Category: Health News

  • How operating like a start-up helped NZ’s Orion Health become profitable again

    How operating like a start-up helped NZ’s Orion Health become profitable again

    Though a selection of enterprises ended up scrambling to defend on their own from the profound modifications triggered by the world wide pandemic, New Zealand’s Orion Wellness was just in the procedure of releasing a timely solution that would assistance guidance overwhelmed wellbeing programs.

    WHAT It is ABOUT

    The wellness IT company experienced to delist from the bourses of Australia and New Zealand in March 2019 and restructure its enterprise as a consequence of the Trump administration’s conclusion to cancel quite a few Obamacare contracts. The corporation had signed this sort of contracts with a selection of states in the US beneath the past Obama administration.

    “In essence, we have long gone again to becoming an entrepreneurial begin-up,” explained Orion Overall health founder and CEO Ian McCrae in a media launch. The company, which is working in 15 countries, has halved its employees to all-around 560 today from 1,200 four several years in the past. 

    To make its way again up yet again, Andrew Bowater, Orion Health’s Global VP of Company Affairs and Internet marketing, advised MobiHealth Information that they shifted their operations to that of a startup. They stripped out paperwork and gave teams the independence to be impressive and produce to purchasers at their possess rate. 

    “Creating these alterations intended that we have been ready to capitalise on the world-wide shift to inhabitants wellbeing. Population health is the vital to handling the well being and wellness of individuals in a Covid-challenged environment. This is not healthcare facility-centred healthcare as a substitute, population health delivers the proper care (normally on the internet), at the appropriate spot (occasionally at home), at the right time (ideally right before you’re really unwell),” he stated.

    Prior to the pandemic, the business was functioning on the Digital Entrance Door (DFD), a wellness facts trade (HIE) platform that integrates new and present wellness details, info, options and providers into a unified hub.

    WHY IT Matters

    Orion Wellness has been pitching this “tailored, neighborhood-certain HIE system” to point out and territory Overall health Departments in Australia as part of its endeavours to increase its enterprise in the place. The DFD, McCrae said, “just isn’t some dressed up affected person portal”. 

    “For the very first time, individuals will be genuinely lively contributors in their possess health care. They’ll have streamlined access to their entire health care heritage from primary treatment, allied health professionals as a result of to medical center interventions.”

    The business promises that the system aids ease health workers’ fatigue though also enabling patients to just take management of their very own overall health by offering access to their overall health data. 

    “We can now link fragmented silos, enabling people today to interact with health and fitness information and facts and make knowledgeable selections in the exact same way they do with economical, vacation and retail transactions,” he additional.

    Immediately after incurring losses of A$50 million ($35 million) and NZ$70 million ($45 million) by the finish of its public listings, the corporation started out turning into profitable once more by the conclusion of March last yr. Presently, Orion Health and fitness is operating with private hospitals to investigate working with its DFD in improving upon surgical patient admissions. 

    THE Much larger Pattern

    In September previous 12 months, Orion Health secured a task to deliver a healthcare facility data procedure for the forthcoming surgical treatment facility at Kaweka Overall health

    It also bagged a agreement from the Justice Health and fitness Forensic Mental Wellbeing Network in New South Wales for the deployment of its treatment management and electronic medications administration platform throughout the group’s electronic well being program.

    Alongside closing these latest contracts in New Zealand and Australia, the business is also seeking to sign two main contracts in North The usa and the Center East. 

    ON THE Document

    As hospitals keep on to be swamped with sufferers through the ongoing pandemic, Dr Chris Hobson, Orion Health’s CMO, explained providers are seeking for means to lighten the workload of well being staff even though lowering physical make contact with among persons the place probable. “We all are entitled to obtain to systems that produce the correct care, at the suitable location and the suitable time. To realize this, we need facts science and technological know-how to do the heavy lifting, not just people today”.

  • Reproductive rights for people with disabilities in NC

    Reproductive rights for people with disabilities in NC


    By Elizabeth Thompson

    As the reproductive rights of people under guardianship came into the national spotlight with the #FreeBritney movement, disability advocates in North Carolina say people with disabilities in this state could easily face similar threats to their rights.

    In the case of pop star Britney Spears, she was not allowed to remove her IUD so she could have a third child, despite being rich, white and in the public eye. Spears was legally unable to make decisions because she was under a conservatorship, a legal process in which the court declares a person “incompetent” and someone else is appointed to make their decisions for them. 

    The social movement to free Spears from her father’s conservatorship showed that even a wealthy celebrity, recognizable by only her first name, could lose her reproductive autonomy.

    “Imagine what it’s like for everyone else,” said Larkin Taylor-Parker, staff attorney at Disability Rights North Carolina (DRNC).

    North Carolinians under guardianship, much like Spears’ conservatorship, can face a similar overthrow of their reproductive rights, Taylor-Parker said. It’s unclear how many guardianships there are in the state, but parents of children with disabilities often seek them out as their child ages into adulthood. It’s also a legal mechanism sought by families of aging parents as their mental state declines.  

    In North Carolina, people with disabilities who are deemed “incompetent” in court are given a guardian to make decisions for them. Those decisions include everything from where they live and how they spend their money to decisions regarding sex and relationships. A guardian can be a family member or state employee, such as a social worker. 

    Often guardianship is not revisited once it is given, meaning people can permanently lose their rights to make decisions for themselves starting as early as age 18, said Betsy MacMichael, president of First in Families of North Carolina, a statewide nonprofit that provides support to people with disabilities and their families.

    No forced sterilization

    North Carolina is one of just two states that bans forced sterilization for people with disabilities under guardianship, a new report from the National Women’s Law Center found. Sterilization is a surgical procedure that permanently prevents pregnancy.

    There are still 31 states and the District of Columbia that allow forced sterilization. The only other state that bans forced sterilization outright is Alaska, according to the report.

    North Carolina’s law was a response to the state’s prior eugenics movement, when thousands of North Carolinians were targeted based on race, class and, in particular, disability and sterilized without their permission throughout much of the 20th century. However, the legacy of the movement continues to live on, advocates say, as long as disabled people often do not have the right to their bodily autonomy.

    Although the state eugenics program was shuttered in the 1970s, the state did not officially outlaw involuntary sterilization until 2003, after groundbreaking research by Johanna Schoen, now a professor at Rutgers, the State University of New Jersey and an investigative series by the Winston-Salem Journal called “Against their Will.”

    Forced sterilization directly compromises a person’s right to their bodily autonomy, said Ma’ayan Anafi, author of the National Women’s Law Center report.

    Just because North Carolina bans forced sterilization does not mean that people with disabilities under guardianship have the ability to make their own reproductive decisions. 

    The right to ​​bodily autonomy

    North Carolina’s law banning forced sterilization, passed in 2003, prevents guardians from consenting to sterilization unless the person under the guardianship “needs to undergo a medical procedure that would result in sterilization.” 

    This statute impedes disabled people’s ability to choose to get sterilized if they want to, Anafi said.

    “Disabled people can make decisions about our health care and about birth control, including sterilization,” Anafi said.

    Taylor-Parker said they also worry that an unintended consequence of the sterilization law is that it could interfere with a transgender person’s ability to get gender confirmation surgery if they are under guardianship.

    “That’s a very real concern that I think will continue to come up in years to come,” Taylor-Parker said. “For reasons no one understands, there is a strong correlation between autism and LGBT identity. So it’s particularly of concern for that population, but also for many others.”

    Even if protections exist against sterilization, access to birth control and the ability to make decisions about sex and relationships could be difficult for people with guardians. 

    Disabled people are often infantilized by non-disabled people, said Corye Dunn, director of public policy at DRNC. Historically, sterilization gave non-disabled people the option to refrain from educating disabled people about sex, even as people with disabilities have higher rates of sexual assault, according to the Centers for Disease Control and Prevention. Denying people with disabilities accurate information about sexuality also ignores the idea that disabled people might want a relationship or to engage in consensual sexual activity, she said.

    “There should be nothing surprising about the fact that people with disabilities are also sexual human beings,” Dunn said, “that they may want to engage in consensual sexual activity.” 

    Guardianship makes it difficult for people with disabilities to make those choices, especially if a guardian is a loved one.

    “Family, often they’re quite opinionated,” MacMichael of First in Families said. “Whether it’s relationships, sexuality, or things like drinking and smoking pot, that kind of thing. So if a person has a guardian over them … they pretty much can’t call the shots.”

    Reassessing guardianship

    A judge overturned Spears’ conservatorship in November of 2021, transforming #FreeBritney from a movement to a statement.

    Disability rights advocates hope that the movement continues, arguing that as long as guardianship remains as widely used and unchecked practice as it is, disabled people will continue to have their rights taken away.

    Dunn advocates for periodically revisiting whether guardianship is necessary. Currently, there is a “presumption of permanency” of a guardianship decision in North Carolina because cases are not required to go back to court.

    “It’s this life sentence,” Dunn said.

    At First in Families, MacMichael suggests alternatives to guardianship, such as support networks, where people with disabilities can make important decisions with the help of an array of people.

    “Just because people need help making decisions does not mean that we have to have substitute decision making,” Dunn said. “We can build in those supports for people in different ways. And I think that sexuality and relationships and reproduction and parenting are some of the most intimate rights that we have and they deserve more attention.”

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  • Is this the year NC gets Medicaid expansion?

    Is this the year NC gets Medicaid expansion?


    By Anne Blythe

    The state Legislative Building designed by architect Edward Durell Stone almost 60 years ago has a maze of hallways where lawmakers often buttonhole each other for private discussions about contentious public issues.

    Rep. Donny Lambeth (R-Winston-Salem) is one of those lawmakers who has been taken aside recently to discuss the pros and cons of expanding Medicaid in North Carolina.

    “One of the hallway conversations always comes around to, ‘Well so and so state has had all kinds of financial problems because they expanded Medicaid’  … so I really want to understand what has been the experience in other states as far as balancing their budgets, the impact on their operating funds and pressure it puts on their operating funds because they expanded,” Lambeth said Friday at the first meeting of the Joint Legislative Committee on Access to Healthcare and Medicaid Expansion.

    While lawmakers from both parties have talked about ways to expand health care access for a while, there seems to be more momentum behind the joint House and Senate committee whose charge grew from budget negotiations last year with Democratic Gov. Roy Cooper, an expansion advocate. 

    Rep. Donny Lambeth (R-Winston-Salem) discussed some of the structural issues with Medicaid that the legislature has addressed over the past few years during a press conference at the NC General Assembly in 2019. Photo credit: Emily Davis

    The new panel of lawmakers met for the first time on Friday to probe how to provide health care coverage to some 500,000 low-income adults who could have access to Medicaid if North Carolina joined 38 other states and expanded the program as the Affordable Care Act has allowed since 2013.

    Through much of the past decade, Medicaid expansion has been a thorny topic that has divided Democrats, who support it, and Republicans who have resisted adding more North Carolinians to the subsidized government health insurance program. More recently, some Republicans including Senate Leader Phil Berger (R-Eden) have warmed up to the idea, recognizing a need to close the insurance gap in the state. 

    Dispelling misinformation

    The federal government subsidizes 90 percent of the cost for adults enrolled through the ACA expansion. The American Rescue Plan Act of 2021 provides additional financial incentive for the 12 states that have yet to approve expansion, allowing them to temporarily draw down additional federal funds. 

    The National Conference of State Legislatures estimates North Carolina could get an additional $1.5 billion to $2 billion in additional federal funding. Kate Blackman, NCSL health director, and Emily Blanford, NCSL program principal, presented a report to the legislators on Friday with specifics on North Carolina and an overview of what other states have done.

    Lambeth told Blanford about another hallway conversation he’s had, one that many Republicans have echoed as they explained their financial worries about expanding Medicaid. They worry the federal government will shift the fiscal burden to the state by decreasing its percentage of funding either abruptly or over time.

    “The second part of that financial piece — you know, hallway conversations — is ‘Well, you know they started at 100 percent, that rate dropped to 90. What prevents them from going down to 70 or 60 or 50, and pull the rug out from under us and put more pressure on our state budget because all of a sudden now we’ve done it. It’s hard to take away a benefit, and we’re just going to have to pay more because you know, they kind of pulled that rug out from under us on that 90 percent,’ ” Lambeth said. “What does the law say about the 90 percent and how would that percent be changed?”

    The federal government’s commitment to providing states with 90 percent of the expansion cost is written into the Social Security Act, Blanford responded, so it would take an act of Congress to change the law.

    Lambeth explained after the meeting that he was trying to get answers throughout the two-and-a-half-hour discussion to dispel misinformation he’d heard from legislators who often stopped him in the corridors because they knew he was co-chair of the new committee.

    Chilly caucus

    Though some longtime critics of expansion have warmed to the idea during the coronavirus pandemic, such as the powerful leader of the Senate, there still are staunch opponents, especially in the state House.

    “We’re not lukewarm in the House,” Lambeth told reporters after the meeting. “It is still rather chilly. It is a heavy lift to convince our House caucus that this is the right direction to go. Now is it impossible? No. I wouldn’t be here if I thought it was impossible.”

    The committee touched on a wide range of health care topics Friday. The lawmakers discussed how to rein in the surprise medical bills that insured people get after inadvertently receiving care from an out-of-network provider they did not choose. They also discussed the shortage of nurses and other health care providers already hampering the state and how to help struggling rural hospitals and expand care access in those areas.

    The next meeting of the Medicaid expansion committee is set for March 1.

    The health care session’

    The coronavirus pandemic has exposed under-funded health care systems and a lack of convenient access to quality care for numerous North Carolinians, many who live in some of the more rural districts represented by Republicans.

    Lambeth said he expected the committee to spend months fact-finding and creating recommendations for what he called a “North Carolina plan” that could be ready in August or September and perhaps put to a full General Assembly vote by October. That could be a politically charged vote before the November elections.

    That plan might expand Medicaid or subsidized coverage to hundreds of thousands of North Carolinians without specifically calling it “Medicaid expansion.”

    “I can sort of view this as the health care session,” Lambeth said.

    Sen. Kevin Corbin (R-Franklin), a committee member, is interested in exploring an array of programs that he has heard other states have used. “The view from 130,000 feet is we have a large number of uninsured people,” he told reporters after the meeting. “We need to get those people insured. How to do that is the question.”

    “Medicaid expansion” used to be a bad word in some corridors of the Legislative Building, he said. “I think it has been, but I think it’s not so much anymore,” Corbin said.

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  • These Simple Steps Can Help Seniors Manage Their Health Care | Health News

    These Simple Steps Can Help Seniors Manage Their Health Care | Health News

    (HealthDay)

    SATURDAY, Feb. 19, 2022 (HealthDay News) — Navigating the health care procedure can be complicated, but an specialist urges more mature persons not to test to go it alone.

    “It can be frequent for an individual who has not had any health and fitness issues all of a sudden to be confronted with their individual problems and the need to navigate the overall health treatment program,” explained Maria Radwanski, supervisor of care transitions and outpatient adult treatment management at Penn State Wellbeing Milton S. Hershey Healthcare Heart.

    “Prior to that takes place, speak with good friends who’ve been working with health worries — primarily if they’ve been in the clinic — to listen to about their encounters so you have a improved concept of what it may be like,” Radwanski explained in a Penn Point out Health information release.

    “It truly is so important for a patient to have an understanding of what the doctor states,” Radwanski mentioned. “Normally, a client would not absolutely digest what the doctor’s indicating. I advise seniors to have another person else at the appointment with a pen and paper to generate every little thing down and make guaranteed there is certainly correct abide by-up.”

    When they see a doctor, older individuals should really convey an up-to-date record of wellbeing concerns — which includes any modifications in their professional medical historical past or new symptoms — as well as a checklist of all current prescription and around-the-counter medications they acquire, together with any supplements, alongside with their dosages.

    Some persons may well come across it easier to bring all their remedies to their appointment, Radwanski said.

    If you you should not fully grasp your health and fitness insurance plan coverage or professional medical bills, request a trustworthy beloved a single or a specialist to go around them with you.

    “There are groups out there and advocacy solutions as a result of senior centers that are a superior useful resource to helping have an understanding of well being care financials,” Radwanski mentioned. “They offer you continuing education-style systems for the general public all the time to support people fully grasp what insurance policies will and will never go over.”

    Older people and their advocates can also operate with care managers or money assist staff at a professional medical middle to assist form via their expenditures.

    Some seniors may possibly be not comfortable asking for enable or may perhaps not even comprehend they want it. So it can be essential for adult small children and other trusted people to talk to, but to do so carefully.

    “You’ll want to get authorization to have these discussions with your mom or dad, aunt or uncle now, ahead of a medical crisis,” Radwanski reported. “Appear in with really like and respect, preferably in a facial area-to-face dialogue. Allow them know how considerably they’re cared for, that you want the most effective for them and that you have some problems you would like to talk about with them. Then talk to their permission to do that.”

    Supply: Penn Condition Wellness, information launch, Feb. 9, 2022

    Copyright © 2022 HealthDay. All legal rights reserved.

  • California Releases Plan For ‘New Phase’ of COVID-19 | Health News

    California Releases Plan For ‘New Phase’ of COVID-19 | Health News

    California Gov. Gavin Newsom on Thursday introduced what appears to be the to start with condition COVID-19 reaction system intended to manual a shift toward residing with the coronavirus.

    Newsom claimed the approach, which emphasizes preparedness and overall flexibility, is not a declaration of victory in excess of the coronavirus. Alternatively, it is “a new section of addressing the troubles and realities of this condition.”

    “We shift out of the pandemic period, and we move into a stage which really should let self confidence that we are not walking absent – that we’re getting the classes acquired, and we are leaning into the long term,” Newsom claimed at a push conference.

    Cartoons on the Coronavirus

    The strategy incorporates techniques like monitoring knowledge and frontline ailments to make certain the state is “ready to respond to new and emerging variants and modifying conditions.” It stresses preserving wastewater surveillance methods and sequencing at least 10{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of good COVID-19 examination specimens to see how the virus improvements. It also “strongly” recommends masking in general public indoor configurations but does not demand it.

    The plan does not give certain metrics that would bring about the implementation of mitigation actions like mask wearing.

    It does include some particular targets, like getting in a position to insert 3,000 health care workers to services throughout the condition in two-three months if necessary and stockpiling 75 million masks.

    “It is apparent the virus will remain with us for some time, if not for good,” the program states. “It is a lot less crystal clear how usually and how much it will continue on to influence our wellbeing and very well-becoming. However, we know what will work and have created the essential equipment in excess of the very last two decades that will allow us to study and hone our defenses to this virus as it evolves.”

    The plan highlights a developing drive between point out leaders to chart paths into a new phase of the pandemic as coronavirus conditions fall.

    Newsom joined a number of Democratic states by allowing California’s indoor mask mandate expire on Tuesday. Washington state and New Mexico both of those announced programs Thursday to fall their mask mandates.

    The moves have set the Biden administration in a tough posture, as they go from existing federal advice. But the head of the Centers for Disease Regulate and Prevention claimed the company will update its coronavirus steering “quickly.”

    “We want to give people a split from items like mask wearing when these metrics are improved and then have the ability to attain for them once more must factors worsen,” CDC Director Rochelle Walensky mentioned on Wednesday.

  • Coronavirus Today – Feb. 17

    Coronavirus Today – Feb. 17


    By Anne Blythe

    On Thursday, Gov. Roy Cooper encouraged school districts and local governments to drop indoor mask requirements by March 7 to give people the option of baring their faces as the state moves toward a new pandemic phase.

    Meanwhile, Republican lawmakers who have often challenged the Democratic governor’s approach to the pandemic, especially in years with elections, were in session on Thursday to redraw electoral districts.

    Amid that weighty topic, the lawmakers resurrected a bill called “Free the Smiles” that was introduced in the state Senate in 2021 and amended it to give parents the choice of whether their children wear masks while at school.

    After the bill passed in the state House of Representatives on Thursday with support from some Democrats, Speaker Tim Moore (R-Kings Mountain) quickly issued a statement. 

    “All health care decisions for our students belong with their parents, not with politicians or bureaucrats. No one cares about these children more than their parents, and no one is better-suited to make these decisions,” said Moore, who is up for election and has considered a run for U.S. Congress.

    Cooper’s term does not end until 2024, but the question of masking in schools has become a hot political topic in North Carolina and other states across the country. Republicans accused him of relying on “political science,” instead of the health experts, case numbers, data and science that have guided his pandemic response.

    In North Carolina, some local school districts have been voting to roll back mask requirements as more people get vaccinated and the Omicron surge is on a steep decline.

    “This pandemic has been difficult for all of us,” Cooper said during the briefing with reporters that was broadcast on North Carolina Public Television. “It’s been particularly tough on parents, teachers and school children. It’s time to focus on getting our children a good education and improving our schools no matter how you feel about masks.

    “As we continue to shake the cobwebs of this virus and work to get more people vaccinated, our eyes are on a very bright horizon,” he continued. “Already, we’re emerging from the pandemic from a place of strength.”

    However, as state health Secretary Kody Kinsley pointed out earlier this week during a meeting of the Joint Legislative Oversight Committee on Health and Human Services, North Carolina is not yet in the endemic phase. Nonetheless, lawmakers encouraged him to develop an exit strategy.

    “You know, endemic is really the concept of being in equilibrium or balance over time,” Kinsley said. “As we have seen with COVID, there can be curveballs and variants that really create pushes in different directions. We are moving in that direction over time, but we still have more to learn with regard to the cyclical nature of this virus, the tools we have in place to respond to it, and making sure that we can prepare. Endemic is about being prepared to manage overall, over the period of time. So we’re not there yet, but our department remains incredibly committed to taking each successive step in giving North Carolinians the best information that they need to protect themselves.”

    Picking up where his predecessor Mandy Cohen left off, Kinsley, head of the state Department of Health and Human Services since Jan. 1, provided North Carolinians with an update on the state’s COVID-19 trends and metrics during the briefing with the governor on Thursday.

    The number of people showing up at emergency departments with COVID symptoms has dropped dramatically, he said, as have the number of new cases and hospitalizations since the peak of the Omicron surge.

    “As we emerge from the latest surge, the COVID-19 landscape looks different today than it did two years ago, or even two months ago,” Kinsley said. “We have learned more about the virus and now have several effective tools that reduce the risk for people. Vaccines and boosters are widely available and have protected millions of people against severe illness, hospitalization and death.”

    Treatments are available for those at high risk for severe disease, Kinsley added, noting that DHHS had expanded a standing order so more people could gain access to the monoclonal antibodies and other treatments.

    Kinsley said DHHS might phase out emphasis on one data point which had helped guide decisions earlier in the pandemic — the positivity rate. The percentage of COVID tests coming back positive compared to the total number of tests no longer has the same significance that it once did when people didn’t have widespread access to home COVID tests.

    Still, Kinsley said, the department was relying on the science and data to announce as it adapted its response to the pandemic to encourage local governments and school boards to ease indoor mask requirements and leave it up to individuals and businesses in most settings.

    Masking still in congregate care settings

    Nursing homes, long-term care facilities, prisons and health care settings should continue to require masks, Kinsley added. People who have not been vaccinated and boosted, when eligible, should continue to wear masks, Kinsley said. Anyone who has tested positive for COVID or been exposed to someone who has should also continue to mask.

    “If our trends continue to improve, beginning March 7, schools and other low-risk settings can consider moving to voluntary masking at the discretion of local authorities. We strongly recommend that schools promote vaccinations and boosters for students and staff, and that schools participate in our testing program.”

    That recommendation to lift masking requirements applies to pre-school children as well, Kinsley said.

    Kinsley and Cooper added that they themselves might choose to wear masks still at crowded indoor settings and other places.

    “Our goal is to use the tools we have so that people can all get back to the people, experiences and places that we love,” Kinsley said, encouraging everyone who is eligible to get a vaccine.

    Kinsley said the changes were being announced a couple of weeks ahead of time to give people an opportunity to get a vaccine if they needed one and allow organizations a bit of planning time.

    “As we move forward, we will remain vigilant and we will respond to changes in the virus so we can protect the health and well-being of North Carolinians,” Kinsley said.

    Coronavirus by the numbers

    According to NCDHHS data, as of Thursday afternoon:

    • 22,061 people in North Carolina have died of coronavirus.
    • 2.5 million cases have been reported since the start of the pandemic. Of those, 2,711 are in the hospital. The hospitalization figure is a snapshot of people hospitalized with COVID-19 infections on a given day and does not represent all of the North Carolinians who may have been in the hospital throughout the course of the epidemic.
    • To date, 25,384,444 tests have been completed in North Carolina. As of July 7, all labs in the state are required to report both their positive and negative test results to the lab, so that figure includes all of the COVID-19 tests performed in the state.
    • There are 2,620 ventilators in hospitals across the state and 1,030 ventilators in use, not just for coronavirus cases but also for patients with other reasons for being in the hospital. As of Thursday, 501 COVID-19 patients were in intensive care units across the state.

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