Midweek update

David Ermer

I am an attorney who practices law in Washington DC. My practice has involved the Federal Employees Health Benefits Program since 1983.

Midweek update

David Ermer–CDC, COVID-19, Uncategorized–

As you know, the FEHBlog tracks the daily COVID-19 cases in the U.S. posted by the Centers for Disease Control. Here are the statistics for this week so far:

COVID 19 Statistics4/54/64/74/8
Cases304,826330,891374,329395,011
Deaths7,6168,91012,06412,754
Deaths over Cases2.50%2.69%3.22%3.23%

We tragically have experienced more COVID-19 deaths so far this week than the approximately 3,000 Americans who died at Pearl Harbor (or on September 11). However, the relatively high death rate (particularly compared to the flu) was flat for the past two days. We will see on Friday whether this encouraging trend continues.

The flattening occurred because the number of deaths stopped increasing proportionally faster than the number of cases. The more rapidly increasing number of COVID-19 cases must be due at least in part to the expansion of COVID-19 testing as discussed in this Healthcare Dive article and this HHS announcement that licensed pharmacists now are authorized to order COVID-19 tests.

Fierce Healthcare reports on the development of a new COVID-19 portal called “The National Response Portal that will provide vital information to healthcare providers, policymakers and the general public as a ‘one-stop-shop’ for all health data related to COVID-19, which is caused by the novel coronavirus, according to the organizations.” The new portal is gathering information now and is expected to go live next week.

It’s World Health Day

David Ermer–CDC, COVID-19, Medicare, OPM–

The World Health Organization has declared today World Health Day appropriately honoring nurses and midwives. U.S. HHS Secretary Alex Azar commented

“This year’s theme for World Health Day, ‘Celebrating Nurses and Midwives,’ is also an important reminder of the work being done by frontline healthcare workers every day, around the world, to save lives. Preparing for and responding to outbreaks that can cross borders is one of the most important contributions we can make to support our healthcare workers, and we applaud the heroic work they have been doing to battle the global pandemic

The FEHBlog heartily agrees. Now, how about some Tuesday Tidbits?

  • Yesterday, as Health Payer Intelligence reports, the Centers for Medicare and Medicaid Services “finalized its Medicare Advantage and Part D rates, including finalizing the disputed Medicare Advantage end-stage renal disease (ESRD) payment rule without changes.” HPI adds that CMS anticipates a slight uptick (1.66 percent) in revenue as a result of the new rate announcement, based on its changes to the reimbursement methodologies for Medicare Advantage organizations, PACE organizations, and Part D sponsors. The uptick does not account for the adjustments related to the underlying coding trend, which CMS anticipates will bump most risk scores by around 3.56 percent.” In the FEHBlog’s view, the extension of Medicare Advantage coverage to beneficiaries under age 65 with end stage renal disease could be disruptive to Medicare Advantage rates.
  • The Centers for Disease Control released yesterday a report on “Coronavirus Disease 2019 in Children — United States, February 12–April 2, 2020.” Here’s the summary

What is already known about this topic?

Data from China suggest that pediatric coronavirus disease 2019 (COVID-19) cases might be less severe than cases in adults and that children (persons aged <18 years) might experience different symptoms than adults.

What is added by this report?

In this preliminary description of pediatric U.S. COVID-19 cases, relatively few children with COVID-19 are hospitalized, and fewer children than adults experience fever, cough, or shortness of breath. Severe outcomes have been reported in children, including three deaths.

What are the implications for public health practice?

Pediatric COVID-19 patients might not have fever or cough. Social distancing and everyday preventive behaviors remain important for all age groups because patients with less serious illness and those without symptoms likely play an important role in disease transmission.

  • TechCrunch brings us up to date another potential COVID-19 vaccine is entering phase 1 human trials with Food and Drug Administration approval. This vaccine is being developed by Inovio Pharmaceuticals with financial backing from the Bill and Melinda Gates Foundation. Best of luck to Inovio and the other developers.
  • A friend of the FEHBlog found this online edited transcript of NYC pulmonologist David Price’s chat and Q&A on COVID-19 discussed in yesterday’s FEHBlog. Check it out.

Pulmonologist video

David Ermer–COVID-19–

Yesterday a friend called the FEHBlog’s attention this 56 minute long video of pulmonologist “Dr. David Price of Weill Cornell Medical Center in New York City sharing information in a Mar. 22 Zoom call with family and friends on empowering and protecting families during the COVID-19 pandemic.” The FEHBlog watched the video this morning. Dr. Price engages in a monologue for the first 30 minutes. In the monologue he beautifully ties together all of the government’s current guidance on how to deal with COVID-19. Dr. Price answers questions in the last 26 minutes. It’s worth watching if you haven’t already seen it.

For example, Dr. Price explains that the likeliest path to catching COVID-19 is to touch an infected person or object and then touch your face. That’s why it’s important to clean your hands frequently and not touch your face. Dr. Price explained that the COVID-19 virus is a wimp that virtually all disinfectants can kill. He said a drop of Purell would do the trick. He explained that the principal purpose of a cloth face mask is to protect your face from unprotected touching by your own hands, which makes sense.

Weekend update

David Ermer–COVID-19, HIPAA Privacy and Security Rules, OPM–

Congress remains on a State / district work period this week with the exception of one Senate Armed Services Committee hearing. The Wall Street Journal reports that

The [coming] week will be “the hardest and saddest week of most Americans’ lives,” Surgeon General Jerome Adams said on Fox News Sunday, drawing comparisons with the 1941 attack on Pearl Harbor and the Sept. 11, 2001, terrorist attacks.

Officials again urged Americans to stay home. “This is the moment to not be going to the grocery store, not going to the pharmacy, but doing everything you can to keep your family and your friends safe,” coronavirus response coordinator Deborah Birx said at a White House news briefing over the weekend.

HHS’s Office for Civil Rights, which enforces the HIPAA Privacy and Security Rules, called attention today to the Federal Bureau of Investigation’s guidance “on defending against video-teleconferencing (VTC) hijacking (referred to as ‘Zoom-bombing’ when attacks are to the Zoom VTC platform). Many organizations and individuals are increasingly dependent on VTC platforms, such as Zoom and Microsoft Teams, to stay connected during the Coronavirus Disease 2019 (COVID-19) pandemic.” This guidance is applicable to both business and personal users of these virtual meeting platforms.

And as this is the FEHBlog, not the COVIDblog, the FEHBlog wants to call attention to this FEDSmith article on how federal employees and annuitants can extend their FEHBP coverage post-mortem to their surviving spouses and children (under age 26 except in the case of total disability.) This unique federal employment benefit should be a top consideration in estate planning for federal employees and annuitants. Here is a link to the OPM website’s discussion of continued FEHB coverage for survivor annuitants. Here are OPM’s survivor annuity websites for the federal government’s legacy retirement system CSRS and its current retirement system, FERS.

Hang in there, my friends.

CDC COVIDView

David Ermer–CDC, COVID-19–

The Centers for Disease Control has started to issue weekly COVIDView reports similar to the FluView reports that the agency issues during flu season.

This CDC report provides a weekly summary and interpretation of key indicators being adapted to track the COVID-19 pandemic in the United States. This includes information related to COVID-19 outpatient visits, emergency department visits, hospitalizations and deaths, as well as laboratory data.

These reports are as of one week behind the issuance date so the first COVIDView is as for the week of March 28, 2020.

COVIDView helpfully supplements the CDC’s Summary of Cases in the U.S. website which is updated daily, including weekends.

New CDC Guidance

David Ermer–CDC, COVID-19–

NPR reports that

President Trump said Friday the Centers for Disease Control and Prevention now recommends that people wear cloth or fabric face coverings, which can be made at home, when entering public spaces such as grocery stores and public transit stations. It is mainly to prevent those people who have the virus — and might not know it — from spreading the infection to others.

The guidelines do not give many details about coverings beyond: “cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.” * * * And the mask need not be professional-grade to offer some benefit. In fact, officials say it probably shouldn’t be: The CDC recommends constructing your own cloth mask.

The New York Times provides guidance on how to make your own mask. The FEHBlog can’t think of a more fun activity for the weekend.

Friday Stats and More

David Ermer–COVID-19, Rx coverage, SCOTUS–

The number of COVID-19 cases continues to grow along with the COVID-19 death rate (number of deaths over number of cases per the CDC). The FEHBlog’s statistics are drawn from the CDC’s now daily Cases in United States Summary.

Cause3/203/274/3
Travel2907121388
Person to Person31013264325
Uncategorized984283318233,566
Total Cases10,44285,356239,279
Total Deaths 15012465442
Death Rate1.44%1.46%2.27%

For context, the CDC’s latest Fluview “estimates that so far this season there have been at least 39 million flu illnesses, 400,000 hospitalizations and 24,000 deaths from flu.” That represents a death rate of less than one tenth of one percent (0.06%). Fortunately this flu season appears to be subsiding. The CDC additionally “estimates that influenza has resulted in between 9 million – 45 million illnesses, between 140,000 – 810,000 hospitalizations and between 12,000 – 61,000 deaths annually since 2010.”

The FEHBlog has wondered where is the light at the end of the COVID-19 tunnel. He now appreciates the fact that we haven’t made it half way through the tunnel. Hang in there.

Not surprisingly but regrettably Govexec.com reports that thousands of federal employees have contracted COVID-19 and attempts to provide a numerical breakdown by agency.

In more upbeat news, MedCity News informs us that

The Food and Drug Administration has given an emergency use authorization to a test for Covid-19 that detects whether a person is infected through the use of antibodies. The FDA granted the authorization to Research Triangle Park, North Carolina-based Cellex, for the qSARS-CoV-2 IgG/IgM Rapid Test, according to a letter from FDA chief scientist Denise Hinton, sent Wednesday to Cellex CEO James Li. The test is designed to produce results in 15-20 minutes.

The advantage of antibody tests is that they not only are less likely to produce false-negative results, but can also be used to detect past infections, meaning that they can be used to determine if a patient without symptoms has previously had Covid-19 and could thus be immune to it. It could also be used to indicate stage of infection and estimate time since exposure. Nevertheless, according to the primer, a limitation to antibody testing is that the body’s immune response to SARS-CoV-2 is slow.

The Labor Department continues to add to its list of now 78 FAQs on the FFCRA’s COVID-19 paid sick leave law which took effect on April 1 while the U.S. Supreme Court cancelled its April oral arguments which would have occurred at the end of this month.

Thursday Miscellany

David Ermer–CDC, COVID-19, HIPAA Privacy and Security Rules–

Healthcare Dive helpfully reviews the benefit improvements that large health insurers have made in response to the COVID-19 emergency.

Hospitals say that’s not enough, and are calling on the biggest payers to follow actions taken by Congress and CMS to help resolve cash flow issues, by accelerating payments or opting into releasing interim periodic payments. The American Hospital Association also is urging payers to eliminate administrative burdens such as prior authorizations.

The more things change, the more they stay the same.

Beckers Hospital Review reports that “Peak demand for hospital resources due to COVID-19 is expected by mid-April in the U.S., according to an analysis from the University of Washington’s Institute for Health Metrics and Evaluation in Seattle.” The report provides an expect peak demand date for each State in the Union and DC.

The HHS Office for Civil Rights which enforces the HIPAA Privacy and Security Rules loosened another Privacy Act provision for the duration of the COVID-19 emergency —

As a matter of enforcement discretion, effective immediately, the HHS Office for Civil Rights (OCR) will exercise its enforcement discretion and will not impose potential penalties for violations of certain provisions of the HIPAA Privacy Rule against covered health care providers or their business associates for uses and disclosures of protected health information by business associates for public health and health oversight activities during the COVID-19 nationwide public health emergency.

Although this is really inside the Beltway, the FEHBlog, as a lawyer, finds it noteworthy to relate that, according to Govexec.com, the Office of Management and Budget “is not directing agencies to extend the amount of time alloted for public feedback on regulation changes during the coronavirus outbreak, despite calls from [House Democrat] lawmakers to do so.”

Finally, the FEHBlog notes that according to the Boston Globe’s Stat News, rumblings about masking the American public continue.


In a draft document obtained by STAT, the CDC recommended that the public use homemade face coverings when in public, reserving higher-grade protective equipment like N95 masks for hospitals and health care workers, who have faced severe shortages in personal protective equipment as the coronavirus pandemic has accelerated through the United States.

Such face coverings, according to the draft guidance, would not be intended to protect the wearer, but rather prevent the wearer from unknowingly spreading the disease when in public. Individuals should wear face coverings in public settings like grocery stores, the guidance said. Children under the age of 2 and people experiencing trouble breathing would be excluded from the mask guidelines.

Midweek update

David Ermer–COVID-19, Federal employment benefits–

Today, the FFCRA Paid COVID-19 Sick Leave Benefit took effect generally for private employers with under 500 employees. The Labor Department which enforces this law published temporary rules on mandated benefit. The informal guidance accompanying the rules explains that

Most employees of the federal government are covered by Title II of the Family and Medical Leave Act, which was not amended by this Act, and are therefore not covered by the expanded family and medical leave provisions of the FFCRA. However, federal employees covered by Title II of the Family and Medical Leave Act are covered by the paid sick leave provision.

Federal News Network discusses the complex impact of COVID-19 on the U.S. Postal Service. The article begins as follows:

With the Postal Service now tracking the deaths of its employees from the coronavirus pandemic, in addition to a growing list of those who have tested positive for the virus, the agency is doing everything it can to continue normal operations — even in the most extraordinary circumstances.

The USPS Board of Governors held a moment of silence Wednesday for postal employees who have died of complications from COVID-19, the illness caused by the current strain of the virus.

Those include Rakkhon Kim, a 50-year old letter carrier in New York City, who died of complications from the virus last week.

Terribly sad.

It’s worth linking to this Wall Street Journal article on nurses working on the COVID-19 front line in the Bronx, New York. The Boston Globe’s STAT discusses how the COVID-19 spreads and creates additional hot spots.

Healthcare Dive reports on a FAIR Health study of consumer use of telehealth and retail clinics relying on data gathered before the current COVID-19 emergency. “Consumer use of telehealth and retail clinics spiked from 2017 to 2018, while use of urgent care centers, ambulatory surgery centers and emergency rooms dropped as consumers increasingly turn to cheaper sites of care for low-acuity medical needs.”

As the article notes, telehealth use has become a necessity in the past month. HIMSS provides a patient guide on how to get the most out of telehealth visits. This may be useful for health plans to share with members.

Tuesday’s Tidbits

David Ermer–COVID-19, Uncategorized–

The Wall Street Journal reports today that “U.S. public-health authorities are reviewing recommendations for wearing face masks and a wave of European governments have ordered citizens to use them outside the home, signaling a shift among Western governments on a contentious issue in the coronavirus pandemic.” The social distancing requirement is intended to serve the same purpose as masking. The FEHBlog does not know where this change would lead.

FiercePharma discusses the ongoing COVID-19 vaccine studies. “In all, about 50 vaccines are in early development across the biopharma landscape, and researchers are exploring about 10 different vaccine approaches, said Jim Mayne, vice president of science and regulatory advocacy at PhRMA.” The FEHBlog is pleased to read that there are a lot of irons in this critically important fire.

The FEHBlog ran across this interesting U.S. Health Weather Map created by Kinsa and Oregon State University.

The U.S. Health Weather Map is a visualization of seasonal illness linked to fever – specifically influenza-like illness. The aggregate, anonymized data visualized here is a product of Kinsa’s network of Smart Thermometers and accompanying mobile applications, and Kinsa is providing this map and associated charts as a public service.

This appears to be the type of health surveillance tool that public health experts are encouraging.