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Where Are Coronavirus Cases Getting Worse? Explore Risk Levels County By County : Shots


This interactive map lets you find out how bad your county’s coronavirus outbreak is.

Harvard Global Health Institute/Microsoft AI/Screenshot by NPR


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Harvard Global Health Institute/Microsoft AI/Screenshot by NPR

This interactive map lets you find out how bad your county’s coronavirus outbreak is.

Harvard Global Health Institute/Microsoft AI/Screenshot by NPR

How severe is the spread of COVID-19 in your community? If you’re confused, you’re not alone. Though state and local dashboards provide lots of numbers, from case counts to deaths, it’s often unclear how to interpret them — and hard to compare them to other places.

“There hasn’t been a unified, national approach to communicating risk, says Danielle Allen, a professor and director of Edmond J. Safra Center for Ethics at Harvard University. “That’s made it harder for people,” she says.

Allen, along with researchers at the Harvard Global Health Institute, is leading a collaboration of top scientists at institutions around the country who have joined forces to create a unified set of metrics, including a shared definition of risk levels — and tools for communities to fight coronavirus.

The collaboration launched these tools Wednesday, including a new, online risk-assessment map that allows people to check the state or the county where they live and see a COVID-19 risk rating of green, yellow, orange or red. The risk levels are based upon the number of new daily cases per 100,000 people.

A community that has fewer than one daily new case per 100,000 is green. One to 10 is yellow; between 10 to 25 is orange; and above 25 puts you in the red. “When you get into that orange and red zone it means, in all likelihood, you’re seeing a lot of velocity, a kind of fast upward trend,” Allen says.

This is by no means the only attempt to categorize risk levels across the U.S. There are a number of frameworks out there using different measures. And that can lead to confusion, says Allen. “What we really need is a shared vocabulary and shared way of presenting data across jurisdictions,” she says. This effort represents the consensus of eight institutions and over a dozen individual experts, who have agreed on these metrics.

Of course, there are other important metrics when it comes to tracking the spread and severity of COVID-19. Local public health leaders need to know how many people are dying and how many people are hospitalized. They need to know how many tests are coming back positive in an area. (The lower the positivity rate, the more likely a community is testing enough to accurately detect the spread of the virus.)

But the group settled on tying the alert level to numbers of new cases per 100,000, because that’s a good indicator to show the current picture of outbreaks and compare them in a consistent way. It’s a standard way to measure the risk against the total population.

“It allows you to compare a rural area in upstate New York compared to New York City and have an apples to apples comparison for relative impact and relative caseload,” says Ellie Graeden of Talus Analytics and the Center for Global Health, Science and Security at Georgetown University, which is part of the convergence group that developed the metrics.

Also, by sticking with a standard, core metric you can compare trends over time. “You want to know whether things are going up or down,” Allen says.

For the public, this means you can now compare the case incidence where you live to that of, say, a nearby county where you’re considering going on an errand. Or the county where your parents live if you’re considering a visit. It gives you a way to assess your community’s risk level compared to others, at a glance, and modify your behavior accordingly.

For policy-makers, the risk levels are meant to signal the intensity of the effort needed to control COVID-19 and to trigger specific interventions. The collaborative released guidance for how state and local leaders should manage their response, depending on their risk level.

“As this [pandemic] unfolded, a lot of us were waiting for the federal government to stand up and really produce… some practical guidance on how those at the state and local level should be responding,” says Graeden. But in the in the absence of that clear guidance, this collaboration aims to fill the void.

If a jurisdiction is at the green level, they’re on track for containing the virus. At yellow, a community should implement measures such as mask-wearing and social distancing and have an active program of testing, contact tracing and isolation — including targeted testing of those in high-risk environments. Orange is considered “dangerous,” and requires surging testing and contact tracing efforts — or if that’s not possible, may call for stay-home orders.

At the red level, “jurisdictions have reached a tipping point for uncontrolled spread” according to the collaborative’s guidance. At this level, “you really need to be back at a stay-at-home [advisory]” Graeden says.

Currently, two states — Arizona and Florida — are at the red level and 13 are orange. Only Hawaii is green. But there’s a great deal of variation county-by-county. In orange Texas, for instance, more than 20 counties are red.

The idea is to take some of the guesswork out of the policy response at a local level, says Graeden, and offer a more standardized way to communicate the risk and the response options.

“We’ve all modified our metrics to align more accurately across the different platforms,” she says. “We’re now communicating and all agreeing on the same basic thresholds for the types of actions that need to be taken. “

The shared metrics and guidance will be incorporated into a number of initiatives and sites focused on COVID-19 response, including Covidlocal.org, led by a group of disease outbreak experts and former public health officials, CovidActNow, led by former technology executives and a group of academics. The convergence group hopes to see it adopted more widely and used by local and state governments.



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A Doctor Confronts Medical Errors — And Systemic Flaws That Create Mistakes : Shots


Dr. Danielle Ofri, author of When We Do Harm: A Doctor Confronts Medical Error, says medical mistakes are likely to increase as resource-strapped hospitals treat a rapid influx of COVID-19 patients.

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Dr. Danielle Ofri, author of When We Do Harm: A Doctor Confronts Medical Error, says medical mistakes are likely to increase as resource-strapped hospitals treat a rapid influx of COVID-19 patients.

Justin Sullivan/Getty Images

For more than two decades as an internist at New York City’s Bellevue Hospital, Dr. Danielle Ofri has seen her share of medical errors. She warns that they are far more common than many people realize — especially as hospitals treat a rapid influx of COVID-19 patients.

“I don’t think we’ll ever know what number, in terms of cause of death, is [due to] medical error — but it’s not small,” she says.

Ofri’s new book, When We Do Harm, explores health care system flaws that foster mistakes — many of which are committed by caring, conscientious medical providers. She notes that many errors go unreported, especially “near misses,” in which a mistake was made, but the patient didn’t suffer an adverse response.

“Near misses are the huge iceberg below the surface where all the future errors are occurring,” she says. “But we don’t know where they are … so we don’t know where to send our resources to fix them or make it less likely to happen.”

Ofri says the reporting of errors — including the “near misses” — is key to improving the system, but she says that shame and guilt prevent medical personnel from admitting their mistakes. “If we don’t talk about the emotions that keep doctors and nurses from speaking up, we’ll never solve this problem,” she says.

Interview Highlights

On Ofri’s experience of making a “near miss” medical error when she was a new doctor

I had a patient admitted for so-called “altered mental status.” There was an elderly patient from a nursing home and they were sent in because someone there thought they looked a little more demented today than they looked yesterday. And of course, we were really busy. … And the labs were fine. The radiology was fine. And so I just basically thought, let me get this patient back to the nursing home. It’s all fine.

So I sent the patient to kind of an intermediate holding area to just wait until their bed opened up back at the nursing home. Well, it turns out that the patient was actually bleeding into their brain, but I missed it because I hadn’t looked at the CAT scan myself. Somebody said to me, “radiology, fine.” And so I took that at their word, and didn’t look at the scan myself as I should have.

Now, luckily, someone else saw the scan. The patient was whisked straight to the [operating room], had the blood drained and the patient did fine. So in fact, this was a near-miss error because the patient didn’t get harmed. Her medical care went just as it should have. But, of course, it was still an error. It was error because I didn’t do what I should have done. And had the patient gone home, they could have died. But, of course, this error never got reported, because the patient did OK. So we don’t know. It never got studied or tallied. So it was missed, kind of, in the greater scheme of how we improve things.

On the effect of having made that ‘near-miss error’ on Ofri’s subsequent judgement

In the short run, I think I was actually much worse, because my mind was in a fog. My soul was in a fog. I’m sure that many errors were committed by me in the weeks that followed, because I wasn’t really all there. I’m sure I missed the subtle signs of a wound infection. Maybe I missed a lab value that was amiss because my brain really wasn’t fully focused and my emotions were just a wreck [after that serious near-miss]. I was ready to quit. And so I’m sure I harmed more patients because of that.

Now that it’s been some time, it’s given me some perspective. I have some empathy for my younger self. And I recognize that the emotional part of medicine is so critical, because it wasn’t science that kept me [from reporting that near-miss]. It was shame. It was guilt. It was all the emotions.

On the source of medical errors in COVID-19 treatment early on in New York and lessons learned

We did pull a lot of people out of their range of specialties and it was urgent. But now that we have some advance warning on that, I think we could take the time to train people better. Another example is we got many donated ventilators. Many hospitals got that, and we needed them. … But it’s like having 10 different remote controls for 10 different TVs. It takes some time to figure that out. And we definitely saw things go wrong as people struggled to figure out how this remote control works from that one. And so trying to coordinate donations to be the same type in the same unit would be one way of minimizing patient harm.

The other area was the patients who don’t have COVID, a lot of their medical illnesses suffered because … we didn’t have a way to take care of them. But now we might want to think ahead. What do we do for the things that are maybe not emergencies, but urgent — cancer surgeries, heart valve surgeries that maybe can wait a week or two, but probably can’t wait three months?

On how patient mix-ups were more common during those peak COVID-19 crisis months in NYC

Dr. Danielle Ofri is a clinical professor of medicine at the New York University Medical School. Her previous books include What Doctors Feel.

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Dr. Danielle Ofri is a clinical professor of medicine at the New York University Medical School. Her previous books include What Doctors Feel.

Rogelio Esparza./Beacon

We had many patients being transferred from overloaded hospitals. And when patients come in a batch of 10 or 20, 30, 40, it is really a setup for things going wrong. So you have to be extremely careful in keeping the patients distinguished. We have to have a system set up to accept the transfers … [and] take the time to carefully sort patients out, especially if every patient comes with the same diagnosis, it is easy to mix patients up. And so, thinking ahead to what does it take to have enough time and space and resources to make sure that nobody gets mixed up.

On how the checklist system used in medicine was adapted from aviation

In the aviation industry, there was a whole development of the process called “the checklist.” And some people date this back to 1935 when a very complex [Boeing] B-17 [Flying] Fortress was being tested with the head of the military aviation division. And it exploded, and the pilot unfortunately died. And when they analyzed what happened, they realized that the high-tech airplane was so complex that a human being could not keep track of everything. And that even if he was the smartest, most experienced pilot, it was just too much and you were bound to have an error. And so they developed the idea of making a checklist to make sure that every single thing you have to check is done. And so it put more of the onus on a system, of checking up on the system, rather than the pilot to keep track of everything. And the checklist quickly decreased the adverse events and bad outcomes in the aviation industry.

And that’s been adapted to medicine, and most famously, Peter Pronovost at Johns Hopkins developed a checklist to decrease the rate of infection when putting in catheters, large IVs, in patients. And the checklist is very simple: Make sure the site is clean. Put on a clean dressing. Make sure you’re wearing the right PPE. Nothing unusual; it’s kind of like checklisting how to brush your teeth. Yet the rate of infections came right down and it seemed to be a miracle. Once you start paying attention to the steps of a process, it’s much easier to minimize the errors that can happen with it.

On how the checklist system did not result in improved safety outcomes when implemented in Canadian operating rooms

The problem is, once you have a million checklists, how do you get your work done as an average nurse or doctor? … They just get in the way of getting through your day. And so we just check all the boxes to get rid of it. And that’s what happened with this pre-op checklist in Canada. And, again, the preoperative checklist was making sure you have the right patient, the right procedure, the right blood type. Very simple. And [the checklist] showed impressive improvements in complication rates in hospitals — both the academic and high-end and even hospitals in developing countries. So, in 2010 the minister of health in Ontario mandated that every hospital would use it — plan to show an improvement in patient safety on this grand scale. And … the data did not budge at all, despite an almost 100% compliance rate. And that lets you know that at some point people just check the boxes to make them go away. And they’re not really gaming the system, per se, but it lets you know that the system wasn’t implemented in a way that’s useful for how health care workers actually work.

On why electronic medical records are flawed and can lead to errors

[Electronic medical records] really started as a method for billing, for interfacing with insurance companies and medical billing with diagnosis codes. And that’s the origin. And then it kind of retroactively was expanded to include the patient care. And so you see that difference now.

For example, … [with] a patient with diabetes … it won’t let me just put “diabetes.” It has to pick out one of the 50 possible variations of on- or off- insulin — with kidney problems, with neurologic problems and to what degree, in what stage — which are important, but I know that it’s there for billing. And each time I’m about to write about it, these 25 different things pop up and I have to address them right now. But of course, I’m not thinking about the billing diagnosis. I want to think about the diabetes. But this gets in the way of my train of thought. And it distracts me. And so I lose what I’m doing if I have to attend to these many things. And that’s really kind of the theme of medical records in the electronic form is that they’re made to be simple for billing and they’re not as logical, or they don’t think in the same logical way that clinicians do. And it’s very fragmented. Things are in different places. Whereas in the chart — in the old paper chart — everything was in one spot. And now they’re in many spots.

On her advice for how to stay vigilant when you’re a patient

Be as aware as you can. Now, of course, you’re busy being sick. You don’t necessarily have the bandwidth to be on top of everything. But to the best that you can, have someone with you, keep a notebook, ask what every medication is for and why you’re getting it. What are the side effects? And if people are too busy to give you an answer, remind them that that’s their job and it’s your right to know and your responsibility to know. And if you can’t get the information you want, there’s almost always a patient advocate office or some kind of ombudsman, either at the hospital or of your insurance company. You should feel free to take advantage of that.

The information in the chart is yours. You own it. And so if someone’s not giving you the time of day or the explanation, it’s your right to demand it. Now, of course, we recognize that people are busy and most people are trying their best. And you could certainly acknowledge how hard everyone’s working. But don’t be afraid to speak up and say, “I need to know what’s going on.”

Sam Briger and Thea Chaloner produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the Web.



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Kansas City officers fire shots towards vehicle that charged at them | News


KANSAS CITY, MO. (KCTV) — Kansas City police officers were forced to fire their weapons at a vehicle that was charging towards their direction on Monday evening.

Police say around 11:30 p.m. on Monday night, a vehicle drove towards police officers in the 7000 block of Winner Road, forcing officers to discharge their firearms.

The incident happened after police noticed the vehicle weaving in and out of traffic as it was heading westbound on Independence Avenue and Prospect.

A vehicle pursuit began when the driver refused to stop.

The driver continued to drive erratically eastbound on Independence Avenue.

The suspect was transported to the hospital with minor injuries and later released.

The injuries were to the suspect’s face and caused from glass of the window. 

He is currently in police custody.

No injuries were reported for the police officers.

KCTV5.com is now with you on the go! Get the latest news updates and video, StormTrack5 weather forecast, weather radar, special investigative reports, sports headlines and much more from KCTV5 News. 

>> Click/tap here to download our free mobile app. <<


Copyright 2019 KCTV (Meredith Corp.) All rights reserved.



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Arrest made after shots fired at Hartford officers | News


HARTFORD, CT (WFSB) – Following an extensive manhunt, Hartford police made an arrest after shots were fired at officers Tuesday evening.

The suspect, identified as 18-year-old Alijay Wallen, was arrested around 2:30 a.m. Wednesday after firing at officers.

It happened in the area of Capen and Vine streets just after 6 p.m. on Tuesday.

Just before the shooting, two officers in an unmarked vehicle were investigating and patrolling the area because there has been recent gun violence.

That’s when they saw Wallen, who started shooting at them.

The SUV was hit at least once, shattering the front passenger’s side window.

The officers were never hit and never fired back.

Police said nine shell casings were found at the scene.

People who live in the area were told to stay inside while officers searched for Wallen.

“The officers were looking at him for a while, he was a person of interest in that investigation, they were circling the block. He observed them and whether he felt spooked, or there was some other incidences going on with him,” Hartford Police Lt. Paul Cicero said.

He added that Wallen is known to them, in regards to street gangs in the area.

Police found Wallen early Wednesday morning at his girlfriend’s home in Manchester.

No officers were injured, but they were brought to the hospital to be evaluated. 

Copyright 2019 WFSB (Meredith Corporation). All rights reserved.



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‘Put some in the river:’ $20K cash bond for man accused of firing shots in Estabrook Park


Geoffrey Graff

Data pix.

MILWAUKEE — Geoffrey Graff, 41, of Milwaukee appeared in court for the first time Saturday, Nov. 23 after charges were filed Friday in the wake of authorities finding two underground shelters near Estabrook Park on Wednesday morning, Nov. 20. Inside those shelters, prosecutors said investigators found a stash of firearms and ammunition.

Graff faces one count of second degree recklessly endangering safety, use of a dangerous weapon, and one count of possession of a short-barreled shotgun.

In court on Saturday, probable cause was found for further proceedings. Cash bond was set at $20,000. Graff was ordered to have no contact with Estabrook Park and Milwaukee Area Technical College. MATC owns the land where the bunkers were found. Additionally, Graff was prohibited from possessing weapons. A preliminary hearing was scheduled for Dec. 3.

Geoffrey Graff

The bunkers Graff is accused of maintaining were found after multiple law enforcement agencies responded to a report of shots fired in the area near E. Capitol Drive and the Estabrook Park Wednesday morning, Nov. 20.

Shelter uncovered near Estabrook Park

A criminal complaint said a University of Wisconsin-Milwaukee police sergeant responding to the scene came upon Graff, who “appeared to be in distress.” Graff said he was searching for his missing German Shepherd, and believed police or the previous owner had taken the dog. The sergeant said he would keep an eye out, but needed to attend to another matter. Graff then said, “I fired off three rounds into the river with my nine millimeter.” Graff was handcuffed. The complaint made reference to the fact that this was a congested area — with commuters and pedestrians present. According to prosecutors, Graff told investigators he had been looking for his dog and, “Put some in the river,” admitting to firing the shots due to his frustration over losing his dog. The complaint said Graff refused to say whether anyone had been struck and injured, and a search ensued.

Shelter uncovered near Estabrook Park

A witness walking his dog in the park said he would see Graff often on the trails, and noted Graff had, “Waved guns in the past.” He led investigators to the two bunkers — the first one appearing caved in an abandoned, the complaint said. At the second, investigators found garbage and debris, with plywood and a tarp covering the pit, and a trap door in the ground, which revealed a rudimentarily constructed bunker — with a 9mm casing found on the floor. A deputy entered the bunker to see whether there was anyone shot or injured inside. Prosecutors said investigators found the following in the bunker after obtaining a search warrant:

  • Single barrel, short-barrel shotgun
  • 9mm semi-automatic handgun in the “lock back position”
  • .22 caliber Marlin rifle
  • Mossberg 12 gauge shotgun
  • Numerous rounds of ammunition
  • Several shotgun stocks and barrels
  • Riflescope
  • Archery bow and six arrows
  • Three knives

Shelter uncovered near Estabrook Park

According to prosecutors, as he was being handcuffed, Graff told investigators he, “Could’ve cleared [the police] pretty easily if I wanted to,” and said, “So you’re not even gonna ask me where the SKS is with the magazines sitting around there that you couldn’t find?” The complaint said he refused to provide information on the SKS, and would only do so depending on when he would be released from custody, telling investigators, “We wouldn’t want that slipping into the wrong hands.”

During an interview with investigators, Graff said, “I know you are here to pick my brain,” and said had been using the structure for seven or 10 years, and there was a short-barrel in the structure. He said he knew law enforcement was looking for the SKS, and he knew he was gonna catch a felony charge. He admitted to firing shots, and said, “You’ve got an active shooter and you wanna run around with your (expletive) lights on,” telling investigators not to worry about the shots because he was shooting in the river. He said UWM police, “Should have shut down the street because one of those innocent college kids could have been shot.” Graff also admitted, “They could stop looking for the shooter because it was him,” the complaint said.

Court records showed Graff has been in the system for years. In 2009, he was cited for causing a disturbance by riding down the street on a bicycle with eight German Shepherd dogs running alongside him. In 2012, he was accused of getting into a scuffle with officers trying to detain him.

The Milwaukee County Sheriff’s Office released this statement following Graff’s initial court appearance:

“On the morning of Wednesday, November 20, the Milwaukee County Sheriff’s Office, the Milwaukee Police Department, the Shorewood Police Department, and the UWM Police Department responded to a report of shots fired in the vicinity of E. Capitol Dr. and Estabrook Parkway. The suspect, later identified as Geoffrey Graff, was arrested, and shelters associated with Mr. Graff were recovered in MATC-owned land on the west bank of the Milwaukee River.”

“Mr. Graff appeared in court today on felony charges of 2nd Degree Recklessly Endangering Safety and Possession of a Short-Barreled Shotgun. Commissioner Cedric Cornwall set his cash bail at $20,000. If Mr. Graff posts the specified $20,000 cash bail and is released pending the resolution of his case, a no-contact order will preclude him from contact with the Milwaukee Area Technical College and Estabrook Park, and from entering a geographic area bounded on the west by N. Holton St., on the east by N. Wilson St., which forms the eastern border of Estabrook Park, on the north by Hampton Ave., and on the south by Capitol Dr. The conditions of Mr. Graff’s release also specify supervision by Justice Point pre-trial services and preclude him from the possession of firearms.”

“Mr. Graff’s preliminary hearing is set for Tuesday, December 3, 2019.”

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10 hospitalized after insulin administered instead of flu shots



Eight of the patients were residents of Jacquelyn House and two were employees, Sgt. Jim Warring, with Bartlesville Police Department told CNN. The facility serves intellectually and developmentally disabled people, according to the website of AbilityWorks, the company that owns the eight-resident site.
EMS and fire crews responding Wednesday afternoon “found … multiple unresponsive people,” police Chief Tracy Roles said during a news conference covered by CNN affiliate KTUL.

Most patients’ suffering symptoms after the medication was administered “were not able to explain the issues,” Warring said. “Many of them are not vocal and not able to walk.”

“All these people are symptomatic, lying on the ground, needing help, but can’t communicate what they need,” Roles said. “That’s why I give a lot of praise to the fire and EMS staff for doing an outstanding job of identifying the problem.”

The pharmacist who injected the insulin was a contractor and went to the facility on Wednesday to administer the flu shot to residents and employees, Rebecca Ingram, CEO of AbilityWorks of Oklahoma, said in a statement.

Ingram said all people who received the injection had reactions and were taken to Jane Phillips Hospital in Bartlesville.

Several remained hospitalized Thursday due to the long-acting insulin that was administered, police said.

Ingram didn’t discuss whether the residents and employees were injected insulin but said authorities were investigating the “cause of the reactions to the injections.”

“I’ve never seen where there’s been some sort of medical misadventure to this magnitude,” Roles said. “But again, it could have been a lot worse. Not to downplay where we are, but thinking about where we could be, it could certainly have been very, very tragic.”

Tony D. Sellars, director of communications for the Oklahoma State Department of Health, said his agency will review the facility’s report on the incident “to determine if we need to follow up or if their action was sufficient.”

“There is no reason to suggest at this point that the facility should have had a reasonable suspicion that this sort of error would occur or be preventable on their part,” Sellars said.

An investigation was still underway on Thursday.

CNN’s Nicole Chavez contributed to this report.



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