New York schools get green light for in-person learning—raising myriad questions


New York state schools have the green light to reopen for in-person learning in September with social distancing and health screenings, Gov. Andrew Cuomo announced Friday—a decision that immediately raised more questions than it answered.

“If any state can do this, we can do this,” said Cuomo during a conference call with reporters. 

The decision comes as school districts across the U.S. grapple with competing pressures to bring students back in September without exacerbating the spread of the coronavirus. Cuomo’s decision paves the way for New York City—the nation’s biggest school district with more than 1.1 million students—to return to the classroom, even as school systems in Los Angeles, Chicago and Dallas plan to remain remote this fall. It’s on track to be the only one of the nation’s top 10 biggest school districts to reopen in-person learning this fall. 

Despite Cuomo’s green light for the state, nearly all of the details will be left up to New York’s 750 school districts, which have only three weeks to hone plans on exactly how students will return, and how schools will monitor the health and safety of pupils and teachers.

Coronavirus update: Global case tally climbs above 19 million; U.S. death toll moves above 160,000 after 11 straight days with 1,000-plus fatalities 

So far, districts are proposing everything from a mix of in-person and remote instruction, such as the hybrid model proposed in New York City, to sending children home before lunch to avoid a risky indoor-dining environment, Cuomo said on a conference call with reporters. 

“I can’t fashion a plan that would work in every school district; they are just too different,” he said. 

Theoretically, individual school districts could still opt to delay the start of in-person learning or go completely remote if they choose, particularly if they face enough pressure from parents and teachers. 

“It’s up to them,” Cuomo said. “In-person, hybrid, outdoor education, remote education, blended, half day, quarter day, third day — that is all up to their discretion.”

The state, through the health department, has set only a few hard rules, including a maximum positivity threshold of 5% — meaning the proportion of testing coming back positive — which would automatically trigger a region’s school buildings to close again. New York City has set a more conservative positivity threshold of 3% for the five boroughs. Schools must conduct health screenings, which at a minimum means daily temperature checks, said Jim Malatras, the president of Empire State College and an adviser to Mr. Cuomo, at the governor’s briefing. 

Districts must also devise a system for testing symptomatic students and staff, he added. 

Also on MarketWatch: Calculating America’s eviction crisis: Up to 40 million people are at risk of being kicked out of their homes

COVID testing is a major concern among parents, from whom the governor said he’s received a “deluge” of worried phone calls. To address that, he gave districts until the end of next week to finalize and post plans about how testing will be carried out, when a child must be tested and where it will be done.

Next week, districts must also publicly post specific plans for tracing outbreaks and explain their remote learning option, he added. 

“We’ve learned from the experiences we’ve had during COVID that remote learning can be quite unequal, given the demographics and given the circumstances,” Cuomo said, adding that he wants districts to draw attention to these three areas of concern so parents aren’t forced to go “wading” through lengthy reopening plans. 

The governor also gave districts until Aug. 21 to conduct three town halls with parents — five for big school districts like New York City — and one with teachers. The next few weeks promise parents, teachers and administrators a whirlwind of information, and certainly some disagreement, over reopening right on the cusp of the school year. 

Parents and teachers are feeling particularly unsure in New York City, once the national epicenter of the pandemic and where many lost colleagues or loved ones during the peak of the crisis. 

“It’s a cloud that hangs over our school,” said Paul Kehoe, who teaches humanities and science at M.S. 250 West Side Collaborative Middle School on Manhattan’s West End Avenue. Students at the school have lost family members, and a fellow teacher was suspected to have died from COVID-19. 

Kehoe, 39, disagrees with New York City’s hybrid-learning plan. He would prefer to see schools continue an improved version of all-remote learning as the safest and least disruptive option for students. The logistics of students coming to school on a rotating schedule, potentially spending the other days at one of the city’s proposed learning centers, all the while taking a bus or public transportation to and from school, creates numerous opportunities for exposure and spread. 

“No matter how much they pretend to have some barriers around, it’s just artifice. It’s just placating people’s concerns,” he said. 

Michael Mulgrew, president of the United Federation of Teachers, which represents most public school teachers in the five boroughs, on Friday applauded the state’s effort to ensure teachers and parents were confident in reopening plans. 

Though, he said, “in New York City, that is still an open question.”

Also see: NYC’s urban oases reopen, providing a much-needed escape for shut-in residents

New York City asked parents to decide whether they would opt for all-remote learning by Friday, even though many of the schools have yet to communicate specific details about the school year to parents. Mayor Bill de Blasio said he would offer more districtwide information on Monday and that school- and child-specific information would arrive “in the course of the next couple of weeks.”

Meanwhile, the state health department is still missing reopening plans from 127 school districts, and has already deemed at least 50 plans incomplete or insufficient. 

Without approved plans, however, Cuomo said: “School districts cannot open.”



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After COVID-19, what is the future of health care for older Americans?


Once the coronavirus pandemic fades — whenever that happens — two health trends for America’s older adults seem nearly unquestionable. Medical appointments through telehealth will be common, especially for those on Medicare. And the need for geriatricians will be great.

Since people over 65 have accounted for roughly 80% of the COVID-19 deaths in the U.S, according to the Centers for Disease Control and Prevention, the older adult population has been at the heart of the pandemic.

Here’s what experts forecast regarding telehealth and physicians specializing in geriatrics post-pandemic:

Telehealth

In 2019, only 11% of U.S. consumers used telehealth — medical appointments via video or telephone — according to McKinsey &  Company Health Care Systems and Services. But in recent months, McKinsey says, 46% have.

Partly, the growth in telehealth has come because so many Americans haven’t been allowed into their doctors’ offices. Partly, doctors have come to embrace these types of appointments. But a key factor has been Medicare rule changes covering telehealth for people 65 and older in important ways.

Related: Where will America’s oldest people live after COVID-19?

During the pandemic, Medicare beneficiaries can receive telehealth in any location, including their homes. Before that, they had to either live in a rural area or go to a clinic, hospital or certain other types of medical facilities.

See: 5 things you probably didn’t know about Medicare

And throughout the coronavirus outbreak, Medicare can pay physicians the same rate as for in-person visits.

Pre-COVID-19, telehealth through Medicare also required interactive audio and video between the practitioner and the patient; now, audio alone is allowed.

Medicare has recently more than doubled the number of services beneficiaries can receive through telehealth — adding 135, including physical, occupational and speech therapy services.

The result of all this? Before the pandemic, about 13,000 people in fee-for-service Medicare received telehealth in a week. These days, roughly 1.7 million do. Over 9 million Medicare beneficiaries have received a telehealth service during the pandemic.

Private Medicare Advantage plans can now offer the latest telehealth technology as part of their basic benefit, too. Now, more than half of those plans do, for up to 13.7 million enrollees.

Said Seema Verma, administrator for the federal Centers for Medicare and Medicaid Services, in a July 15, 2020 Health Affairs blog about Medicare’s telehealth expansion: “It’s hard to imagine merely reverting to the way things were before.”

Rep. Kevin Brady, the lead Republican on the House Ways and Means Committee, is currently drafting legislation to make permanent Medicare’s telehealth changes created in the pandemic.

Penny Shaffer, South Florida market president of Florida Blue, the state’s oldest and largest health insurer, says the increase in telehealth for older adults has been the biggest health care impact of COVID-19 for them.

“There’s a lot to say for the convenience of interacting with a provider from the comfort of your home: it’s safer in many ways, given no travel or transport is required, and there’s no interaction with other patients in waiting rooms,” she notes.

But, as Judith Graham of Kaiser Health News recently wrote, not all Americans have access to technology or can afford tech devices. Some have health issues (like dementia, hearing loss and impaired vision) preventing them from using telehealth. And some need translation services.

Read: How to get the most out of a telehealth appointment: 9 tips

Mario Schlosser, CEO of the tech-focused health insurer Oscar, noted that the total number of health visits by his policyholders during the pandemic has dropped in half.

Shaffer, of Florida Blue, acknowledges that while telehealth isn’t the right method for every condition, patient or situation, “there are a number of encounters that can be satisfied with a telehealth visit.”

Florida Blue, like other health insurers, envisions even greater use of technology and virtual visits in the future to monitor patients with chronic conditions and as a postsurgical tool, to reduce the risk of infection.

That prediction was echoed by Catherine McCallum, a clinical social worker and aging care management consultant who runs Coral Life Strategies in Bethesda, Md.

Also see: Why older Americans are more likely to be harmed by medical care

McCallum also likes telehealth patients’ ability to schedule appointments quickly, rather than having to wait too long for an appointment. “But,” she adds, “not all medical practices set up their own secure line; some rely on Zoom
ZM,
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or another platform, which has shown to be less secure.”

McCallum says there can be other difficulties and limitations relying on video health visits, especially for counseling patients, too.

“Right now, when we speak with patients using applications like Zoom, especially older adults, we have to get very specific about what they need to do and how to interact with the computer or smartphone,” she says. “And we have to remind them to turn off other devices.”

However, McCallum is confident that older patients will increasingly become more comfortable with the technology — and that it will become more available and user friendly.

As an insurer, the long-term financing of telehealth is very much a concern for Shaffer. She fears that post-COVID-19, Medicare reimbursement rates will return to paying doctors less for telehealth visits than in-person ones.

Schlosser, of Oscar Health, feels that identical reimbursement rates for virtual and in-person visits will be unsustainable, but acknowledges that health providers will want to ensure they’re compensated adequately for virtual visits.

He also believes that once the pandemic crisis passes, people who pay for their own health care are likely to raise more questions about why doctors are charging the same for telehealth visits as for in-person visits since they don’t always feel that they get the same level of service.

And Robert Sullivan, a health care consultant and formerly the chief operations officer for Health Industries Advisory at the tax and consulting firm PricewaterhouseCoopers, predicts that the greater use of technology for medical records during the pandemic will have a long-lasting, positive effect on health care costs due to better medical database management.

“For the longest time,” he says, “all your medical records were with your family physician. And if you needed to send information to a specialist or just needed to check on your own status, you had to get the information from your doctor. That was costly for the provider as well as for the insurance companies.”

But there’s been a huge growth in the use of third-party data management of medical records during COVID-19. That portability, Sullivan believes, will save money for doctors’ offices and insurers.

Geriatric medicine

“The big change for me as a result of COVID-19 is the heightened awareness of the need for more geriatric physicians,” says Sullivan. “We’re already woefully short of the number of geriatric physicians and that number is going to get even worse in the future.”

According to the American Geriatric Society, there are about 7,000 certified geriatricians in the United States. But the federal Health Resources & Services Administration, which tracks data on the workforce that’s needed, estimates that by 2025, the U.S. needs to have close to 23,000 geriatric physicians to accommodate the number of boomers, who’ll then be 61 to 79.

Read: The case for defunding nursing homes and replacing them with a radically different model

One of the reasons for this discrepancy: the expected income for those going in geriatrics.

“Geriatric medicine has not been the most lucrative specialty,” Sullivan says.

The American Geriatric Society reports that the average income for a geriatrician is lower than even for family practice, even though the specialty requires an additional year of schooling. According to ZipRecruiter, the average pay for a geriatrician in the U.S. is $198,740. By contrast, average pay for family physicians is about $208,000.

Still, Sullivan says he’s optimistic about future prospects for geriatricians.

“I think the pandemic put the spotlight on older adults, which will likely increase the number of people going into the field. And,” he adds, “it’s also likely to increase the income for geriatric physicians as the demand becomes greater.”

Young people seem to agree.

In his School of Aging Studies class at the University of Maryland Baltimore County, Prof. Steve Gurney, asked his young college students whether they thought there would be more emphasis in the health community on geriatric medicine in the post COVID-19 world. Almost all of the comments were similar to this one:

“COVID-19 made us more aware of the health risk factors our elderly population faces. People, including myself, have kept our older generation in mind more now than ever before. And moving forward, people will have a better understanding of geriatric medicine and its importance.”



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Gilead is protecting its drug patent instead of protecting COVID-19 patients


Greed is the great motivator in our economy. It prods people and companies to constantly strive to innovate, to create new and better products with the hope of earning fabulous riches.

But greed doesn’t always work the way the textbooks teach it. In the real world, companies that maximize profits don’t always improve the lives of consumers, contrary to what you might have learned in Econ 101 from reading Adam Smith’s musings about how it is the greed of bakers—not their benevolence—that gives us our daily bread.


It seems that “standard practice” in the drug industry directly contradicts the Constitution’s reasons for granting intellectual property rights. Instead of promoting “the Progress of Science and useful Arts,” patents too often serve to retard the advancement of science and useful arts, such as medicine.

Even Smith recognized that his invisible hand dematerializes once a company gains monopoly power; for instance, by controlling patents, as Gilead Sciences
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does.

Gilead’s gold mine

In a time of global pandemic, Gilead—with its suite of antiviral drugs—is sitting on a gold mine. One of its drugs, remdesivir, has been proven to be effective in shortening hospitalizations of COVID-19 patients. It’s not a panacea, but it is better than nothing.

Breaking news: Pfizer to help manufacture Gilead’s remdesivir

But Gilead may have a better drug in its pipeline that it won’t sell, a compound known as GS-441524 that is closely related to remdesivir and which, limited studies suggest, could be cheaper and more effective as a treatment for COVID-19.

The consumer watchdog group Public Citizen charged Tuesday that the company refuses to test and develop GS-441524 because selling the inferior drug remdesivir is more profitable. (Gilead did not respond to a request for a comment.)

In other words, Gilead owns a gold mine, but it will only sell us the tin it unearths. It leaves the gold in the ground, because the inferior metal is more profitable.

“It is unclear why Gilead and federal scientists have not been pursuing GS-441524 as aggressively as remdesivir, but the answer may be found in the corporation’s patent holdings,” Public Citizen said in a letter sent to the company and to top federal health officials. “The corporation’s monopoly over remdesivir may last five years longer than that for GS-441524, allowing Gilead to make substantially greater profits from the sale of remdesivir as a COVID-19 treatment.”

GS-441524 may work better

Two medical researchers signed on to Public Citizen’s complaint. In an opinion column published by Statnews.com in May, Florian L. Muller and Victoria C. Yan of the University of Texas’s MD Anderson Cancer Center urged the company to “ditch remdesivir and focus on its simpler and safer ancestor.” They also speculated that Gilead was giving remdesivir more attention because of potential monopoly windfall profits instead of thinking about potential benefits for public health.

In their op-ed and in a paper published in June by the American Chemical Society, Muller and Yan argued that manufacturing GS-441524 is much less complicated than making remdesivir and that it probably works better. “The benefit of using GS-441524 over remdesivir is that GS-441524 can almost certainly be given at much higher doses due to its lower toxicity,” they wrote. It could be a more effective therapy for many more patients, they theorized.

The two drugs are quite similar. “Remdesivir has a small but clever modification that makes it better at entering cells, but it and GS-441524 work in exactly the same way to inhibit viruses,” Sarah Zhang summarized in a story she wrote for The Atlantic.

But no one knows for sure if GS-441524 will work in human patients. No one even knows if GS-441524 is safe for humans, because it has never been tested.

Black market for cat lovers

This isn’t the first time Gilead has abandoned GS-441524 despite its promise as an antiviral. Although the company has not sought approval for veterinary uses, a large and highly illegal black market for the drug (mysteriously sourced from Chinese bootleggers for $7,000 to $12,000 per course of treatment) sprung up after researchers found it to be safe and very effective in treating an otherwise fatal disease in cats that’s caused by a feline coronavirus related to the coronavirus that causes COVID-19 in humans.

“The company has refused to license GS-441524 for animal use, out of fear that its similarity to remdesivir could interfere with the human drug’s FDA-approval process—originally for Ebola,” Zhang wrote in her Atlantic story about the bizarre black market for GS-441524 among cat lovers.

Zhang explains: “Because GS-441524 and remdesivir are so similar, any adverse effects uncovered in cats might have to be reported and investigated to guarantee remdesivir’s safety in humans. Gilead’s caution about generating unnecessary cat data is standard industry practice.”

Ah ha! Now we may be getting closer to solving the mystery. For a patent holder, ignorance is sometimes more profitable than knowledge.

It seems that “standard practice” in the drug industry directly contradicts the Constitution’s reasons for granting intellectual property rights. Instead of promoting “the Progress of Science and useful Arts,” patents too often serve to retard the advancement of science and useful arts, such as medicine.

In this case, retarding the advancement of knowledge is causing great suffering among both humans and cats.

Follow the money

I can hear your objections already. Gilead discovered these drugs and has the absolute right to do whatever it wants with them, just as a poet has the right to burn their verses. The world is poorer for it, true, but “it is what it is.”

These are strong moral arguments, but they ignore the fact that you and I paid much of the cost of the discovery of these drugs. We should own at least a stake in them. The federal government gave Gilead at least $70 million to develop antiviral drugs to save lives and reduce suffering, not to enrich Gilead’s managers and shareholders.

Gilead has great scientists and researchers and they should be amply rewarded for their success. Gilead should earn a fair profit for its work, but it should not get an unearned windfall, and it should not be able to lock up promising drugs merely because it is greedy. The public paid for the discovery of GS-441524 and remdesivir, and that intellectual property should be in the public domain.

By the way, the argument for public control of intellectual property funded by the public also applies to the billions of dollars that governments here and in Europe have given to various companies and organizations to develop vaccines for COVID-19. And it also applies to the hundreds of billions the public has invested in other drugs and medical treatments.

The money was given to solve a problem, not to reward greed. Because greed isn’t always good.

Rex Nutting has been covering economics and politics in Washington for more than 25 years.

Suggested further reading

Richard Haass: How nationalism could ruin the COVID-19 vaccine

Mariana Mazzucato: How to make sure the drug companies don’t make off like bandits as we develop a COVID-19 vaccine

Joseph Stiglitz: Should patents come before patients? How drug monopolies hamper the fight against coronavirus



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The market is underpricing the possibility of a vaccine, Goldman Sachs strategists say


French engineer-virologist Thomas Mollet looks at 24 well plates adherent cells monolayer infected with a SARS-CoV-2 virus at the Biosafety level 3 laboratory of the Valneva SE Group headquarters in Saint-Herblain, near Nantes, France, on July 30, 2020.


jean-francois monier/Agence France-Presse/Getty Images

The market is underpricing the possibility of a vaccine, Goldman Sachs strategists say.

Forecasts are assuming a nearly 40% chance of a vaccine being broadly available by the first quarter of 2021, and the strategists, led by Kamakshya Trivedi, say there is a good chance that at least one vaccine will be approved by the Food and Drug Administration by the end of November and broadly distributed by the middle of 2021. “This kind of timeline could see a substantial boost to GDP [gross domestic product] relative to a ‘no-vaccine’ case, particularly for the U.S., which is likely to lead the vaccine race and is likely to experience worse outcomes than in Europe without a vaccine,” the strategists say.

The steep rise in vaccine probabilities is one key reason that the equity market has managed to make new highs even without definitive improvement in U.S. health outcomes, the strategists add, with the other reason being the fall in inflation-adjusted bond yields.

The S&P 500
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+0.64%

has climbed 49% from its March lows, and the technology-led Nasdaq Composite
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+0.99%

has registered 31 records this year.

The current equity market level is consistent, they say, with a 60% chance of no vaccine.

“On these estimates, options markets may be underpricing the fatness of both ‘tails,’ especially the upside case. Out-of-the-money call options on the S&P 500 (and some other indices) still look attractively priced given our view of the vaccine timeline outcomes,” they say.

The strategists also say the U.S. election is being underappreciated, not for its impact on domestic policy but for international relations. The “international implications both in the run-up to the election and beyond will be equally important for market direction in coming months,” they say. While the slow-motion decoupling of the U.S. and China will probably continue regardless of who wins, “a Biden administration would likely use different tactics, including more cooperation with traditional allies and less aggressive use of tariffs.” This, in turn, could lead to another leg of the dollar
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+0.38%

falling, particularly against the yuan
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+0.10%
.

A vaccine could spark a renewed rotation toward traditional cyclicals, steeper bond-market yield curves, and outperformance in emerging market currencies and equities. “We suspect that it is still too early to position aggressively for that shift, but think that options exposure in some of these areas may already make sense,” they say.

School reopening risks, they add, may continue the theme of low real rates, tech leadership, and the defensive rally of the past month. “But with some of these moves getting stretched, investors should be open-minded about the possibility of a shift in leadership across global markets in the months beyond, especially if the news flow on the vaccine front continues to be encouraging,” the strategists said.



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Trump’s ban against WeChat owner Tencent could have huge implications for U.S. companies


Did President Donald Trump just blow up the U.S. videogame industry?

That was the question on a lot of minds after Trump issued executive orders Thursday night banning “transactions” with the Chinese owners of the TikTok and WeChat apps starting Sept. 20. While the move against TikTok’s owner — Beijing-based Bytedance — was not a huge surprise, action against WeChat’s owner — Shenzhen-based tech giant Tencent Holdings Inc. — was.

That’s because Tencent is one of the world’s largest and most valuable companies, with ownership stakes in a number of U.S. videogame companies, including Riot Games, which makes “League of Legends”; Epic Games, which makes “Fortnite”; and Activision Blizzard
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, which makes “World of Warcraft.”

Tencent also has significant stakes in Tesla Inc.
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+0.30%

and Snap Inc.
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, the maker of Snapchat, and the Chinese company has streaming deals in place with the NBA, the NFL and Major League Baseball. The order could potentially also affect Apple Inc.
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+3.48%

and Alphabet’s
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+1.74%

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Google app stores, which feature Tencent-owned apps.

The executive order took aim directly at WeChat, which has more than 1 billion users worldwide, and whose “data collection threatens to allow the Chinese Communist Party access to Americans’ personal and proprietary information,” the order said.

But the wording of the order made it unclear if the ban affected just WeChat or all of Tencent’s holdings, saying: “any transaction that is related to WeChat by any person, or with respect to any property, subject to the jurisdiction of the United States, with Tencent Holdings Ltd. … Shenzhen, China, or any subsidiary of that entity.”

Either way, the order is likely to be challenged in court.

Tencent shares
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-4.41%

in Hong Kong sank in Friday trading after the announcement. The news broke after the extended trading session in the U.S. closed, but traders will likely keep a close eye on how shares of Tesla, Activision Blizzard and others fare in the morning.

Banning all business by U.S. companies with WeChat’s parent — if that is the case — could prove to have much farther-reaching effects than Trump may have anticipated.

“Likely he had no idea,” tech journalist Kara Swisher tweeted Thursday night.

Many on social media Thursday night expressed surprise and alarm:





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