on a logarithmic scale). While this is good news, the trends are still worrisome.
Let’s focus on hospitalizations for a moment to understand why. Hospitalizations are often an intermediate step between rising cases and increased mortality. They can also signal the extent to which a health care system is strained and, when they start rising, provide a warning that more resources need to be marshaled quickly.
Earlier in the pandemic, there was a two-week lag between an uptick in cases and a rise in hospitalizations, said Maria DeJoseph Van Kerkhove, the WHO’s Covid-19 technical lead. And when hospitals became crowded with Covid-19 patients, that was followed by an increase in Covid-19 deaths.
Yet, for most of the summer, the surging Covid-19 caseload in European countries wasn’t accompanied by that growth in hospitalizations or deaths — a trend many attributed to the shift in transmission from mainly older to younger groups.
“Across Europe, there were a number of outbreaks in social settings — nightclubs, restaurants, and social gatherings,” Van Kerkhove told Vox. The median age of cases dropped. So even though cases overall grew, hospitalizations and deaths were down — and that makes sense because younger people are more likely to experience mild or symptom-free infections.
Covid-19 demographics are changing again — shifting back into older populations. In France, for example, 4 percent of tests performed on people age 60 and older are now positive — a doubling from two weeks ago. By September 10, there was a 44 percent increase in the proportion of people over age 75 who have been diagnosed with the virus compared to the previous week.
In Italy, the median age of cases went down from nearly 60 in February to 30 at the end of August. It’s back up to 40 — and Riccardo thinks it’ll rise again as outbreaks move from social settings like nightclubs into households again.
So it has taken time for hospitalizations and deaths to start rising again — but they are now in France and Spain, Van Kerkhove said.
[Updated data for September 14] Ongoing hospitalizations for COVID-19 in France's 10 largest urban areas
• Nice: 38% of its first-wave peak
• Bordeaux: 36%
• Marseille: 34%
• Toulouse: 31%
• Rennes: 29% pic.twitter.com/ThAFQnLxX6 — Edouard Mathieu (@redouad) September 14, 2020
[Updated data for September 15]
Latest COVID-19 figures for French hospitals:
• 2,713 new hospitalizations in the last week (+30% week-on-week)
• 479 new ICU admissions (+34%)
• 183 new deaths (+26%) pic.twitter.com/xlpAxJJqwx — Edouard Mathieu (@redouad) September 15, 2020
Mathieu walked me through the situation in France, which he’s been tracking. In July, cases started increasing in a way that couldn’t be explained by testing alone — albeit slowly, doubling every two weeks instead of every 3.5 days, like in March. A rise in hospitalizations didn’t follow immediately.
It’s become clear that was because younger people were catching the virus. By mid-August, “the virus started to affect older people, and then a few weeks later, hospitalizations have started to increase,” said Mathieu. By September 10, the French public health ministry reported that new Covid-19 hospitalizations were growing in all but one region of the country.
“Now we are starting to see deaths increase,” Mathieu added. In late July, there were 10 Covid-19 deaths per day. Now, there are 30. “This whole process took almost two months instead of [several] weeks.”
The exact same trend is playing out now in Spain, he added. “In March, the number of deaths was doubling every two to three days in Spain,” he said. “The current rate is much slower — deaths are doubling on average every two weeks.” But they’re still doubling.
Even if it’s happening more slowly this time, it’s still exponential growth that could require more lockdowns
There’s one last factor to consider in the slowing Covid-19 death rate — and it’s good news. Doctors are better at diagnosing and treating the disease than they were at the start of the pandemic, so patients are more likely to survive.
“Governments like to congratulate themselves because they are not seeing the level of hospitalizations and deaths as we saw at peak — and the reason for that is not because Covid isn’t still burning in the same way,” said Lawrence Gostin, a Georgetown University global expert. “We’re catching it earlier and treating it better. So you see lower death rates because of earlier detection, better treatment, and elderly and vulnerable were either exposed and died or they learned the lesson and are staying away.”
These treatments include cheap and readily available drugs like dexamethasone and hydrocortisone, which can cut the risk of dying in very sick patients by a third.
While that’s certainly comforting, when cases start to rise and resources to deal with patients — drugs, personal protective equipment, beds, staff — don’t grow fast enough to meet demand, “your fatality rate will increase again,” Devi Sridhar, professor and chair of Global Public Health at the University of Edinburgh, warned.
And that’s when the specter of lockdowns starts reappearing. “If you see hospitals filling up and ICU beds full, [politicians will] have no choice but to implement some kind of lockdown unless you want your health system to collapse,” Sridhar added. “You can’t have people dying in hospital doorways because they can’t get access to oxygen.”
Sridhar wasn’t at all surprised that Israel just imposed a new lockdown, or that Madrid — where doctors are calling the situation “March in slow motion” — is also resorting to lockdown measures. She also predicts there will be more to come for Europe — that we’ll “pay for summer holidays with winter lockdowns.”
“Every country was under pressure to lift restrictions as soon as possible,” she said. “What’s happened is a muddling of economic and health objectives — we’re not doing either properly.”
Mathieu finds this frustrating since it was so predictable. It’s “exactly what happened the first time: People failed to think in terms of exponential growth.”
During phase one of the pandemic, coronavirus outbreaks proliferated exponentially, meaning an uptick in cases that appeared slow at first rapidly accelerated, outstripping countries’ abilities to manage them. Governments were forced to use the only instrument they had to deal with unchecked Covid-19 spread — one that didn’t require an exponential increase in doctors or hospital beds, Mathieu pointed out: the lockdown.
This time, the growth is happening even more slowly — we have an even better warning. Yet, Mathieu said, “There’s a weird benchmark thing going on where some people think there’s a threshold of terribleness and as long as we’re under that threshold, we shouldn’t worry about it” — even though it’s still exponential growth.
Take France, for example. While the country’s death rate is nowhere near the last peak, when 1,000 people were dying each day from Covid-19, “30 could soon be 50 or 100. And that’s dangerous for a mathematical reason ... exponential growth.”
If hospitalizations in France keep increasing exponentially at the current rate of 30 percent per week, for example, it’ll take only eight weeks to reach April levels again. “For now, every line is going up exponentially in France — hospitalizations, ICU admissions, death — even though for now the absolute numbers are still very low.”
“We need to strike a balance,” he added, “between telling people it’s not the same thing [as the first coronavirus peak], it’s not as bad, it’s slower — but we should do something about it.”
Oliver Johnson, a professor of information theory and the director of the Institute for Statistical Science at the University of Bristol, is also worried that people have already forgotten about exponential growth. “Two, three weeks ago, [people were saying] it’s just cases. Now, people are saying it’s just hospitalizations. And it’s like okay, well — what’s the next stage after that?”
Now we’re heading into winter, when social distancing is more challenging and people are more likely to gather indoors, where the virus has a much better chance of spreading. “We have reason to believe these kinds of viruses spread better when it’s cold. And if you start counting even to Christmas, it starts to look quite scary,” Johnson added. “My worry is that it’s a long winter.”