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MCLEANSBORO (WSIL) — This weekend will be the final race of the year for our cross country runners.

For a local pair of athletes, they realize it’s their time to shine.

Competition brings out the best in athletes. Hamilton County’s Maddie Karcher hasn’t lost a race all year. She knew she’d have to run her best to top Benton at Regionals, and she did just that winning with a time of 19:28.

“I usually never like to look behind me in a race, Karcher said. “Focus what’s in front of me and go for it so whenever we had a turn over there it was kind of a hairpin turn around a pole and I could kind of glance over and see how far and I knew I had a few feet on them but I also knew they could also sprint so I knew I had to kick it the last half mile, quarter mile for sure and once we got on the track I knew I had to give it everything I had.”

Carmi White’s Ty Barbre is a runner we haven’t talked much about but he’s a good one. The Bulldogs senior finished second with a fast time of 15:55. Following the race, the competitior in Barbre already had him thinking strategy for sectionals.

“I tried to rely on my kick but I went out way too slow because I went out with the pack but I should’ve just trusted my pace and went out 5:05, 5:10 and could’ve gotten a lot more more momentum going but starting off as slow as I did, I couldn’t pick it up so that’s where I got to improve from regionals to sectionals,” Barbre said. “I’ve got to run my race regardless of what everyone else does.”

The temperature dropped dramatically for regionals but the cold weather plays into Karchers favor.

“My body just never hurts as bad and I feel like I have that extra boost of energy and I’m not worried about sweating and a nice cool day is what I love,” Karcher said.

Karcher gets the attention but the Hamilton County girls are a strong team. They suffered their first loss to Benton at Regionals but the entire team advanced to Sentionals.

“We have three or four new girls that have not run with us in the past, they came out and they worked hard and they were awesome additions to our team and we’ve worked hard all year and I’m just so super proud of our girls.”

Carmi White’s Barbre is quite the athlete. Excels in basketball, finished third in the 1A golf sectionals and is about to write the final chapter of his high school cross country career. The dedication and commitment is like no other.

“The fall is brutal, I’m not going to lie,” Barbre said. “It’s probably why I’m not going to do two sports in college, it’s proven it’s hard for me to keep up but it’s pretty crazy. You wake up at 5 to run and you are getting in 40 miles in a week and on top of that you golf until dark if you are a devoted golfer, care about it, practice enough so we’re talking 5-7 o’clock I’m at work with school in between, no time to sit at home, relax so it’s been a crazy schedule this fall for sure but this past week I’ve been able to go home and rest because I don’t have golf any more so that’s been pretty nice but it gets pretty hectic, it gets really crazy.”

So could this be the last time Ty races competitively? Which sport is he going to compete in at the collegiate level?

“I’m leaning more towards golf honestly because it would be so much easier on my body but it’s hard to give up running because I’m competitive for sure and I just love winning. It’s my favorite part of it. Running you can control everything, you are in control of everything besides injuries maybe but in golf there are so many outside factors, there is a little more luck involved in it. That’s the hard part, again I love running but it’s going to be so hard on my body so I’m leaning towards golf in college I’d say.”

Months into a crisis that highlighted flaws in the global supply chain, concerns around personal protective equipment still linger for healthcare providers. Thankfully, the pain today isn’t as acute.

Hospitals are in a much better position now than at the beginning of this year. They’ve sourced through new channels, begun stockpiling efforts and used newly approved sanitization methods to lengthen the life of existing gear.

But industry experts say the remedies are Band-Aids for a bigger problem, as flu season looms and COVID-19 hot spots re-emerge, posing broader questions about the fragility of the global healthcare supply chain.

Stockpiles abound with no coordinated strategy

The federal government’s emergency stockpiles maintained for times of crisis fell short when demand surged this spring, relegating hospitals to ramp up their own efforts.

Three-quarters of hospital staff responding to a recent survey from group purchasing organization Premier said accessing the Strategic National Stockpile through their state was complicated, confusing and overly bureaucratic.

Since then, hospitals have focused on building up their own PPE inventories, at the same time as government agencies replenish their reserves in preparation for the fall and winter.

The competing stockpiles are one of the Band-Aids for the current supply chain problems, Chaun Powell, group vice president for disaster response at Premier said.

“Frankly, those stockpiles place an additional burden on the supply chain in the near term, as it has taken products out of circulation to be used to deliver patient care to be put into stockpiles to prepare for the fall,” Powell said.

In Premier’s survey, respondents expressed concern that stockpiling efforts among hospitals and government agencies are lacking a coordinated strategy, and said there is currently no mechanism to transparently share inventory levels or create standards for how, when and why to access a stockpile.

At the same time, New York passed a law this year requiring hospitals maintain 90 days worth of PPE on hand. California passed a similar law requiring hospitals stock enough PPE to operate through 45 days at surge capacity levels. Those mandates are likely to increase supply shortages and drive up costs to hospitals, according to a paper from Premier.

Premier estimates a 90-day supply of PPE for a 350-bed hospital takes up around 5,700 square feet — roughly the size of 13 to 15 tractor trailers, and could cost up to $2 million.

Prior to the pandemic, hospitals often carried very low PPE inventory themselves, relying instead on distributors, Eugene Schneller, professor of supply chain management at Arizona State University’s W. P. Carey School of Business, said.

He thinks the mandates in New York and California will be burdensome for hospitals.

“I mean, I think it can be managed, but I don’t think it could be managed at the hospital level,” Schneller said. “You don’t want to buy it all at once, because then it expires all at once, so you want to be able to rotate those stocks.”

“It gets into the issue of you know, it is shifting, in a sense, the responsibility of the national stockpile to the individual hospital,” Schneller said.

How hospitals are handling it now

When demand for PPE skyrocketed earlier this year, health systems were forced to quickly adapt. Some had to find the space to put the supplies and the people to move it all.

Sacramento-based Sutter Health initially had an “urgent request process,” prompting units throughout the 24-hospital system to fill out a form saying they were on the verge of stocking out.

“We realized pretty quickly that was a very reactive process, right, and also a little bit expensive as you’re hiring couriers and FedEx to move stuff around the system,” Lee Ayers, senior director of supply chain operations and logistics for Sutter, said.

Once shortages started to ease, Sutter converted two of its already-existing warehouses into stockpiles for distribution across the system. Rather than wait for urgent requests to come through, it began pushing weekly quantities based on previous demand, Ayers said.

Some other regionally-based systems employed self-distribution models already, before the pandemic caused major disruptions, like Pennsylvania-based Geisinger Health.

The 13-hospital system invested in a central inventory and logistics warehouse close to its flagship hospital years ago, Kate Polczynski, VP for enterprise supply chain services at Geisinger, said.

“Unlike some of my colleagues whose first step was to go find space, we were very fortunate that we had a warehouse that we could utilize,” Polczynski​ said.

Utah-based Intermountain Health also employed a self-distribution model before the pandemic, distributing supplies across its 24 hospitals and other clinics from a centrally located warehouse.

After the worst this spring, PPE consumption has slowed significantly, John Wright, vice president of supply chain and support services for Intermountain, said. But demand is only increasing as systems and other players continue stocking up, rendering individual actions futile if extreme shortages return. 

“I’ll be frank with you, we are concerned,” Wright said. “We have concerns just in our manufacturers’ abilities to keep up with demand on a global basis. Because it’s a global issue. It’s not a regional issue, or even a U.S.-based issue.”

Polczynski of Geisinger shared similar concerns.

“It’s not just the activity going on in my state, or my region, that’s going to influence my success in securing products,” Polczynski said. “Because what’s happening in Europe is also impacting my success here in Pennsylvania.”

Flu season looms

Despite those worries, some systems say they are doing all they can to prepare for the worst this winter and feel confident about their new strategies.

Many are employing artificial intelligence and other new technology, using data to track burn rates (how quickly facilities burn through supplies), and better manage resources going forward.

Ayers with Sutter said he monitors his systems’ data dashboard daily and pre-purchased “a lot of needles, a lot of syringes and alcohol pads, different things that we know we receive spikes in for flu season in particular.”

But flu season layered on top of the pandemic remains a big unknown.

Demand through the fall will significantly impact whether PPE shortages are over, Powell with Premier said.

“How much complexity of layering flu season on top of COVID is that going to bring to our testing capacity, and then with that, are we going to have ample supplies to protect our front-line caregivers, such that we won’t have to cancel elective procedures?” Powell said.

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JOHNSON COUNTY, KS (KCTV) — With potential snowfall in the forecast for next week, it’s important that people get their vehicles equipped for the changing weather.

That’s why it’s important to not only prepare the interior but also the exterior of your vehicle for winter.

Most of the handy items for the exterior of a vehicle will focus on your windshield, starting with de-icer,

“Just a few pumps of the de-icer spray on your windshield and it clears up pretty quick,” says Joe Drake the store leader at O’Reilly Auto Parts in Shawnee.

Drake says don’t use hot water to clear ice because it can break your windshield. 

If you don’t have the liquid you can do things the old-fashioned way, with an ice scraper.

“One like this has an ice scraper on this side and then a brush on this one so you can brush off the car and get to that ice and snow if it’s built up there,” says Drake.

If you want to skip the liquid and the scraping, you can get a windshield cover.

“Put the cover on the night before and then just put it through your doors and just peel that ice off in the morning,” says Drake.

“If the ice builds up on the key slot, there’s a de-icer for that, and last but not least if you get stuck in snow, you can use ice melt,” says Drake.

Officials say with the temperatures dropping you should always be prepare your vehicles.

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A great number of cryptocurrency businesses are preparing for the upcoming Financial Action Task Force (FATF) rules toward cryptocurrencies, specifically the Travel Rule. This month 25 Virtual Asset Service Providers (VASPs) published a paper that outlines how American-based VASPs aim to comply with the FATF Travel Rule.

Digital currency companies, otherwise known as Virtual Asset Service Providers (VASPs) in the eyes of global regulators are concerned about regulation and compliance this year. In fact, in the recent report written by the Digital Currency Group (DCG), the survey’s findings indicate over 150 crypto executives said regulation is the top concern. Currently, a great number of crypto firms are drawing up plans in order to comply with the Travel Rule.

The ‘Travel Rule’ is a descriptive label for the Bank Secrecy Act (BSA) rule [31 CFR 103.33(g)]. Basically, the rule mandates that all companies that deal with finances have to pass on transmission data like KYC/AML to the next financial institution. “The funds’ transfer rules are designed to help law enforcement agencies detect, investigate and prosecute money laundering and other financial crimes by preserving an information trail about persons sending and receiving funds through funds transfer systems,” financial regulators explain.

Back in June 2019, FATF had published the “Interpretive Note to Recommendation 15,” which mandates that VASPs have to comply with the regulator’s Anti-Money Laundering (AML) and Combating the Financing of Terrorism (CFT) guidance. The recommendation from FATF concerning digital currency businesses also clarified that VASPs also must comply with the Travel Rule.

More recently, the Financial Action Task Force (FATF) published its FATF Plenary on June 30, 2020. The documents show that cryptocurrency businesses would get a 12-month extension in order to become compliant with the Travel Rule. The rule will apply to VASPs when clients transfer funds exceeding $3k, and the VASPs will be required to share KYC/AML information about the service’s clientele.

FATF’s Travel Rule has sparked the creation of the United States Travel Rule Working Group (USTRWG) which recently published a paper called the “Travel Rule Solution” version one.

The USTRWG paper notes that the working group acknowledges that the regulatory landscape is constantly changing and still evolving globally. The group’s paper dated “October 2020” gives great detail into how these specific U.S. VASPs plan to comply with the Travel Rule.

“The ultimate objective of the USTRWG is to solve the industry’s three key components to Travel Rule compliance applied to the virtual currency industry: (1) governance, (2) reliable counterparty identification, and (3) secure data transmission,” the USTRWG paper reveals.

“The USTRWG solution addresses these functions by proposing: (1) a governance structure to facilitate the formation of a trusted VASP network, (2) a centralized “bulletin board” mechanism to enable identification of transaction counterparties, and (3) an encrypted, point-to-point communication channel to securely transmit required Travel Rule information between VASPs,” the paper’s authors add. Of course, the USTRWG understands that the solution and phased approach will develop differently in a myriad of global jurisdictions.

The USTRWG paper further states:

The solution aims to address the governance, technology, and security needs presented by Travel Rule compliance. The solution initially addresses the U.S. Travel Rule requirements and will evolve over time through a phased approach to enable compliance across different jurisdictions.

USTRWG’s attempt to comply isn’t set in stone and it is uncertain if regulators would approve such coordination. With the 12-month extension, VASPs are expecting the FATF’s Travel Rule to go into effect by June 2021. USTRWG’s paper says that the working group is very “committed to effectively implementing the Travel Rule solution.”

Moreover, the working group details that future USTRWG publications will explain how things are going and evolving within the VASP community.

“Ultimately, the vision and objective of the USTRWG and the proposed solution is to build a VASP network to standardize the VASP discovery/identification process and transmission of Travel Rule data across multiple regulatory regimes in a compliant and secure manner,” the paper’s authors add.

What do you think about the upcoming Travel Rule and the recently formed USTRWG? Let us know what you think about this subject in the comments section below.

Image Credits: Shutterstock, Pixabay, Wiki Commons, The USTRWG white paper,

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Black preppers are real.

According to the National Park Service, as early as 1866, when the law stated that Blacks were allowed to benefit from the Homestead Act signed by Abraham Lincoln, homesteading became the entry way for Blacks to build their own self-sufficient communities in the Great Plains.  Unfortunately, this bit of history is dismissed and in danger of being lost.  Recently, the New York Times published a pandemic-inspired story called I’m Not A Housewife, I’m a Prepper, that some may argue painted a superficial image of a lifestyle with deep historical roots that people of color, particularly Black slaves, had no choice but to adopt and make stretch the scraps they were given to nourish and heal their bodies. 

Today, prepping has created popular images from the suburban housewife pressure canning meat to the hipster bulk buying frozen kale to – possibly the most popular image – the bearded white survivalist living in a bunker. Prepping, in its plainest language, boils down to owning your housing, providing your own security and growing your own food. It goes far beyond toilet paper and Lysol. 

Black homesteader and prepper Sharon Ross, is owner of Afrovivalist, a platform that teaches others to be fully self-reliant and independent, and one of the leaders in a space that more Black people want to embrace again.

Maryann Reid: Homesteaders are often seen as the “original preppers”. What is the difference between homesteading and prepping? 

Sharon Ross: I feel that the homesteader is a prepper because the homesteader stores food and supplies also like a prepper does. A homesteader is a person who wants to live a self-sufficient and nontraditional lifestyle outside of the cities. Some live off-grid, in the forest or on a farm or ranch. Most preppers live in a city or suburban lifestyle who also store food and supplies to survive a disaster.  

Reid: Preppers are often depicted in the media as racist, white, or poor. How has being a Black female prepper changed your life?

Ross: Being a Black prepper, has changed my life because it provides me with a sense of security. Prepping is my life insurance. In the past, I have been called crazy, a conspiracy theorist, and I have lost friends because of my new lifestyle. But now that we are in a global pandemic, I am no longer crazy. 

Reid: How have Black women prepped before it was “in style”? 

Ross: My grandmother would have eggs in a bucket with hay in it and put them in the root cellar until she was able to sell them.  Unfortunately, before Covid-19, prepping was not popular among my community. But that has now changed and there are more women prepping. Everyone has gotten use to the convenience of fast paced service everywhere. Covid-19 caught a lot of people off guard and they were not prepared to be sheltered in place for three months. Now, they realize that our lives could change at any moment. Thank goodness people are getting prepared.

Reid: What are we missing these days that prepping is looked down upon and week to week living is praised?

Ross: Alot of people are missing the fact the we are on the verge of being in a war. The situation with China and Taiwan is escalating to become a war. It is my opinion that once they start battling, it will not stay on Taiwan or China shores. Their war may come the United States soil. Which is another reason we need to prepare.

Reid: You live in Oregon and Washington. What is the Black prepper community like there?

Ross: It is my opinion that there are not enough Black preppers. Honestly, there are not enough people of color prepping outside of African descent either. It is important that everyone prepares for the unexpected disaster. Now, that Covid-19 is here, that has changed. People of color are waking up to the reality of needing to be prepared.

Reid: Why is now an important time for Black people to learn about their prepper roots?

Ross: It is very important that we as Black people return to our roots. Our ancestors have been preppers and we need to prepare for the upcoming civil unrest and possible war. When we experienced natural disaster, it has become clear that the community of people of color are the last to receive funds, and supplies to survive, therefore, we have to prepare for ourselves.

Reid: If someone can only do one thing to make prepping a part of their lifestyle what would that be? 

Ross: Store water and learn how to purify water. Water is life. We can only survive three days without it.

Reid: How can someone get started in prepping? 

Ross: People can start prepping by starting in their kitchen. Look for long shelf-life foods like noodles, rice, beans and canned foods. In addition, start attending prepper groups in your community to be able to have a better understanding of what to prepare for in your region. Please feel free to take a look at my website, www.afrovivalist.com and my social media sites.

Reid: What’s next for you?

Ross: I am working on deCamp Outdoors for next year, a preparedness outdoor camp to focus on preparing your pantry, how to evacuate, start a fire and more. This country is going through changes and they will get worse before it gets better. It is very important not to panic. Prepare at your own pace and set a prepping budget and pay down your current debt.

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Black preppers are real.

According to the National Park Service, as early as 1866, when the law stated that Blacks were allowed to benefit from the Homestead Act signed by Abraham Lincoln, homesteading became the entry way for Blacks to build their own self-sufficient communities in the Great Plains.  Unfortunately, this bit of history is dismissed and in danger of being lost.  Recently, the New York Times published a pandemic-inspired story called I’m Not A Housewife, I’m a Prepper, that some may argue painted a superficial image of a lifestyle with deep historical roots that people of color, particularly Black slaves, had no choice but to adopt and make stretch the scraps they were given to nourish and heal their bodies. 

Today, prepping has created popular images from the suburban housewife pressure canning meat to the hipster bulk buying frozen kale to – possibly the most popular image – the bearded white survivalist living in a bunker. Prepping, in its plainest language, boils down to owning your housing, providing your own security and growing your own food. It goes far beyond toilet paper and Lysol. 

Black homesteader and prepper Sharon Ross, is owner of Afrovivalist, a platform that teaches others to be fully self-reliant and independent, and one of the leaders in a space that more Black people want to embrace again.

Maryann Reid: Homesteaders are often seen as the “original preppers”. What is the difference between homesteading and prepping? 

Sharon Ross: I feel that the homesteader is a prepper because the homesteader stores food and supplies also like a prepper does. A homesteader is a person who wants to live a self-sufficient and nontraditional lifestyle outside of the cities. Some live off-grid, in the forest or on a farm or ranch. Most preppers live in a city or suburban lifestyle who also store food and supplies to survive a disaster.  

Reid: Preppers are often depicted in the media as racist, white, or poor. How has being a Black female prepper changed your life?

Ross: Being a Black prepper, has changed my life because it provides me with a sense of security. Prepping is my life insurance. In the past, I have been called crazy, a conspiracy theorist, and I have lost friends because of my new lifestyle. But now that we are in a global pandemic, I am no longer crazy. 

Reid: How have Black women prepped before it was “in style”? 

Ross: My grandmother would have eggs in a bucket with hay in it and put them in the root cellar until she was able to sell them.  Unfortunately, before Covid-19, prepping was not popular among my community. But that has now changed and there are more women prepping. Everyone has gotten use to the convenience of fast paced service everywhere. Covid-19 caught a lot of people off guard and they were not prepared to be sheltered in place for three months. Now, they realize that our lives could change at any moment. Thank goodness people are getting prepared.

Reid: What are we missing these days that prepping is looked down upon and week to week living is praised?

Ross: Alot of people are missing the fact the we are on the verge of being in a war. The situation with China and Taiwan is escalating to become a war. It is my opinion that once they start battling, it will not stay on Taiwan or China shores. Their war may come the United States soil. Which is another reason we need to prepare.

Reid: You live in Oregon and Washington. What is the Black prepper community like there?

Ross: It is my opinion that there are not enough Black preppers. Honestly, there are not enough people of color prepping outside of African descent either. It is important that everyone prepares for the unexpected disaster. Now, that Covid-19 is here, that has changed. People of color are waking up to the reality of needing to be prepared.

Reid: Why is now an important time for Black people to learn about their prepper roots?

Ross: It is very important that we as Black people return to our roots. Our ancestors have been preppers and we need to prepare for the upcoming civil unrest and possible war. When we experienced natural disaster, it has become clear that the community of people of color are the last to receive funds, and supplies to survive, therefore, we have to prepare for ourselves.

Reid: If someone can only do one thing to make prepping a part of their lifestyle what would that be? 

Ross: Store water and learn how to purify water. Water is life. We can only survive three days without it.

Reid: How can someone get started in prepping? 

Ross: People can start prepping by starting in their kitchen. Look for long shelf-life foods like noodles, rice, beans and canned foods. In addition, start attending prepper groups in your community to be able to have a better understanding of what to prepare for in your region. Please feel free to take a look at my website, www.afrovivalist.com and my social media sites.

Reid: What’s next for you?

Ross: I am working on deCamp Outdoors for next year, a preparedness outdoor camp to focus on preparing your pantry, how to evacuate, start a fire and more. This country is going through changes and they will get worse before it gets better. It is very important not to panic. Prepare at your own pace and set a prepping budget and pay down your current debt.

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Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.

The patient was asked a series of questions about exposure to SARS-CoV-2 before he came into the clinic. He professed no exposure. Once in the office, he told a nurse that he now recalled he’d been around a friend who had recently tested positive. The patient was alsohaving symptoms that indicated possible infection.

The nurse immediately left the room and came back in full personal protective equipment (PPE) to test him. But results weren’t expected for days, which meant that multiple exposures could occur in the meantime.

That situation has been playing out in physician offices for months and likely will be repeated multiple times over as influenza season starts, said Jacqueline W. Fincher, MD, an internist in Augusta, Georgia, who had that patient in her office.

“The big issue going forward is what the volume is going to be,” Fincher, president of the American College of Physicians (ACP), told Medscape Medical News.

Patients often don’t mention symptoms during screening calls, said Gary LeRoy, MD, FAAP, a family doctor at a federally qualified health center in Dayton, Ohio. But the unrelenting presence of COVID-19 creates anxiety, he said. Patients might be in for diabetes but ask, “Can you check me for COVID?” LeRoy, president of the American Academy of Family Physicians (AAFP), said in an interview with Medscape Medical News.

The set-up for primary care physicians this winter is looking worrisome.

“The worst case is that you have high co-circulation of both SARS-CoV-2 and the flu, and you’re using a lot of the same reagents and supplies for both of those pathogens and you run into supply chain issues or capacity issues at individual laboratories because of testing volume,” Kelly Wroblewski, director of infectious diseases at the Association of Public Health Laboratories, told Medscape Medical News.

And Wroblewski doesn’t foresee any improvement soon. “Through the end of the calendar year, we are expecting an uncomfortably tight supply chain,” she said.

With predicted shortages and rapid COVID-19 tests not always available, clinicians may have to get creative.

Will Rapid Tests Help?

Physicians will want to quickly determine if a patient’s symptoms are due to influenza or SARS-CoV-2.

“It sure would be nice to have that point-of-care rapid COVID test because you can tell that patient right then, ‘You need to quarantine for 10 to 14 days,’ ” said Fincher.

But front-line physicians aren’t likely to have an infinite supply of rapid COVID-19 tests at their disposal. Nursing homes, universities, large employers — like those in food production — and others are seeking the same tests.

The US Food and Drug Administration (FDA) has granted emergency use authorizations (EUAs) for four rapid, point-of-care antigen tests that detect fragments of SARS-CoV-2 in the nasal cavity. The tests are generally less sensitive than the gold standard molecular tests that use polymerase chain reaction (PCR) to measure viral DNA or RNA, according to the AAFP’s COVID-19 testing guide. The antigen tests may also result in false negatives, said the AAFP.

In late August, the FDA granted an EUA for Abbott Laboratories’ BinaxNOW COVID-19 Ag Card, which takes 15 minutes to deliver results and costs $5, according to the US Department of Health & Human Services (HHS).

HHS paid Abbott $760 million for 150 million tests. It is shipping those to nursing homes, congregate facilities, historically black colleges and universities, and states. HHS hopes states will use them for children in kindergarten through grade 12.

HHS Assistant Secretary Brett Giroir, MD, who leads the government’s COVID-19 testing efforts, said that rapid-antigen test makers are tripling production. But the government will not facilitate COVID-19 or other test distribution to private physicians, Giroir told Medscape Medical News.

They will be able to get point-of-care tests “through their normal distribution channels, so we are not going to interfere with that,” he said.

Rapid COVID-19 tests will soon be widely available, predicted Giroir. “We’ve also reviewed the orders for them, and they will be going heavily to primary care, which was their primary market before COVID,” he said.

LeRoy, however, was skeptical. “The use of these tests is an individual practice choice based on availability, cost, and safety,” he said.

COVID-19 Triaging Even More Critical

With the COVID-19 testing landscape unclear, physicians are considering other strategies. Vaccination is one means of keeping a lid on the spread of influenza. AAFP recommends a further ramping up of triage schemes aimed at keeping potentially infected patients out of the office.

“Many of us are not inviting people to come in to find out whether they have flu or COVID-19,” said LeRoy.

Primary care physicians have been at heightened risk, as patients seem to prefer going to their doctors to see if they have COVID-19, he said.

In March and April, he did not have COVID-19 tests or enough PPE. “We couldn’t get our hands on the doggone tests, no matter how hard we tried,” he told Medscape Medical News, noting that big-volume purchasers were in line ahead of physicians and clinics. “We don’t buy millions of the tests, we buy maybe hundreds,” said LeRoy.

His office screens patients with questions about potential exposures and symptoms. If their temperature is higher than 100.4°F at the door, they are not allowed into the office, but are triaged there and sent to an alternative place where they can be tested for flu or COVID-19.

Fincher has a similar protocol. Patients who report acute illness or exposure by phone might be converted to a telemedicine visit or told to come to the thrice-weekly acute respiratory clinic for testing.

This fall and winter, “as much as possible, we want to take flu off the table,” Fincher said. “If we don’t have enough test kits for COVID, and if we don’t have a turnaround time that is reasonable, like within 3 days,” she said, “it becomes irrelevant.”

CDC: Treat Flu Empirically

Neither AAFP nor ACP plan to issue new guidance on influenza and COVID-19. LeRoy said AAFP looks to the World Health Organization, Centers for Disease Control and Prevention (CDC), and state health departments to inform its recommendations.

The CDC updated its guidance on use of antivirals in influenza in late August, which included a section on differentiating flu and COVID-19. The agency urged physicians to steer patients with acute respiratory illness to telemedicine.

For outpatients with suspected influenza, clinicians “can consider starting early (≤ 48 hours after illness onset) empiric antiviral treatment,” said the agency, even if the patient was not seen in the office.  

“Clinicians should not wait for the results of influenza testing, SARS-CoV-2 testing, or multiplex molecular assays that detect influenza A and B viruses and SARS-CoV-2 to initiate empiric antiviral treatment for influenza” in priority groups, which include patients who are hospitalized, have severe, complicated, or progressive illness, or are at higher risk for flu complications.

The CDC cautioned that a positive SARS-CoV-2 test does not preclude influenza infection, and that a positive flu test does not preclude SARS-CoV-2 infection.

The FDA issued an EUA in July for a CDC multiplex molecular diagnostic that can detect and differentiate SARS-CoV-2 and influenza A and B. But the PCR-based test must be conducted in a lab certified under the Clinical Laboratory Improvement Amendments (CLIA) and will require many of the same supplies that have been experiencing shortages.

Two manufacturers, BioFire Diagnostics and Qiagen, have received EUAs for PCR-based diagnostics that detect multiple pathogens, including SARS-CoV-2 and other coronaviruses, and influenza A and B.

LeRoy said he worries about the cost of multiplex tests. “If the population at most risk can’t afford the test, that’s misplaced resources,” he said.

Wroblewski said testing should be driven by the individual’s history and what’s happening in a given geographic area.

“If you have respiratory symptoms and you have no known exposure to somebody with flu or somebody with COVID, I think you want a multiplex test,” said Wroblewski. But if the patient’s child has the flu, then a flu test will be fine, she said. If an area has high COVID-19 case rates, the SARS-CoV-2 diagnostic is probably sufficient.

“We’re going to have to be kind of nimble as we go through this respiratory season and responsive to which viruses are circulating,” she said.

‘No Excuse‘ for Lack of Tests

The public health labs — which provide “situational awareness” to state health officials and clinicians about public health threats — are also planning for how to deal with potential testing shortages, Wroblewski said.

Much of the focus for those labs is on prioritizing how much testing will be multiplex and which patients should get those tests, she said.

But physicians are not optimistic. The ACP took matters into its own hands for the lack of PPE by bulk purchasing for small practices. But it can’t replicate that for diagnostics, said Fincher. She said it would be great if the federal government stepped in and ensured the testing supply is adequate.

With the advent of the Abbott tests, “it is definitely getting significantly better,” Fincher said.

But, she added, “There’s just really no excuse why we don’t have enough tests. There’s just not.”

Alicia Ault is a Lutherville, Maryland-based freelance journalist whose work has appeared in publications including Smithsonian.com, the New York Times, and the Washington Post. You can find her on Twitter @aliciaault. 

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Between the end of last week’s Shriners Hospitals for Children Open and the Masters, there are four PGA Tour tournaments. This week’s CJ Cup. Next week’s Zozo Championship. The Bermuda Championship at the end of the month. The Houston Open the first week of November. 

Bryson DeChambeau will play in zero. 

He walked off the 18th green at TPC Summerlin last Sunday. He began marching toward the 1st tee at Augusta National. No PGA Tour event in between. From after his U.S. Open win at Winged Foot, to the Masters, he will have played in just the Shriners. 

“It’s going to be just trying to figure more stuff out as always,” DeChambeau said last Sunday of his preparation. 

“I still got some equipment stuff coming in the next two months, that’s mainly why I’m taking it off,” he said in response to another question. “I feel like the advantages that I usually have could be much improved upon with the equipment, and we don’t have it yet, but we’re diligently working on it behind the scenes. I’ll have that in a couple weeks, we’ll prototype and test it and see if it works. If it doesn’t, we’ll go back and tool it and hopefully have it ready for Augusta.”

Week 1 of Masters prep: Working out. And no golf. He wants to go from 235 pounds – he’s put on about 40 in the past year – to 245.   

“I’m going to be working out like crazy,” he said. “This first week back home, I’m not really going to touch a club too much and going to be training pretty hard and getting myself up to hopefully around 245, something like that, in weight. Be the first time I’ve ever done that, so I’m going to be consuming a lot and working out a lot and see what can go from there.”

Weeks 2 through 4 of Masters prep. Hitting. Lots of hitting. Lots of driver hitting, too. DeChambeau had said earlier last week that he might use a 48-inch driver at Augusta. Which would give him even more length off the tee.  

“I don’t know how many drivers I’ll hit, but I’ll hit as many as I need to,” DeChambeau said. “And from a speed-training perspective, I could probably go upwards of over 1,000 to probably 2,000, around 2,000 drives the next four weeks trying to get my speed up.”

Sometime during weeks 2 through 4 of Masters prep: a round at Augusta. DeChambeau has played the Masters three times and finished 21st in 2016, 38th in 2018 and 29th last year. 

“Yeah, yeah, I’ll play a practice round with a good friend of mine, and we’ll have some fun and see what I can do,” he said. 

Weeks 1 through 4 of Masters prep. Recalculation. This year’s Masters will be his first with his bigger weight, and with it, his bigger distance. 

“Well, No. 1 may be different; I don’t know, just depends on the wind conditions, obviously,” DeChambeau said. “I would say No. 2 is different, 3 is different, 5’s different, 7 will be different, 8 will be different, 9 will be different, 11 will be different, 13 will be different, 14 will be different, 15 will be different, 17 will be different, 18 will definitely be different.”

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MASON CITY, Iowa – A blanket won’t be enough to keep you warm tonight.  You’ll probably need to switch on the heater.  There’s a few things to keep in mind before you flip the switch.

Make sure and check or change your furnace filter.  It should be done every month, although some filters can last up to 3 months or even a year, depending on the manufacturers specifications.

If your thermostat runs on batteries, you might want to consider replacing those as well.

Check the heater exhaust vent on the side of the house and make sure it’s not blocked up by debris.

It’s also a good idea to have your heating system inspected by a reputable HVAC company.  Nick Fitch with North Central Mechanical Services explains what technicians will check on your system.

“They should be coming out and just doing a full inspection of the system. Checking the motors over, cleaning your flame sensors, the different sensors’ wires. Checking the heat exchangers,” said Fitch.

When you first turn on your heater, you might get a whiff of a nasty burning smell.  Don’t worry, that odor is just dust on the heat exchangers and it will wear off quickly.  If the smell does not wear off, it could mean there is a problem with your system.