What the Bankruptcy Onslaught Means for the Future of Retail – The Business of Fashion

NEW YORK, United States When Modells Sporting Goods filed for Chapter 11 Bankruptcy in March, it was supposed to be a standard liquidation: the New York-based retailer would conduct going-out-of-business sales at its 134 locations and then close the stores. The proceeds would go to creditors.

Just days later, many US states went into lockdown. Modells stores closed, making going-out-of-business sales impossible. On March 27, a New Jersey bankruptcy judge granted Modells a month-long reprieve, which was later extended to the end of May.

Retailers are caught in an unusual, if not unprecedented situation: they are starting to go bankrupt because the economy is shut down, but the bankruptcy process itself is a casualty of the lockdowns.

The repercussions go far beyond a few delays: in the US, companies use the bankruptcy process to reduce unmanageable debt loads, wiggle out of orders for unsellable clothes and cancel onerous store leases. Those benefits are difficult to realise when stores are closed and the legal system has slowed to a crawl.

In a normal bankruptcy process, the path forward is clear: theres reorganisation and a cleaned up balance sheet, said Matt Kaden, managing director at financial services firm MMG Advisors. So much of a bankruptcy is based on being able to liquidate assets, but what happens now when thats impossible?

In fashion, the list of bankrupt brands is growing longer by the day: it includes large retailers Neiman Marcus, plus smaller brands including True Religion, John Varvatos. A filing by J.C. Penney is expected soon. Credit agency Moodys is expecting the default rate for retail and apparel companies to surge between now and next year, from a pre-Coronavirus estimate of 6 percent to 17.2 percent.

J.Crew and Neiman Marcus both filed for Chapter 11 bankruptcy protection last week, complete with plans for how they could emerge from the process with healthy finances in the space of a few months.

Some financial experts argue that filing for bankruptcy makes more sense than ever as retailers can be protected from economic uncertainty for a few months. A backlogged bankruptcy court could mean that a judge would be more deferential toward the companys management decisions, said Susheel Kirpalani, partner at law firm Quinn Emanuel.

Companies may be able to count on their investors to keep them afloat by exchanging debt for increased ownership stakes, Kirpalani said. The investors would be gambling that their stakes would generate higher returns than the portion of their loans they would be able to collect from a bankrupt retailer.

J.Crew effectively handed the reins to its top creditors, including hedge fund Anchorage Capital, agreeing to convert $1.7 billion of debt into equity. Pier 1 Imports took this approach as well after the worsening pandemic dimmed the furniture retailers chances of finding a buyer in a bankruptcy auction.

Nothing is certain in bankruptcy, however, and the stakes are high. Companies must indicate a recovery is possible within six months of filing, or creditors can urge a bankruptcy judge to force a liquidation. Covid-19 has made this process even more unpredictable, as even the most meticulous recovery plans could be derailed if the economic climate turns out to be worse than expected, or new outbreaks force stores to close again.

The ultimate goal of a chapter 11 plan is to file a plan of reorganisation, which will be voted on by creditors, said Joseph Lemkin, partner at law firm Stark & Stark. In order to be approved by the court, the plan must be feasible. Given the uncertainty in retail, it may be difficult for retailers to come up with...a [feasible] proposed plan."

Get the Money Up Front

When a corporation files for Chapter 11 bankruptcy, it typically follows one of three scenarios: liquidation (Roberto Cavalli), reorganisation (J.Crew) or sale (Barneys New York), though some level of liquidation is likely to take place in every case.

In each scenario, companies need financing to keep operating while they work through the bankruptcy process. This money is known as a debtor-in-possession, or DIP, loan, typically backed by a retailers assets. Neiman Marcus, for example, was in negotiation with its lenders for weeks leading up to its filing on May 7. Before it had secured its current $675 million in financing, a challenger group of investors, including distress-focused investment firm Mudrick Capital Management L, submitted a $700 million DIP proposal pushing for Neiman to sell itself.

Retailers must normally liquidate some assets to secure DIP funding in order to guarantee the lenders at least some of their cash back. Often part of any bankruptcy proceeding, brands and store operators have to monetise their existing inventory in order to continue operating during the bankruptcy. Rent, for instance, is still an expense during the course of restructuring. Liquidation will be hard to do as long as stores are closed.

Early bankruptcy filers have another advantage though: banks still have plenty of money to lend to distressed retailers. That may not be true if a wave of large brands file for Chapter 11 all at once.

Retailers, healthy and distressed alike, have tapped their credit lines with banks, which are now overextended and cautious about the sector, said Danielle Garno, the head of the fashion, beauty and luxury goods practice at law firm Cozen OConnor.

If everyone files at the same time, theyll be fighting for the same fewer dollars, she said.

It might be smart to file for bankruptcy sooner rather than later to avoid the crush, according to Kirpalani. In the airline industry, those that were in bankruptcy early and emerged early were on a stronger footing maybe itll be similar in retail, he said.

The Takeover Opportunity

Hedge funds with existing stakes in struggling retailers see bankruptcy as a way to acquire companies at bargain prices, such as in the case of J.Crew and its hedge fund debtor, Anchorage Capital. Neiman Marcus has a similar arrangement where creditors have exchanged its $5 billion of debt for equity in the company, though its unclear which types of firms are leading the deal.

Many funds were already in the market for acquisitions, and they see opportunities in the plunging valuations for once-hot direct-to-consumer brands and struggling mall retailers alike.

Hedge funds have been sitting on a fair amount of cash and now they figure the returns they can generate by providing fairly secure financing [to bankrupt retailers] exceeds what they can get in other places, said Kirpalani of Quinn Emanuel.

Bankruptcies Upon Bankruptcies

Investors will likely have their pick of retailers to buy.

When a big box retailer like J.C.Penney goes under, there will be a ripple effect in the retail landscape, starting with vendors and neighbouring stores in the mall.

People can hate on J.C.Penney all they want but that is an anchor store at a mall, and the mall will be a dead mall unless they add something else to fill that space, said Gabriella Santaniello, founder of consultancy A Line Partners.

Some vendors rely on one retailer for the bulk of their business. When that business is unable to pay its bills and liquidates, these suppliers find themselves at the back of the line for repayment, behind DIP lenders.

This kind of loss could trigger bankruptcies of their own. After Barneys went bankrupt, for instance, a number of emerging jewellery brands lost 50 percent or more of their business.

The Survivor Opportunity

As more incumbents fail to measure up, those that do adapt to the new normal will end up thriving, said Mickey Chadha, vice president of Moodys Investors Service. Theyll also benefit from having fewer competitors. Case in point? The demise of Barneys paved the way for Saks Fifth Avenue and Neiman Marcus to be the only two national luxury retail department store chains in the US.

The stronger players going into the crisis will take more market share when they come out, he said.

For some retailers, bankruptcy may be the only path to joining the ranks of survivors. Neiman Marcus and J.Crew are both successfully refinanced their debt and are on the restructuring trajectory, rather than liquidation. Because of the uncertainties in retail ahead and the temporary impossibility of liquidation, stakeholders in the industry have reason to be optimistic about recovery, according to Jonathan Treiber, chief executive of retail management platform RevTrax.

Sometimes the situation is so bad that the retailer actually has leverage, and right now I think thats true because theyre facing unprecedented risk, he said. This requires lenders to be much more flexible than before, when liquidation was still an option.

Were tracking the latest on the coronavirus outbreak and its impact on the global fashion business. Visit ourlive blogfor everything you need to know.

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What the Bankruptcy Onslaught Means for the Future of Retail - The Business of Fashion

JC Penney poised to file for Chapter 11 bankruptcy protection – Northeast Mississippi Daily Journal

Iconic retailer J.C.Penney, which has missed a debt payment last week of $17 million, has until tomorrow to pay a $12 million payment is skipped in April.

All signs point to the company filing for Chapter 11 bankruptcy protection.

Multiple reports indicate that the retailer also is poised to close some 200 of its 850 stores as it hopes to climb out of the hole that it is in, made deeper by having to close during the COVID-19 pandemic.

As of February, JCPenney had $386 million in cash on hand, plus the roughly $1.25 billion it tapped from its $2.35 billion revolving credit line two months ago. A bankruptcy filing could give the company the opportunity to save money on imminent debt payments and rework some of its finances.

And according to Footwear News, in a filing with the Securities and Exchange Commission over the weekend, JC Penney announced it had granted a cash award of $4.5 million to CEO Jill Soltau, while CFO Bill Wafford, chief merchant Michelle Wlazlo and chief human resources officer Brynn Evanson each received $1 million.

The bonuses are subject to repayment if the executive is terminated or resigns before January next year and if certain performance goals are not achieved. (The repaid funds will then be used to pay severance to employees who did not receive cash awards.) In exchange for the bonuses, the executives are giving up their previously granted equity worth more than $10 million for Soltau alone.

The company has reportedly asked for $450 million debtor-in-possession financing before its bankruptcy filing.

For fiscal year 2019 that ended on Feb. 1 of this year, JC Penney had sales of $10.72 billion, down 8% from the $11.66 billion from a year earlier. It also posted a loss of $8 million.

As of Feb. 1, the company had nine stores in Mississippi, with two stores in Northeast Mississippi Tupelo and Starkville.

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JC Penney poised to file for Chapter 11 bankruptcy protection - Northeast Mississippi Daily Journal

Flaggs floats bankruptcy as possible solution for city ‘devastated by the loss of revenue’ – The Vicksburg Post – Vicksburg Post

While state and federal officials continue to discuss and debate stimulus plans, municipalities like Vicksburg continue to flounder in an economy brought to a halt by the COVID-19 pandemic.

Early last week, Mayor George Flaggs Jr. and city officials itemized nearly $3 million in projected revenue losses. They not only discussed the losses, but drastic steps the city might be forced to take especially making deep cuts to the citys personnel numbers to in some way offset the loss of revenue tied to sales taxes and the currently shuttered casino industry.

But that was last week, and those possible solutions might not be enough.

Thursday, Flaggs said the losses have continued to mount, while the options to keep from significantly cutting city services have started to narrow, especially if stimulus money from the state and federal governments is further delayed.

One option at the disposal of Flaggs and other city leaders throughout the state is bankruptcy, particularly Chapter 9 bankruptcy.

It is an option. It is a progressive option, Flaggs said. What do you do when you want to protect your assets and make sure you have enough flexibility to move around so that you can make the best decisions for the city? To lose the kind of revenue that we have lost has not happened in the history of this state.

The estimated and itemized losses as of last week for the city were $2.8 million, but that was before officials with the Miss Mississippi Corporation announced both the annual teen pageant and Miss Mississippi Competition would be postponed until 2021. According to figures from the Vicksburg Convention Center, the Miss Mississippi event alone provides a $2.3 million economic impact to the city.

Flaggs said that cancellation and the loss of sales tax revenues connected to participants, along with friends and families, not coming to Vicksburg has since raised the projection of lost revenues to $3.5 million.

Flaggs said he is not ready to move ahead with bankruptcy just yet.

I have not spoken to anyone in the city about Chapter 9. I havent gotten a legal opinion or talked with anyone. I just know as a former legislator the options that are available to municipalities when you are under dire financial stress, he said. I am not just speaking for one city, I am speaking for all cities. This is nothing like Katrina. Katrina and other incidents was isolated. I dont know a city or county in this state that has not been devastated by the loss of revenue.

According to U.S. bankruptcy law, Chapter 9 bankruptcy is a reorganizational option for municipalities and school districts that allows a financially-distressed municipality protection from its creditors while it develops and negotiates a plan for adjusting its debts.

It protects the city from its creditors and allows you the opportunity to move money around, refinance, restructure so you can not have to reduce services, Flaggs said. That is probably the last thing you would ever want to do in government, but it is an option; so too is tapping into the reserve fund, laying off people, moving to 32-hour work weeks and furloughs.

Flaggs knows discussing the option of bankruptcy is a shock to some, but he said it is vital for everyone to know just how serious this matter is.

I am trying to convey to the Legislature that this is a very serious issue and the Legislatures responsibility to step in and help us, he said. We have casinos that are closed, we have tourism, our economy is based on revenue from tourism. We have a local 2 percent sales tax on our hotels and restaurants to fund our sports complex. You dont think we have been impacted?

Even though bankruptcy is an option, Flaggs is confident today that it will likely not be needed and that state and federal governments will act.

I feel confident the Legislature and that the federal government will help us by way of the White House and the Congress, Flaggs said, adding that on Monday he presented a letter to Lt. Gov. Delbert Hosemann, Speaker of the House Phillip Gunn and Gov. Tate Reeves outlining the citys itemized and projected revenue losses. He also said that, since Monday, Hosemann had followed up to get updated lost revenue figures and other expenses related to the losses.

Flaggs admits, though, that even if the city and other municipalities get stimulus money from state and federal governments, that it will not be a long-term solution. It will get us out of this fiscal year, Flaggs said.

I am trying to minimize the cost without devastating this local government or reduce any services, he said. This pandemic was not a result of anybodys mistake and the Congress and the Legislature have got to understand and they have to do something. I am confident we are going to get there.

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Flaggs floats bankruptcy as possible solution for city 'devastated by the loss of revenue' - The Vicksburg Post - Vicksburg Post

Key Canadian bankruptcy laws and terms – Yahoo Canada Finance

With thenumber ofcommercial bankruptcies and insolvencies expected to rise in the coming months,here are some key Canadian laws and terms that will show up as corporations look to restructure their operations:

A corporation becomes insolvent when it's unable to pay themoney it owes, generallyto suppliers of goods or services. This can stretch on for a long period before the corporationrelies on legislation that governscommercial insolvency and restructuring proceedings in Canada.

Canada's insolvency laws are intended to help return a corporation to a productiveexistence by allowingit to restructure itself (through what's called a Plan of Arrangement) instead of closing operations. The insolvency and restructuring regime consists of two statutes, which are similar to restructurings in Chapter 11 and liquidations in Chapter 7 of the U.S. Bankruptcy Code.

The Companies' Creditors Arrangement Act offers legislative framework for an insolvent company to restructure,with guidance from the courts, typically through an appointed monitor an independent third party who oversees operations and reports back to the court. The act only applies to large capital companieswho owe their creditors more than $5 million. While under CCAA, the creditors are prevented from taking any legal action to collect their owed money, while the insolvent company navigates the next steps for its business, whichcould include a compromise on debts to be voted on by the creditors. Insome instances, theinsolvent companynever files a plan to reorganize, but rather sells off parts, or the entirety, of its assets, sometimes through liquidation.

Filing under CCAA can offer a company a chance to avoid bankruptcy and pay creditors someofwhat's owed.

The framework of the Bankruptcy and Insolvency Actallows a company toeither liquidate assets and distribute the proceeds to creditors in a process overseen by the courts, or allow the insolvent business to avoid bankruptcy by reaching arrangements with its creditors that help reorganize the business.

Sources: Canada.ca, Pwc, Rumanek & Company

This report by The Canadian Press was first published May 14, 2020.

The Canadian Press

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Key Canadian bankruptcy laws and terms - Yahoo Canada Finance

Boeing Predicts an Airline Bankruptcy. Heres a Way to Calculate the Odds for Each. – Barron’s

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Boeing CEO Dave Calhoun said in an NBC interview on Tuesday that a U.S. airline bankruptcy is likely in 2020. It is a curious comment coming from an executive whose company sells to airlines, but Covid-19 has hit the industry particularly hard.

Looking ahead, Calhouns comment raises two questions for investors: which airline and is that bad for Boeing?

The answer to the second question is: not so much. Many airlines have gone bankrupt in the past and demand for air travelwhich fuels demand for Boeings (ticker: BA) planescontinued to grow year by year.

Covid-19, of course, is unprecedented, cratering demand for air travel like no other event in history. Air travel in the U.S. is down more than 90% year over year. Boeing expects demand to be back to roughly 50% of previous levels by year-end. That assumes the economy reopens and things start to get back to normal. Many Wall Street analysts think it will take years to get back to pre-virus demand.

Boeing shares are down on that expectation, falling about 60% year to date, worse than comparable drops of the Dow Jones Industrial Average and S&P 500. Shares of major U.S. airlines are down, on average, about 60% year to date, too. But if bankruptcy is in the offing, some airline shares might have further to fall.

There are financial instruments that help investors judge the odds of default for any company, namely the credit default swaps, or CDS, that helped catalyze the 2008-09 financial crisis. Buying a CDS literally swaps the risk of a bond default from one investor to another investor. The investor who takes the risk gets paid. The riskier the bond, the higher the price.

Examples among airlines are Southwest Airlines (LUV) and Delta Air Lines (DAL), which have the best balance sheets in the industry and appear to be in the best position to weather the downturn.

Credit default swaps of Southwest and Delta are trading at spread of about 4.7% and 12%, respectively. That means that bondholders wanting to swap the risk of default have to pay $4.70 and $12, respectively, for each $100 of bonds they want to protect.

Those prices are much higher than normal. Protecting Apple (AAPL) bonds, for instance, costs about 30 cents per $100, according to Bloomberg CDS pricing quotes.

American Airlines (AAL) CDS are trading at spreads of 54%. United Airlines (UAL) CDS trade for 24%. JetBlue Airways (JBLU) CDS trade for 1.6%. Investors appear to be most nervous about Americans ability to repay. Thus, its bonds are the costliest to insure.

There is, of course, no guarantee that Calhouns prediction will come true. The federal government is offering support to the airlines, including American, much like the support offered to banks in 2008-09. That is one way airlines might avoid bankruptcy. But the government will take some form of equity in the airlines receiving money, diluting the value of existing shareholder stakes.

Warren Buffett recently made headlines when he said his Berkshire Hathaway (BRK.A) sold all the airline stocks it held. He explained at the companys annual meeting that it wasnt anything that the airlines had done strategically. He makes a good point. No one saw the virus coming, nor its devastating impact on air travel.

Boeing stock fell 2.9% Tuesday afternoon. Shares of large U.S. airlines fell between 3% and 6%.

Write to Al Root at allen.root@dowjones.com

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Boeing Predicts an Airline Bankruptcy. Heres a Way to Calculate the Odds for Each. - Barron's

Oil And Gas Companies Have Begun Filing For Bankruptcy. Heres Why More Could Be On The Way. – Houston Public Media

A pumpjack sits idle at sunset in Falls City, Texas, Thursday, April 23, 2020. The oil industry continues to suffer due to the ongoing COVID-19 outbreak. (AP Photo/Eric Gay)

Houston oil and gas companies are reporting billions in losses for the first quarter of 2020, and the next few months are not looking much better. As Texas oil continues to hover around $20-25 per barrel, companies are slashing budgets and cutting workers.

Houston-based Diamond Offshore Drilling has already filed for Chapter 11 bankruptcy amid the conoronavirus pandemic. And experts who watch the industry say more bankruptcies are on the way.

Charlie Beckham specializes in oil and gas bankruptcies at Haynes and Boone in Houston. He spoke with energy reporter Kyra Buckley about why companies are vulnerable during the oil price crash.

You can listen to the interview above. Here are some highlights, edited for length and clarity:

What are some of the things oil companies do to prevent being in the position to go bankrupt?

One way is to have no debt. Unfortunately for all of the companies that are in the industry, except for a very few, they all have some amount of debt for their continuing operations. Its a common aspect of the industry that an exploration and production company borrows money. I think many, many of the oil companies here in Houston and across the country have been caught with a decrease in the price for the oil that they sell compared to the amount of debt theyre carrying on their books.

The oil and gas industry was still recovering from the 2015 price crash. Does that mean some companies may be in more vulnerable situations?

The challenge for so many companies that were able to survive the downturn in the 2015 to 2017 era is that they didnt eliminate all of the debt on their books. They kept what many consider to be a manageable amount of debt for purposes of operations. That was all premised on a belief that by 2019, 2020, commodity prices would return to a manageable level.

Some have said companies are in this situation also because of so-called cheap debt. Can you explain what they mean by that?

Where you saw a lot of the interest in the oil and gas industry over the last 10 years was from investors who flooded money into the only gas industry generally on a junior basis meaning they loaned money to oil and gas companies at generally low interest rates with an expectation that there was such tremendous cash flow in the oil and gas industry that it would be easy for companies to repay those loans on a timely basis. That simply has not happened.

Instead, youve had what weve seen the last month of oil going negative, which was an anomaly. But still oil is low today, in the $20s, and its simply not high enough to repay the billions of dollars of debt that was invested in the industry over the last decade.

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Oil And Gas Companies Have Begun Filing For Bankruptcy. Heres Why More Could Be On The Way. - Houston Public Media

Red-and-white flags line KC neighborhood to honor health care workers – KSHB

KANSAS CITY, Mo. Dean Cox knows most of the people in his Kansas City neighborhood. He knows not only their names and what they do, but how their days are and if something seems wrong.

We just look out for each other, he said.

Its a community-first mindset that has become even more apparent during the recent coronavirus pandemic, quite literally.

Every single home on his street has either a red or a white flag hanging up.

How could you pass the opportunity up? People stop by all the time and ask us what its about, so its fun to tell them, Jessica Burton, who lives across the street, said.

The idea came about when Cox and his neighbor, Matthew Bertalott, were discussing ways to show their support for health care workers. Their homes are located a couple streets away from the University of Kansas Hospital.

He wanted to do red-and-white lights, and I thought that might just be a little much for people to drag out their Christmas lights, Cox said.

Instead, Cox ordered 26 flags 13 Red Cross flags and 13 Switzerland flags. The idea was to alternate the two flags at every home on the block.

I looked out the window one day and there was a flag in my yard and I thought, How odd,'" neighbor Cyndie Majher said. "I looked down the street and there were flags in everybodys yard. Again I thought, How odd,' and then I thought to myself, I bet Dean had something to do with this.'"

Before Cox passed out the flags to his neighbors, his nephew was in a bad car accident. Eight days later, he died at the hospital.

Watching the nurses and doctors work tirelessly, hours and hours on end, and not being able to visit him, we realized what it really meant, he said.

People who have driven through the neighborhood have pulled over and asked what the flags represent.

Some, according to neighbors, said they even plan on buying flags for their street.

It just speaks that we are willing to come together for something thats really important as well as recognizing the doctors and nurses, Cox said.

During the pandemic, 41 Action News wants to spotlight people, organizations and companies helping the community. To share these stories, use #WeSeeYouKSHB on social media.

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Workers and COVID-19: Access to healthcare, now ‘a matter of life and death’ – UN News

The report onSocial protection responses to the COVID-19 pandemic in developing countries,describes social protection as an indispensable mechanism for delivering support to individuals during the crisis. It looks at response measures introduced in some countries, such as the removal of financial barriers to quality health care, and protecting incomes and jobs, among other interventions.

The ability to access affordable, quality, healthcare has become a matter of life and death, the UN labour agency brief says.

It cautions policy makers against a singular focus on COVID-19, which could reduce the ability of health systems to respond to other conditions that kill people daily. According to its data, 55 per cent of the worlds population 4 billion people lack social insurance or social assistance. Only 20 per cent of unemployed people are covered by unemployment benefits.

The second brief -Sickness benefits during sick leave and quarantine: Country responses and policy considerations in the context of COVID-19 warns that gaps in sickness benefit coverage, results in anxious workers being forced to go to work when they are ill, or should self-quarantine, increasing the risk of infecting others. The related income loss increases the risk of poverty for workers and their families.

It calls for urgent, short-term measures to close the coverage gaps which, in turn, would bring about support for public health, poverty prevention and promotion of the human rights to health and social security.

It proposes extending sickness benefit coverage to everyone, as well as increasing benefit levels to ensure they provide income security, speeding benefit delivery and expanding the scope of benefits to include prevention, diagnosis and treatment.

The COVID-19 crisis is a wake-up call, said Shahra Razavi, Director of the ILO Social Protection Department. It has shown that a lack of social protection not only affects the poor but also exposes the vulnerability of those who have been getting by relatively well, she said, as medical charges and income loss, can easily destroy decades of family savings.

Putting robust social protection systems in place can be a huge challenge, says ILO development economist Jayati Ghosh.

While the need for social protection has never been more evident, these large demands on public fiscal resources come just as most developing countries are facing rapid declines in export and tourism revenues, and capital outflows.

While most developed countries are instituting large fiscal stimulus packages, this is much more difficult for developing countries. Their estimated financing needs are around $2.5 trillion, she says, while the immediately required increase in health spending, is projected to reach between $160 billion and $500 billion.

One way to achieve this goal is through a large new issue of Special Drawing Rights by the International Monetary Fund - reserve assets created to supplement countries official foreign exchange reserves.

She also says a halt to all debt repayments (both principal and interest) would be required for one year or until debt restructuring packages are worked out. This is essential because as much as $1.6 trillion of developing country external debt is due to be repaid in 2020, with a further $1.1 trillion due in 2021.

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Workers and COVID-19: Access to healthcare, now 'a matter of life and death' - UN News

Camp Evergreen offers free childcare to first responders and health care workers – KPTV.com

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Camp Evergreen offers free childcare to first responders and health care workers - KPTV.com

Predicting The Impact Of Coronavirus: How Healthcare Organizations Forecast Demand, ICU Capacity, And A Second Wave – Forbes

Even before the COVID-19 pandemic hit, healthcare systems were starting to leverage the power of predictive analytics to better anticipate and administer care. When the novel coronavirus began to spread across the globe there was increased pressure to understand and predict the surge and its impact on individual care facilities by not only healthcare administrators but also public health officials and government entities charged with making decisions about stay-at-home orders.

Predicting The Impact Of Coronavirus: How Healthcare Organizations Forecast Demand, ICU Capacity, ... [+] And A Second Wave

Due to the rapid rate of spread, the goal was to control the outbreak so that the number of patients requiring intensive care beds and support wouldnt exceed capacity.

Here, you can watch a video interview with Nina Monkton, chief insight officer, on how they are using analytics in the UK National Health Service:

I recently spoke with the Orlando Agrippa, CEO of Draper & Dash, a London-based healthcare AI and machine learning predictive data and analytics company, about how his firm supported healthcare systems and patients before and throughout the crisis and plans to do so into the future.

"Our normal day job pre-COVID was to work with hospitals and help to predict how long patients would be in the bed and, more importantly, how to get them discharged effectively. As we saw the emergence of the virus, we considered how to flip this technology on its head to help hospitals see into the future, plan ahead, and the impact that the virus would have on beds and very limited ICU/high-intensity beds. What does our capacity look like not only in volume but in complexity?" Agrippa explained.

Hospitals Leverage Data and Technology

Globally, hospitals operate similarly, and many hospitals leverage data and technology that drives the data to work out the potential impact of COVID but also to help better operate under normal times when not under the strain of a pandemic. The goal of predictive analytics is to use data from events in the past to predict what would likely occur in the future based on patterns identified by data analysis.

Agrippa's team used data that was available from countries who experienced COVID-19 earlier, such as Singapore, to inform the machine-learning models used to help predict the impact on healthcare systems that were preparing for it to hit.

In reality, data and the analysis of it allow decision-makers in healthcare and government to be one step ahead of events to make better-informed decisions about clinical, financial, administrative, customer service, and even data security issues, among other business functions.

Draper & Dash's focus during COVID was to use a mix of structured and unstructured data to inform decisions at the hospital and system level. They fed the models data that was deemed reliable either because of its source or it passed the firm's data confidence tests. They juxtaposed real-time data with a hospital's historical data that included specific information about that hospital's population, screening programs, the population's underlying conditions, and even how splits in the economic category in that population have impacted healthcare outcomes in the past. Then machine learning algorithms would get to work to produce predictive models that would inform decision-making around the issues faced with COVID-19.

Forecasting Demand, ICU Capacity, and a Second Wave

The novel coronavirus is quite complex and has a spread rate almost double of the normal flu. In addition, there are asymptomatic carriers, lack of testing kits, and many months before a vaccine or cure will be developed, all with the potential to overwhelm our healthcare systems. While there are tremendous challenges, today, we have the power of data and technology such as machine learning on our side, unlike previous pandemics such as the Spanish Flu of 1918.

Personal electronic devices such as smartwatches, smartphones, fitness trackers, and the like provide data professionals with an unprecedented amount of data that can provide valuable contact tracing for countries using it to monitor the contagion of the disease. This data can be extremely beneficial in trying to contain the spread of the disease.

By looking at the historical contagion of COVID-19 since it first was identified in Wuhan, China, and impacted populations first hit, the information is extremely beneficial in understanding how it might impact other populations and how fast. This knowledge helps healthcare systems forecast the demands on their resources.

The patient journey through the hospital and analysis of the flow of patients through various stages of the disease can help determine if there are enough ICU beds and ventilators to accommodate the predicted need.

As Agrippa explained to me, This pandemic has demonstrated the problems that people are struggling with are the same things. It gives us a great opportunity to learn quickly. The more data that has been accumulated as COVID-19 traveled around the globe, the better machine learning algorithms can use that information to understand how the virus operates and to create more accurate models.

Health experts agree that in the fall, we will have not only COVID-19 to battle, but it will become exacerbated by seasonal influenza, causing an incredible strain on our healthcare systems. At that point, we will have more data available to continue learning and to enable algorithms to arm healthcare and public official decision-makers with the best intel to make decisions.

The Future of AI, Data, Healthcare

Even before COVID, there was a real issue around the lack of a clinical workforce to accommodate the demand for care globally. COVID just compounded that issue. The stark reality is that we aren't able to "grow" doctors fast enough to meet the needs. Agrippa said the future of technology, AI, and data in the healthcare system would be an acceleration of creating clinical decision support tools. Using technology, and also the learnings from COVID, to help clinical teams profile patients with the highest risk, optimize pathways and discharge patients faster will be the goal.

You can watch the full interview with Orlando Agrippa here:

Read more about key technology trends in my new book,Tech Trends in Practice: The 25 Technologies That Are Driving The 4th Industrial Revolution.

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Predicting The Impact Of Coronavirus: How Healthcare Organizations Forecast Demand, ICU Capacity, And A Second Wave - Forbes

Coronaviruss lingering impact on US economy and health care, explained – Vox.com

The US health system is enduring a shock during the coronavirus pandemic and the aftershocks will continue to be felt long after the virus itself has been contained.

Hospitals nationwide have canceled elective surgeries en masse. Visits to primary care doctors and specialists have dropped off precipitously. Now the US economy is experiencing levels of unemployment not seen since the Great Depression and millions of people have lost their employer-sponsored health insurance.

I posed a simple question to a few different experts who study population health: Have we ever seen disruption to medical care like this before?

I dont recall there ever being a disruption to the health system like were seeing, Cheryl Damberg, the director of the RAND Center of Excellence on Health System Performance, told me. Weve had recessions where people have lost insurance and there is more uncompensated care, but nothing like canceling surgeries and declines in ambulatory visits.

Others concurred. I do not believe there has ever been a similar hiatus, Mark Cullen, director of Stanford Universitys Center for Population Health Science, told me, and the short answer is that yes, it will take some time before we will know the total health impact, or even to effectively estimate some

It is, unfortunately, an unplanned natural experiment. Rifat Atun, a professor studying global health systems at Harvard University, gave me a useful way of understanding the sprawling effects that a major trauma like the coronavirus pandemic will likely have on Americans health. You can put them, for starters, into four broad categories.

1.3 million cases. Nearly 80,000 people dead (at a minimum). Tens of thousands of people hospitalized we arent even sure how many. At least 86,000, according to a tracking project at the University of Minnesota.

It may be easy to become numb to them, but those numbers we have been tracking for weeks are the first and most direct impact of the coronavirus. We should also be bracing ourselves for second, third, fourth waves of the outbreak. The virus itself wont be fully neutralized until there is a vaccine or treatment.

And those acute effects could, somewhat paradoxically, linger with us for a long time. Just because people have recovered from Covid-19 doesnt mean their health has gone back to normal.

As Lois Parshley wrote for Vox recently, the long-term health consequences of this disease are just starting to come into focus:

Because Covid-19 is a new disease, there are no studies about its long-term trajectory for those with more severe symptoms; even the earliest patients to recover in China were only infected a few months ago. But doctors say the novel coronavirus can attach to human cells in many parts of the body and penetrate many major organs, including the heart, kidneys, brain, and even blood vessels.

The difficulty is sorting out long-term consequences, says Joseph Brennan, a cardiologist at the Yale School of Medicine. While some patients may fully recover, he and other experts worry others will suffer long-term damage, including lung scarring, heart damage, and neurological and mental health effects.

Parshley ticks through some of the potential long-term complications: lung scarring, strokes, embolisms, blood clotting, heart damage, mental health, and more. The point is, people will be living with this disease and the damage it did to their body for years and so will our health system.

All those canceled surgeries, delayed doctor appointments, and the rest will also have a lasting effect on peoples health.

One of the key concerns that practitioners in particular are having is related to the backlog that is piling up, Ellen Nolte, professor of health services and systems research at the London School of Hygiene and Tropical Medicine, told me, and the impacts this will have on medium- and long-term outcomes, in particular for people with chronic conditions.

As I reported recently, visits to primary care doctors and other outpatient specialists have fallen off steeply during the Covid-19 pandemic. Here it is, in one chart:

Ateev Mehrotra, a professor at Harvard Medical School who led the study above, told me our real concern is those patients who might have deferred a visit and theyre going to have a flare-up of their chronic illness. In the worst-case scenario, a patient could die because they werent able to have a routine check-up.

Dania Palanker, an assistant research professor for the Center on Health Insurance Reforms at Georgetowns Health Policy Institute, said she worries about people recently diagnosed with diabetes or heart disease who wont be able to get that critical first appointment with a new doctor. You cant delay those appointments for a few months.

And if people do delay care whether because their surgery was canceled, their doctors office was closed, or they chose on their own to skip treatment to avoid potential exposure to Covid-19 their health outcomes are probably going to be worse.

There is also a risk that the decline weve seen in medical utilization will lead rural hospitals to close or primary care practices to consolidate, which in turn restricts access and drives up costs. That is another factor that could lead to less timely medical care for Americans in the future, which would in turn lead to more adverse health outcomes.

And there is one other obvious thing could lead to people postponing medical care: a loss of income and/or health insurance.

More staggering numbers: 33 million people have filed for unemployment benefits since the pandemic took hold and the unemployment rate is nearly 15 percent. Experts project that as many as 7 million people will be left uninsured as a result of the economic crisis precipitated by Covid-19.

Economic downturns can have countervailing effects on peoples health. We know that losses in income and health insurance can have a negative impact. Atun has actually studied this question himself, looking specifically at cancer-related mortality. He and a team of researchers found that in the 2008-2010 recession, there were an estimated 260,000 excess cancer-related deaths in that time, including 40,000 from treatable cancers, in OECD countries.

Those consequences were felt most in countries without universal health coverage of which, of course, the United States is one. And now millions of Americans have lost the health insurance they did have.

On the other hand, there is some research suggesting that overall mortality actually falls during economic downturns. But the reasons are not well understood and, for people who actually experience joblessness or other financial trouble, there still appears to be higher rates of acute heart problems and overall mortality, according to a 2011 summary of the available research.

Excess mortality is a complicated soup of many different variables, some of which hurt health and some of which may help it (if, for example, people smoke less and exercise more during a recession). This is one of the reasons why it will take us so long to understand the full impact of Covid-19.

But I think the negative effects far outweigh what these positive effects might be, Atun told me.

If there is one place where the research on economic turbulence and health outcomes converges, its that behavioral and psychological well-being is harmed during an economic crisis.

This is perhaps the most speculative category, so I will keep it short. But Atun pointed out that the various social distancing measures weve taken to clamp down on Covid-19 will have an effect on our collective mental health, as will the economic crisis and the simple, painful reality of 100,000 or more people dying of the virus in just a few short months. There is a medical toll to all that mental pain, though it will again take a long time to reveal itself.

And that is the point. It will take years for the full impact of the coronavirus to be understood.

The effects will be longer-lasting than the immediate figures that we see, Atun said. Or as Cullen put it: Bottom line is this will be a beast to sort out.

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Racetrack owner thanks Douglas County health care workers with gift baskets – FOX 31 Denver

PARKER, Colo. (KDVR) Hospital workers in Douglas County got a much needed break from the stress of their jobs Thursday.

It was dubbed Operation Rolling Thunder and they made quite an entrance Parker Adventist Hospital, escorted by Douglas County sheriffs deputies, Parker police and Castle Rock police.

Jim Mundle owns Overdrive Raceway in Colorado Springs. He told the health care workers, We want to know how much you all are appreciated.

He visited four Douglas County hospitals, with his race cars as well as gift baskets with goodies donated from the community.

Mundle said, I think its really important right now to look at the frontline workers working every day and believe me, its a tough job. They like to see the cars, they like the baskets. They like to be appreciated and we really have a lot to be appreciative for. We need to go out of our way to thank them.

Doctors, nurses and staff had a chance to sit in the Lamborghini and take pictures. But more importantly, they got to just take a break.

I think it just gives them a diversion and a chance to think about something other things, maybe a more normal life than we have faced for several weeks now and taking care of very sick patients. Parker Adventist Hospital CEO Mike Goebel said, adding, To put a smile on their face and give them a quick break from this is what we wanted to try to do, and I think weve succeeded there.

Mundle plans to reopen Overdrive Raceway in Colorado Springs on Friday. He says it will provide some much-needed fun and entertainment.

I think its essential to be able to get peoples minds in the right place and it makes very good therapy to have adrenaline and competition and fun and see people laugh, he said.

Mundle says he will follow all the guidelines and make it as safe as possible, because he doesnt want to make health care workers jobs any harder.

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Racetrack owner thanks Douglas County health care workers with gift baskets - FOX 31 Denver

SD Air Guard to fly F-16s over Mitchell, honoring health care workers efforts – The Daily Republic

Local health care workers who have been on the front lines of the COVID-19 battle will receive an honor from the sky on Saturday, as F-16 fighter jets will fly over Mitchell.

The F-16 fighting falcons are expected to soar over the Mitchell community at 2:20 p.m. and move out by 2:30 p.m.

Mitchell is one of nine eastern South Dakota cities that the South Dakota Air National Guard will be flying their aircrafts over on Saturday to recognize the brave efforts of the health care workers who have been providing critical care for those infected with the novel coronavirus. The stealthy jets are a part of the 114th Fighter Wing, a unit of the South Dakota Air National Guard, stationed out of Sioux Falls.

This Armed Forces Day, we would like to salute our fellow Americans working hard to keep South Dakotans safe, said Col. Mark Morrell, 114th Fighter Wing commander. They have demonstrated true commitment and selfless service, and this is our way of saying thank you.

Its only fitting the pilots will fly the F-16s over Avera Queen of Peace hospital, the local health care facility that has treated several COVID-19 infected patients since the virus first spread into Davison County in early March, making it one of the first counties in the state to see a positive case of the virus. The first fatality caused by the virus also occurred at Avera Queen of Peace hospital, after a Pennington County man in his 60s was admitted to the hospital in early March and died March 9. As of Wednesday afternoon, Davison County had a total of eight confirmed cases, two of which are active, according to the South Dakota Department of Health.

Community members are invited and encouraged to join the health care staff in watching the fly over outside. The S.D. Air National Guard is recommending viewers to maintain social distancing and adequate physical separation.

Joining Mitchell in the flyover are Brookings, Watertown, Aberdeen, Pierre, Huron, Yankton, Vermillion and Sioux Falls. The pilots first flyover will take place at 1:10 p.m. in Brookings and conclude 3 p.m. in Sioux Falls.

Similar flyovers have been taking place across the country in recognition of the health care workers efforts amid the pandemic. Throughout the COVID-19 outbreak, the 114th Fighter Wing has maintained its readiness for missions, while supporting overseas operations and defending U.S. airspace.

We hope everyone can share in this moment of gratitude, and remember that we are all in this together, Col. Morrell said in a press release.

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SD Air Guard to fly F-16s over Mitchell, honoring health care workers efforts - The Daily Republic

What is single-payer health care? – Fox Business

Allianz Chief Economic Adviser Mohamed El-Erian projects what economic recovery will look like and how to invest amid coronavirus markets.

Get all the latest news on coronavirus and more delivered daily to your inbox.Sign up here.

The coronavirus pandemic has pushed support for Medicare-for-all to the highest level in months as the outbreak triggers unprecedented health and economic crises.

The universal health care bill championed by Vermont Sen. Bernie Sanders, a two-time Democratic presidential candidate, would essentiallyestablish a single-payer health program in the U.S.

NUMBER OF UNINSURED AMERICANS RISES FOR FIRST TIME IN A DECADE

In a single-payer health system, there are no competing health insurance companies. Instead, there's a single public or quasi-public agencythat providesresidents with health care coverage. Under the one health insurance plan, residents would have access to all necessary services, including doctors, hospitals, long-term care, prescription drugs, dentists and vision care.

Individuals may still choose where they receive care -- similar to Medicare in the U.S.

Proponents of a single-pay system argue that it would address several problems in the U.S., one of the most expensive health care systems in the developed world, like extending coverage to all Americans.

WHICH COUNTRIES HAVE UNIVERSAL HEALTH CARE?

The system may also incentivize the government to put more health-care spending toward public health measures, such as implementing childhood obesity prevention programs in schools.

Critics of the system, however, argue that it creates lengthy wait times and can be restrictive of certain services, such as cosmetic procedures or elective surgeries.

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What is single-payer health care? - Fox Business

How hospitals make tough ethical calls about which lives to save during a pandemic – CNN

"I have spent my life trying to live big and make a difference," Stephens said. "I believe my life is my message: A life with Down syndrome is a life worth living."

The 38-year-old has spent much of the last six weeks quarantined with his parents, watching movies and focusing on "home fun," he said. "My family and I are being very careful."

Stephens hasn't traveled more than two miles from his home in Fairfax, Virginia, since the beginning of the pandemic. He's immune compromised and isn't taking any chances.

He's worried about recent news around triage guidelines for those with disabilities should health care resources become scarce.

"I have heard that some hospitals have plans that would put me at the back of the line," he said.

Not all triage guidelines are created equal

In medical systems around the world overwhelmed by Covid-19, where overburdened hospitals have to choose who lives and who dies, disability advocates worry their lives won't count.

Contemplating the actual value of a life during a pandemic may be abhorrent to some people, but hospitals with more patients than ventilators have to identify which patients get priority.

One system for patient prioritization was developed by Dr. Douglas White, a professor of critical care medicine at the University of Pittsburgh.

"These are inevitably tragic choices with only bad options," White said. "But the only thing worse than developing a clear allocation framework is not developing one, because then decisions made during a crisis will be biased and arbitrary."

When looking at the number of life years a patient may have left, White's point system de-prioritizes patients with medical conditions associated with a life expectancy of less than one year, and then two to five years.

White's triage guidelines don't take into account an individual's disability status: Blindness or handicaps don't have a direct bearing on an individual's expected lifespan.

But in some cases, states use other criteria to determine whether patients might lose access to life-saving health care, including ventilators.

Disability advocates are staying vigilant

Advocacy groups have filed lawsuits against states they say have discriminatory guidelines.

Global Down Syndrome Foundation is part of a coalition of disability-related organizations monitoring state guidelines that could "blatantly discriminate" against certain disability groups, said Michelle Sie Whitten, Global's co-founder and CEO.

During the first wave of coronavirus infections, Whitten acknowledged it's been rare for the emergency triage guidelines to be used in real-life situations. But she said it was important to address any discriminatory procedures now, particularly if a predicted second wave of infections later this year decimates hospital resources again.

That's why The Arc and the Center for Public Representation have filed complaints against a number of states to the US Department of Health and Human Services' Office for Civil Rights.

Whitten said she wasn't surprised that bias was cropping up in these life-or-death situations.

Since time immemorial, disability rights has gotten "buried in times of relative prosperity," she said. But during the pandemic, the contrast between the able-bodied and disability community is in stark relief.

Some in the disability community fear discrimination

"All of these traits are grounded in biases and assumptions of what is 'good' and 'valuable,' leaving people who don't fit as deviant, unworthy and 'lazy,'" she continued.

Wong uses a wheelchair, receives breathing help from a ventilator and has two full-time family members who serve as her caregivers.

She said her needs don't stop her from pursuing a vivid and fulfilled life of purpose, and she sees her own situation as an opportunity to advocate for others facing similar challenges.

Policies that devalue the worth of those with disabilities also devalue the diversity of lived human experiences that can constitute a life well lived, she said.

Thinking of those with disabilities as a drain on health care resources "objectifies disabled people as mere 'consumers' of precious goods and services rather than whole beings who are valued and loved by their communities," Wong said.

She's keeping tabs on some of the public debate and legal battles about how the US prioritizes health resources for able-bodied people over people living with disabilities.

"It's scary how some guidelines make sweeping generalizations based on diagnosis," she said. "Each person with cancer, dementia or a developmental disability has unique needs and must be evaluated on an individual basis when it comes to treatment for Covid-19."

Bioethicists argue against separating patients by disability

Questions of rights and dignity emerge now as triage in hospitals and discrimination suits in courts. But at its root, the value of life is a question founded in thousands of years of philosophical debate.

"We have to do the most good that we can with the resources we have," said Chad Horne, an assistant professor of philosophy at Northwestern University.

In bioethics there are multiple broad ways of going about maximizing the good that health providers and society at large can achieve, he explained.

One way of accomplishing this is through a utilitarian framework, in which a hospital that tries to save the greatest number of patient lives and the highest number of patient life years, similar to White's "Model Hospital Policy."

While hospitals may prioritize ventilators or other resources to "the ones who are likely to recover," that doesn't mean that "your life isn't as worth living as someone without that impairment," Horne said.

Another way of thinking about it, he said, would be through a "prioritarian" framework, he said. From that point of view, rather than saving the greatest number of ultimate life years, providers could seek to prioritize their resources to where there's the greatest amount of need.

Based on those values assumptions, in a triage situation, ventilators would be prioritized for the elderly and the frail, rather than the young and the healthy.

Hospital guidelines are driven by a society's deeper values

In the fog of war against coronavirus, philosophers say our North Star is the innate value of each human life.

Though in crisis situations it's hard to make perfect outcomes, there were ways in which hospitals could help as many people as they could.

"We should never have to make these kinds of decisions between patients," he said. But he cautioned that it's wrong to think of this potential health rationing scenario as "death panels saying that Grandma has to die."

"I think in general we could defend the idea that prognosis matters," Bognar said. "So those patients get the treatment who will live the longest."

Outside of evaluating a patient's prognosis, he argued that it wouldn't be ethically permissible to extend the idea of prognosis any further than life or death.

For instance, the category comprised of individuals with disabilities might include those lacking eyesight or people using wheelchairs to get around. But in many cases, physical or intellectual differences don't have any bearing on life expectancy, and can't therefore be used to decide who would get a ventilator first in a hospital overrun with Covid-19 patients.

Beyond that, Bognar noted that bioethicists don't consider it valid to make determinations that a life lived in poverty or in suffering is any less worth saving than one lived in less trying circumstances. A human life is a human life.

"You don't want to make quality of life judgments about person X having a better life than person Y," he said.

That's been the message that Wong has been pushing for years through her work running the Disability Visibility Project, helping to amplify the voices of those with disabilities so that those human experiences aren't erased especially in periods of heightened risk like our present moment.

"No one should feel ashamed for needing help or feeling vulnerable. Weakness is not a moral deficit," Wong said. "Everyone is interdependent with one another, and we all have the power to support and care for each other."

CNN's Majlie de Puy Kamp, Curt Devine and Drew Griffin contributed to this story.

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How hospitals make tough ethical calls about which lives to save during a pandemic - CNN

St. Mary’s Healthcare receives proclamation from city of Amsterdam recognizing National Hospital Week – The Daily Gazette

AMSTERDAM St. Marys Healthcare has received a proclamation from the city of Amsterdam and Mayo Michael Cinquanti, recognizing the healthcare organizations work as part of National Hospital Week, which runs through Saturday.

The proclamation declares May 10-16 as Hospital Week at St. Marys Hospital in the City of Amsterdam and urges residents to express their appreciation for the dedicated people, facilities and technologies that make reliable health care possible in our community.

The proclamation states that the city is honored to join the many national Hospital Week partners in celebrating St. Mary's Healthcare and the men and women who are on the front lines working tirelessly to help others in their greatest time of need especially during this period when our city and country are in the throes of the COVID-19 pandemic.

A news release from St. Marys Healthcare states: As we all continue to do our part to fight against this COVID-19 challenge, the role of our healthcare workers is now more important than ever. The tremendous efforts on the front lines of this pandemic and their commitment to quality care and patient safety not just now, but year-round are critical to the mission of St. Marys Healthcare."

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St. Mary's Healthcare receives proclamation from city of Amsterdam recognizing National Hospital Week - The Daily Gazette

Nurses, lab workers, physicians among ‘alarming’ number of health-care workers with COVID-19 – CBC.ca

As the number of COVID-19 cases among health-care workers continues to rise in Ontario, clinicians say multiple factors could be fuelling thespike in various settings, from long-term care homes to laboratories with risks beyondjust patient care.

The latest provincial data shows 3,607positive cases confirmed among health-care workers, making up nearly 17 per centof all cases across Ontario. That's up from around 10 per cent of all cases in early April.

That rise is "alarming," said Dr. David Carr, a hospital emergency physician in Toronto.

"It's frightening to work in a place where there are outbreaks, and you look to your left and your right and you feel like everyone's doing the right thing."

While the publicly-available numbers from the Ministry of Health don't reveal a breakdown by profession, the latest available Public Health Ontario data provided to CBC News shows positive tests have been confirmed for:

With cases popping up in workers across the spectrum, Carr warned even the best efforts of front-line staff aren't enough to mitigate the spread of the new coronavirus among their peers within health-care settings.

In many hospital departments, he noted, shift-based workers are often arriving all at once, bringing large groups into tight quarters like change rooms and break rooms indoor areas where there's a clear risk of transmission.

"You have the majority of your staff showing up at the exact same time, putting their stuff in the fridge, getting changed, taking the elevator," Carr said.

"At hospitals, we're sitting in congregate areas, in close quarters. There's just no space."

While provincial data doesn't reveal where each individual worker acquired the virus, including any settings outside of health care, the numbers do show several hundred outbreaks directly within long-term care facilities and hospital units.

At least nine health-care workers have also died of COVID-19, including a nurse, two hospital cleaners, and six personal support workers.

One of those, 61-year-old Leonard Rodriquez, was a long-time personal support worker in Toronto. Hisfamily blames his death on a lack of personal protective equipment provided by his employer, which forced him to buy his own masks at a dollar store.

Similar concerns have been common among health-care workers and CBC News has previously reported on staff rationing equipment and re-using masks at variousfacilities.

And even highly-trained professionals can make potentially-dangerous errors while taking off their personal protective equipment, notedChristine Nielsen, CEO of theCanadian Society for Medical Laboratory Science,the national certifying body for medical laboratory technologists and medical laboratory assistants.

"You can't see a virus; it's not like blood," she said.

So what can be done to boost safety for workers on the front line of the COVID-19 crisis?

Ensuring infection control protocols are followed to protect not only patients, but the workers themselves, is crucial, Carr stressed, including encouraging proper hand washingand doffing of protective equipment, and maintaining distancefrom colleagues after their gear is off.

He added more health-care facilities and departments alsoneed to stagger shift start times as much as possible to ensure there is no influx ofstaff arriving at or congregating in health-care settings.

There'salso greater "peace of mind" for health-care professionals as provincial testing efforts are ramping up, according to Nielsen.

When asked by CBC News on Thursday about the rising number of infected health-care workers, and what additional efforts the province could make to test and protect them, Ontario's Chief Medical Officer of Health Dr. David Williams didn't divulge any specific plans.

The province has asked to have "further analysis undertaken in that regard ...to see if there's anything we can do to flatten that curve and keep it down as well," he said.

Nomatter how many precautions are taken, front-line staff working through this pandemic will always face some risks.

"They have the average exposure the public has then they go to a health-care facility," Nielsen said.

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Nurses, lab workers, physicians among 'alarming' number of health-care workers with COVID-19 - CBC.ca

Fans Think Kate Middleton Is Sending a Secret Message to Health Care Workers With Her Recent Outfits – Yahoo Lifestyle

Even though they're on lockdown like the rest of us, Kate Middleton and Prince William are still working as senior royals, making virtual appearances and doing Zoom interviews to talk about how their family is coping amid the coronavirus. They also made a rare TV appearance on April 23 to show their support for frontline health care workers. The work they're doing is important, but because it's 2020, fans are now zeroing in on the outfits Middleton has worn during these digital engagements. She's opted for bright colors for almost every interview, leaving some fans wondering if she's sending a message.

Don't worry: The message isn't anything bad. It's hopeful. You see, Brits have adopted the rainbow as a symbol of hope and happiness during this trying time. Civilians are even hanging up rainbow-colored photos outside their homes to cheer up passersby. And now some people think Middleton is doing the samevirtually, through her wardrobe. The popular @CambridgeMums Instagram account pointed out on May 12 that Middleton has essentially worn all the colors of the rainbow for her various online speaking engagements. Is this, as the account speculates, a message that Middleton's sending to health care workers and civilians? Something to lift their spirits, perhaps? It's possible.

"KATE HAS LITERALLY WORN A RAINBOW Our duchess of impact has quite literally used her lockdown wardrobe to send a message, and WE ARE HERE FOR IT " @CambridgeMums wrote in the caption of a grid photo showing Middleton's various looks. Check it out for yourself, below:

Coincidence or strategically planned fashion? We'll probably never know for sure, but Kate Middleton and Prince William are doing their part to send good vibes in other ways. Exhibit A: This delightful sound bite they gave BBC in an April interview about FaceTime and Prince Louis. "We've been talking to all the family online," Prince William said. "It's been a really good way of keeping in touch and seeing each other. For some reason, [Louis] sees the red button and always wants to press the red button."

Story continues

Keep the cute family anecdotes coming, Will and Kate. We need the joy.

Originally Appeared on Glamour

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Fans Think Kate Middleton Is Sending a Secret Message to Health Care Workers With Her Recent Outfits - Yahoo Lifestyle

Governor Cuomo Announces New York Has Issued First-in-the-Nation Criteria to Healthcare Professionals Defining COVID-Related Inflammatory Illness in…

Governor Cuomo Announces New York Has Issued First-in-the-Nation Criteria to Healthcare Professionals Defining COVID-Related Inflammatory Illness in Children | Governor Andrew M. Cuomo Skip to main content

Criteria Establishes New Name for Syndrome and Definition of What Symptoms Healthcare Providers Should Look For

State is Investigating 110 Reported Cases & 3 DeathsRelated to COVID Illness in Children with Symptoms Similar to an Atypical Kawasaki Disease and Toxic Shock-Like Syndrome

New York State is Leading a National Effort to Understand and Combat this New Syndrome

Governor Andrew M. Cuomo today announced New York has issued first-in-the-nationcriteriato healthcare professionals establishing an interim case definition for COVID-related inflammatory illness in children. The criteria establishes a new name for the syndrome - pediatric multi-system inflammatory syndrome - and a definition of what symptoms healthcare providers should look for. Case definitions also help standardize tracking and reporting and can help ensure a better health outcome.

The State is currently investigating 110 reported cases in New York where children - predominantly school-aged - are experiencing these symptoms possibly due to COVID-19. The illness has taken the lives of three young New Yorkers, including a 5-year old in New York City, a 7-year old in Westchester Countyand a teenager inSuffolk County.

"We're still learning a lot about this virus and we must remain vigilant because the situation is changing every day," Governor Cuomo said. "We now have 110 cases of COVID-related inflammatory illness in children and I expect this is only going to grow. We are leading the national effort to better understand and combat this new emerging syndrome, and we want to make sure everyone is informed and is looking out for the symptoms of this illness in children."

New Yorkers should seek immediate care if a child has:

Predominant Symptoms:

New York State is leading a national effort to understand and combat this illness related to COVID-19 in children. Governor Cuomo has directed hospitals statewide to prioritize COVID-19 testing for children displaying symptoms similar to an atypical Kawasaki disease and toxic shock-like syndrome. Today, the State Department of Health is hosting a statewide webinar tomorrow for all healthcare providers to discuss the symptoms, testing and care of reported inflammatory disease in children related to COVID-19.

The State Department of Health is also partnering with the NY Genome Center and Rockefeller University to conduct a genome and RNA sequencing study to better understand COVID-related illnesses in children and the possible genetic basis of this syndrome.

At the direction of Governor Cuomo, the State Department of Health has issued an advisory about this serious inflammatory disease, called "Pediatric Multi-System Inflammatory Syndrome Associated with COVID-19," to inform healthcare providers of the condition, as well as to provide guidance for testing and reporting. Health care providers, including hospitals, are required to report to the Department of Health all cases of pediatric multisystem inflammatory syndrome potentially associated with COVID-19 in those under 21 years of age.

Though most children who get COVID-19 experience only mild symptoms, in the United Kingdom, a possible link has also been reported between pediatric COVID-19 and serious inflammatory disease. The inflammatory syndrome has features which overlap with Kawasaki disease and toxic shock syndrome and may occur days to weeks after acute COVID-19 illness. It can include persistent fever, abdominal symptoms, rash, and even cardiovascular symptoms requiring intensive care.

Early recognition by pediatricians and referral to a specialist including to critical care is essential. Molecular and serological testing for COVID-19 in children exhibiting the above symptoms is recommended. The majority of patients have tested positive for COVID-19, some on molecular testing for SARS-COV-2, others on serological testing.

For more information, visit http://www.health.ny.gov.

The State of New York does not imply approval of the listed destinations, warrant the accuracy of any information set out in those destinations, or endorse any opinions expressed therein. External web sites operate at the direction of their respective owners who should be contacted directly with questions regarding the content of these sites.

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Governor Cuomo Announces New York Has Issued First-in-the-Nation Criteria to Healthcare Professionals Defining COVID-Related Inflammatory Illness in...

NVIDIA expands its Clara healthcare platform to help healthcare partners take on COVID-19 – Healthcare IT News

NVIDIA recently announced a major expansion of its Clara healthcare platform with new software and tools to help healthcare researchers, technology solutions providers and hospitals tackle the pandemic faster.

The first of this expansion is the availability of NVIDIA Clara Parabricks computational genomics software via a free, 90-day license to COVID-19 researchers. The software is capable of analyzing the whole human genome DNA sequence in under 20 minutes.

NVIDIA also introduced GPU-accelerated RNA-sequencing pipelines that return results in less than 2 hours, giving researchers critical insights into patient susceptibility to disease, its progression, and response to treatment.

HIMSS20 Digital

NVIDIA also released a set of AI models that can help researchers detect and study infected patients through chest CT scan data. Jointly developed by NVIDIAs applied research team and clinicians and data scientists at the National Institutes of Health (NIH) through a cooperative research and development agreement, the models used data from locations with high rates of COVID-19 infections, including China, Italy, Japan, and the United States.

The AI models were built using the NVIDIA Clara application framework for medical imaging. NVIDIA Clara contains domain-specific AI training and deployment workflow tools that allowed NVIDIA and NIH to develop the models in under three weeks.

Finally, the new NVIDIA Clara Guardian application framework enables a critically needed ecosystem of AI solutions for hospital public safety and patient monitoring by transforming everyday sensors into smart sensors. Critical use cases include automated body temperature screening, protective masks detection, safe social distancing, and remote patient monitoring.

THE LARGER TREND

In a HIMSS20 Digital presentation, leaders from Google Cloud, Nuance and the Health Data Analytics Institute agreed that AI and machine learning technologies are key to responding to the coronavirus pandemic, and how they can aid patients and providers.

Healthcare technology company Cerner and Amazon Web Services also teamed up to offer researchers fighting the COVID-19 pandemic access to de-identified patient data for them to build intelligent models, which could in theory anticipate patient outcomes or help improve predictive analytics, HealthCare IT News reported.

Last October, the University of California, San Francisco partnered with NVIDIA to develop new AI tools for radiology. The AI projects include brain tumor segmentation, liver segmentation and clinical deployment, leveraging NVIDIAs Clara healthcare toolkit and the tech giant's DGX-2 AI system.

ON THE RECORD

The COVID-19 pandemic has supercharged the collaboration of technology, research and the healthcare industry to develop new computing solutions that accelerate the understanding of the spread, scale and severity of this disease, said Kimberly Powell, Vice President of Healthcare atNVIDIA.

Never before has there been such a critical need to apply the best AI technology and accelerated computing to every facet of healthcare, and its effects will be felt widely beyond this pandemic and across healthcare going forward.

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NVIDIA expands its Clara healthcare platform to help healthcare partners take on COVID-19 - Healthcare IT News