Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Who’s Going to Pick Up the Trash? Using the Build America Bond Program to Help State and Local Governments’ Cash Deficits

All over the United States, state and local governments are facing increasing revenue deficits due to the current economic recession. Even during good economic times, state and local governments experience temporary cash-flow deficits. State and local governments use short-term municipal bond debt to finance temporary cash-flow deficits caused by the normal erratic collection of tax revenue. The issuance of short-term debt secured by future tax revenue has always been a financing tool that helped local governments with cash-flow problems. The effects of the subprime mortgage crisis and the current recession threaten state and local governments’ ability to use this financial tool. The increased cost of issuing short-term debt, coupled with the general reduction of tax revenue collected due to the current recession, has restricted state and local governments’ ability to issue short-term debt. Without the use of affordable short-term debt, state and local governments are faced with severe cash-flow problems that threaten their ability to pay for services for their citizens. For example, local governments may be faced with the decision to layoff public safety workers such as fire fighters and police officers, reducing library and recreational park hours, or, in some cases, reducing trash pickup within their communities. To reduce the borrowing costs for state and local government issuers of short-term municipal bonds that are used to finance cash-flow deficits, this article proposes to utilize a federal subsidized taxable bond program similar to the Build America Bond program