September 28, 2022

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NEW YORK (AP) — When the U.S. strike 1 million COVID-19 deaths on Monday, the news was driven by a federal government tally derived from loss of life certificates.

But which is not the only tally. And you may perhaps be pondering, where do these numbers arrive from? A search powering the information:

Fatalities certificates have lengthy been thought of the most detailed record of deaths and their brings about. The Centers for Disorder Command and Prevention systematically collects information from all 50 states to monitor fatalities from all results in, like cancer, drug overdoses and now COVID-19.

But early in the pandemic, officers regarded the COVID-19 details was sluggish and incomplete.

Tests was generally unavailable. In some areas — specifically rural types — coroners or health-related examiners did not have the team to ask about coronavirus signs when folks died at home. Even when details was obtainable, overworked doctors could be gradual to do the dying certificate paperwork.

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With information and facts on death certificates gradual to arrive, specialists and information organizations commenced wanting to other serious-time resources of fatalities.

They turned to state wellbeing division tallies derived from preliminary reviews that had been mainly of folks diagnosed with COVID-19 who went to a clinic and died. These kinds of info was extra timely than loss of life certificates, which can take weeks to fill out and process.

Johns Hopkins College became a leader in looking point out health and fitness office web sites and promptly analyzing and publishing individuals figures.

Other companies have their individual counts, like NBC News, which two months in the past noted that the U.S. had surpassed 1 million COVID-19 deaths, but did not reveal in its story how it arrived at that determine.

Very last 7 days, federal officials issued statements about the nation hitting 1 million fatalities, even while the U.S. government’s personal data had however to display it. Primarily based on lags in the reporting of loss of life certification data, officials concluded it was most likely the milestone had passed and that it was acceptable to remark on it.

HOW THE TALLIES HAVE Transformed

As the pandemic dragged on, several states reduce back again on submitting case and death numbers — some to just the moment a week.

“We’ve missing a whole lot of immediacy in our reporting.” Emily Pond, a Johns Hopkins exploration data analyst, explained in an email.

At the exact time, the figures dependent on death certificates rose speedier. One particular purpose: Investigators have been going again and incorporating numerous thousand fatalities in which COVID-19 was not named to begin with but was identified later on following autopsies or other health-related investigations, stated Robert Anderson, who oversees dying information for the CDC’s Nationwide Middle for Health Figures.

Most of these deaths transpired early in the pandemic, when COVID-19 was however new and underdiagnosed. Anderson said several were being relabeled final year, largely

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3 min read

Claudia and Jesús Fierro of Yuma, Ariz., review their medical bills. They pay $1,000 a month for health insurance yet still owed more than $7,000 after two episodes of care at the local hospital.

Lisa Hornak for Kaiser Health News


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Lisa Hornak for Kaiser Health News


Claudia and Jesús Fierro of Yuma, Ariz., review their medical bills. They pay $1,000 a month for health insurance yet still owed more than $7,000 after two episodes of care at the local hospital.

Lisa Hornak for Kaiser Health News

The Fierro family of Yuma, Ariz., had a string of bad medical luck that started in December 2020.

That’s when Jesús Fierro Sr. was admitted to the hospital with a serious case of COVID-19. He spent 18 days at Yuma Regional Medical Center, where he lost 60 pounds. He came home weak and dependent on an oxygen tank.

Then, in June 2021, his wife, Claudia Fierro, fainted while waiting for a table at the local Olive Garden restaurant. She felt dizzy one minute and was in an ambulance on her way to the same medical center the next. She was told her magnesium levels were low and was sent home within 24 hours.

The family has health insurance through Jesús Sr.’s job, but it didn’t protect the Fierros from owing thousands of dollars. So when their son Jesús Fierro Jr. dislocated his shoulder, the Fierros — who hadn’t yet paid the bills for their own care — opted out of U.S. health care and headed south to the U.S.-Mexico border.

And no other bills came for at least one member of the family.

The patients: Jesús Fierro Sr., 48; Claudia Fierro, 51; and Jesús Fierro Jr., 17. The family has Blue Cross and Blue Shield of Texas health insurance through Jesús Sr.’s employment with NOV, formerly National Oilwell Varco, an American multinational oil company based in Houston.

Medical services: For Jesús Sr., 18 days of inpatient care for a severe case of COVID-19. For Claudia, fewer than 24 hours of emergency care after fainting. For Jesús Jr., a walk-in appointment for a dislocated shoulder.

Total bills: Jesús Sr. was charged $3,894.86. The total bill was $107,905.80 for COVID-19 treatment. Claudia was charged $3,252.74, including $202.36 for treatment from an out-of-network physician. The total bill was $13,429.50 for less than one day of treatment. Jesús Jr. was charged $5 (70 pesos) for an outpatient visit that the family paid in cash.

Service providers: Yuma Regional Medical Center, a 406-bed nonprofit hospital in Yuma, Ariz. It’s in the Fierros’ insurance network. And a private doctor’s office in Mexicali, Mexico, which is not.

What gives: The Fierros were trapped in a situation in which more and more Americans find themselves. They are what some experts term “functionally uninsured.” They have insurance — in this case, through Jesús Sr.’s job, which pays $72,000 a year. But their health plan is expensive, and they don’t have the liquid savings to pay their share of

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3 min read

Three generations, (from left to right) grandmother Genoveva Calloway, daughter Petra Gonzales, and granddaughter Vanesa Quintero, live next door to each other in San Pablo, Calif. Recently their extended family was hit with a second wave of COVID infections a year after the first.

Beth LaBerge/KQED


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Three generations, (from left to right) grandmother Genoveva Calloway, daughter Petra Gonzales, and granddaughter Vanesa Quintero, live next door to each other in San Pablo, Calif. Recently their extended family was hit with a second wave of COVID infections a year after the first.

Beth LaBerge/KQED

On a Friday afternoon in early October this year, 8-year-old Maricia Redondo came home from her third grade class in the San Francisco Bay Area with puffy eyes, a runny nose and a cough.

“On Saturday morning we both got tested,” says Vanessa Quintero, Maricia’s 31-year-old mother. “Our results came back Monday that we were both positive.”

Vanessa stared at her phone in shock and called her doctor’s test-result hotline again, in disbelief. “This is wrong,” she thought. “I hung up and dialed again. It’s positive. This is wrong. I hung up again. And then I did it again!”

She was freaking out for two reasons. First, her large, extended family had already fought a harrowing battle against COVID-19 last year — in the fall of 2020. The virus had traveled fast and furious through their working class neighborhood back then, in the East Bay city of San Pablo. Four generations of Vanessa’s family live next door to each other in three different houses there, all connected by a backyard.

Vanessa was also terrified because she couldn’t fathom another round of treatment against a more dangerous variant than she’d faced before. The pandemic has disproportionately struck Latino families across the United States, and delta is currently the predominant variant in the U.S., according to the U.S. Centers for Disease Control and Prevention. It’s twice as contagious and may cause more severe illnesses than previous variants in unvaccinated people.

The family’s bad luck was uncanny. Research suggests immunity against a natural infection lasts about a year. And here it was almost exactly the same time of year and the family was fighting COVID-19 again.

“Reinfection is a thing,” says Dr. Peter Chin-Hong, a specialist in infections diseases and professor of medicine at the University of California, San Francisco. “It probably manifests itself more when the variant in town looks different enough from the previous variants. Or enough time has elapsed since you first got it, [and] immunity has waned.” He says a second infection is still not common, but doctors are starting to see more cases.

Computer models in a recent study suggest that people who have been infected by the virus can expect a reinfection within a year or two if they do not wear a mask or receive a vaccination. The findings show that the risk of a second bout rises over time. A person has a 5% chance

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3 min read

Fact: A full-body strength workout doesn’t need to be overly long or filled with complicated exercises in order to be effective. This four-move, total-body routine proves you can hit every major muscle group without spending hours in the gym doing a million different exercises.

“I’m a huge believer in the minimum effective dose,” ACE-certified personal trainer Sivan Fagan, C.P.T., owner of Strong With Sivan, tells SELF. That means focusing on the quality of a workout rather than the quantity as a way to get the most bang-for-your-exercise-buck and progress towards your goals.

Focusing on quality is really about having good form and giving your best effort, no matter how long your workout is. With this approach, you can get super solid results while saving yourself time and energy and reducing your risk of injury, says Fagan.

One easy way to get a quick-yet-effective total-body workout? Incorporate compound movements, which are exercises that involve multiple joints and stimulate large muscle groups. Compared to isolation movements, which target just one muscle, compound movements are a great choice for getting a lot done in a short period of time. And if you pick compound exercises that follow the four major movement patterns—hinging, squatting, pressing, and pulling—your workout becomes that much more efficient and functional.

Including unilateral exercises is another solid way to get the most from a workout when you want to keep it simple. Unilateral exercises require you to rely on the strength of just one limb to perform a movement, which means they often feel more intense than bilateral moves (moves done with two limbs). And because unilateral work demands balance, your core has to fire more too, in order to keep you stable and resist bending or rotating, as SELF previously reported.

The following four-move dumbbell workout, which Fagan created for SELF, checks all of these boxes. It hits the major movement patterns with compound moves and incorporates lots of unilateral work too, so you can smoke every major muscle group in your body in a short amount of time.

Depending on your fitness level, you can do this routine two to three times a week, either as a standalone routine or as part of a larger workout. One easy way to add it to a larger workout? Combine it with some shorter core and/or shoulder work, says Fagan (though you certainly don’t need to add on; this is a super-solid workout by itself). However you choose to do this routine, make sure to pencil in enough rest in between sessions so your muscles have enough time to recover—scheduling at least 48 hours of downtime is a good general rule of thumb.

Also important: Before jumping into this routine, do a quick warm-up to mobilize your joints and activate your muscles. Several minutes of moves like pull-aparts, arm swings, squats, and striders can do the trick, says Fagan. (You can also try this five-minute dynamic warm-up here.)

Then, when doing the actual workout, be sure to give it your

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