By Debbie Gregory.

It’s a good bet that you are spending a lot more time on your phone, tablet or laptop than usual. Our devices can be a lifeline of sorts.  Below are a few interesting new apps that may help you beat some boredom during this difficult time.

COVID News: Apple’s COVID-19 App:

Apple’s COVID-19 app brings together almost everything that you need to know about the virus and staying healthy that is happening right now. It also includes information on what to do if you think you may have become infected. This app is updated constantly with verifiable information.

Cooking: Project Foodie: Guided Cooking:

You may or may not know your way around the kitchen. This app will help you learn to be an overall better cook. It breaks down recipes step-by-step in video format and is led by professional chefs.  It can also be a lot of fun and encourage you to try making dishes that you might never have done.

Learning: EdX and Duolingo:

EdX offers over 2,000 classes on just about any topic that you can image and then some. Duolingo is a language learning app that is structured more like a game. It is image heavy, fast-paced, and incentivizes you to keep going with small rewards. There are 35 languages that you can try, including fictional tongues like “Star Trek’s” Klingon and “Game of Thrones'” High Valyrian.  Enjoy!

Social: Nextdoor:

Nextdoor connects you with neighbors in your specific neighborhood and some you may have never actually met in person. Though this app was popular and useful before the pandemic, it now it is a fantastic tool to help you connect with your neighbors and help each other out.   It provides you valuable information on what is happening in your neighborhood in a timely manner whether help finding a lost pet or which stores have toilet paper.

Relaxation: Stop, Breathe & Think:

This meditation app is designed to ease your mind and help you start to check and evaluate your physical and emotional well-being. The app analyzes your current state and gives you activities that will help you based on your own evaluation.  It includes things such as guided breathing, brief meditations or even calming compilations of cat videos.   This is a time with a great deal of stress and anxiety that is unhealthy for us so this app can be an excellent resource.

Exercise: Aaptiv, Peloton, and Runkeeper:

Aaptiv is an all audio-based app so you can start it, pop your phone in your pocket, and go! The Peloton app gives you 30-days of free guided workout videos (strength training classes, yoga classes, boot camps, and cooldowns too). The Runkeeper app tracks your runs and measures your progress. This one is a bit unique since you can earn rewards toward real-life training gear.  Exercise is very important, especially now and will help keep you emotionally and physically fit.

Games: Playing with friends: Heads Up! on Houseparty and Playing solo: The Sims Mobile:

Heads Up! on Houseparty is kind of like reverse charades that you play with one or more friends. The Sims Mobile is a fun condensed version of the popular videogame The Sims! You get to manipulate the life of a virtual person who can shop, date, throw parties, meet ghosts, buy homes, get a job, adopt a child, and so much more.   You can live vicariously through your virtual person.

VAMBOA is providing this information to be helpful and does not endorse any of these apps nor do we receive any compensation for featuring them.   If you have another app that will provide help or fun for others, please let us know.  Email:  info@vamboa.org.

STAY SAFE AND SOCIAL DISTANCE.

By Debbie Gregory.

We are physicians. We are experts at triaging and prioritizing action. Our decisions mean the difference between life and death. We regularly balance competing interests in the setting of constrained resources. We fight hard for our patients. Our job has been likened to “walking through minefields in clown shoes.” It breeds humility. If we make a bad decision, the unthinkable happens. And we are frequently reminded of the fragility of life. We have glimpsed the future of COVID-19 and are horrified.

At this point, New York alone is outpacing Lombardia, and the U.S. is outpacing everyone else. We are not waiting for the cavalry to ride in, because there is not one coming. It is up to us.

Here is what we should demand of our state and federal governments:

Physicians, nurses, and hospitals have been working nonstop for weeks and know the tsunami is here. We should have acted long ago, but we cannot waste time arguing about what could’ve been done. We are in the now, and we are going to need your help.

The prescription for ending this epidemic is: leadership, organization, creativity, hard work, and proven public health measures. We will need to draw on every resource to do this in the most efficient and effective manner so we can save lives, and everyone else can get back to their own.

It is critical to flatten the curve.  If our ventilators run out, like the toilet paper did, many will die unnecessarily because of shortages. Survival for those who become critically ill is poor, despite every desperate measure we take. Our horror as health care workers on the front line is that we have little to offer patients to change the course of their disease. States can bend the curve and “buy time” with decisive leadership and action. Buying time means we can:

• Create better, widely available tests to know who is infected
• Acquire PPE to protect health care workers
• Adjust our “business as usual” processes
• Discover a new therapy that makes this disease an inconvenience and not a death sentence
• Find a vaccine that is safe and effective
• Reinstate our normal life-saving care for those who are not infected

So, yes, it is incredibly important that everyone stays home now to buy us time and save lives.  But it isn’t enough. What we do with this time purchased at great expense really matters. We are at a crossroads, and the government decisions will determine the path we will take. The task may seem impossible, but it is NOT impossible.

It will take unprecedented coordination and effort, but we are fortunate to have roadmaps laid out for us by Singapore and South Korea, democratic nations that are winning the war on COVID-19. South Korea’s daily case count is declining.  As of March 23rd, there were more cased of COVID-19 diagnosed in NYC alone than the entire country of Korea. Singapore has lived with this for months longer than we have, yet life goes on, and they have not shut down schools. Their strategy and coordinated efforts have paid off. What it requires, however, is decisive and strong leadership along with the humility to recognize that this is neither “business as usual” nor “disaster as usual.” We cannot be Italy– we will fail.

Here are the immediate steps that governments should take:

Shelter in place. We must limit all nonessential contact to reduce the spread of the virus. This cannot last forever but it will be important to implement the strategies we need.

Strategic planning and organization. We should employ and leverage every resource available in our state to fight this. A team of non-medical professionals, working in parallel to our health systems, state, and universities, should be established to offload work and support the state’s COVID-19 response. Best practices and treatment breakthroughs should be distributed widely among the health care community. While the hospitals and physicians are working and preparing, this group should start now working to assist in the following ways:

• Determine a strategic plan and framework for prioritizing needs, opportunities, barriers, and communications
• Work with the state and federal leadership to overcome regulatory barriers to implementing interventions quickly
• Identify and implement initiatives that must be done at the state level and cannot be accomplished by individual health systems alone
• Identify and communicate best practices across the state to every overburdened hospital system
• Coordinate partnerships with the many corporations willing and poised to make a huge impact
• Develop and deploy technology (or workers from other industries) that can make traditional public health measures, such as contact tracing and isolation, scalable

Control hospital hot spots. Hospitals are a major source of spread for COVID-19. If patients decompensate, they tend to do so on day 7 or 8. Patients should only come to the hospital if they need services that cannot be rendered in another location. Hotels, nursing homes, conference facilities, concert venues could be repurposed to house patients who cannot care for themselves at home. We should follow Singapore and Hong Kong who set up trailer parks and dorms along with home delivery services to those in quarantine. Patients can be monitored via telemedicine for changes in respiratory rate or oxygen saturation to indicate if they need more intensive medical care. If this occurs, they can be taken to dedicated COVID-19 hospitals, where the risk to health care workers is concentrated, and there are no other patients who will become infected by nosocomial spread.

A current issue facing hospitals is the EMTALA law that states no patient can be turned away from the hospital.  Emergency physicians fully support this law, but in this case, it creates a challenge because patients cannot be directed to a designated “COVID-19 hospital” but instead must be fully assessed at whichever hospital they present to first, thus increasing and distributing the risk of health care worker exposure to COVID-19 at additional sites.

The following policies can help containment:

• Changes to hospital policies, processes, and organization to focus on containment
• Create regulatory guidance instructing patients, EMS and health systems to allow known COVID-19 patients to be sent preferentially to COVID-19 hospitals where care can be cohorted, reducing risk other patients and health care workers
• Build or repurpose alternative housing for COVID-19 positive patients who do not need critical care and the homeless who need quarantine
• Build telemedicine services to support home care and identify patients who need to be hospitalized
• Coordinate hospitals at a state level, to allow for isolation of COVID-19 positive patients in the most efficient manner, limit risk and nosocomial spread

Protect health care workers.  Even with appropriate PPE usage, American physicians and nurses have already died. Health care workers need to be appropriately protected to conserve this vital workforce,  but also to snuff out the pandemic. In Italy, nearly one in ten of those infected are health care workers.  Health care worker infection is a driving force in the spread. It is unethical to expect health care workers to martyr themselves without proper protection. And that means appropriate PPE as well as changes to the “business as usual” processes.

The crisis standard of care is triggered by the need for containment, not by volume surges. We can accomplish this with changes to our operations. In the SARS response in Taiwain utilizing best practices for isolation and triage dramatically reduced health care worker and patient infections. In the 18 hospitals implementing these best practices, zero health care workers and only two patients developed nosocomial SARS infection. In contrast, in the 33 control hospitals, 115 HWSs, and 203 patients developed SARS. Health care workers do not need to die to provide care. If they do, it is a failure of leadership, not knowledge or technology.

Deploy federal disaster assistance. FEMA is an expert in disaster management and communications. The National Guard could be directed to provide boots-on-the-ground assistance. Among the many ways they could help:

• Deploy to hospitals and serve as “dofficers” to watch health care workers as they doff (take off) their PPE to be sure they are not self-contaminating during this most critical step
• Assist in rapid deployment of video intercom technology
• Set up tent triage to contain and limit the spread of infection
• Create community COVID-19 housing in a hotel or other location
• Assist in performing mass screening and testing
• Perform contact screening per Department of Health protocols

Expand proven public health measures:  The lack of testing has been catastrophic because traditional public health surveillance and case tracking measures have not been available. It is nearly impossible to screen for this virus, given that infected patients can be minimally symptomatic with a diverse array of symptoms. As soon as testing comes available, either PCR or antibody testing it should be ramped up and deployed as quickly as possible We will need to change our normal business practices and make this testing widely available.   We need a method to track and communicate results to patients and the department of public health.   Singapore and South Korea perform “contact tracing” on COVID-19 positive patients and isolate individuals who are at high risk of contracting the virus.  Dr. Tedros Ghebreyesus, the World Health Organization’s director-general, gives this advice: “Find, isolate, test and treat every case, and trace every contact.”

The U.S. is on the verge of becoming the new epicenter for this pandemic.  Medicine is only one small tool in this war. Society must do their part.

All of our lives will depend on it.

Amy Cho, Mark Pappadakis and Theresa Tassey are emergency physicians Sunny Jha is an anesthesiologist.

Reprinted from KevinMD.Com – Social Media’s Leading Physicans’ Voice

By Debbie Gregory.

By now you most likely know that the United States government is sending out economic impact payments or “stimulus” checks to many of its citizens. With these checks come criminals who would like to see that money in their pockets instead of yours.

We want to cover below in this article who should be getting a stimulus check as well as what scams are going on targeting these checks.

Who will get a stimulus check?

• A person who filed a federal tax return in either 2018 or 2019
• People who receive Social Security or other retirement benefits
• People who receive public benefits like SSDI, disability, or veterans’ benefits
• People who do not have to file a federal tax return, including people who made no income or made less than $12,200 (or $24,400 for married couples)

Eligible individuals do not need a minimum income for the Payment.

However, for higher income individuals, the Payment amount is reduced by 5% of the amount that your adjusted gross income exceeds:

• $75,000 for individual taxpayers
• $112,500 for taxpayers filing as head of household
• $150,000 for taxpayers filing a joint return), until it is $0.

The $1,200 Payment for eligible individuals with no qualifying children ($2,400 for married couples filing a joint return) will be reduced to $0 once adjusted gross income reaches the following thresholds:

• $198,000 for taxpayers filing a joint return
• $136,500 for taxpayers filing as head of household
• $99,000 for all others

How do you get your check?

Most people will not have to do anything. You will either receive your stimulus check through the United States mail or through direct deposit. The IRS will use the same payment method that you selected for them to use for your tax return (if applicable) in either 2018 or 2019.

If you have questions you can go directly to the IRS’ site at irs.gov/coronavirus.

For example:

• If the IRS doesn’t have your direct deposit information and you would prefer they directly deposit your check simply click on “Get My Payment” and let them know where to send your direct deposit
• If you don’t usually file a tax return, click “Non-filer” to figure out what you need to do to claim your money, if anything
• To check on the status of your payment, click on “Get My Payment”

Avoiding Stimulus Payment Scams:

Unsurprisingly criminals are targeting these stimulus checks. What should you be on the lookout for? Some criminals are trying to convince people that they need to pay a fee to receive their stimulus payment, you do not have to pay any fee(s). They are also trying to get people to give them their Social Security number, bank account number, or government benefits debit card account number, DON’T!

• Only use the IRS’s official website (irs.gov/coronavirus) to submit information to the IRS regarding your stimulus check
• The IRS will NEVER contact you by phone, email, text message, or social media with information about your stimulus payment
• The IRS will NEVER ask you for your Social Security number, bank account, or government benefits debit card account number
• There are zero fees that you need to pay in order to get your stimulus money

If you have seen any of these types of scams please report them to the Federal Trade Commission at ftc.gov/complaint.

If you want more information or simply wish to keep up with the latest scams, sign up for the FTC’s consumer alerts.

By Debbie Gregory.

The DPA is a powerful tool to be employed to protect the nation.  Now that the nation’s industries are responding to the crisis, the best use of the DPA is as surgical tool for specific issues and as leverage to prompt best behavior and information sharing.

Elected members of the House and Senate now speak of the act daily. It’s also very much in the media.

The Defense Production Act first came into being in 1950 as the Truman administration realized it needed more authorities to mobilize the industrial base to fight the Korean War. The act has been re-authorized by Congress some 50 times since then, undergoing significant revision along the way.

The revisions made took basic two forms. Authorities no longer needed such as those dealing with requisitioning, rationing, wage and price-fixing, and labor disputes—were dropped.

Other revisions have broadened the original narrow definition of national defense.  It now extends to such things as energy security, space security and national disasters.

Of the seven original titles in the DPA, three remain—Titles I, III, and VII.  Here is a quick description to help understand what is taking place today with the COVID-19 crisis.

• Title I broadly contains the priorities and allocation authorities. The priorityauthority allows the federal government to ensure the timely availability of critical materials and services produced in the private market in the interest of national defense, and to receive items through contracts before any other competing interest. The allocation authority gives the president the power to allocate or control the general distribution of materials, services, and facilities.

The Department of Defense is the most frequent user of Title I, using it to insert priority clauses into its contracts. These provisions requiring contractors to give the Pentagon preference over all other customers in delivering goods or services.

In 2018 the department did this over 300,000 times. The Pentagon used its highest rating to prioritize the delivery of Mine Resistant-Ambush Protected (MRAP) vehicles for the Iraq War, as well as to obtain body armor for troops. The other federal departments use priority ratings much less. The Department of Homeland Security (DHS) used DPA-rated contracts only about 2,000 times in 2018, mostly for hurricane response.

The President has delegated his DPA authorities to the appropriate cabinet secretaries. On March 18, he signed Executive Order 13909 delegating his priorities authority to the Secretary of Health and Human Services (HHS).  This marked what the President and the media referred to as “invoking the Defense Production Act.”

Five days later, President Trump signed Executive Order 13910 giving HHS the allocations authority under Title I to stop hoarding and price gouging for medical equipment and supplies.  This authority has already been used in at least one instance to seize hoarded masks and protective equipment.

In the following week, the White House started to get specific about how to wield these authorities. On March 27, the president issued a memorandum telling HHS Secretary Alex Azar to direct General Motors to accept and prioritize contracts for ventilator production. Then, on April 2, the President signed two additional memorandums: the first directing 3M Company to ramp up N95 mask production; the other directing Azar to speed up delivery of component parts to the big manufacturers of ventilators.

• Now, let us look at Title III. It allows the President to provide grants and loans to develop, maintain, and expand domestic production capacity for resources needed for national defense.

Again, the Pentagon has been the most frequent user of these authorities, using them to provide money—typically in amounts less than $50 million—to companies to help shore up a recognized deficiency in the defense industrial base.  In the last year or two, the Defense Department has used Title III authority to help assure access to rare earths, explosives, and lithium seawater batteries.

In a typical year, the Pentagon asks for about $30 million for the Title III DPA Fund.  In 2020 it sought $34 million.

In terms of recent activity using Title III authorities, the newly-enacted CARES Act appropriates an unprecedented $1 billion to the DPA.  It is anticipated that most of that funding will go to medical manufacturing, including for vaccines and therapeutics. The CARES act also eliminates certain limits on DPA funding and reporting requirements.

The President also delegated his Title III authorities to his HHS and DHS secretaries. (DHS is involved because it controls FEMA, the Federal Emergency Management Agency.) Now, both departments can make direct investments in U.S. corporations to increase their capacity to manufacture medical supplies and equipment.

• The final section of the DPA, Title VII, contains a grab bag of authorities. The one most pertinent today is probably the authority for the government to enter voluntary arrangements with private companies.  Arrangements which, in normal circumstances, might look like sole-source contract awards, are thus permissible using Title VII.

For example, companies have approached the White House offering to make goods such as N95 respirators. Normally such transactions must be openly competed and competitively awarded. Title VII authorities provide for exceptions.

So, that is the DPA in a nutshell: Title I—priorities and allocation authorities; Title III—direct investments, and Title VII—voluntary agreements.

It’s likely that every one of the thousands of contracts being issued by the Defense Department and FEMA to fight the COVID-19 emergency have a DPA Title I rating.. And now that the federal government has developed a better understanding of the situation, General Motors has been directed to produce ventilators, 3M to make respirators, and ventilator parts suppliers to make more. Additional use of DPA authorities is likely in the coming weeks.

Over the last two weeks, we have seen may private like Ford and Toyota volunteer to partner with medical companies to make ventilators; Honeywell, 3M, Hanes, and others to make millions of N95 masks; and Anheuser Busch, Baccardi, and scores of boutique distillers to make hand sanitizer.

The DPA is a powerful tool to be employed to protect the nation.

SHARING FROM THE U.S. Department of Labor / Published April 21, 2020

During these challenging times, our nation’s Guardsmen and Reservists are answering the call to duty to protect the health and well-being of all Americans. We owe a duty to them to ensure full compliance with the employment and reemployment rights of the Uniformed Services Employment and Reemployment Rights Act of 1994 (USERRA)

The Veteran’s Employment and Training Service (VETS) interprets and provides guidance on USERRA and investigates complaints filed under this law. VETS offers the following frequently asked questions and answers:

Does this fact sheet create new USERRA rights and obligations in light of COVID-19?

No. The statute and regulations still govern USERRA rights and obligations. This factsheet addresses some scenarios that might arise from the application of USERRA in the context of this pandemic.

Does a member of the National Guard or Reserves who is called to active duty in response to the COVID-19 emergency have employment and reemployment protections under USERRA?

• Yes, if called to duty under federal authority. National Guard or Reserve duty under federal authority (such as Title 10 or Title 32) is covered by USERRA.
  • National Guard duty under state authority, commonly referred to as State Active Duty, is not covered under USERRA. However, members of the National Guard serving on State Active Duty may have similar employment protections under state law and should contact the appropriate state office for assistance.
  • Note that the authority under which orders are issued can change, even in the course of a service member’s performance of service.

Can a service member be furloughed or laid off upon return from uniformed service?

• Yes, if it is reasonably certain that he or she would have been furloughed or laid off had he or she not been absent for uniformed service.

May an employer delay a service member’s reemployment out of concern that the service member’s service in a COVID-19 affected area may have exposed him or her to COVID-19?

• No. If the employee satisfies the prerequisites to reemployment, the employee should be promptly reemployed in the job position that he or she would have attained with reasonable certainty if not for the absence due to uniformed service.
  • Promptness generally depends on the length of time an individual was away, ranging from the next day after returning from duty, if the deployment was relatively short, to up to fourteen days in the case of a multi-year deployment.
  • When reemploying a service member who might have been exposed to COVID-19, an employer must make reasonable efforts in order to qualify the returning employee for his or her proper reemployment position. This can include temporarily providing paid leave, remote work, or another position during a period of quarantine for an exposed reemployed service member or COVID-19 infected reemployed service member, before reemploying the individual into his or her proper reemployment position.

Where to Obtain Additional Information:

Important USERRA-related resources and compliance assistance materials for employees and employers are available through the Veterans’ Employment and Training Service website at www.dol.gov/agencies/vets/programs/userra, which contains a USERRA elaws Advisor, FAQs, fact sheets, and links to the statute and implementing regulations. Our toll-free information and helpline, available 8:00 a.m. – 8:00 p.m. Eastern Time, is 1-866-4-USA-DOL (1-866-487-2365). The Department of Defense’s Employer Support of the Guard and Reserve also provides resources available at www.esgr.mil.

U.S. Department of Labor                             1-866-4-USA-DOL
200 Constitution Ave NW                              TTY: 1-877-TTY-5627
Washington, DC 20210

/Portals/13/USERRA-COVID-19-Impact.pdf