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The Club PUBlication  03/31/2020   Coronavirus - (2)

3/31/2020

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Global race for answers turns to
​                     genomics


High-tech sleuthing is unlocking secrets of viruses – how they’re transmitted, how they evolve and how to stop them.

                By MELISSA HEALY • Los Angeles Times

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HOW THE VIRUS ATTACKS:
Here’s what experts have learned about the progression of the coronavirus.

The genetic code of the coronavirus that causes COVID-19 is only about 30,000 characters long, but what a story it tells.

Those nucleotides conceal secrets of the virus’ past, including its origins, its passage among families and its journey to distant ports. They signal how long it has been at large and whether it can hide by infecting people who show no outward signs of illness. And they can point the way to medicines, vaccines and public health strategies.


Unlocking all of that requires a combination of teamwork and technology that didn’t exist when the SARS epidemic broke out nearly 20 years ago. But today, geneticists are indispensable players in the international game of whodunit. “Now we can really get a much fuller version of that puzzle,” said Dr. Liliana Brown of the National Institute of Allergy and Infectious Diseases.

For much of the 20th century the central technique of germ-hunting has been a labor-intensive process called contact tracing. It starts with a search for the person first infected. Then it expands to the people those initial patients interacted with, then the ones they interacted with, and so on.

With luck, the result is a time-stamped map of the germ’s spread that includes every case of illness, death and recovery. These investigations provide insights about how a pathogen spreads, how deadly it is, and what measures could slow its transmission.

Yet contact tracing relies on memories, candor, and an absence of chance encounters with strangers. With genomics, scientists can follow the progression of mutations from patient to patient and establish relatedness among them. That can fill in gaps left by memory lapses or concealment. It can even flag new means of transmissions between distant strangers — through vents or pipes linking apartments, for instance.

“Genomics has completely transformed our ability to track viruses and understand their spread,” said Kristian Andersen, an infectious disease and genomics expert.

A virus gives up its secrets one mutation at a time. As it passes from host to host, or population to population, it sheds, gains or revises the sequences that define it.

Armed with computers and a maturing grasp of how genes function and change, geneticists search for data that will give them the upper hand. To do so, they break down the DNA or RNA sequences of viral specimens collected from different people or animals. Then they stack those sequences on top of each other to see how and where they have changed. By looking around the common ancestor of all samples, they may find an outbreak’s earliest patients.

That can help scientists determine when the virus first colonized humans and narrow the list of species that might have incubated it. They can glean insights about who infected whom, how quickly transmission occurred, and whether mutations made the virus more infectious or more lethal.

When the genetic diversity of samples seems improbably broad, researchers must explore new possibilities. Perhaps it has infected far more people than initially thought, but spread without causing symptoms. Maybe it launched multiple assaults on humans from its home base in animals. Or it could have been circulating harmlessly in humans for years and recently acquired a mutation that causes its hosts to become ill.

In just over a decade, this type of genetic sleuthing — scientists call it phylodynamic analysis — has changed the way disease detectives investigate an outbreak.

Genomic analyses of the Ebola virus turned up several points during its three-year reign of terror when it appeared to get better at jumping from person to person.

Studies of the Zika virus revealed that it became harmful to fetuses in 2013 in French Polynesia, more than a year before it triggered a wave of birth defects in Brazil.

Genetic sequencing helped identify bats as the origin of the virus responsible for Middle East respiratory syndrome, and camels as the animals that conveyed it to humans.

So far, Chinese scientists have sequenced the full genomes of at least 115 samples of the COVID-19 coronavirus and shared the details with an international community of geneticists. Combining genetic sequencing technology with old-fashioned disease hunting has given scientists a rare glimpse of evolution in near real time. Observing it in long-lived organisms such as humans would take thousands of years. By sifting through samples from a single outbreak, researchers can capture the subtle process of adaptation. Even a tiny shift might reveal a pivotal moment when the virus mutates in ways that increase its fitness or spell its demise, said Dr. Marc Suchard, a biomathematician .

The details of a virus’ life cycle can help answer some of the most fraught questions: Who should get vaccinated first? Will a quarantine work? When do comforting cultural practices endanger a community’s safety? In a world of relentless viral threats, he said, the results could be lifesaving.

EYES , NOSE, MOUTH

Viral particles enter through nose, mouth or eyes, then travel to the back of nasal passages and throat. There, it hijacks the metabolism of the cell, allowing the virus to burst out and infect other cells, replicating by the millions.

LUNGS
Virus crawls down bronchial tubes and lungs, inflaming mucous membranes and damaging lung sacs. Swelling and impaired flow of oxygen can cause lungs to fill with fluid, pus and dead cells.

GUT, DIGESTIVE TRACK
Virus spreads through mucous membranes, and may be able to infect cells in the gastrointestinal system, causing diarrhea or indigestion. Its RNA has been found in stool, but it’s unclear whether infectious virus can persist there.

BLOODSTREAM
Virus can make 10,000 copies of itself in a cell within hours. Within a few days, there are hundreds of millions of viral particles in every teaspoon of blood. There may also be some inflammation in small blood vessels.

ORGANS
The virus can land on organs like the heart, kidney and liver, resulting in inflammation that may cause the organs to malfunction. As a result, damage can be inflicted not just by the virus but by person’s own immune system.

“Genomics has completely transformed our ability to track viruses and understand their spread.”

Kristian Andersen, infectious disease and genomics expert




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The Club PUBlication  03/30/2020  (Coronavirus -1)

3/30/2020

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      Evolution of a virus

How the cause of the coronavirus disease has evolved to be particularly infectious.

Story by JEREMY OLSON Illustrations by NURI DUCASSI Star Tribune staff

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Current scientific knowledge about the coronavirus causing a global COVID-19 pandemic is like a television screen with missing pixels to Mayo Clinic’s Dr. Gregory Poland.

Trouble is, as the picture fills in, scientists and public health leaders are discovering misconceptions that may have misguided the world’s initial response to this virus, named SARS-CoV-2.

It’s more infectious than SARS-CoV-1, which spread globally in 2002-2003 but fizzled out after only causing eight confirmed U.S. cases. It’s more destructive at a cellular level than garden-variety coronaviruses that cause common colds. And yet, it’s still just one of many viruses engaged in ceaseless quests to find hosts in which to spread.

“The good news is that it is impossible to get infected with this virus if you don’t breathe it in or introduce it to your body with your hands,” said Poland, director of Mayo’s Vaccine Research Group. “There’s nothing exotic about this virus. It’s just a different virus, so if you take the actual precautions [such as hand washing and covering coughs], there’s no way to get infected.”

“Therein lies the hard part,” he said, “because human behavior is irrational.”

Leading theories based on the genetic composition of SARS-CoV-2 is that it originated in bats and passed through an animal host that passed it along to humans this winter. The first SARS was passed from bats to humans via civet cats that were sold in markets in China, and that may be the case with the new virus as well — though it has genetic features that suggest it might have passed through pangolin anteaters.

Close up, the COVID-19 virus looks like a dog’s chew toy — a ball with protruding crown-like spikes (hence the name corona, which in Latin means crown.) The spikes help the virus bind to cells via their ACE-2 receptors, enzymes on the cell surfaces that have a role in regulating blood pressure.

Adding to the virus’ efficiency is the fact that its new, so nobody has immunity to it.

“There has been an evolution from SARS in the COVID-19 virus so that it binds much more tightly and effectively” to those receptors, said Dr. Ashley Haase, head of the University of Minnesota’s Department of Microbiology and Immunology.

A consequence of the virus attacking ACE-2 receptors is that they no longer regulate a hormone called angiotensin II, which then causes lungs to constrict and fluid to build up. Many infected patients struggle to breathe and, in severe cases, need ventilators to maintain adequate airflow.

Initial reports out of China suggested that 80% of cases produced only mild symptoms, but that anywhere from 1% to 3.4% of cases were fatal and that the elderly and people with other health problems were at greatest risk. Tracking of the first U.S. cases also found a rising death rate with age.

Some patients defy the odds. Minnesota’s first hospitalized case was a person in the 30s age range who has been in critical condition.

Genetics might play a factor in the severity of illness — a theory advanced by the deaths of a mother and three adult children in a New Jersey family. Other doctors found that patients with severe illness spent extended time with other infected patients and developed higher viral loads.

“The ones that have been the most severe cases have tended to be within that zone of close contact while someone is symptomatic for an extended period of time,” said Dr. Clayton Cowl, Mayo’s chair of preventive medicine.

One study raised concerns about people who take ACE inhibitor drugs for diabetes, which seem to result in a buildup of ACE-2 enzymes and more targets for the virus.

The COVID-19 virus is complex and has a “novel proofreading capacity” to prevent harmful mutations that could choke its replication, said Dr. Frank Rhame, a virologist with Allina Health in Minneapolis.

One positive: the complexity of this virus presents opportunities for drugs to “gum up” its replicating process. Studies underway with an experimental drug, remdesivir, target a key enzyme for the virus.

One concern: the virus spreads more easily than initially thought. People with SARS were most infectious after five days and the onset of telltale symptoms. The COVID-19 virus, by comparison, sets up shop early in the throat and nasal cavities, even before symptoms have emerged.

“By the time a patient has symptoms, you’re already behind the epidemiologic curve,” Haase said, “because that person has had contact and passed it to other folks.”

The COVID-19 virus was found in studies to last up to 24 hours on cardboard and for days on metal surfaces, though only in pristine lab conditions. Traces of the virus also were found on the Grand Princess long after people disembarked from the cruise ship, which had been quarantined for days due to COVID-19 cases on board.

Even so, hand-to-mouth contact probably isn’t the dominant cause of this outbreak, said Michael Osterholm, director of the U’s Center for Infectious Disease Research and Policy. Many cases are due to patients coughing or sneezing droplets that land on others, but Osterholm said there is now adequate proof that it hangs in the air and presents risks that way as well.

“We’ve never had one that was like this virus in terms of how it transmits and how it causes disease,” he said.

The state health department is aware of the potential for airborne transmission, but is considering that risk more in the context of hospital rooms and making sure that health care workers in close contact with patients are protected, said Kris Ehresmann, infectious disease director for the Minnesota Department of Health.

This coronavirus clearly isn’t the measles, though, she said. Measles can spread through the air so easily that health officials in 1991 found that it traveled from an infected person on the field at the Minneapolis Metro-dome during a Special Olympics event to fans in the upper deck.

Viruses are measured by R-naught values, or the number of people who will catch them from other infected people. The value for measles is as high as 18. COVID-19’s value is 2 to 3, comparable to pandemic strains of influenza.

Ehresmann said new information about the virus has changed how her department does investigations to quarantine close contacts of people with the infection. At first, state epidemiologists searched for contacts of infected people who had already developed symptoms. Now they also ask infected people about contacts in the 24 hours before symptom onset.

Some of the pioneering work on how viruses spread, even in the absence of coughing or sneezing, was done at the U in the 1950s, Rhame said. Volunteers stuck their heads inside tubes and talked. Sensors measured how far particles traveled.

“A lot of stuff comes out of our mouths when we’re just talking,” Rhame said, although “it doesn’t go much farther than 2 meters.”

One hope is that the COVID-19 virus is similar to common coronaviruses that tend to dissipate in warm, humid climates. Even the SARS outbreak declined in warmer months, but Osterholm said he believes that was coincidental and noted that the MERS coronavirus persists in the heat of the Gulf region.“It had nothing to do with the seasons,” he said.

Officials said they believe the best protection is the ongoing series of social distancing strategies to separate people so they don’t transmit the virus to others so quickly.

So-called “bend the curve” strategies, to stretch out the onset of cases over time so that hospitals aren’t overwhelmed, come in part from analysis of the 1918 Spanish flu. Hardest-hit cities at that time, such as Philadelphia, resisted social distancing.

“This distancing business is a war of attrition,” Rhame said. “It’s a war of tiny effects by a large concerted effort over a long time that will bring that R-naught value down. That’s desperately needed.”
​
                                  Jeremy Olson • 612-673-7744 • @stribjo
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The Club PUBlication  03/23/2020

3/23/2020

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Trump brushed off early, repeated virus warnings

By SHANE HARRIS, GREG MILLER, JOSH DAWSEY and ELLEN NAKASHIMA Washington Post



WASHINGTON –

​U.S. intelligence agencies were issuing ominous, classified warnings in January and February about the global danger posed by the coronavirus while President Donald Trump and lawmakers played down the threat and failed to take action that might have slowed the spread of the pathogen, according to U.S. officials familiar with spy agency reporting.


The intelligence reports didn’t predict when the virus might land on U.S. shores or recommend particular steps that public health officials should take, issues outside the purview of the intelligence agencies. But they did track the spread of the virus in China, and later in other countries, and warned that Chinese officials appeared to be minimizing the severity of the outbreak.

Taken together, the reports and warnings painted an early picture of a virus that showed the characteristics of a globe-encircling pandemic that could require governments to take swift actions to contain it. But despite that constant flow of reporting, Trump continued publicly and privately to play down the threat the virus posed to Americans. Lawmakers, too, did not grapple with the virus in earnest until this month, as officials scrambled to keep citizens in their homes and hospitals braced for a surge in patients suffering from COVID-19, the disease caused by the coronavirus.

Intelligence agencies “have been warning on this since January,” said a U.S. official who had access to intelligence reporting that was disseminated to members of Congress and their staffs as well as to officials in the Trump administration, and who, along with others, spoke on the condition of anonymity to describe sensitive information.

“Donald Trump may not have been expecting this, but a lot of other people in the government were — they just couldn’t get him to do anything about it,” this official said. “The system was blinking red.”

Spokespeople for the CIA and the Office of the Director of National Intelligence declined to comment, and a White House spokesman rebutted criticism of Trump’s response.

“President Trump has taken historic, aggressive measures to protect the health, wealth and safety of the American people,” Hogan Gidley said in a statement.
Public health experts have criticized China for being slow to respond to the coronavirus outbreak, which originated in Wuhan, and have said precious time was lost in the effort to slow the spread. At a White House briefing Friday, Health and Human Services Secretary Alex Azar said officials had been alerted to the initial reports of the virus by discussions that the director of the Centers for Disease Control and Prevention had with Chinese colleagues on Jan. 3.

The warnings from U.S. intelligence agencies increased in volume toward the end of January and into early February, said officials familiar with the reports. By then, a majority of the intelligence reporting included in daily briefing papers and digests from the Office of the Director of National Intelligence and the CIA was about COVID-19, said officials who have read the reports.

At the State Department, personnel had been nervously tracking early reports about the virus. One official noted that it was discussed at a meeting in the third week of January, around the time that cable traffic showed that U.S. diplomats in Wuhan were being brought home on chartered planes — a sign that the public health risk was significant.

Inside the White House, Trump’s advisers struggled to get him to take the virus seriously, according to multiple officials with knowledge of meetings among those advisers and with the president.

Azar couldn’t get through to Trump to speak with him about the virus until Jan. 18, according to two senior administration officials. When he reached Trump by phone, the president interjected to ask about vaping, the senior administration officials said.

On Jan. 27, White House aides huddled with then-acting chief of staff Mick Mulvaney in his office, trying to get senior officials to pay more attention to the virus, according to people briefed on the meeting. Joe Grogan, the head of the White House Domestic Policy Council, argued that the administration needed to take the virus seriously or it could cost the president his re-election, and that dealing with the virus was likely to dominate life in the United States for many months.

Mulvaney then began convening more regular meetings. In early briefings, however, officials said Trump was dismissive because he did not believe that the virus had spread widely throughout the United States.

By early February, Grogan and others worried that there weren’t enough tests to determine the rate of infection, according to people who spoke directly to Grogan. Other officials began calling for a more forceful response, according to people briefed on White House meetings.

But Trump resisted and continued to assure Americans that the coronavirus would never run rampant as it had in other countries.

“I think it’s going to work out fine,” Trump said on Feb.19. “I think when we get into April, in the warmer weather, that has a very negative effect on that and that type of a virus.”

“The Coronavirus is very much under control in the USA,” Trump tweeted five days later. “Stock Market starting to look very good to me!”

As the first cases of infection were confirmed in the United States, Trump continued to insist that the risk to Americans was small.

“We have a very small number of people in the country, right now, with it,” he said four days later. “It’s like around 12. Many of them are getting better. Some are fully recovered already. So we’re in very good shape.”

Trump eventually changed his tone after being shown statistical models about the spread of the virus from other countries and hearing directly from Deborah Birx, the coordinator of the White House coronavirus task force, as well as from chief executives last week rattled by a plunge in the stock market, said people familiar with Trump’s conversations.
​

But by then, the signs pointing to a major outbreak in the United States were everywhere.



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The Club PUBlication  03/16/2020

3/16/2020

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                                   GAINS AND LOSSES
Market panic is a virus we can contain

​Before you quarantine your investments, let's examine what is going on. 

​By  Ross Levin Special to the Star Tribune
MARCH 13, 2020 — 1:28PM

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Markets plunged Monday, causing many investors to think about rebalancing their portfolios.
​A virus is spreading across the world and it is far less physically dangerous than the coronavirus. It is transmitted through the airwaves, news outlets, discussions in coffee shops and other social settings, and is observed in real time by anyone checking their 401(k) balances or their investment statements. This virus not only makes victims miserable, it is self-imposed. It is also misdiagnosed.

The U.S. stock markets have had their worst week since 2008, when essentially too much borrowing brought us to the brink of a depression. But for most companies, this is not 2008. Before you quarantine your investments, let’s examine what is going on.

Stock prices are bets on the earnings of companies far into the future. While earnings today will be depressed by the coronavirus because of short-term closings and restrictions, what is the likely long-term impact?

Companies that make things and people who buy them have three choices. Let’s use the panic over Tokyo temporarily running out of toilet paper because of hoarding as an example:

1) They can delay their purchases. The likelihood that people will no longer buy toilet paper when it is manufactured is slim.

2) They can make a substitution — some of which could be permanent. There will be a few items where permanent substitutions are likely (toilet paper not being one of them, unless there is a universal switch to bidets).
3) People can avoid buying completely. Impulse purchases may temporarily go away as people realize that they don’t need what they were going to buy. But impulse buying won’t go away forever, and one person’s impulse is another’s need.

The importance of this moment is that the coronavirus will affect this year’s earnings for companies, but not in the same way for different companies in future years. There may be some industries where the substitution could cause seismic shifts — other types of travel substituted for cruises, for example — but most industries will see little long-term effect as the entire world is motivated to recalibrate
.
That doesn’t mean that all companies are equally inoculated. Companies with large current debt loads may have trouble making their payments and could end up being taken over or even having to file for bankruptcy. We are seeing some governments, specifically Germany, come to the aid of companies having liquidity troubles. We will continue to see more interventions.

COVID-19 will affect all of us in some way. As companies try to manage their cash flow, we will know people who have been laid off. We will hear of hourly workers who miss work due to illness struggling to meet their budgets. Our favorite servers at coffee shops and restaurants will see their income fall as more people stay home. Working from home creates a different type of socialization than working in an office environment, leading to a sense of disconnection. None of us are financially or socially immune from the coronavirus.

It’s important to be sensitive to those who are having financial difficulties from this. For those of you watching your portfolios fall, be careful trying to perform triage. You can bank on volatility as the news ebbs and flows. The challenge with selling out of the market is that you have to make a second decision of when to get back in. This is harder than the first.

Market corrections are uncomfortable and necessary. You can’t get returns without risk. That’s why money that is going to be spent over the next two or three years should be saved, not invested. But if you are a longer-term investor, rather than look at the current situation as a crisis, use it as a time to see whether you are comfortable with the risks you have been taking and whether opportunities have surfaced from this temporary meltdown.

While you may be feeling sick, take some steps to hasten your recovery. Just like you wouldn’t take your temperature every few minutes, stop looking at your investment accounts every few hours. Unless you are going to be taking action, there is no need for that kind of vigilance. Look at rebalancing your portfolio (which would cause you to sell bonds and buy stocks). If you have money that you want to put to work for the long-term, spoon some into the market rather than dumping it in all at once. And if you are on a regular investment program in your retirement plans, focus on the number of shares you are continuing to buy rather than their current value.
​

The symptoms from a falling market are uncomfortable, but they are not deadly.


Ross Levin is the chief executive & founder of Accredited Investors Wealth Management in Edina.
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The CLUB PUBlication  03/09/2020

3/9/2020

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Unlock the debtor's prison of student loans

Without intervention by Congress and a change of heart at the Education Department, struggling borrowers will continue to be trapped. 

By Liz Weston 
NerdWallet
 MARCH 7, 2020 — 8:20AM

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Getting student loans erased in bankruptcy, while technically possible, is so hard and expensive that few people try; even fewer succeed.

​Earlier this year, a judge denounced the myth that student loans can’t be erased in bankruptcy court as she excused a Navy veteran from having to pay $221,000 in education debt. Bankruptcy Judge Cecelia G. Morris’ decision garnered plenty of headlines, along with speculation that the ruling might make such discharges easier.


The battle isn’t over, though. A few days later, Morris’ ruling was appealed by the Education Credit Management Corp., a nonprofit company that guarantees and services federal student loans for the U.S. Department of Education.

The reality is that getting student loans erased in bankruptcy, while technically possible, is so hard and expensive that few people try; even fewer succeed. Without intervention by Congress and a change of heart at the Education Department, struggling borrowers will continue to be trapped in a virtual debtor’s prison: unable to pay what they owe and unable to move on with their lives.

Taxpayer money is being wasted, as well. ECMC has a long history of aggressively opposing student loan discharges, even when there’s little hope of recovering any money.

Obviously, walking away from student loan debt should never be easy. But getting relief from unpayable education debt should never have become this hard.

That was the consensus of an expert group of bankruptcy judges, lawyers and scholars who studied the issue and made their recommendations public last year. The American Bankruptcy Institute’s Commission on Consumer Bankruptcy suggested changes judges could make to help more borrowers, but real reform will require new laws and a more sensible, cost-effective approach by the Education Department.

Among the commission’s recommendations:

​Allow private student loans to be erased. Federal student loans are backed by taxpayer money, so it makes sense that they are harder to discharge than credit card debt or medical bills. But Congress extended the same status to private student loans in 2005. Unlike federal student loans, private student loans are underwritten — which means the lenders assess borrowers’ ability to repay, charge interest rates that reflect the risk of default and often require co-signers to guarantee repayment. Shielding private student loans in bankruptcy court may protect lender profits, but it’s hard to make the case that doing so is somehow in the taxpayers’ best interest. The commission recommends Congress change the law to allow private student loans, as well as loans taken out by parents and other relatives for their children, to be more easily erased.

The seven-year standard should be restored. In 1976, Congress decided that overwhelmed borrowers could get their student loans wiped out in bankruptcy once five years had passed since the first payment was due. Debtors could get relief earlier if repayment represented an “undue hardship.” In 1990, Congress lengthened the waiting period to seven years.

In 1998, Congress removed the time element entirely. Now borrowers are held to the strict standards the courts had developed under previous laws, but without the promise of eventual relief. The commission recommends returning to the seven-year standard, noting that if borrowers were still struggling at that point, their circumstances were unlikely to improve enough to repay a significant portion of their loans. Getting rid of the debt, on the other hand, could allow people to buy homes, start families, launch businesses and otherwise engage in productive activity that contributes to the tax base.

Call off the dogs. The commission decried “costly and inefficient litigation,” noting that the Education Department and ECMC regularly fight discharges regardless of the costs or benefits.

Instead, the commission recommended the department adopt clearly defined rules that would prevent student loan collectors from opposing discharges for people collecting disability benefits from Social Security or Veterans Affairs, or whose incomes were less than 175% of federal poverty levels. In other cases, collectors would be required to do a cost-benefit analysis so they don’t waste government money.

“That doesn’t mean we’re saying to the department you just ought to wipe out every student-loan debt,” saaid William Houston Brown, a retired bankruptcy judge who co-chaired the commission. “Just don’t spend the money litigating over things that are pointless.”

E-mail: [email protected]. Twitter: @lizweston.
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The Club PUBlication  03/02/2020

3/2/2020

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​BUSINESS 568253622
Unpleasant surprises in retirement aren't what you think
Large events that stress a nest egg are more common than you might imagine. 

By Jeff D. Opdyke Rate.com
 FEBRUARY 29, 2020 — 8:49AM
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To reduce the financial stress of retirement, cover essential living costs from guaranteed income.

​Unexpected financial shocks can be particularly stressful for retirees. Not run-of-the-mill expenses like, say, a higher auto insurance premium or a property-tax increase. We are talking about large events that stress a nest egg. They are more common than you might imagine.


Indeed, the Society of Actuaries’ Committee on Post-Retirement Needs and Risks has been working for two decades to better grasp how retirees manage financial issues.

The results: Nearly one in five retirees, and nearly one in four retired widows will experience four or more financial shocks.

Unexpected health care costs get a lot of attention, but the actuaries found that’s typically not the biggest bugaboo. Retirees who have Medicare and a supplemental plan (about 81% of them, according to Kaiser Family Foundation) typically have their medical bills well covered.

Instead, the actuaries report that, based on focus groups, the most common financial shocks are major home repairs (28% of retirees) and major dental costs (24%). The latter occurs because Medicare and most supplemental plans have weak or no dental coverage.

Other significant shocks include widowhood, divorce during retirement, long-term care expenses and adult children needing financial assistance.
The actuaries’ research suggests retirees are resilient, making necessary adjustments to their spending to cover the shocks. But those adjustments are often substantial, leading to a degraded lifestyle.

More than a third of retirees saw their assets decline by 25% or more. Roughly 10% had to reduce monthly spending by 50% or more.

Will you need $20,000 of emergency dental work in a few years? Will you and your spouse have to drastically reduce the assets on which you live? Will a hailstorm in 2023 damage your roof, allowing rain to seep in over time and rot walls and promote mold? Will an adult child need help?

Surviving such events means, of course, preparing for them, sometimes after you’ve retired. Building an emergency fund as large as possible is the obvious first step. That will help defray the costs of a new roof or a dental emergency.
​

Some costs, like long-term care, are beyond all but the biggest emergency fund. A long-term care policy is one option. Having a line of credit available can also help you navigate a financial shock. Most lines of credit are structured around home equity, and these days they charge interest rates of 4.3% to 6.5%. That’s substantially less than credit cards.
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