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One step forward, 2 steps back: Harvard’s Dr. Thomas Tsai assesses Trump’s response to COVID-19, and tells us his fears and hopes about the months ahead

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  • Dr. Thomas Tsai, of the Harvard Global Health Institute, spoke to Business Insider about where the United States stands in the fight against COVID-19 and President Donald Trump’s claim to be leading the world’s best response.
  • “It’s as if we are taking one step forward and two steps back,” Tsai said of the US response to the pandemic. “We started off with a peak, we settled for a plateau, and we ended up with a mountain range.”
  • “We’re breaking records every single day on state-level and national-level positive tests. What that means is that in one to two weeks from now, those record numbers of cases may translate to an increasing number of hospitalizations, ICU admissions, and, unfortunately, even fatalities.”
  • Dr. Tsai said President Donald Trump’s approach has left much to be desired. “Right now, at the highest peak of cases that we’ve had, it’s also been where the federal government has been most absent, where there has been no White House coronavirus task force briefing.”
  • “This pandemic has clearly shown the failure of a patchwork response and the result of a vacuum in terms of a national coordinated strategy.”
  • He faulted leadership in some states, such as Florida, for being unwilling to close down when necessary.
  • “Politicians are unwilling to dial things back. They’re only willing to sort of keep it from moving forward. Clearly, in the states where the pandemic has gotten out of control, a limited shutdown is needed to prevent hospitals from being overrun.”
  • Visit Business Insider’s homepage for more stories.

Not only are a record number of Americans testing positive for COVID-19, but, contra President Donald Trump’s false claim that the US has the lowest mortality rate in the world, more and more of them are dying, even with improvements in care. In the South, former success stories, such as Florida and Texas, are seeing a surge in infections — the consequence, experts say, of reopening their economies without first building up the capacity to test, trace, and quarantine.

Over 131,000 people have now died from COVID-19, which is certainly an undercount, not including those who died without ever being tested, nor those who were unable to get treatment for other disorders as a result of hospitals being overrun by a pandemic. Fourteen states have seen a double-digit increase in their coronavirus mortality rate over the last week, according to a count from The Washington Post, and, by the end of the month, the US Centers for Disease Control and Prevention projects the death toll to be as high as 160,000.

Dr. Thomas Tsai, a professor at Harvard University’s School of Public Health, feared this would happen, warning that happy talk of a speedy recovery was only masking the severity of the crisis. A member of Harvard’s Global Health Institute, he told Business Insider this week that the United States is even worse off than it was in the spring — “It’s as if we are taking one step forward and two steps back” — and that if Trump wishes to boast of his handling of this crisis, he would have to let scientists take the lead, and use the full power of the federal government to mobilize a national response.

This transcript has been lightly edited for clarity.

Charles Davis:

In March, you said, “There is a true fear that we may emerge as the new epicenter for the global pandemic.” What made you fear that then, and where do you think we are today?

Dr. Thomas Tsai:

Back in March, the fear was driven by the lack of preparation in both, at that time, the testing capacity as well as the ability to treat the patients in terms of hospital capacity, our supply of PPE, and even ventilators. What’s frustrating is that, four months later, we’re back to having the same exact conversation, if not on a national level, at least on a state-to-state level.

tsai

Dr. Thomas Tsai is a surgeon and professor at Harvard University’s T.H. Chan School of Public Health.
Harvard University

So we’re back to talking about testing capacity issues in some of our southern states, tests that take over one to two weeks to get back the results from. We’re back to talking about crisis standards of care, which is rationing of hospital ICU beds. We’re back to talking about test positive rates that are reaching almost 10% again. So it’s not even we’re taking two steps forward, one step back. It’s as if we are taking one step forward and two steps back. The current peak now is higher than the peak that was in April. 

We started off with a peak, we settled for a plateau, and we ended up with a mountain range.

Davis:

You also lead an effort to project COVID-19 hospitalization rates. We were talking about how we’re at a mountain peak right now — what do you expect we’ll see in the months ahead?

Tsai:

So my fear is that with the hospitalizations that we’re seeing now, they’re actually reflecting the community-level transmissions that were occurring about two weeks ago. But the surge in cases hasn’t gone down over the last two weeks. They’ve actually gone the opposite direction. We’re breaking records every single day on state-level and national-level positive tests. What that means is that in one to two weeks from now, those record number of cases may translate to an increasing number of hospitalizations, ICU admissions, and, unfortunately, even fatalities.

The challenge with balancing hospital capacity was that in March, there was a concerted effort to truly flatten the curve, with hospitals around the country postponing elective surgical procedures and medical admissions to free up beds for the anticipated wave of COVID-19 patients. What we couldn’t have predicted was how variable the transmission curves would be state-to-state. So instead of one peak, we basically have had 50 different state trajectories with 50 different peaks, all occurring at different points.

Right now, in these southern states, we’re at a critical moment where hospitals are busy trying to take care of patients with non-COVID conditions that were postponed and deferred appropriately during March, April, or May, but now they have the double burden of also trying to address the current rise in the COVID-19 cases. In some ways, it’s sort of a perfect storm in some of these southern states.

Davis:

I’ve been covering Florida a lot recently, and some of the doctors I’ve spoken to there have attributed the most recent surge to the fact that the state opened up so early without developing the capacity to test and trace positive cases in their contacts with others. That makes sense to me. 

But then I look at California, which is also surging right now, and at least early on, the story was that California was doing this the right way. We shut down early. We did not reopen early. So I guess what explains California? How do we reconcile the fact that California seemed to do it right, Florida seemed to do it wrong, but they’re kind of having the same outcome now?

Tsai:

Right. California is a challenging state, because it’s the United States in microcosm. It has very urban areas, very rural areas. It has areas that are medically underserved and areas that have some of the best hospitals in the country. So a lot of the challenges that California is facing, in some ways, is the US sort of writ large.

The issue around reopening is California did try to follow the data in terms of a phased reopening. It was one of the earlier states to shut down, and they also reopened with cases declining. What’s happened in California, which is different than Florida, in California, the test positive rate has been a stable 6% for the last several weeks. So what that means is California has been able to keep the lid on the pot and keep things from boiling over. It really hasn’t had the opportunity to turn the temperature down, because the cases are still increasing. But California is doing a lot of testing — 100,000 tests a day. California is a very, very big state, and that test positive rate translates to a large number of individuals in California.

In Florida, it’s the opposite, where the surge in cases has outpaced the rise in tests. I think what has happened is that some states have been content to flatten the curve as opposed to really bend the curve and drive it down to zero. I think part of the challenge as states had reopened was the guidelines were to not proceed with each phase of reopening unless there were two consistent weeks of declining positive cases and test positive rates and an adequate testing infrastructure in place. I think some states have followed that for moving to phase one, but sort of as they moved on to phase two, phase three, that guidance seems to have been ignored.

Davis:

I wanted to ask you what state you thought was doing best so far, but I also kind of wonder if, in a 50-state federal system like ours, if a state really can do that much better job than any other state when the federal government is not perhaps playing the role that some public health experts had wished it were playing in terms of providing the national leadership on supporting the adoption of masks and ramping up PPE production. 

Is it possible for a state to excel if there is lacking federal leadership? Do you see the leadership on the federal level as having played a detrimental role?

Tsai:

I sort of have three answers to that. The short answer is “no.” This pandemic has clearly shown the failure of a patchwork response and the result of a vacuum in terms of a national coordinated strategy. We go back to March, with states outbidding each other, trying to get supplies of PPE. Now we’re seeing different lag times in terms of testing capacity at different state levels.

So clearly, a coordinated strategy needs to happen. If it can’t happen at the federal level for political reasons, then it needs to happen at the state level. So governors need to work together and form interstate compacts and collaboratives to coordinate testing and social distancing policy on the regional level and that also translate down to within a state to coordinate that effort county to county.

The second answer — [an example] of a state that’s doing well, it’s easy to point to a state that had very low cases and stayed low, but that’s not a fair comparison. But we can look at Massachusetts. I’m partial to Massachusetts because I live here, but the state had a very high burden of COVID cases and hospitalizations and fatalities. About two-thirds of our outbreak occurred in patients from nursing homes and assisted living centers. Two-thirds of our fatalities, rather.

But now Massachusetts is testing at a 2% test positive rate, and cases are continuing to go down. Positive rate continues to go down. Hospitalizations continue to go down. So Massachusetts is an example of what a thoughtful, data-driven approach can work, but it takes time. Now, it’s been four months to get here, and there are no easy solutions, but people here, despite the 2% test positive rate, are still wearing masks on the street, everywhere you look. So it’s a beacon of hope that even in a state that was very severely affected by COVID-19 that good public health can sort lead you out of the wild and get you back into … or sort of lead you off the mountain in terms of the peak of cases is probably a better way of putting it.

The third point is that, now, there’s a lack of collective action to deal with the pandemic. Some of the states that did really well are now looking at the southern states and saying, “Well, gosh darn, you guys opened too soon.” What we need is the same collective energy that we had in March to flatten the curve, to work together, and to get control of the pandemic.

What I mean is everybody was so focused on New York, appropriately, in March and April, but now we need to take that same energy, because Los Angeles is a new New York. Phoenix is a new New York. Miami is a new New York. We should be making sure that medical volunteers are available in these severely affected areas, that hospitals in these areas now also have PPE or ventilators or field hospitals, that we have adequate testing in some of the southern states that are seeing peaks in cases.

So a lot of that collective energy [is gone]. We were hearing stories about governors shipping ventilators to other states early in March and April. But it seems that collective energy seems to have dissipated. I think this is a time where that needs to sort of come together again.

Davis:

When I talk to experts such as yourself, I hear the same refrain — that we should be “Testing more, tracing more.” But we’ve been saying that for months, and some states more than others have not really decided to ramp up testing and tracing. I just reported on Miami-Dade County, where, back in May, the mayor was talking about hiring 1,000 contact tracers, really ramping up before the storm, and that just never happened

Do you think there is the willpower to do that now? Is it too late? What happens if we don’t build up that capacity?

Tsai:

I think there is willpower. I don’t think it’s too late, because Massachusetts and New York looked really grim in March and April, and look at where the states are now. But what needs to happen is two things. One is it’s not enough to talk about the number of tests, the number of contact tracers. We actually have to measure how well those processes are performing.

In pre-COVID times, I worked on healthcare quality, and we have a framework of quality called the Donabedian framework around structure, process, and outcomes. So the structural measures are things like the tests, the number of contact tracers, number of beds. The outcomes are cases, fatalities, hospitalizations. But you have to connect the dots and turn the structure, which allows you to have the opportunity to have a strategy, into processes. So what we need are actually key performance indicators of how well our testing is actually working.

We have been part of a large collaborative group, and some of these new metrics are posted on globalepidemics.org. Our website released two dashboards last week, and some of these key performance indicators include the turnaround time for tests, the trace time, the time it takes to perform a contact tracing, because if it takes a week or two weeks to do this, then, mathematically, it becomes very challenging for the contact tracing alone to get ahead of the pandemic growth curve.

We also need to be looking at the percent of cases, positive cases that are actually coming from the contact tracing or targeted surveillance testing efforts, as opposed to just symptomatic individuals, because, again, we’ve gone backwards. Now some states are only testing symptomatic individuals again.

We need to measure these processes, because if we’re not measuring them, if you don’t know how long it takes for tests to come back, then you can’t figure out the process steps that are needed to improve these. I think every government dashboard, state, federal needs to have these sort of metrics, because it’s not enough to say, “We’re going to hire 1,000 contact tracers.” Did you, and if you did, how many people actually got traced? How many of those actually answered your call? How many people actually gave contacts? How many of those contacts actually got tested? How many of those people who tested positive actually underwent supported isolation? If you can’t measure it, you can’t improve it.

The second part is that testing by itself, we don’t have any new miracle cure, pharmacological or non-pharmacologic, right? The same toolkit that we have now is what we had in March. It worked in March, in April. We were able to flatten the curve back then, but we sort of somehow gave up in May and June.

This is why, as part of our dashboard, we had the county-level COVID risk levels. So counties are grouped into green, yellow, orange, and red based off of their incident number of new cases. So if you have more than 25 per 100,000 cases, that puts you in the red zone, which is the tipping point. That’s the point where just the contact tracing strategy alone may not be enough, and you have to enforce universal masking and social distancing. That may even mean a shutdown. It’s not meant to be a permanent shutdown, but you may need a shutdown to once again gain control of the infection and flatten the curve.

I’ve been saying all along that social distancing policy was never meant to be an on/off switch. It was always meant to be a dial that had to be dialed up and dialed down according to the data. However, it seems that the dial is stuck. It only turns in one direction, and politicians are unwilling to dial things back. They’re only willing to sort of keep it from moving forward. Clearly, in the states where the pandemic has gotten out of control, a limited shutdown is needed to prevent hospitals from being overrun.

Davis:

I have some pessimistic friends who think that the coronavirus is going to be like the seasonal flu, in the sense that even if we have a vaccine, it’s going to mutate. The vaccine will only be so effective, and that this “new normal” is going to be the new normal. What do you think of that?

Tsai:

We don’t know how effective the vaccine will be. The vaccine trials are underway currently, so we’ll know a lot more in a few more months. So I think it’s too early to tell. In the absence of sort of concrete information, I can’t think it’s a good idea to sort of hope for the best.

But, again, this is not the new normal. We have two normals in the United States currently. In the North, we have a normal where the case counts are very low. We can reopen the economy. People can go back to work, assuming that people are still getting tested adequately, wearing masks, and social distancing. You have another normal in the South, where cases are exploding. So the normal is relative. Normal depends on what the underlying COVID-19 prevalence is, and what’s important for people to understand is that you can change that. 

None of this is written in stone. We all can control the trajectory of the pandemic. It’s a matter of executing the game plan. We have the game plan. We know what works. We’ve seen it work in other countries. We’ve seen it with New York and other states, and now it’s just the time to do that. So you can create the normal. It’s just which normal are you willing to accept?

Davis:

I don’t want to wade into politics too much or make you the target of a presidential tweet, but President Trump, as you have probably seen, claims that we’re doing probably the best job of any country in the world. I won’t even ask for your opinion on that because I think, objectively, we know that’s not true. But I guess if President Trump wanted the United States to truly be the best country in terms of its response to this pandemic, what could or should he do, starting right now?

Tsai:

I think right now, we need to get the public health experts and scientists back front and center, briefing the country on what the data are every single day. Right now, at the highest peak of cases that we’ve had, it’s also been where the federal government has been most absent, where there has been no White House coronavirus task force briefing. So what we need is we need our public health experts like Dr. Fauci and Dr. Birx out there, front and center, explaining to the public what the data means, because if the public understands the severity of the pandemic, they’ll understand the level of response that’s needed. So I think that getting the information out objectively is incredibly important right now.

Second, there needs to be a coordination of testing on a national level, and that means fixing the supply chain issues. It also means financing not just the supply of tests, but also financing the demand for testing. So that may mean prepaying tests or using the Defense Production Act or a voucher program to make sure that testing is accessible, available, and affordable in the communities where people need them.

I think those two steps would be important steps in the right direction, and convening these sort of interstate compacts or collaboratives so the state governors can work together, because it is going to be very local. We need a national strategy. We need a national resolve. The actual plans are going to look very different, state-to-state, as they should. It’s hard to compare Vermont to Arizona right now. So that’s why there’s a national resolve and support and production of evidence and best practices. But, obviously, the policies will have to be flexible, depending on what the pandemic is telling us.

We have to let the pandemic drive our policymaking. That’s the only way to beat the pandemic. Let the data and the underlying growth curve guide our decision making, with the understanding that we can’t be reactive. Being reactive is what’s gotten us to where we were in March and April, and it’s gotten to us where we are now. We have to be proactive in order to beat this.

Have a news tip? Email this reporter: cdavis@insider.com

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Source: https://www.businessinsider.com/covid-19-harvards-dr-thomas-tsai-asseses-trumps-pandemic-response-2020-7

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AutoNation Board Raises Share Repurchase Authorization – Quick Facts

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(RTTNews) – AutoNation, Inc. (AN) announced that its Board of Directors increased the company’s outstanding share repurchase authorization to an aggregate of $500 million. As of October 19, 2020, the company had approximately 87.9 million shares outstanding.

AutoNation said it continues to prioritize capital expenditures towards opportunities with the greatest return potential. The company plans to build over 100 AutoNation USA pre-owned vehicle stores, with over 50 completed by the end of 2025. The company plans to open five new AutoNation USA stores by the end of 2021.

Source: https://markets.businessinsider.com/news/stocks/autonation-board-raises-share-repurchase-authorization-quick-facts-1029704014

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Conversion Labs Appoints Former White House Physician and U.S. Navy Rear Admiral, Dr. Connie Mariano, to Board of Directors

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NEW YORK, Oct. 21, 2020 (GLOBE NEWSWIRE) — Conversion Labs, Inc. (OTCQB: CVLB), a direct-to-consumer telemedicine and wellness company, has appointed healthcare veteran, Dr. Connie Mariano, to its board of directors. Following her appointment, the board will have eight members, with five serving independently. 

Board certified in internal medicine, Dr. Mariano brings 30 years of executive leadership in healthcare to Conversion Labs. She will advise company management on health care services and product development related to the company’s telemedicine brands, including Rex MD™, Shapiro MD™, SOS Rx™, Veritas MD™ and others under development.

Dr. Mariano has been a pioneer in breaking down barriers and shattering glass ceilings, including becoming the first Filipino American promoted to the rank of U.S. Navy Rear Admiral and the first military woman to be appointed White House Physician. She later became director of the White House Medical Unit and served for nine years at the White House as physician to three sitting presidents.

“A phenomenal healthcare leader, Dr. Mariano brings to our board extensive knowledge and experience in providing the best in quality health care,” noted Justin Schreiber, chairman and CEO of Conversion Labs. “Her background in internal medicine and concierge care represents a valuable addition to our board. We look forward to her insights and guidance as we continue to enhance and expand our telehealth platform.”

After leaving the White House, Dr. Mariano became a consultant in the executive health program at the Mayo Clinic in Scottsdale, Arizona, where she provided holistic health evaluations for senior executives. She later founded the Center for Executive Medicine, a concierge medical practice that provides ‘presidential-quality’ care to CEOs and their families.

She earned her bachelor’s degree with honors from Revelle College at the University of California, San Diego. She received her medical degree from the Uniformed Services University School of Medicine in Bethesda, Maryland, where she was commissioned as a U.S. Navy lieutenant upon graduation.

“Conversion Labs has earned a strong reputation of delivering quality, cutting-edge telehealth products and services, which is evident in its strong customer growth over the past year,” commented Dr. Mariano. “There is a growing need for telemedicine services in today’s post-COVID world, and I believe Conversion Labs is uniquely positioned to address this need. I look forward to contributing my knowledge and experience to support Conversion Labs’ growth in this very important field.”

Conversion Labs has seen an acceleration in its operational and financial performance since the beginning of the year. The company recently reported its annualized revenue run rate hit $46.8 million versus $12.5 million for all of 2019 — a more than three-fold increase.

About Conversion Labs
Conversion Labs, Inc. is a telemedicine company with a portfolio of online direct-to-consumer brands. The company’s brands combine virtual medical treatment with prescription medications and unique over-the-counter products. Its network of licensed physicians offers telemedicine services and direct-to-consumer pharmacy to consumers across the U.S. To learn more, visit Conversionlabs.com.

Important Cautions Regarding Forward-Looking Statements
This news release includes forward-looking statements within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934, as amended, regarding, among other things our plans, strategies and prospects — both business and financial. Although we believe that our plans, intentions and expectations reflected in or suggested by these forward-looking statements are reasonable, we cannot assure you that we will achieve or realize these plans, intentions or expectations. Forward-looking statements are inherently subject to risks, uncertainties and assumptions. Many of the forward-looking statements contained in this news release may be identified by the use of forward-looking words such as “believe,” “expect,” “anticipate,” “should,” “planned,” “will,” “may,” “intend,” “estimated,” and “potential,” among others. Important factors that could cause actual results to differ materially from the forward-looking statements we make in this news release include market conditions and those set forth in reports or documents that we file from time to time with the United States Securities and Exchange Commission. All forward-looking statements attributable to Conversion Labs, Inc. or a person acting on its behalf are expressly qualified in their entirety by this cautionary language.

Trademarks are the property of their respective owners.

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Juan Manuel Piñeiro Dagnery
CFO
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Ron Both or Grant Stude
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Mehiläinen Yhtiöt Oy supplements the tender offer document dated 8 January 2020 regarding the public cash tender offer for all shares in Pihlajalinna Plc

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THIS STOCK EXCHANGE RELEASE MAY NOT BE RELEASED, PUBLISHED OR OTHERWISE DISTRIBUTED, IN WHOLE OR IN PART, DIRECTLY OR INDIRECTLY, IN OR INTO AUSTRALIA, CANADA, HONG KONG SPECIAL ADMINISTRATIVE REGION OF THE PEOPLE’S REPUBLIC OF CHINA, JAPAN, NEW ZEALAND, OR SOUTH AFRICA, OR ANY OTHER JURISDICTION IN WHICH THE TENDER OFFER WOULD BE PROHIBITED BY APPLICABLE LAW. FOR FURTHER INFORMATION, PLEASE SEE SECTION ENTITLED “IMPORTANT INFORMATION” BELOW.

HELSINKI, Oct. 21, 2020 /PRNewswire/ — Mehiläinen Yhtiöt Oy (“Mehiläinen” or the “Offeror“) and Pihlajalinna Plc (“Pihlajalinna“) announced on 5 November 2019 that they had entered into a combination agreement pursuant to which Mehiläinen undertook to make a voluntary recommended public cash tender offer for all issued and outstanding shares in Pihlajalinna (the “Tender Offer“). The acceptance period under the Tender Offer (the “Offer Period“) commenced on 9 January 2020 at 9:30 a.m. (Finnish time) and will expire on 20 November 2020 at 4:00 p.m. (Finnish time), unless extended further or discontinued in accordance with, and subject to, the terms and conditions of the Tender Offer and applicable laws and regulations.

The Finnish Financial Supervisory Authority has today approved a supplement to the tender offer document, dated 8 January 2020, concerning the Tender Offer (the “Tender Offer Document“, and such supplement hereinafter the “Supplement Document“). The Supplement Document relates to the Offeror’s decision published by the Offeror on 15 October 2020 to extend the Offer Period to expire on 20 November 2020 at 4:00 p.m. (Finnish time). The Supplement Document and the stock exchange release published by the Offeror on 15 October 2020 are attached as Appendix 1 to this stock exchange release. In addition, the stock exchange release published by the Offeror on 15 October 2020 has been included as Appendix L to the Tender Offer Document.

The Tender Offer Document and the Supplement Document will be available in Finnish from 21 October 2020 onwards at the headquarters of Mehiläinen, Pohjoinen Hesperiankatu 17 C, 6th floor, FI-00260 Helsinki, Finland, the headquarters of Nordea Bank Abp, Satamaradankatu 5, FI-00020 Nordea, Finland and at Nasdaq Helsinki, Fabianinkatu 14, FI-00100 Helsinki, Finland. The electronic versions of the Tender Offer Document and the Supplement Document will be available in Finnish from 21 October 2020 onwards online at ostotarjous.mehilainen.fi, investors.pihlajalinna.fi/public-tender-offer and nordea.fi/osakkeet, and in English from 21 October 2020 onwards online at ostotarjous.mehilainen.fi, investors.pihlajalinna.fi/public-tender-offer.aspx?sc_lang=en and nordea.fi/equities.

Contacts for media and investor inquiries:

Mehiläinen

Janne-Olli Järvenpää, CEO of Mehiläinen

Requests for contacts through Mehiläinen’s communications:

Manager Laura Martinsuo
tel. +358 40 196 2892
Laura.martinsuo@mehilainen.fi

Pihlajalinna

Joni Aaltonen, CEO of Pihlajalinna Plc
Requests for contacts through Pihlajalinna’s communications:
Communications manager Taina Lehtomäki
tel. +358 50 451 3678
taina.lehtomaki@pihlajalinna.fi

Mehiläinen in brief:

Now 110 years old, Mehiläinen is a rapidly developing and growing private provider of healthcare and social care services, offering comprehensive high-quality services to private, corporate, municipal and insurance customers. Mehiläinen provides help, support and care for approximately 1.3 million customers every year across Finland. In 2019, our revenue was EUR 1064.1 million and our customers were cared for by more than 21,800 employees and private practitioners at over 500 locations. In all of its business areas, Mehiläinen invests in high-quality health care with an impact and develops and exports Finnish digital healthcare know-how across the world as a forerunner in its field.

Pihlajalinna in brief:

Pihlajalinna is one of the leading private providers of social, healthcare and well-being services in Finland. The company provides services for households, companies, insurance companies and public sector entities, such as municipalities, federations of municipalities and hospital districts. Listed on the official list of Nasdaq Helsinki since 2015, Pihlajalinna’s reported revenue was EUR 518.6 million in 2019. Pihlajalinna’s nearly 6,000 employees and approximately 1,200 private practitioners produce services in over 210 locations across Finland.

IMPORTANT INFORMATION

THIS STOCK EXCHANGE RELEASE MAY NOT BE RELEASED, PUBLISHED OR OTHERWISE DISTRIBUTED, IN WHOLE OR IN PART, DIRECTLY OR INDIRECTLY, IN OR INTO AUSTRALIA, CANADA, HONG KONG SPECIAL ADMINISTRATIVE REGION OF THE PEOPLE’S REPUBLIC OF CHINA, JAPAN, NEW ZEALAND, OR SOUTH AFRICA, OR ANY OTHER JURISDICTION IN WHICH THE TENDER OFFER WOULD BE PROHIBITED BY APPLICABLE LAW.

THIS STOCK EXCHANGE RELEASE IS NOT A TENDER OFFER DOCUMENT AND AS SUCH DOES NOT CONSTITUTE AN OFFER OR INVITATION TO MAKE A SALES OFFER. IN PARTICULAR, THIS STOCK EXCHANGE RELEASE IS NOT AN OFFER TO SELL OR THE SOLICITATION OF AN OFFER TO BUY ANY SECURITIES DESCRIBED HEREIN, AND IS NOT AN EXTENSION OF THE TENDER OFFER, IN, AUSTRALIA, CANADA, HONG KONG SPECIAL ADMINISTRATIVE REGION OF THE PEOPLE’S REPUBLIC OF CHINA, JAPAN, NEW ZEALAND, OR SOUTH AFRICA. INVESTORS SHALL ACCEPT THE TENDER OFFER FOR THE SHARES ONLY ON THE BASIS OF THE INFORMATION PROVIDED IN A TENDER OFFER DOCUMENT. THE TENDER OFFER IS NOT BEING MADE, AND THE SHARES WILL NOT BE ACCEPTED FOR PURCHASE FROM OR ON BEHALF OF PERSONS, DIRECTLY OR INDIRECTLY IN ANY JURISDICTION WHERE EITHER AN OFFER OR ACCEPTANCE THEREOF IS PROHIBITED BY APPLICABLE LAW OR WHERE ANY TENDER OFFER DOCUMENT OR REGISTRATION OR OTHER REQUIREMENTS WOULD APPLY IN ADDITION TO THOSE UNDERTAKEN IN FINLAND.

THE TENDER OFFER IS NOT BEING MADE DIRECTLY OR INDIRECTLY IN ANY JURISDICTION WHERE PROHIBITED BY APPLICABLE LAW, AND THE TENDER OFFER DOCUMENT AND RELATED ACCEPTANCE FORMS AND SUPPLEMENT DOCUMENTS WILL NOT AND MAY NOT BE DISTRIBUTED, FORWARDED OR TRANSMITTED INTO OR FROM ANY JURISDICTION WHERE PROHIBITED BY APPLICABLE LAWS OR REGULATIONS. IN PARTICULAR, THE TENDER OFFER IS NOT BEING MADE, DIRECTLY OR INDIRECTLY, BY ANY MEANS OR INSTRUMENTALITY (INCLUDING WITHOUT LIMITATION E-MAIL, POST, FACSIMILE TRANSMISSION, TELEX, TELEPHONE OR ELECTRONIC TRANSMISSION BY WAY OF THE INTERNET OR OTHERWISE), IN OR INTO, OR BY USE OF THE POSTAL SERVICE OF, OR THROUGH ANY FACILITIES OF A NATIONAL SECURITIES EXCHANGE OF, AUSTRALIA, CANADA, HONG KONG SPECIAL ADMINISTRATIVE REGION OF THE PEOPLE’S REPUBLIC OF CHINA, JAPAN, NEW ZEALAND, OR SOUTH AFRICA. THE TENDER OFFER CANNOT BE ACCEPTED, DIRECTLY OR INDIRECTLY, BY ANY SUCH USE, MEANS OR INSTRUMENTALITY OR FROM WITHIN, AUSTRALIA, CANADA, HONG KONG SPECIAL ADMINISTRATIVE REGION OF THE PEOPLE’S REPUBLIC OF CHINA, JAPAN, NEW ZEALAND, OR SOUTH AFRICA. ANY PURPOTED ACCEPTANCE OF THE TENDER OFFER RESULTING DIRECTLY OR INDIRECTLY FROM A VIOLATION OF THESE RESTRICTIONS WILL BE INVALID.

THIS STOCK EXCHANGE RELEASE OR ANY OTHER DOCUMENT OR MATERIALS RELATING TO THE TENDER OFFER IS NOT BEING MADE AND HAVE NOT BEEN APPROVED BY AN AUTHORISED PERSON FOR THE PURPOSES OF SECTION 21 OF THE UK FINANCIAL SERVICES AND MARKETS ACT 2000 (THE “FSMA“). ACCORDINGLY, THIS STOCK EXCHANGE RELEASE OR ANY OTHER DOCUMENT OR MATERIALS RELATING TO THE TENDER OFFER ARE NOT BEING DISTRIBUTED TO, AND MUST NOT BE PASSED ON TO, THE GENERAL PUBLIC IN THE UNITED KINGDOM. THE COMMUNICATION OF THIS STOCK EXCHANGE RELEASE OR ANY OTHER DOCUMENT OR MATERIALS RELATING TO THE TENDER OFFER IS EXEMPT FROM THE RESTRICTION ON FINANCIAL PROMOTIONS UNDER SECTION 21 OF THE FSMA ON THE BASIS THAT IT IS A COMMUNICATION BY OR ON BEHALF OF A BODY CORPORATE WHICH RELATES TO A TRANSACTION TO ACQUIRE DAY TO DAY CONTROL OF THE AFFAIRS OF A BODY CORPORATE; OR TO ACQUIRE 50 PER CENT. OR MORE OF THE VOTING SHARES IN A BODY CORPORATE, WITHIN ARTICLE 62 OF THE FINANCIAL SERVICES AND MARKETS ACT 2000 (FINANCIAL PROMOTION) ORDER 2005.

Information to shareholders in the United States

Shareholders in the United States are advised that the shares in Pihlajalinna are not listed on a U.S. securities exchange and that Pihlajalinna is not subject to the periodic reporting requirements of the U.S. Securities Exchange Act of 1934, as amended (the “Exchange Act“), and is not required to, and does not, file any reports with the U.S. Securities and Exchange Commission (the “SEC“) thereunder.

The Tender Offer will be made for the issued and outstanding shares in Pihlajalinna, which is domiciled in Finland, and is subject to Finnish disclosure and procedural requirements. The Tender Offer is made in the United States in compliance with Section 14(e) of the Exchange Act and the applicable rules and regulations promulgated thereunder, including Regulation 14E (in each case, subject to any exemptions or relief therefrom, if applicable) and otherwise in accordance with the disclosure and procedural requirements of Finnish law, including with respect to the Tender Offer timetable, settlement procedures, withdrawal, waiver of conditions and timing of payments, which are different from those of the United States. In particular, the financial information included in this stock exchange release has been prepared in accordance with applicable accounting standards in Finland, which may not be comparable to the financial statements or financial information of U.S. companies. The Tender Offer is made to Pihlajalinna’s shareholders resident in the United States on the same terms and conditions as those made to all other shareholders of Pihlajalinna to whom an offer is made. Any information documents, including this stock exchange release, are being disseminated to U.S. shareholders on a basis comparable to the method that such documents are provided to Pihlajalinna’s other shareholders.

To the extent permissible under applicable law or regulations, including Rule 14e-5 under the Exchange Act, Mehiläinen and its affiliates or its brokers and its brokers’ affiliates (acting as agents for Mehiläinen or its affiliates, as applicable) may from time to time and during the pendency of the Tender Offer, and other than pursuant to the Tender Offer and combination, directly or indirectly, purchase or arrange to purchase, the shares in Pihlajalinna or any securities that are convertible into, exchangeable for or exercisable for such shares. These purchases may occur either in the open market at prevailing prices or in private transactions at negotiated prices. To the extent information about such purchases or arrangements to purchase is made public in Finland, such information will be disclosed by means of a press release or other means reasonably calculated to inform U.S. shareholders of Pihlajalinna of such information. In addition, the financial advisers to Mehiläinen may also engage in ordinary course trading activities in securities of Pihlajalinna, which may include purchases or arrangements to purchase such securities. To the extent required in Finland, any information about such purchases will be made public in Finland in the manner required by Finnish law.

Neither the SEC nor any U.S. state securities commission has approved or disapproved the Tender Offer, passed upon the merits or fairness of the Tender Offer, or passed any comment upon the adequacy, accuracy or completeness of the disclosure in this stock exchange release. Any representation to the contrary is a criminal offence in the United States.

The receipt of cash pursuant to the Tender Offer by a U.S. holder of shares in Pihlajalinna may be a taxable transaction for U.S. federal income tax purposes and under applicable U.S. state and local, as well as foreign and other, tax laws. Each holder of shares in Pihlajalinna is urged to consult its independent professional adviser immediately regarding the tax consequences of accepting the Tender Offer.

It may be difficult for Pihlajalinna’s shareholders to enforce their rights and any claims they may have arising under the U.S. federal securities laws, since Mehiläinen and Pihlajalinna are located in non-U.S. jurisdictions, and some or all of their respective officers and directors may be residents of non-U.S. jurisdictions. Pihlajalinna’s shareholders may not be able to sue Mehiläinen or Pihlajalinna or their respective officers or directors in a non-U.S. court for violations of the U.S. federal securities laws. It may be difficult to compel Mehiläinen and Pihlajalinna and their respective affiliates to subject themselves to a U.S. court’s judgment.

Forward-looking statements

This stock exchange release contains statements that, to the extent they are not historical facts, constitute “forward-looking statements”. Forward-looking statements include statements concerning plans, expectations, projections, objectives, targets, goals, strategies, future events, future revenues or performance, capital expenditures, financing needs, plans or intentions relating to acquisitions, competitive strengths and weaknesses, plans or goals relating to financial position, future operations and development, business strategy and the trends in the industries and the political and legal environment and other information that is not historical information. In some instances, they can be identified by the use of forward-looking terminology, including the terms “believes”, “intends”, “may”, “will” or “should” or, in each case, their negative or variations on comparable terminology. By their very nature, forward-looking statements involve inherent risks, uncertainties and assumptions, both general and specific, and risks exist that the predictions, forecasts, projections and other forward-looking statements will not be achieved. Given these risks, uncertainties and assumptions, investors are cautioned not to place undue reliance on such forward-looking statements. Any forward-looking statements contained herein speak only as at the date of this stock exchange release.

Appendix 1 Supplement Document and the stock exchange release published by the Offeror on 15 October 2020

This information was brought to you by Cision https://news.cision.com

The following files are available for download:

https://mb.cision.com/Public/14605/3220021/9bf5b2a139e0555b.pdf

Supplement Document 21 October 2020

Source: https://markets.businessinsider.com/news/stocks/mehilaeinen-yhtioet-oy-supplements-the-tender-offer-document-dated-8-january-2020-regarding-the-public-cash-tender-offer-for-all-shares-in-pihlajalinna-plc-1029704037

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Business Insider

AutoNation Inc. Q3 adjusted earnings Beat Estimates

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(RTTNews) – AutoNation Inc. (AN) released a profit for its third quarter that climbed from the same period last year.

The company’s bottom line totaled $182.6 million, or $2.05 per share. This compares with $99.5 million, or $1.10 per share, in last year’s third quarter.

Excluding items, AutoNation Inc. reported adjusted earnings of $211.8 million or $2.38 per share for the period.

Analysts had expected the company to earn $1.60 per share, according to figures compiled by Thomson Reuters. Analysts’ estimates typically exclude special items.

The company’s revenue for the quarter fell 1.1% to $5.40 billion from $5.46 billion last year.

AutoNation Inc. earnings at a glance:

-Earnings (Q3): $211.8 Mln. vs. $106.3 Mln. last year.
-EPS (Q3): $2.38 vs. $1.18 last year.
-Analysts Estimate: $1.60
-Revenue (Q3): $5.40 Bln vs. $5.46 Bln last year.

Source: https://markets.businessinsider.com/news/stocks/autonation-inc-q3-adjusted-earnings-beat-estimates-1029704015

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