National News Content

Black Tech Founders Want to Change the Culture of Health Care, One Click at a Time

When Ashlee Wisdom launched an early version of her health and wellness website, more than 34,000 users — most of them Black — visited the platform in the first two weeks.

“It wasn’t the most fully functioning platform,” recalled Wisdom, 31. “It was not sexy.”

But the launch was successful. Now, more than a year later, Wisdom’s company, Health in Her Hue, connects Black women and other women of color to culturally sensitive doctors, doulas, nurses and therapists nationally.

As more patients seek culturally competent care — the acknowledgment of a patient’s heritage, beliefs and values during treatment — a new wave of Black tech founders like Wisdom want to help. In the same way Uber Eats and Grubhub revolutionized food delivery, Black tech health startups across the United States want to change how people exercise, how they eat and how they communicate with doctors.

Inspired by their own experiences, plus those of their parents and grandparents, Black entrepreneurs are launching startups that aim to close the cultural gap in health care with technology — and create profitable businesses at the same time.

“One of the most exciting growth opportunities across health innovation is to back underrepresented founders building health companies focusing on underserved markets,” said Unity Stoakes, president and co-founder of StartUp Health, a company headquartered in San Francisco that has invested in a number of health companies led by people of color. He said those leaders have “an essential and powerful understanding of how to solve some of the biggest challenges in health care.”

Platforms created by Black founders for Black people and communities of color continue to blossom because those entrepreneurs often see problems and solutions others might miss. Without diverse voices, entire categories and products simply would not exist in critical areas like health care, business experts say.

“We’re really speaking to a need,” said Kevin Dedner, 45, founder of the mental health startup Hurdle. “Mission alone is not enough. You have to solve a problem.”

Dedner’s company, headquartered in Washington, D.C., pairs patients with therapists who “honor culture instead of ignoring it,” he said. He started the company three years ago, but more people turned to Hurdle after the killing of George Floyd.

In Memphis, Tennessee, Erica Plybeah, 33, is focused on providing transportation. Her company, MedHaul, works with providers and patients to secure low-cost rides to get people to and from their medical appointments. Caregivers, patients or providers fill out a form on MedHaul’s website, then Plybeah’s team helps them schedule a ride.

While MedHaul is for everyone, Plybeah knows people of color, anyone with a low income and residents of rural areas are more likely to face transportation hurdles. She founded the company in 2017 after years of watching her mother take care of her grandmother, who had lost two limbs to Type 2 diabetes. They lived in the Mississippi Delta, where transportation options were scarce.

“For years, my family struggled with our transportation because my mom was her primary transporter,” Plybeah said. “Trying to schedule all of her doctor’s appointments around her work schedule was just a nightmare.”

Plybeah’s company recently received funding from Citi, the banking giant.

“I’m more than proud of her,” said Plybeah’s mother, Annie Steele. “Every step amazes me. What she is doing is going to help people for many years to come.”

Mission alone is not enough. You have to solve a problem.

Kevin Dedner

Health in Her Hue launched in 2018 with just six doctors on the roster. Two years later, users can download the app at no cost and then scroll through roughly 1,000 providers.

“People are constantly talking about Black women’s poor health outcomes, and that’s where the conversation stops,” said Wisdom, who lives in New York City. “I didn’t see anyone building anything to empower us.”

As her business continues to grow, Wisdom draws inspiration from friends such as Nathan Pelzer, 37, another Black tech founder, who has launched a company in Chicago. Clinify Health works with community health centers and independent clinics in underserved communities. The company analyzes medical and social data to help doctors identify their most at-risk patients and those they haven’t seen in awhile. By focusing on getting those patients preventive care, the medical providers can help them improve their health and avoid trips to the emergency room.

“You can think of Clinify Health as a company that supports triage outside of the emergency room,” Pelzer said.

Pelzer said he started the company by printing out online slideshows he’d made and throwing them in the trunk of his car. “I was driving around the South Side of Chicago, knocking on doors, saying, ‘Hey, this is my idea,’” he said.

Wisdom got her app idea from being so stressed while working a job during grad school that she broke out in hives.

“It was really bad,” Wisdom recalled. “My hand would just swell up, and I couldn’t figure out what it was.”

The breakouts also baffled her allergist, a white woman, who told Wisdom to take two Allegra every day to manage the discomfort. “I remember thinking if she was a Black woman, I might have shared a bit more about what was going on in my life,” Wisdom said.

The moment inspired her to build an online community. Her idea started off small. She found health content in academic journals, searched for eye-catching photos that would complement the text and then posted the information on Instagram.

I didn’t see anyone building anything to empower us.

Ashlee Wisdom

Things took off from there. This fall, Health in Her Hue launched “care squads” for users who want to discuss their health with doctors or with other women interested in the same topics.

“The last thing you want to do when you go into the doctor’s office is feel like you have to put on an armor and feel like you have to fight the person or, like, you know, be at odds with the person who’s supposed to be helping you on your health journey,” Wisdom said. “And that’s oftentimes the position that Black people, and largely also Black women, are having to deal with as they’re navigating health care. And it just should not be the case.”

As Black tech founders, Wisdom, Dedner, Pelzer and Plybeah look for ways to support one another by trading advice, chatting about funding and looking for ways to come together. Pelzer and Wisdom met a few years ago as participants in a competition sponsored by Johnson & Johnson. They reconnected at a different event for Black founders of technology companies and decided to help each other.

“We’re each other’s therapists,” Pelzer said. “It can get lonely out here as a Black founder.”

In the future, Plybeah wants to offer transportation services and additional assistance to people caring for aging family members. She also hopes to expand the service to include dropping off customers for grocery and pharmacy runs, workouts at gyms and other basic errands.

Pelzer wants Clinify Health to make tracking health care more fun — possibly with incentives to keep users engaged. He is developing plans and wants to tap into the same competitive energy that fitness companies do.

Wisdom wants to support physicians who seek to improve their relationships with patients of color. The company plans to build a library of resources that professionals could use as a guide.

“We’re not the first people to try to solve these problems,” Dedner said. Yet he and the other three feel the pressure to succeed for more than just themselves and those who came before them.

“I feel like, if I fail, that’s potentially going to shut the door for other Black women who are trying to build in this space,” Wisdom said. “But I try not to think about that too much.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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‘An Arm and a Leg’: How to Avoid the Worst Health Insurance

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Click here for a transcript of the episode.

This episode kicks off with a wild ride: How one journalist nearly got roped into a scam.

While hunting for a new health insurance plan, award-winning journalist Mitra Kaboli got an offer that seemed too good to be true — and seemed to be coming from her current insurer. She was skeptical and, it turns out, had every reason to be. Dania Palanker of Georgetown University’s Center on Health Insurance Reforms unpacks this sketchy scheme and gives us the key to avoiding it: When you’re searching for health insurance, skip Google. Seriously.

Then, top health insurance nerds teach us the right way to shop for health insurance: where to find the fine print and how to read it.

They also deliver some good news (for once): The subsidies in the American Rescue Plan ensure that some deals this year are actually … deals! Meaning: Health insurance has become more affordable for lots of people.

To read all of those tips in one place, check out “First Aid Kit,” a newsletter in which we sum up all the practical stuff we’ve been learning since “An Arm and a Leg” podcast launched. 

“An Arm and a Leg” is a co-production of KHN and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

To hear all KHN podcasts, click here.

And subscribe to “An Arm and a Leg” on Spotify, Apple Podcasts, StitcherPocket Casts, or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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California Joins States Trying to Shorten Wait Times for Mental Health Care

When Greta Christina fell into a deep depression five years ago, she called up her therapist in San Francisco. She’d had a great connection with the provider when she needed therapy in the past. She was delighted to learn that he was now “in network” with her insurance company, meaning she wouldn’t have to pay out-of-pocket anymore to see him.

But her excitement was short-lived. Over time, Christina’s appointments with the therapist went from every two weeks, to every four weeks, to every five or six.

“To tell somebody with serious, chronic, disabling depression that they can only see their therapist every five or six weeks is like telling somebody with a broken leg that they can only see their physical therapist every five or six weeks,” she said. “It’s not enough. It’s not even close to enough.”

Then, this summer, Christina was diagnosed with breast cancer. Everything related to her cancer care — her mammogram, biopsy, surgery appointments — happened promptly (like a “well-oiled machine,” she said), while her depression care stumbled along.

“It is a hot mess,” she said. “I need to be in therapy — I have cancer! And still nothing has changed.”

A new law signed by Gov. Gavin Newsom in October aims to fix this problem for Californians. Senate Bill 221, which passed the state legislature with a nearly unanimous vote, requires health insurers across the state to reduce wait times for mental health care to no more than 10 business days. Six other states — including Colorado, Maryland and Texas — have similar laws limiting wait times.

Long waits for mental health treatment are a nationwide problem, with reports of patients waiting an average of five or six weeks for care in community clinics, at Department of Veterans Affairs facilities and in private offices from Maryland to Los Angeles County. Across California, half of residents surveyed by the California Health Care Foundation in late 2019 said they had to wait too long to see a mental health care provider when they needed one.

At Kaiser Permanente, the state’s largest insurance company, 87% of therapists said weekly appointments were not available to patients who needed them, according to a 2020 survey by the National Union of Healthcare Workers, which represents KP therapists — and was the main sponsor of the California wait times legislation.

“It just feels so unethical,” said triage therapist Brandi Plumley, referring to the typical two-month wait time she sees at Kaiser Permanente’s mental health clinic in Vallejo, east of San Francisco.

Every day, she takes multiple crisis calls from patients who have therapists assigned to them but can’t get in to see them, she said, describing the providers’ caseloads as “enormous.”

“It’s heartbreaking. And it eats on me day after day after day,” Plumley said. “What Kaiser simply needs to do is hire more clinicians.”

Kaiser Permanente says there just aren’t enough therapists out there to hire. KP is an integrated system — it is a health provider and insurance company under one umbrella — and has struggled to fill 300 job vacancies in clinical behavioral health, according to a statement from Yener Balan, the insurer’s Northern California vice president of behavioral health.

Hiring more clinicians won’t solve the problem, said Balan, who suggested that sustaining one-on-one therapy for all who want it in the future wouldn’t be possible in the current system: “We all must reimagine our approach to the existing national model of care.”

Kaiser Permanente lodged concerns about the wait times bill when it was introduced. And the trade group representing insurers in the state, the California Association of Health Plans, opposed it, saying the shortage of therapists would make meeting the two-week mandate too difficult.

“The COVID-19 pandemic has only exacerbated this workforce shortage, and demand for these services significantly increased,” said Jedd Hampton, a lobbyist for the California Association of Health Plans, in testimony during a state Senate hearing for the bill in the spring.

Hampton referred to a University of California-San Francisco study that predicted California would have nearly 30% fewer therapists than needed to meet demand by 2028.

“Simply put, mandating increased frequency of appointments without addressing the underlying workforce shortage will not lead to increased quality of care,” Hampton said.

Lawmakers pushed back. State Sen. Scott Wiener (D-San Francisco), who authored the bill, accused insurers of overstating the shortage. State Sen. Connie Leyva (D-Chino) said that the therapeutic providers are out there but that insurers are responsible for recruiting them into their networks by paying higher rates and reducing administrative burdens.

If insurers want more young people to enter the mental health care profession, they must improve salaries and working conditions now, said state Sen. Richard Pan (D-Sacramento). (A 2016 KQED investigation uncovered multiple ways that insurers save money by keeping provider networks artificially small.)

As bipartisan support for the bill grew in Sacramento, insurers withdrew their formal opposition.

But whether other states have the political will, or the resources, to legislate a similar solution is unclear, said Hemi Tewarson, executive director of the nonpartisan National Academy for State Health Policy in Washington, D.C. Although California may be able to force insurers to hire more therapists, she said, places like New Mexico, Montana, Wyoming, and parts of the South don’t have enough therapists at any price.

“They don’t have the providers, so you could fine the insurers as much as you want, you’re not going to be able to, in the short term, make up those wait times if they already exist,” she said.

The new California law is a solid step toward improving access to mental health care, with communities of color standing to benefit the most, said Lonnie Snowden, a professor of health policy and management at the University of California-Berkeley. African Americans, Asian Americans and Latinos face the most barriers getting into care, Snowden said, and when people of color do come in for treatment, they are more likely to drop out.

Oversight and enforcement are needed for the new rules to work, said Keith Humphreys, a psychiatry professor at Stanford University. Kaiser Permanente has data systems that can track the time between appointments, but other insurers set up contracts with therapists in private practice, who manage their own caseloads and schedules.

“Who would keep track of whether people who’ve been seen once were seen again in 10 days, when it’s hard enough just to keep track of how many providers we have and who they are seeing?” he asked.

Questions like that one will fall to state regulators, primarily the California Department of Managed Health Care. The department has fined insurers $6.9 million since 2013 for violating state standards, including a $4 million penalty against Kaiser Permanente for excessive wait times for mental health care. Previous state law required insurers to provide initial mental health care appointments within 10 days, and the new law clarifies that they must do the same for follow-up appointments.

Greta Christina, who gets her care at a Kaiser Permanente facility, said she is desperate for the new law to start working. It takes effect on July 1, 2022. Christina thought about paying out-of-pocket in the meantime, to find a therapist she could see more often. But in a cancer crisis, she said, starting over with someone new would be too hard. So she’s waiting.

“Knowing that this bill is on the horizon has been helping me hang on,” she said.

This story is part of a partnership that includes  KQEDNPR and KHN.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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It Takes a Team: A Doctor With Terminal Cancer Relies on a Close-Knit Group in Her Final Days

Latest Updates From Kaiser Health News - Wed, 11/24/2021 - 5:00am

The decisions have been gut-wrenching. Should she try another round of chemotherapy, even though she barely tolerated the last one? Should she continue eating, although it’s getting difficult? Should she take more painkillers, even if she ends up heavily sedated?

Dr. Susan Massad, 83, has been making these choices with a group of close friends and family — a “health team” she created in 2014 after learning her breast cancer had metastasized to her spine. Since then, doctors have found cancer in her colon and pancreas, too.

Now, as Massad lies dying at home in New York City, the team is focused on how she wants to live through her final weeks. It’s understood this is a mutual concern, not hers alone. Or, as Massad told me, “Health is about more than the individual. It’s something that people do together.”

Originally, five of Massad’s team members lived with her in a Greenwich Village brownstone she bought with friends in 1993. They are in their 60s or 70s and have known one another a long time. Earlier this year, Massad’s two daughters and four other close friends joined the team when she was considering another round of chemotherapy.

Massad ended up saying “no” to that option in September after weighing the team’s input and consulting with a physician who researches treatments on her behalf. Several weeks ago, she stopped eating — a decision she also made with the group. A hospice nurse visits weekly, and an aide comes five hours a day.

Anyone with a question or concern is free to raise it with the team, which meets now “as needed.” The group does not exist just for Massad, explained Kate Henselmans, her partner, “it’s about our collective well-being.” And it’s not just about team members’ medical conditions; it’s about “wellness” much more broadly defined.

Massad, a primary care physician, first embraced the concept of a “health team” in the mid-1980s, when a college professor she knew was diagnosed with metastatic cancer. Massad was deeply involved in community organizing in New York City, and this professor was part of those circles. A self-professed loner, the professor said she wanted deeper connections to other people during the last stage of her life.

Massad joined with the woman’s social therapist and two of her close friends to provide assistance. (Social therapy is a form of group therapy.) Over the next three years, they helped manage the woman’s physical and emotional symptoms, accompanied her to doctors’ visits and mobilized friends to make sure she was rarely alone.

As word got out about this “let’s do this together” model, dozens of Massad’s friends and colleagues formed health teams lasting from a few months to a few years. Each is unique, but they all revolve around the belief that illness is a communal experience and that significant emotional growth remains possible for all involved.

“Most health teams have been organized around people who have fairly serious illness, and their overarching goal is to help people live the most fulfilling life, the most giving life, the most social life they can, given that reality,” Massad told me. An emphasis on collaborative decision-making distinguishes them from support groups.

Emilie Knoerzer, 68, who lives next door to Massad and Henselmans and is a member of the health team, gives an example from a couple of years ago. She and her partner, Sandy Friedman, were fighting often and “that was bad for the health of the whole house,” she told me. “So, the whole house brought us together and said, ‘‘This isn’t going well, let’s help you work on this.’ And if we started getting into something, we’d go ask someone for help. And it’s much better for us now.”

Mary Fridley, 67, a close friend of Massad’s and another health team member, offered another example. After experiencing serious problems with her digestive system this past year, she pulled together a health team to help her make sense of her experiences with the medical system. None of the many doctors Fridley consulted could tell her what was wrong, and she felt enormous stress as a result.

“My team asked me to journal and to keep track of what I was eating and how I was responding. That was helpful,” Fridley told me. “We worked on my not being so defensive and humiliated every time I went to the doctor. At some point, I said, ‘All I want to do is cry,’ and we cried together for a long time. And it wasn’t just me. Other people shared what was going on for them as well.”

Dr. Hugh Polk, a psychiatrist who’s known Massad for 40 years, calls her a “health pioneer” who practiced patient-centered care long before it became a buzzword. “She would tell patients, ‘We’re going to work together as partners in creating your health. I have expertise as a doctor, but I want to hear from you. I want you to tell me how you feel, what your symptoms are, what your life is like,’” he said.

As Massad’s end has drawn near, the hardest but most satisfying part of her teamwork is “sharing emotionally what I’m going through and allowing other people to share with me. And asking for help. Those aren’t things that come easy,” she told me by phone conversation.

“It’s very challenging to watch her dying,” said her daughter Jessica Massad, 54. “I don’t know how people do this on their own.”

Every day, a few people inside or outside her house stop by to read to Massad or listen to music with her — a schedule her team is overseeing. “It is a very intimate experience, and Susan feels loved so much,” said Henselmans.

For Massad, being surrounded by this kind of support is freeing. “I don’t feel compelled to keep living just because my friends want me to,” she said. “We cry together, we feel sad together, and that can be difficult. But I feel so well taken care of, not alone at all with what I’m going through.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Florida Sen. Rick Scott Off Base in Claim That Rise in Medicare Premiums Is Due to Inflation

Latest Updates From Kaiser Health News - Wed, 11/24/2021 - 5:00am

An increase in Medicare Part B premiums means “America’s Seniors Are Paying the Price for Biden’s Inflation Crisis”

— The headline of a press release from Sen. Rick Scott (R-Fla.)

[UPDATED at 4:15 p.m. ET]

Republicans blame President Joe Biden for this year’s historic surge in inflation, reflected in higher prices for almost everything — from cars and gas to food and housing. They see last month’s 6.2% annual inflation rate — the highest in decades and mostly driven by an increase in consumer spending and supply issues related to the covid-19 pandemic — as a ticket to taking back control of Congress in next year’s midterm elections.

A key voting bloc will be older Americans, and the GOP aims to illustrate how much worse life has grown for them under the Biden administration.

Sen. Rick Scott (R-Fla.) issued a press release Nov. 16 suggesting that rising general inflation was behind the large increase in next year’s standard premiums for Medicare Part B, which covers physician and some drug costs and other outpatient services.

Sen. Rick Scott: America’s Seniors Are Paying the Price for Biden’s Inflation Crisis” was the headline. The senator’s statement within that press release said, “We need to be LOWERING health care and drug prices and strengthening this vital program for seniors and future generations, not crippling the system and leaving families to pay the cost.” The press release from Scott says he is “slamming Biden’s inaction to address the inflation crisis he and Washington Democrats have created with reckless spending and socialist policies, which is expected to cause significant price increases on [senior] citizens and Medicare recipients.” Scott’s statement in that same press release also says the administration’s “reckless spending” will leave U.S. seniors “paying HUNDREDS more for the care they need.”

We wondered whether these points were true. Was the climbing annual inflation rate over the past several months to blame for the increase in Medicare Part B premiums?

We reached out to Scott’s office for more detail but received no reply. Upon further investigation, we found there is little, if any, connection between general inflation in the past few months and the increase in Medicare Part B premiums.

What’s the Status of Medicare Premiums?

Medicare Part B premiums have been growing steadily for decades to keep up with rising health spending.

The U.S. inflation rate, for years held at bay, has been above 4% since April, hitting 6.2% in October, the highest rate in decades.

On Nov. 12, the Centers for Medicare & Medicaid Services announced that the standard monthly premium for Medicare Part B would rise to $170.10 in 2022, from $148.50 this year. The 14.5% increase is the largest one-year increase in the program’s history.

Scott’s press release refers to the CMS report.

CMS cited three main factors for the increase: rising health care costs, a move by Congress last year that held the premium increase to just $3 a month because of the pandemic, and the need to raise money for a possible unprecedented surge in drug costs. Inflation was not on that list.

In fact, half of the premium increase was due to making sure the program was ready in case Medicare next year decides to start covering Aduhelm, a new Alzheimer’s drug priced at $56,000 per year, per patient. It’s been estimated that total Medicare spending for the drug for one year alone would be nearly $29 billion, far more than any other drug.

How Big a Hit Will Seniors Feel?

The Part B premium is typically subtracted automatically from enrollees’ Social Security checks. Because Social Security recipients will receive a 5.9% cost-of-living increase next year — about $91 monthly for the average beneficiary — they’ll still see a net gain, though a chunk will be eaten away by the hike in Medicare premiums.

Some Medicare beneficiaries won’t face a 14.5% increase, however, because a “hold-harmless” provision in federal law protects them from a decrease in their Social Security payments. But that rule won’t apply for most enrollees in 2022 because the increase in their monthly benefit checks will cover the higher monthly premium, said Juliette Cubanski, deputy director of the program on Medicare policy at KFF.

What Role Does Inflation Play?

Several Medicare experts said the spike in the general inflation rate has little or nothing to do with the Medicare premium increase. In fact, Medicare is largely immune from inflation, because the program sets prices for hospitals and doctors.

“This is so false that it is annoying,” Paul Ginsburg, a professor of health policy at the Sol Price School of Public Policy at the University of Southern California, said of Scott’s claim that general inflation is behind the premium increase. “The effect of the inflation spike so far on prices is zero because Medicare controls prices.”

Medicare Part B premiums, he said, reflect changes in the amount of health services delivered and a more expensive mix of drugs. “Premiums are tracking spending, only a portion of which reflects prices,” Ginsburg said. “I can’t see that the administration really had any discretion” in setting the premium increase due to the need to build a reserve to pay for the Alzheimer’s drug and make up for the reduced increase last year, he said.

Stephen Zuckerman, co-director of the Urban Institute’s health policy center, said a rise in wages caused by inflation could spur a small boost in Medicare spending because wages help determine how much the program pays providers. But, he said, such an increase would have to occur for more than a few months to affect premiums. Continued soaring inflation could influence 2023 Medicare premiums, not those for 2022. “The claim that premium increases are due to inflation in the last couple of months doesn’t make sense,” Zuckerman said.

CMS faced the challenge of trying to estimate costs for an expensive drug not yet covered by Medicare. “It is a very difficult projection to make, and they want to have enough contingency reserved,” said Gretchen Jacobson, a vice president of the nonpartisan Commonwealth Fund.

Our Ruling

Scott said in a press release about the 2022 increase in Medicare Part B premiums that “America’s seniors are paying the price for Biden’s inflation crisis.”

Though his statement contains a sliver of truth, Scott’s assertion ignores critical facts that create a different impression.

For instance, Medicare policy experts said, current general inflation has little, if anything, to do with the increase in premiums. CMS said the increase was needed to put away money in case Medicare starts paying for an Alzheimer’s drug that could add tens of billions in costs in one year and to make up for congressional action last year that held down premiums.

We rate the claim Mostly False.

SOURCES:

Telephone interview and emails with Juliette Cubanski, deputy director of the Program on Medicare Policy at KFF, Nov. 24, 2021.

Telephone interview with Stephen Zuckerman, co-director of the Health Policy Center at the Urban Institute, Nov. 19, 2021.

Telephone interview with Paul Ginsburg, professor of health policy at the Sol Price School of Public Policy at the University of Southern California, Nov. 18, 2021.

Telephone interview with Gretchen Jacobson, vice president of the Medicare program at the Commonwealth Fund, Nov. 18, 2021.

Telephone interview with Joe Antos, senior fellow with American Enterprise Institute, Nov. 18, 2021.

Sen. Rick Scott’s press release, Nov. 16, 2021.

Statista, monthly inflation rates, accessed Nov. 19, 2021.

Centers for Medicare & Medicaid Services press release about Medicare Part B premiums, accessed Nov. 19, 2021.

Medicareresources.org’s fact sheet about the Medicare hold-harmless provision, accessed Nov. 19, 2021.

Medicareresources.org fact sheet about high earners not subject to the hold-harmless provision, accessed Nov. 19, 2021.

Social Security blog about the hold-harmless provision, accessed Nov. 19, 2021.

AARP blog about the biggest-ever increase in Medicare Part B premiums, accessed Nov. 18, 2021.

Medicare Trustees Report, 2021 (see page 90 for Medicare Part B premiums by year since program inception).

KFF brief on the impact Aduhelm could have on Medicare costs, accessed Nov. 18, 2021.

CMS’ “2022 Medicare Parts A & B Premiums and Deductibles/2022 Medicare Part D Income-Related Monthly Adjustment Amounts” report, accessed Nov. 12, 2021.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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KHN’s ‘What the Health?’: The Big Biden Budget Bill Passes the House

Latest Updates From Kaiser Health News - Tue, 11/23/2021 - 2:55pm

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President Joe Biden’s “Build Back Better” social spending bill passed the House last week, but the legislation faces a new and different set of hurdles in the Senate, where it will need the support of every single Democrat, plus approval by the Senate parliamentarian.

Meanwhile, covid-19 is surging again in Europe as well as in many parts of the United States, just as travel picks up for the holidays. And the Supreme Court prepares to hear oral arguments in an abortion case out of Mississippi that could lead to the weakening or overturning of Roe v. Wade — and could upend the political landscape in the U.S.

This week’s panelists are Julie Rovner of KHN, Margot Sanger-Katz of The New York Times, Joanne Kenen of Politico and the Johns Hopkins School of Public Health, and Mary Agnes Carey of KHN.

Among the takeaways from this week’s episode:

  • There are roadblocks ahead in the Senate for the social spending plan. Some moderate Democrats may want to make changes, and parts of the bill could be challenged under tight Senate rules that require bills being passed using the budget reconciliation procedures — which prohibit filibustering — to show that the provisions have an effect on the budget.
  • Among the health provisions that could be affected are paid family leave and the restrictions on drug price increases for plans outside of the Medicare program.
  • As the bill passed by the House gets scrutinized, some of the smaller provisions that may not have garnered attention initially are now targets of debate and industry lobbying. Among them: a decision to tax vaping products, which some opponents suggest will lead users to continue to use cigarettes instead. Another is a mandate for nursing homes to have registered nurses in place 24/7, even though industry officials say they can’t recruit enough staff, which might lead some homes to close.
  • If Congress does approve the bill, it’s good to remember that passage is not the final word. Industry and advocates will continue to lobby the administration on regulations to implement the legislation, and those who are distressed by the law could take their grievances to court.
  • With the decision last week by the Food and Drug Administration and the Centers for Disease Control and Prevention to authorize covid vaccine boosters for all adults, public health messaging on the shots has shifted. While officials were much more nuanced when boosters first became available, they are now pushing hard for everyone to get the extra doses.
  • Public attitudes about covid also appear to be shifting, perhaps a result of pandemic fatigue. Where once Americans looked to vaccines to release them from the drudgeries of avoiding covid, many now acknowledge the virus will be around for a long time and are struggling to figure out how to return to a more normal life.

Also this week, Rovner interviews Mary Ziegler of the Florida State University College of Law about the Supreme Court’s upcoming oral arguments in the Mississippi abortion case.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: The Wall Street Journal’s “Telehealth Rollbacks Leave Patients Stranded, Some Doctors Say,” by Stephanie Armour and Robbie Whelan.

Margot Sanger-Katz: The New York Times’ “Everything in the House Democrats’ Budget Bill,” by Alicia Parlapiano and Quoctrung Bui.

Joanne Kenen: Politico’s “VA Stats Show Devastating Covid Toll at Vets’ Nursing Homes,” by Joanne Kenen, Darius Tahir and Allan James Vestal.

Mary Agnes Carey: KHN’s “A Covid Head-Scratcher: Why Lice Lurk Despite Physical Distancing,” by Rae Ellen Bichell.

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Etching the Pain of Covid Into the Flesh of Survivors

Latest Updates From Kaiser Health News - Tue, 11/23/2021 - 5:00am

It was Saturday morning at Southbay Tattoo and Body Piercing in Carson, California, and owner Efrain Espinoza Diaz Jr. was prepping for his first tattoo of the day — a memorial portrait of a man that his widow wanted on her forearm.

Diaz, known as “Rock,” has been a tattoo artist for 26 years but still gets a little nervous when doing memorial tattoos, and this one was particularly sensitive. Diaz was inking a portrait of Philip Martin Martinez, a fellow tattoo artist and friend who was 45 when he died of covid-19 in August.

“I need to concentrate,” said Diaz, 52. “It’s a picture of my friend, my mentor.”

Martinez, known to his friends and clients as “Sparky,” was a tattoo artist of some renown in nearby Wilmington, in Los Angeles’ South Bay region. A tattoo had brought Sparky and Anita together; Sparky gave Anita her first tattoo — a portrait of her father — in 2012, and the experience sparked a romance. Over the years of their relationship, he had covered her body with intertwining roses and a portrait of her mother.

Now his widow, she was getting the same photograph that was etched on Sparky’s tomb inked into her arm. And this would be her first tattoo that Sparky had not applied.

“It feels a little odd, but Rock has been really good to us,” Anita Martinez said. Rock and Sparky “grew up together.” They met in the 1990s, at a time when there were no Mexican-American-owned tattoo shops in their neighborhood but Sparky was gaining a reputation. “It was artists like Phil that would inspire a lot of us to take that step into the professional tattoo industry,” Rock said.

After Sparky got sick, Anita wasn’t allowed in her husband’s hospital room, an isolating experience shared by hundreds of thousands of Americans who lost a loved one to covid. They let her in only at the very end.

“I got cheated out of being with him in his last moments,” said Martinez, 43. “When I got there, I felt he was already gone. We never got to say goodbye. We never got to hug.”

“I don’t even know if I’m ever going to heal,” she said, as Diaz began sketching the outlines of the portrait below her elbow, “but at least I’ll get to see him every day.”

According to a 2015 Harris Poll, almost 30% of Americans have at least one tattoo, a 10% increase from 2011. At least 80% of tattoos are for commemoration, said Deborah Davidson, a professor of sociology at York University in Toronto who has been researching memorial tattoos since 2009.

“Memorial tattoos help us speak our grief, bandage our wounds and open dialogue about death,” she said. “They help us integrate loss into our lives to help us heal.”

Covid, sadly, has provided many opportunities for such memorials.

Juan Rodriguez, a tattoo artist who goes by “Monch,” has been seeing twice as many clients as before the pandemic and is booked months in advance at his parlor in Pacoima, an L.A. neighborhood in the San Fernando Valley. Memorial tattoos, which can include names, portraits and special artwork, are common in his line of work, but there’s been an increase in requests due to the pandemic. “One client called me on the way to his brother’s funeral,” Rodriguez said.

Rodriguez thinks memorial tattoos help people process traumatic experiences. As he moves his needle over the arms, legs and backs of his clients, and they share stories of their loved ones, he feels he is part artist, part therapist.

Healthy grievers do not resolve grief by detaching from the deceased but by creating a new relationship with them, said Jennifer R. Levin, a therapist in Pasadena, California, who specializes in traumatic grief. “Tattoos can be a way of sustaining that relationship,” she said.

It’s common for her patients in the 20-to-50 age range to get memorial tattoos, she said. “It’s a powerful way of acknowledging life, death and legacy.”

Sazalea Martinez, a kinesiology student at Antelope Valley College in Palmdale, California, came to Rodriguez in September to memorialize her grandparents. Her grandfather died of covid in February, her grandmother in April. She chose to have Rodriguez tattoo an image of azaleas with “I love you” written in her grandmother’s handwriting.

The azaleas, which are part of her name, represent her grandfather, she said. Sazalea decided not to get a portrait of her grandmother because the latter didn’t approve of tattoos. “The ‘I love you’ is something simple and it’s comforting to me,” she said. “It’s going to let me heal and I know she would have understood that.”

Sazalea teared up as the needle moved across her forearm, tracing her grandmother’s handwriting. “It’s still super fresh,” she said. “They basically raised me. They impacted who I am as a person, so to have them with me will be comforting.”

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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When the Eye on Older Patients Is a Camera

Latest Updates From Kaiser Health News - Tue, 11/23/2021 - 5:00am

In the middle of a rainy Michigan night, 88-year-old Dian Wurdock walked out the front door of her son’s home in Grand Rapids, barefoot and coatless. Her destination was unknown even to herself.

Wurdock was several years into a dementia diagnosis that turned out to be Alzheimer’s disease. By luck, her son woke up and found her before she stepped too far down the street. As the Alzheimer’s progressed, so did her wandering and with it, her children’s anxiety.

“I was losing it,” said her daughter, Deb Weathers-Jablonski. “I needed to keep her safe, especially at night.”

Weathers-Jablonski installed a monitoring system with nine motion sensors around the house — in her mother’s bedroom, the hallway, kitchen, living room, dining room and bathroom and near three doors that led outside. They connected to an app on her phone, which sent activity alerts and provided a log of her mother’s movements.

“When I went to bed at night, I didn’t have to guess what she was doing,” Weathers-Jablonski said. “I was actually able to get some sleep.”

New monitoring technology is helping family caregivers manage the relentless task of looking out for older adults with cognitive decline. Setting up an extensive monitoring system can be expensive — Weathers-Jablonski’s system from People Power Co. costs $299 for the hardware and $40 a month for use of the app. With scores of companies selling such gear, including SentryTell and Caregiver Smart Solutions, they are readily available to people who can pay out-of-pocket.

But that’s not an option for everyone. While the technology is in line with President Joe Biden’s plan to direct billions of dollars toward helping older and disabled Americans live more independently at home, the costs of such systems aren’t always covered by private insurers and rarely by Medicare or Medicaid.

Monitoring also raises ethical questions about privacy and quality of care. Still, the systems make it possible for many older people to stay in their home, which can cost them far less than institutional care. Living at home is what most people prefer, especially in light of the toll the covid-19 pandemic took on nursing homes.

Technology could help fill a huge gap in home care for the elderly. Paid caregivers are in short supply to meet the needs of the aging population, which is expected to more than double in coming decades. The shortage is fueled by low pay, meager benefits and high rates of burnout.

And for the nearly 1 in 5 U.S adults who are caregivers to a family member or friend over age 50, the gadgets have made a hard job just a little easier.

Passive surveillance systems are replacing the “I’ve fallen and I can’t get up” medical alert buttons. Using artificial intelligence, the new devices can automatically detect something is wrong and make an emergency call unasked. They also can monitor pill dispensers and kitchen appliances using motion sensors, like EllieGrid and WallFlower. Some systems include wearable watches for fall detection, such as QMedic, or can track GPS location, like SmartSole’s shoe insoles. Others are video cameras that record. People use surveillance systems like Ring inside the home.

Some caregivers may be tempted to use technology to replace care, as researchers in England found in a recent study. A participant who had visited his father every weekend began visiting less often after his dad started wearing a fall detector around his wrist. Another participant believed her father was active around the house, as evidenced by activity sensor data. She later realized the app was showing not her father’s movement, but his dog’s. The monitoring system picked up the dog’s movements in the living room and logged it as activity.

Technology isn’t a substitute for face-to-face interaction, stressed Crista Barnett Nelson, executive director of Senior Advocacy Services, a nonprofit group that helps older adults and their families in the North Bay area outside San Francisco. “You can’t tell if someone has soiled their briefs with a camera. You can’t tell if they’re in pain, or if they just need an interaction,” she said.

In some instances, people being monitored changed their habits in response to technology. Clara Berridge, a professor of social work at the University of Washington who studies the use of technology in elder care, interviewed a woman who stopped her usual practice of falling asleep on the recliner because the technology would falsely alert her family that something was wrong based on inactivity deemed abnormal by the system. Another senior reported rushing in the bathroom for fear an alert would go out if they took too long.

The technology presents another worry for those being monitored. “A caregiver is generally going to be really concerned about safety. Older adults are often very concerned about safety too, but they may also weigh privacy really heavily, or their sense of identity or dignity,” Berridge said.

Charles Vergos, 92 and living in Las Vegas, is uncomfortable with video cameras in his house and wasn’t interested in wearing gadgets. But he liked the idea that someone would know if something went wrong while he was alone. His niece, who lives in Palo Alto, California, suggested Vergos install a home sensor system so she could monitor him from afar.

“The first question I asked is, does it take pictures?” Vergos recalled. Because the sensors don’t have a video component, he was fine with them. “Actually, after you have them in the house for a while, you don’t even think about it,” Vergos said.

The sensors also have made conversations with his niece more convenient for him. She knows he likes to talk on the phone while he’s in his chair in the den, so she’ll check his activity on her iPad to determine whether it’s a good time to call.

People making audio and video recordings must abide by state privacy laws, which typically require the consent of the person being recorded. It’s not as clear, however, if consent is needed to collect the activity data that sensors gather. That falls into a gray area of the law, similar to data collected through internet browsing.

Then there is the problem of how to pay for it all. Medicaid, the federal-state health program for low-income people, does cover some passive monitoring for home care, but it’s not clear how many states have opted to pay for such service.

Some seniors also lack access to robust internet broadband, putting much of the more sophisticated technology out of reach, noted Karen Lincoln, founder of Advocates for African American Elders at the University of Southern California.

The relief monitoring devices bring caregivers may be the most compelling reason for their use. Delaine Whitehead, who lives in Orange County, California, started taking medication for anxiety about a year after her husband, Walt, was diagnosed with Alzheimer’s.

Like Weathers-Jablonski, Whitehead sought technology to help, finding peace of mind in sensors installed on the toilets in her home.

Her husband often flushed too many times, causing the toilets to overflow. Before Whitehead installed the sensors in 2019, Walt had caused $8,000 worth of water damage in their bathroom. With the sensors, Whitehead received an alert on her phone when the water got too high.

“It did ease up a lot of my stress,” she said.

Sofie Kodner is a writer with the Investigative Reporting Program at the University of California-Berkeley Graduate School of Journalism. The IRP reported this story through a grant from The SCAN Foundation.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Becerra Says Surprise Billing Rules Force Doctors Who Overcharge to Accept Fair Prices

Latest Updates From Kaiser Health News - Mon, 11/22/2021 - 11:30am

Overpriced doctors and other medical providers who can’t charge a reasonable rate for their services could be put out of business when new rules against surprise medical bills take effect in January, and that’s a good thing, Health and Human Services Secretary Xavier Becerra told KHN, in defending the regulations.

The proposed rules represent the Biden administration’s plan to carry out the No Surprises Act, which Congress passed to spare patients from the shockingly high bills they get when one or more of their providers unexpectedly turn out to be outside their insurance plan’s network.

The law shields patients from those bills, requiring providers and insurers to work out how much the physicians or hospitals should be paid, first through negotiation and then, if they can’t agree, arbitration. Doctor groups and medical associations, however, have lashed out at the interim final rules that HHS unveiled last month, saying they favor insurance companies in the arbitration phase. That’s because, although the rules tell arbiters to take many factors into account, they are instructed to start with a benchmark largely determined by insurers: the median rate negotiated for similar services among in-network providers.

The doctor groups say giving the insurers the upper hand will let them drive payment rates down and potentially force doctors out of networks or even out of business, reducing access to health care.

The department has heard those concerns, Becerra said, but the bottom line is protecting patients. Medical providers who have taken advantage of a complicated system to charge exorbitant rates will have to bear their share of the cost, or close if they can’t, he said.

“I don’t think when someone is overcharging, that it’s going to hurt the overcharger to now have to [accept] a fair price,” Becerra said. “Those who are overcharging either have to tighten their belt and do it better, or they don’t last in the business.”

“It’s not fair to say that we have to let someone gouge us in order for them to be in business,” he added.

Nonetheless, Becerra said he did not foresee a wave of closures, or diminished access for consumers. Instead, he suggested that a competitive, market-driven process will find a balance, especially when consumers know better what they are paying for.

“We’re willing to pay a fair price,” he said. But he emphasized that “I’ll pay for the best, but I don’t want to have to pay for the best and then three times more on top of that and get blindsided by the bill.”

Becerra also pointed to a report on surprise medical bills that HHS released Monday and that was provided to KHN in advance, highlighting the impacts of negotiation and arbitration laws already in effect in 18 states.

The report, which aggregates previous research, found people getting hit with surprise bills averaging $1,219 for anesthesiologists, $2,633 for surgical assistants, $744 for childbirth and north of $24,000 for air ambulances.

In the states that use benchmarks similar to what doctors are suggesting HHS use, such as New York and New Jersey, the report found costs rising. New York has a “baseball-style” system in which the arbiter chooses between the offers presented by the provider and the insurer, although the arbiter is told to consider the offer closest to the 80th percentile of charges. “Since the amount providers charge is typically much higher than the actual negotiated rate, this approach risks leading to significantly higher overall costs,” the report found. In New Jersey, billed charges or “usual and customary” rates are considered.

“When the arbitration process is wide open, no boundaries, at the end of the day health care costs go up, not down,” Becerra said of the methods doctors prefer. “We want costs to go down. And so we want to set up a system that helps provide the guideposts to keep us efficient, transparent and cost-effective.”

The system chosen by the Biden administration was expected to push insurance premiums down by 0.5% to 1%, the Congressional Budget Office estimated.

“Everyone has to give a little to get to a good place,” Becerra said. “That sweet spot, I hope, is one where patients … are extracted from that food fight. And if there continues to be a food fight, the arbitration process will help settle it in a way that is efficient, but it also will lead to lower costs.”

While the administration chose a benchmark that physician and hospital groups don’t like, the law does specify that other factors should be considered, such as a provider’s experience, the market and the complexity of a case. Becerra said those factors help ensure arbitration is fair.

“What we simply did was set up a rule that says, ‘Show the evidence,’” Becerra said. “It has to be relevant, material evidence. And let the best person win in that fight in arbitration.”

The interim final rules were published Oct. 7, giving stakeholders 60 days to comment and seek changes. More than 150 members of Congress, many of them doctors, have asked HHS and other relevant federal agencies to reconsider before the law takes effect Jan. 1. The lawmakers charge that the administration is not adhering to the spirit of the compromises Congress made in passing the law.

Rules that are this far along tend to go into effect with little or no changes, but Becerra said his department was still listening. “If we think there’s a need to make any changes, we are prepared to do so,” the secretary said.

The HHS report also noted that the law requires extensive monthly and annual reporting to regulators and Congress to determine if the regulations are out of whack or have undesirable consequences like those the physicians are warning of.

Becerra said he thinks the rules strike the right balance, favoring not insurers or doctors, but the people who need medical care.

“We want it to be transparent, so we can lead to more competition, and keep costs low — not just for the payer, the insurer, not just for the provider, the hospital or doctor, but for the patients especially,” he said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Success of Covid Antiviral Pills Hinges on Access to Speedy and Accurate Tests

Latest Updates From Kaiser Health News - Mon, 11/22/2021 - 5:00am

Within a few weeks, perhaps before many Americans finish decorating for the holidays, the U.S. could have access to a new antiviral pill from Merck expected to alter the deadly trajectory of the covid-19 pandemic — with a second option from Pfizer to follow shortly after.

Now under federal review, both pills are being hailed by infectious-disease doctors not prone to superlatives.

“This is truly a game changer,” said Dr. Daniel Griffin, an expert on infectious diseases and immunology at Columbia University. “This is up there with vaccines. It’s not a substitute for vaccines; we still want to get people vaccinated. But, boy, this is just another great tool to have.”

The new regimens, which require 30 or 40 pills to be taken over five days, have been shown to dramatically reduce hospitalizations and prevent deaths in adults with mild to moderate covid who are at risk for severe disease because of age or underlying conditions. But experts say the success of the treatments would hinge on one uncertain factor: whether high-risk patients infected with covid will be able to get tested — and then treated — fast enough to make a difference.

“Early, accessible testing and access to the results in a time frame that allows us to make a decision is really going to be key to these medications,” said Dr. Erica Johnson, who chairs the Infectious Disease Board of the American Board of Internal Medicine. “It puts the onus on our public health strategy to make these available.”

In clinical trials, molnupiravir, the antiviral drug developed by Merck & Co. and Ridgeback Biotherapeutics, was given to non-hospitalized, unvaccinated, high-risk adult patients within five days of their first covid symptoms. Pfizer’s product, Paxlovid, was tested in similar patients as early as three days — just 72 hours — after symptoms emerged.

Results from the Merck trial, released last month, showed the drug reduced the risk of hospitalizations by about 50% and prevented deaths entirely. It will be considered by an advisory panel to the federal Food and Drug Administration on Nov. 30. Pfizer officials, who requested FDA emergency authorization for their drug on Nov. 16, said Paxlovid cut the risk of hospitalizations and deaths by 89%. Both drugs work by hampering the way the covid virus reproduces, though they do so at different points in the process.

But those promising results assume the drugs can be administered in the narrow window of time used in the trials, a proven challenge when getting antiviral treatments to actual patients. Similar drugs can prevent dire outcomes from influenza if given early, but research shows that only about 40% of high-risk patients during five recent flu seasons sought medical care within three days of falling ill.

“That’s just not human nature,” said Kelly Wroblewski, director of infectious disease programs for the Association of Public Health Laboratories. “If you have a sniffle, you wait to see if it gets worse.”

Even when patients do seek early care, access to covid testing has been wildly variable since the start of the pandemic. U.S. testing capacity continues to be plagued by a host of problems, including supply-chain bottlenecks, staffing shortages, intermittent spikes in demand and results that can take hours — or far longer.

PCR, or polymerase chain reaction tests, the gold standard to detect SARS-CoV-2, can require scheduled appointments at medical offices or urgent care centers, and patients often wait days to learn the results. Rapid antigen tests are faster but less accurate, and some medical providers are hesitant to rely on them. Over-the-counter tests that can be used at home provide results quickly but are hard to find in stores and remain expensive. And it’s not yet clear how those results would be confirmed and whether they would be accepted as a reason for treatment.

“Get ready,” Griffin said. “You don’t want to call someone four days later to say, ‘Ooh, you’re now outside the window,’ and the efficacy of this oral medication has been lost because of problems on our end with getting those results.”

The situation is expected to improve after a Biden administration push to invest $3 billion in rapid testing, including $650 million to ramp up manufacturing capacity for rapid tests. But it could be months before the change is apparent.

“Supplies will be getting better, but it’s going to be slow,” said Mara Aspinall, co-founder of Arizona State University’s biomedical diagnostics program, who writes a weekly newsletter monitoring national testing capacity.

If getting tests will be tough, acquiring doses of the antiviral drugs is expected to be tougher, at least at first. The federal government has agreed to purchase about 3.1 million courses of molnupiravir for $2.2 billion, which works out to about $700 per course of treatment. The Biden administration is planning to announce a deal to pay $5 billion for 10 million courses of the Pfizer drug, paying about $500 per treatment course, according to The Washington Post.

Doses of the drugs distributed by the federal government would go to states and patients at no cost. But only a fraction of the planned inventory will be available to start, said Dr. Lisa Piercey, Tennessee’s health commissioner, who has been part of a small group of state health officials working on the distribution plans.

Under one scenario, in which 100,000 courses of the Merck drug are available as early as Dec. 6, Piercey said Tennessee would receive just 2,000 patient courses even as the state is reporting more than 1,200 new cases a week on average. Deciding which sick patients receive those scarce supplies will be “an educated stab in the dark,” Piercey said.

U.S. Department of Health and Human Services officials have said the antiviral treatments will be distributed through the same state-based system adopted for monoclonal antibody treatments. The lab-made molecules, delivered via IV infusion or injection, mimic human antibodies that fight the covid virus and reduce the risk of severe disease and death. Federal officials took over distribution in September, after a covid surge in Southern states with low vaccination rates led to a run on national supplies. They’re now allotted to states based on the number of recent covid cases and hospitalizations and past use.

The antivirals will be cheaper than the monoclonal antibody treatments, which cost the government about $1,250 per dose and can carry infusion fees that leave patients with hundreds of dollars in copays. The pills are much easier to use, and pharmacies likely will be allowed to order and dispense them for home use.

Still, the antiviral pills won’t replace the antibody treatments, said Dr. Brandon Webb, an infectious-disease specialist at Intermountain Healthcare in Salt Lake City.

Questions remain about the long-term safety of the drugs in some populations. Merck’s molnupiravir works by causing mutations that prevent the virus from reproducing. The Pfizer treatment, which includes Paxlovid and a low dose of ritonavir, an HIV antiretroviral, may cause interactions with other drugs or even over-the-counter supplements, Webb said.

Consequently, the antivirals likely won’t be used in children, people with kidney or liver disease, or pregnant people. They’ll need to be administered to patients capable of taking multiple pills at once, a couple of times a day, and those patients should be monitored to make sure they complete the therapy.

“We’ll be on an interesting tightrope in which we’ll be trying to identify eligible patients early on to treat them with antivirals,” Webb said. “We’re just going to need to be nimble and ready to pivot.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Lifting DC’s Strict Indoor Mask Mandate Triggers Mix of Confusion, Anxiety and Relief

Latest Updates From Kaiser Health News - Mon, 11/22/2021 - 5:00am

A mile northeast of Capitol Hill in Washington, D.C., along what’s known as the H Street corridor, about half the people crowding the sidewalks are wearing masks. Perhaps it’s because they know that when they step into any business or establishment here, they will have to put one on anyway. The capital, after all, is one of the few remaining cities or states nationwide that mandate masks for public indoor spaces — at least it has, until today.

“We have a bunch of rule followers,” said Claire Bengur, the owner of Atlas Salon, which has been in the neighborhood since 2018. “I am so thankful that my salon is in D.C.” She’s been glad to have a mask requirement, she said, because it’s impossible to do clients’ hair without standing close to them.

Bengur is unsure how to feel about Mayor Muriel Bowser’s decision to roll back the mandate. As the covid-19 pandemic has worn on, many Washingtonians have come to view masking as something between a habit and a security blanket. Even when the rule was lifted for about two months starting in May, many people continued to use masks in places like grocery stores. While face coverings will still be required in select spaces, such as public transit and schools, the District of Columbia will no longer require them in private businesses like Atlas Salon. And that has triggered mixed feelings.

Bengur had been debating whether to continue to ask clients to wear masks because the district gives businesses that option. But at the same time, “there is a certain level of excitement … like I don’t want to wear masks forever.” She ultimately decided to let clients choose for themselves. Bengur and her staff feel more at ease than they did earlier in the pandemic because her salon requires proof of vaccination.

A block away at the H Street Northeast location of Solidcore, a boutique fitness chain that started in the district, CEO Bryan Myers had an it’s-about-time take. “This will be game-changing for our clients’ comfort while working out and the health of our industry,” he said.

On the whole, Washington has been especially cautious when it comes to covid, which has helped the city avoid the worst of the pandemic. Now, the mayor is moving away from ordering protective measures and instead offering recommendations based on vaccination status.

This change can partly be explained by adjustments in the district health department’s goal, which no longer is to reach zero cases. Viewing covid as more of an “endemic” disease — one regularly found in particular populations — Bowser explained her decision this way: “This does not mean that everyone needs to stop wearing their masks. But it does mean that we are shifting the government’s response to providing you risk-based information.” While she’s reserved the right to reinstate the mandate, Bowser has doubled down on her decision. “Quite frankly, I don’t expect many D.C. residents will change their current behavior,” she said Friday during an interview on a local radio show.

The shift has some residents feeling perplexed, if not nervous, especially given the timing.

Children ages 5 to 11 just became eligible for vaccination, so they are not fully immunized yet, and infections are likely to climb with the holidays coming. Cases have already increased in half the states. That neighboring Montgomery County reinstated its mask mandate over the weekend leaves some people all the more baffled. A majority of district council members are already pushing the mayor to reconsider. Meanwhile, the White House, just steps from the mayor’s office, is not lifting its mask requirement, noting that the Centers for Disease Control and Prevention recommends one given the substantial level of community transmission.

“I’m a little bit iffy about the whole thing,” said Sandra Basanti, co-owner of Pie Shop, which offers fresh pies and live music on H Street.

Basanti has two young children who are not yet fully vaccinated. She’s unsure whether she’ll require customers to wear masks but expects to — at least at first. She’s hesitant because staffers received pushback when Pie Shop became one of the first venues in town to impose a vaccine requirement. She would like to see Washington follow New York City’s example and require proof of vaccination to enter public spaces such as shopping centers, sports arenas and theaters.

“We were just kind of waiting for the city to make that call for us so that we wouldn’t have to fight people on it, and they never did,” said Basanti. “I just don’t want to make the staff feel like they now also have to be the mask police again.”

“Being the mask police sucks,” she added.

The owner of the dive bar across the street agrees. “I’m very exhausted with arguing with people about masks and all the different things,” said Tony Tomelden of the Pug, which will not require patrons to wear masks but will insist that they be vaccinated. “Once a week, at least, there’s some kind of argument with some customer.”

Tomelden worries that talk of endemic covid means leaders are moving on without addressing all the pandemic-induced needs of small businesses beyond masking. “I’m so tired of begging for a break on bills and for grants and that kind of thing, but we’re still not fully recovered,” he said.

Like residents, public health experts are not in agreement on whether the district is acting prematurely.

“It makes sense,” Dr. Lynn Goldman, dean of the Milken Institute School of Public Health at George Washington University, said of the mayor’s decision. She reasoned that, thanks to vaccination, the district has few covid hospitalizations and deaths. “At the same time … we don’t really know how it’s going to go.”

Meanwhile, Dr. David Dowdy, an associate professor of epidemiology at Johns Hopkins Bloomberg School of Public Health, said he generally recommends against easing restrictions at a time like this. “My expectation is that we’re likely to see something of an increase in cases over the winter,” he said, “and then this probably is going to become after that point in time something of an endemic disease.”

“We’ve come this far. It probably is not too difficult to keep our guard up for a couple more months,” he added. “But the flip side of that is we’ve been doing this for a really long time and people are very tired.”

Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, sees Washington’s experience as emblematic of what can happen when leaders do not clearly explain their response to covid or why mask mandates are imposed or withdrawn.

Part of the challenge, Osterholm said, is that the explanations are unsatisfying. “We do not understand why surges start or stop,” he said. “Why they start and stop surely can’t be tied to human mitigation strategies. What can be tied to those is how big those surges get.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Why You Can’t Find Cheap At-Home Covid Tests

Latest Updates From Kaiser Health News - Mon, 11/22/2021 - 5:00am

While developing a rapid test that detects the coronavirus in someone’s saliva, Blink Science, a Florida-based startup, heard something startling: The Food and Drug Administration had more than 3,000 emergency use authorization applications and didn’t have the resources to get through them.

“We want to try to avoid the EUA quagmire,” said Peb Hendrix, the startup’s vice president of operations. Its test is still in early development. On the advice of consultants, the company is weighing an alternative route through the FDA to the U.S. market.

“It’s just the way our government works,” Hendrix said, which is a challenge for businesses that are “anxious to get started and think they’ve got something that can help.”

The U.S. produced covid-19 vaccines in record time, but, nearly two years into the pandemic, consumers have few options for cheap tests that quickly screen for infection, though they are widely available in Europe. Experts say the paucity of tests and their high prices undermine efforts in the U.S. to return to normal life.

Some experts say the FDA’s approach to clearing rapid tests has been onerous and overly focused on exceptional accuracy to detect positive results, rather than on what would really benefit people en masse: speedy results. The main use of rapid tests is to screen people so they can safely attend work, school, meetings or gatherings. This screening can then be followed up with a more sensitive, lab-based polymerase chain reaction (PCR) test for diagnosis.

The FDA has authorized just 12 over-the-counter options for rapid tests. But the problems go beyond that agency: The Biden administration recently put $3 billion toward boosting the supply of rapid tests, but public health and industry experts say the government didn’t move quickly enough early in the pandemic to support development and manufacturing.

“Should we have had an equivalent of Operation Warp Speed for testing?” asked Mara Aspinall, a co-founder of life sciences fund BlueStone Venture Partners and a board member for OraSure Technologies, which received FDA authorization for an over-the-counter rapid test. “Absolutely. … For too long, people thought of testing as an extra and not the core, and it needs to be thought of as the core.”

During the pandemic, the FDA has received more than 4,500 emergency use authorization and related requests for covid tests, according to FDA spokesperson Jim McKinney. The agency says it is prioritizing reviews of at-home and point-of-care tests that can be produced in high volumes. Two recently authorized tests alone could boost availability by as much as 13 million tests a day, McKinney said, adding that it would “efficiently review the submissions that will have the biggest impact on the nation’s testing needs.”

In addition to the slow pace of approvals, manufacturing bottlenecks created by materials and labor shortages are keeping prices high. Prices of rapid tests range from $14 for a two-pack to well over $50 a test, far from affordable for regular use.

The FDA says it can’t move more quickly as it balances ensuring that safe and useful devices reach the marketplace with the urgent need to deliver options for widespread daily testing.

“The FDA carefully weighs the known and potential risks and … benefits of emergency use authorization for COVID-19 diagnostic tests based on sound science,” McKinney said in response to questions. But he noted many submissions “are incomplete or contain insufficient information.”

Startups said navigating the ins and outs of this regulatory apparatus is daunting. E25Bio of Cambridge, Massachusetts, is developing a low-cost antigen test, which detects covid by identifying proteins called antigens. Since July 2020, the company has repeatedly adjusted its FDA application as the agency updates its recommendations. The requirement that test results be reported directly to federal health authorities has added to delays.

“As a smaller company, we didn’t have the capabilities to develop that technology at first,” said Bobby Brooke Herrera, co-founder and chief science officer. E25Bio now has a mobile app that verifies results and sends the anonymized data to public health authorities.

Another speed bump: The FDA requires U.S. clinical trials, making the company’s data from Latin America unusable.

Herrera hopes to sell the over-the-counter rapid test in the U.S. for less than $5, cheaper than anything currently on the market.

Hendrix said Blink Science is considering a different path to FDA approval. Known as de novo, it can be used to bring novel, low-risk medical devices to market. For now, he said, the company is likely to prioritize approval in developing countries where vaccination rates are much lower than in the U.S.

Steradian Technologies, which hopes to launch a 30-second breath test, says it was told by regulatory consultants and others who ran into snags in the EUA process that it “might not be worth it” because the agency is so backed up, according to Tra Tran, the company’s director of development and clinical affairs. The FDA’s regular approval process might be the best option.

“We don’t have the budget to spend on doing an EUA and then being told, ‘Well, actually you wasted six months and hundreds of thousands of dollars,’” she said. “Only certain people have the capital to be able to afford staying in this FDA regulatory process for forever.”

The Companies’ View

Several public health experts and people in the testing industry said that the Biden administration’s recent moves will help supply but that meeting demand will take time.

Australian test-maker Ellume received $232 million in federal funds in February to boost U.S. manufacturing of its rapid at-home test, but the company says its new plant in Frederick, Maryland, won’t start production until December. It could eventually manufacture 15 million tests a month.

The FDA authorized Ellume’s over-the-counter covid test in December 2020, but the road has been rocky: The company recalled 2.2 million tests in the U.S. because of “higher-than-acceptable false positive” results, the FDA said, and the FDA warned that their use “may cause serious adverse health consequences or death.” All came from Ellume’s Australian facility.

IHealth Labs, which received FDA authorization Nov. 5 for a test priced at $14 for a two-pack, says that by January it will be able to make 200 million tests a month.

OraSure aims to make 4 million covid tests a month by January and 8 million a month by June. It plans to scale up to 200 million covid tests annually — but not until 2024.

Scott Gleason, OraSure’s interim chief financial officer, said the company faces headwinds at its plant in Pennsylvania’s Lehigh Valley. “We’re having some challenges with hiring enough people to work in our factories to meet the demand,” he said. A two-pack has recently retailed between $14 and $24, and that price won’t drop anytime soon, Gleason said.

Ellume has faced shortages of swabs, steel for its facility and electronics components for the tests.

The View From the FDA

The FDA has authorized more than 400 covid tests, including at-home options and those processed by a medical provider or a lab. The FDA is still getting more than 100 EUA submissions for covid tests per month, many from overseas. But, McKinney said, the vast majority are not for the type most needed now: tests for over-the-counter use.

The FDA may be reluctant to ease its scrutiny. The pandemic’s first-iteration rapid tests, like Abbott Laboratories’ ID Now, raised safety and accuracy concerns, and the FDA has sent warning letters to at least six companies selling bogus rapid tests and has issued numerous recalls. Separately, the agency put over 260 tests that detect covid antibodies on a “do not use” list.

“If we did to antigen tests what happened with antibody tests, we would completely destroy the credibility of the test,” said Aspinall, the venture capitalist. “As frustrating as this is, I have to respect the FDA for ensuring that we continue to have quality tests.”

The agency’s review times for covid test EUA applications have improved, according to an assessment by consulting firm Booz Allen Hamilton. Approvals were generally cleared faster than denials. As of March, the median time for the FDA to grant authorization was seven days and 38 days for denials. When the country isn’t in a national emergency, getting through the FDA’s reviews might take months or years.

Nonetheless, the bottlenecks are felt by Americans trying to keep their employees and families safe.

LabCentral — a biotech co-working facility in Cambridge, Massachusetts, that was part of E25Bio’s testing study — requires participating startups to test workers twice a week. That’s a costly safety measure for a nonprofit, said Celina Chang, LabCentral’s vice president, so it recently bought rapid tests from Germany for $1.50 each.

“In order to test people twice a week on a regular basis for months on end,” she said, “we need it to be, just the same as anyone, affordable.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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‘An Arm and a Leg’: The Insurance Warrior’s Battle Plan

Latest Updates From Kaiser Health News - Mon, 11/22/2021 - 5:00am

Can’t see the audio player? Click here to listen.

Click here for a transcript of the episode.

Matthew Lientz was an engineer for Boeing for over 30 years. When he was diagnosed with a rare form of cancer, he needed surgery from an expert doctor in another state. Although the surgery was his only option, his insurance denied the claim. That’s when his wife, Diane, contacted Laurie Todd, who calls herself the “Insurance Warrior.” 

Together, the three of them made the case for Lientz’s life. Fourteen years later, the speeches they gave in a conference room full of executives are a master class in winning insurance appeals — and living to tell the tale. 

Through this battle, Todd learned that taking on your health insurance provider often means going up against your employer. That’s because most large companies “self-insure.” 

And in this case, that employer was one of the biggest businesses in the world.

For the origin story of the “Insurance Warrior,” check out our previous episode.

“An Arm and a Leg” is a co-production of KHN and Public Road Productions.

To keep in touch with “An Arm and a Leg,” subscribe to the newsletter. You can also follow the show on Facebook and Twitter. And if you’ve got stories to tell about the health care system, the producers would love to hear from you.

To hear all KHN podcasts, click here.

And subscribe to “An Arm and a Leg” on Spotify, Apple Podcasts, StitcherPocket Casts, or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Journalists Cover Issues From Pollution to Vaccines and the Spread of Covid in Hospitals

Latest Updates From Kaiser Health News - Sat, 11/20/2021 - 5:00am

KHN freelancer Jim Robbins discussed unhealthy ozone levels in the West on KUNC’s “Colorado Edition” on Tuesday.

Christina Jewett, a senior correspondent with KHN’s enterprise team, detailed her findings on the spread of covid-19 in hospitals on KGO’s “The Chip Franklin Show” on Nov. 4, and on KCBS on Nov. 5.

KHN senior correspondent and enterprise reporter Liz Szabo discussed whether giving 5- to 11-year-olds covid vaccines at pediatricians’ offices would help clear up vaccine myths on Sirius XM’s “Doctor Radio Reports” on Oct. 26.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Por qué los piojos siguen acechando, a pesar del distanciamiento social

Latest Updates From Kaiser Health News - Fri, 11/19/2021 - 11:16am

Una noche reciente, la familia Marker recibió en su casa a una mujer vestida de púrpura, con una actitud militar hacia la limpieza.

Linda Holmes, que ha trabajado como técnica con LiceDoctors durante cinco años, llegó directamente de su trabajo en un hospital después de recibir la llamada de un despachador de que la familia Marker la necesitaba lo antes posible.

Los expertos en el Pediculus humanus capitis, el desagradable piojo de la cabeza, están de vuelta.

“Definitivamente están regresando”, dijo Kelli Boswell, propietaria de Lice & Easy, una boutique donde las personas en el área de Denver pueden librarse de los piojos, un proceso que puede variar de minutos a horas según el método y el grado de infestación. “Es una señal de que las cosas están volviendo a la normalidad”.

Los resfriados y los gérmenes más peligrosos como el virus respiratorio sincitial, más conocido como RSV, también están de regreso. Eso puede hacer que algunos se pregunten: con todas las medidas de prevención implementadas por covid, ¿cómo comparten los niños estas cosas?

Al igual que el coronavirus, todos estos “contagios” dependen de la sociabilidad humana. Desafortunadamente, las medidas que han tomado muchas escuelas para prevenir la transmisión del covid-19 (máscaras, lavado de manos, vacunación) al reabrir hacen poco para prevenir la propagación del piojo de la cabeza.

Sin embargo, el distanciamiento físico, como espaciar los escritorios a un metro de distancia, debería ayudar.

En teoría, es más difícil que se diseminen los piojos que el virus SARS-CoV-2, porque la proximidad por sí sola no es suficiente: por lo general, necesitan contacto directo. Si un niño contrae piojos, lo más probable es que signifique que el niño pasó un tiempo importante lo suficientemente cerca de otro niño como para que el parásito se mueva. (Los investigadores tienden a estar de acuerdo en que la transmisión a través de objetos inanimados como peines y sombreros es mínima).

El piojo de la cabeza no es conocido por su fortaleza o destreza atlética. Los adultos no pueden sobrevivir más de uno o dos días sin tomar sangre. Sus huevos no pueden eclosionar sin el calor de una cabeza humana y morirán dentro de una semana sin esas condiciones acogedoras. Estos insectos no pueden saltar ni volar, solo gatear. Lo único a favor del piojo de la cabeza son sus garras altamente especializadas, desarrolladas para engancharse al cabello humano.

A diferencia del piojo del cuerpo, el de la cabeza no es conocido por propagar enfermedades. Una infestación no indica nada sobre la higiene de una persona. (De hecho, expertos dicen que los insectos prefieren el cabello limpio porque es más fácil engancharse). Y, a pesar de los conceptos erróneos comunes, pueden colonizar a personas de todas las edades, razas y etnias.

Desde el punto de vista de la dominación mundial de piojos, las cuarentenas por covid no fueron suficiente. Estas criaturas están en las cabezas humanas desde hace miles de años. Un pequeño encierro no iba a acabar con este romance.

Federico Galassi, investigador del Centro de Investigación de Plagas e Insecticidas de Argentina, descubrió que los estrictos cierres tempranos de covid condujeron, de hecho, a una disminución de los piojos entre los niños de Buenos Aires, pero los insectos no estuvieron ni cerca de ser eliminados. Su estudio encontró que la prevalencia se redujo de aproximadamente un 70% a cerca de un 44%.

Y una cosa está clara: cuando la gente cerraba sus puertas y se acurrucaba durante los primeros cierres, los piojos estaban allí, acurrucados con nosotros. Cuando SaLeah Snelling volvió a abrir las puertas de su salón Lice Clinics of America en Boise, Idaho, en mayo, dijo que “los casos de piojos eran más graves de lo que jamás habíamos visto”. Y no eran solo una o dos personas de la casa con piojos, sino toda la familia.

Ahora, dicen Galassi y los exterminadores de piojos estadounidenses, las tasas de infestación han vuelto a ser como las previas al cierre, a pesar de las protecciones escolares por covid.

Nix, una marca de productos contra los piojos, publica un mapa que afirma que los piojos son malos en este momento en Houston, la mayor parte de Alabama y Nuevo México, además de Tulsa, Oklahoma. El mapa dirige a las personas a ubicaciones que venden sus productos.

Richard Pollack, director científico del servicio gratuito de identificación de plagas IdentifyUS, dijo que la mayoría de las afirmaciones sobre la prevalencia de piojos son “tonterías de marketing” de una industria en gran parte no regulada centrada en aparentes infestaciones que a menudo resultan ser solo caspa, purpurina, laca para el cabello, insectos que habitan en la hierba, hongos inocuos o incluso migas de galletas.

Es posible que el reciente aumento en este negocio sugiera que las personas ahora se sienten cómodas buscando ayuda fuera del hogar en lugar de ser una señal de un aumento de estos insectos.

Si bien existe poca investigación para confirmar si hay un aumento de piojos, Boswell, Pollack e incluso la Asociación Nacional de Enfermeras Escolares están de acuerdo: es probable que los insectos no se propaguen en el aula porque la transmisión de piojos en la escuela se considera rara. En cambio, dijo Boswell, es más probable que a medida que se reanudan otras actividades (fiestas de pijamas, citas para jugar, campamentos de verano, reuniones familiares) los insectos están prosperando una vez más.

Pollack escribió una vez en una diapositiva de una presentación: “Los piojos indican que el niño tiene amigos”. Los niños en edad preescolar tienden a tener más infestaciones “porque son más cariñosos”, dijo Julia Wilson, copropietaria de Rocky Mountain Lice Removal en Lafayette, Colorado. Pero también ha notado un aumento entre los adolescentes, que atribuye a tomarse selfies con amigos.

“Les dices: ‘¿Han juntado sus cabezas?’ Y el adolescente dice: ‘No, nunca’”, dijo Wilson. “Y luego, de repente, literalmente se están tomando una foto selfie con sus amigos”.

La familia Marker no está segura de dónde se originaron los piojos de Huntley, que es alumna de tercer grado. ¿Quizás un amigo cercano o su grupo de baile? Los Markers gastaron más de $200 para que revisaran a los cuatro miembros del hogar, incluidas las cejas y la barba de papá. Su padre y su hermano en edad preescolar no tenían liendres. Pero Holmes encontró un par de liendres en Paris, la madre de Huntley.

“Puedes quemarme toda la cabeza ahora mismo”, dijo Paris.

Después de peinar cada cabeza con cuidado, Holmes terminó la sesión despidiéndose de sus clientes con un abrazo, prueba de que confía en su trabajo.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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The ER Charged Him $6,500 for Six Stitches. No Wonder His Critically Ill Wife Avoided the ER.

Latest Updates From Kaiser Health News - Fri, 11/19/2021 - 5:00am

Jason and DeeAnn Dean recently relocated to her hometown of Dellrose, Tennessee, where she grew up on a farm. Both in their late 40s, they’re trying to start a green dream business that combines organic farming with a health and wellness consulting company. They want to inspire people to grow their own food in this fertile rolling farmland, just north of the border with Alabama.

Until the business fully launches, Jason is working construction. In May, he was injured on the job site when a piece of sheet metal slipped and caught him on the kneecap. He bled quite a bit. After closing the wound with a butterfly bandage, he thought that might be enough. But on his drive home, he figured it’d be best to have a professional stitch it up.

It was late in the day, and the emergency room seemed the best option since his doctor’s office was closed. He and DeeAnn had opted for a health plan with lower monthly payments and a high deductible. So, he knew the cost of care wouldn’t be cheap — and he was right. When the bills for thousands of dollars came, they were shocked. They were in the midst of fighting them in August when DeeAnn started feeling as bad as she’s ever felt.

“I haven’t eaten. I’m not drinking. I have a horrible fever. I can’t get out of bed. I’m shaking,” she said.

She was pretty sure she had contracted covid-19 — the delta variant was surging across the South. The natural-health fanatic was kicking herself for putting off vaccination. She got tested and the result was negative. She visited a doctor the next day, who said her condition was bad enough to go to the ER — but she regarded that option as financially unacceptable.

“That is fear,” said DeeAnn. “If they charged Jason this much, what would they charge me?”

She was terrified of a potential bill from the same ER in Pulaski, Tennessee, that had treated her husband. So even though she was deliriously ill, she hit the road in search of cheaper treatment, asking her parents to drive her. They headed south first to an ER in Huntsville, Alabama, but it was so full of covid patients, she would have had to wait all day. Then, they drove north nearly an hour to Maury Regional Medical Center, a public hospital in Columbia, Tennessee, where she was diagnosed with Rocky Mountain spotted fever, a potentially deadly tick-borne infection. She got treatment with appropriate antibiotics and IV fluids.

“I would have had organ damage or possibly death in a few days,” she said.

And then the bills came.

The Patients: Jason and DeeAnn Dean, entrepreneurs and aspiring organic farmers who bought a BlueCross BlueShield of Tennessee insurance plan with a deductible of $8,000.

Medical Services: Jason received six sutures for a laceration on his knee and a tetanus shot. DeeAnn received diagnosis and treatment for Rocky Mountain spotted fever.

Total Bills: Jason was charged $4,582.77 by the hospital for a Level 4 emergency visit, including $497.40 for a tetanus shot. The ER physicians who treated him sent a separate bill of $2,007, for a total of $6,589.77. The Deans’ share of these bills came to $4,278.05. At a different ER, DeeAnn was charged for a Level 4 emergency and lab tests. BCBST paid a negotiated rate of $1,990.63 and the Deans owed $566.33.

Service Providers: Jason received care at Southern Tennessee Regional Health System-Pulaski, part of the LifePoint Health hospital chain. DeeAnn received care at Maury Regional Medical Center, a county-owned hospital in Columbia, Tennessee, about twice as far from her home as the Pulaski hospital.

What Gives: The Deans were snagged by a host of major problems in American health care: very high billing, obscure pricing, high-deductible insurance plans and few options for care in rural areas. The net result could have cost DeeAnn her life.

When Jason went to the only local ER for stitches, the staff assured him his insurance would cover the treatment. “I’m not versed in medical billing or medical law,” he said. “So I said, ‘Let’s go ahead and stitch it up.’”

It took 30 minutes. Despite his questions about coverage, no one ever told him what he would be charged. He guessed no more than $1,000 for the 30-minute visit.

Then, a few weeks later, he began receiving bills. The hospital charged a total of $4,582.77, asking him to pay $3,391.25 for his six stitches. Workers’ compensation insurance wouldn’t cover the injury because Jason was working for the company as an independent contractor.

LifePoint Health, the hospital’s owner, is a large hospital chain headquartered in Nashville that specializes in rural hospital operations. The ER physicians, who sent a separate bill for $2,007 (discounted to $886.80), are part of TeamHealth, based in Knoxville. His ER visit was coded as Level 4 on the five-level scale. A Level 4 is supposed to require a detailed examination and medical history, along with decision-making of moderate complexity.

Both the physicians and the hospital are part of companies recently taken over by private-equity investors. TeamHealth has been sued by the nation’s largest health insurer, UnitedHealthcare, for overusing Level 4 and Level 5 charges on bills. It’s a practice insurance companies refer to as “upcoding.” TeamHealth calls the accusation an attempt at “downcoding” a physician’s expertise.

Both companies, through spokespeople, essentially said Jason’s charges are what they are. LifePoint wouldn’t discuss specifics.

DeeAnn was still worried about her Maury Regional bill, especially after a battery of tests and being hooked to IV fluids. But, despite the high level of care she received and having the same high-deductible plan as her husband, she’s out only $600 — an amount she said she will gladly pay.

As is so often the case with Bill of the Month sagas, the question of responsibility has all sides blaming the others. TeamHealth, the ER staffing firm, which controls billing in an estimated 17% of all emergency rooms, blames insurers for selling high-deductible plans. And patients.

“Unfortunately, it is all too common that patients are not knowledgeable about their financial responsibilities under high-deductible plans,” TeamHealth spokesperson Greg Blair said in a written statement.

And the high prices do come at a cost for people’s health. For 1 in 10 Americans, according to the Peterson-KFF Health System Tracker, costs cause patients to put off necessary care.

Resolution: The Deans spent hours on the phone, asking the hospital and the physicians’ group to review the charges for Jason’s $1,000-per-stitch care. Both companies are sticking by the original bills. But the Deans are still fighting.

DeeAnn said they regret gambling on a high-deductible plan. But the difference in monthly premiums was substantial compared with low-deductible plans, especially when they’re launching a business, and the risk seemed minimal given their lack of chronic conditions and focus on healthy living.

Pulaski is lucky to still have a hospital, though. Southern states — and Tennessee especially — have seen rural hospitals close faster than anywhere else in the country. It’s a phenomenon routinely blamed on the lack of Medicaid expansion, which leaves many people uninsured.

“I get it,” DeeAnn said. “But that doesn’t mean they get to take advantage of the people going through there.”

The Takeaway: It is a national tragedy that many Americans avoid or defer needed medical care because of fear of costs. Still, there are steps you can take to protect yourself.

Emergency rooms are expensive places, so think twice before using them — although, in many circumstances, they are the only option on nights and weekends, particularly in rural areas.

Don’t be reassured by a provider’s insistence that your insurance should cover treatment. If you have a high-deductible plan, “you’re covered” doesn’t mean much because you’re responsible for — in Jason’s case — the first $8,000 in charges. Also, even if your insurer, in theory, covers your medical encounter, you may receive big bills from doctors outside your network or be required to contribute a hefty coinsurance share under the terms of your plan.

Related Links

You can ask whether the self-pay cash price is an option — thereby waiving your insurance. But many facilities will require those who have insurance to use it — knowing they can bill higher prices that way.

If a physician gives you the option of having a lab test, MRI or X-ray on the spot in the ER versus doing it once you’re discharged, choose the latter. Tests run while in the ER are often many times more expensive than elsewhere. After your visit, check how it was coded. If the bill says Level 4 or 5 and the visit was fairly simple, ask more questions. Here’s a handy chart with descriptions of the five CPT (current procedural terminology) codes for the levels of ER service.

Finally, it’s worth knowing in advance who staffs the emergency departments of hospitals in your area, especially if you have a high-deductible plan. Are the doctors employed by the hospital or are they employed by a private-equity-owned staffing firm? The latter type of arrangement, research shows, often means high prices and more aggressive billing. Driving a few extra miles could save thousands of dollars.

Bill of the Month is a crowdsourced investigation by KHN and NPR that dissects and explains medical bills. Do you have an interesting medical bill you want to share with us? Tell us about it!

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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Vaccine-or-Test Requirements Increase Work and Costs for Governments

Latest Updates From Kaiser Health News - Fri, 11/19/2021 - 5:00am

Amanda Kostroski, a 911 dispatcher in Madison, Wisconsin, leaves her busy job once a week to go to a county health clinic to be tested for covid-19.

She’s been making the 15-minute drive from work since late September, when Dane County mandated all employees get vaccinated or tested weekly. The testing is free, and she is typically back to work within an hour.

Kostroski is among 10% of county employees who are unvaccinated and get weekly tests. She chose not to get immunized because she thinks the vaccines are too new and she fears side effects.

Kostroski said she doesn’t understand the need for the shots or why vaccinated people are not tested, since they can sometimes also transmit the virus. “I think it’s pointless,” said Kostroski, 34, who has always tested negative. She’s been told by vaccinated colleagues that they feel burdened filling in for people getting tested.

Dane is one of several dozen counties, cities and states that require workers to get a covid vaccine or get tested regularly. While some employees complained about the policy, county officials say, it helps keep the workplace safe with modest interruptions. They also say vaccinated workers don’t need testing because they are less likely to get infected and, if they do, are less likely to contract a severe case of covid. But it has been costly, often requiring governments to use federal covid relief dollars they would rather have spent elsewhere.

Some private employers have adopted similar policies. And starting Jan. 4, the Biden administration will require private employers with 100 or more workers to insist on shots or weekly testing.

But opposition to those mandates runs deep among some workers, unions and conservative leaders. More than two dozen Republican state attorneys general sued the administration, arguing the federal government lacks the authority. A federal appeals court agreed with them and temporarily blocked the order, and the case might end up before the Supreme Court.

Still, these early efforts by state and local governments offer insights into what Biden’s rule might mean for the wider private sector as companies deal with setting up and paying for testing and then monitoring the results. The regimen adds more work for government managers even in localities like Dane County, where nearly 90% of adults are at least partly vaccinated.

Nationally, about 81% of adults are at least partly vaccinated against covid, although rates vary widely among states, according to the Centers for Disease Control and Prevention.

Jurisdictions run by conservative officials tend to have lower vaccination rates and are unlikely to require vaccinations or testing for workers — meaning experiences to date don’t reflect areas that have had strong opposition to vaccines and other covid requirements.

Local and state governments that have embraced the testing option have done so because it straddles the line between creating a safe work environment and giving reluctant employees a way to opt out of the vaccine without losing their job.

Blaire Bryant, associate legislative director for health at the National Association of Counties, said, “It’s too early to give a definitive answer on how well it’s going, but so far [we have] not heard any major issues.”

Counties are relying on free covid testing in their communities, paying for it through federal covid relief dollars, or having their health insurance companies foot the bill.

Local governments have a smorgasbord of policies on who is subject to the vaccine-or-test requirement and how it’s enforced. For example, all unvaccinated employees of San Diego County, California, who do not work in a health care setting need to provide proof of weekly testing to their supervisor, said spokesperson Michael Workman.

Miami-Dade County’s policy applies only to nonunion workers, or about 9% of its 29,000 employees. About 380 undergo weekly testing. The Florida county is still negotiating with unions about adding the requirement.

Virginia’s Department of Corrections requires unvaccinated employees who work in crowded settings to get tested every three days, and the rest, every seven days. And the expense? It cost the department nearly $7,000 to test 442 staff members over two days in October. The state is tapping federal covid relief funds to pay for the testing.

Securing scarce testing supplies can be difficult. The Virginia State Police had to wait more than a month to start a testing program in part because of delays in delivery.

While the Biden administration hoped its rule would motivate more people to get vaccinated, counties have had mixed results.

Officials in Fairfax County, Virginia, outside Washington, D.C., said they have not seen a significant increase in employees submitting vaccination verification since its mandatory shot policy took effect in October. More than 80% of county employees are vaccinated.

The county distributes and pays for self-administered tests for its 2,300 employees who need them, said spokesperson Dawn Nieters. The cost ranges from $35 for a rapid test to $53 for a PCR test, considered the gold standard for detecting covid.

Mecklenburg County, North Carolina, which includes Charlotte, did see the needle move. Employees there are responsible for getting their own tests. The vaccination rate jumped from 62% to 85% one month after the requirement was implemented in early September.

George Dunlap, chairman of Mecklenburg’s Board of County Commissioners, said he prefers the vaccine-or-test requirement to a vaccine-only mandate because “you have to allow for human behavior that might be different than yours.” But he isn’t sure the policy will encourage any more workers to get vaccinated.

“The people that I know personally who decided to do the testing are still getting testing. They didn’t change their mind about the vaccination,” he said.

Some health experts question the value of testing as a backup and instead favor mandating the shots.

“A vaccine-and/or-testing policy is second best,” said Jeffrey Levi, a professor of health management and policy at George Washington University. “A testing policy catches a problem early. It doesn’t prevent a problem, whereas the vaccination requirement helps to prevent it.”

Marc Elrich, the executive in Montgomery County, Maryland, in suburban Washington, supports a vaccine-only mandate in theory but worries imposing it would result in workers leaving for jobs in neighboring jurisdictions without similar requirements.

“I wish the federal government would impose a [vaccine-only] mandate, because if the feds were to do it, there wouldn’t be any job portability,” said Elrich. “I wouldn’t have to deal with an employee’s ability to go from, particularly in this region, Montgomery County Police Department to pretty much every other police department around here.”

Robb Pitts, who chairs the Fulton County Board of Commissioners in Atlanta, would also like to do away with the testing option. “But I don’t think my colleagues would necessarily go along with that,” he said. About a third of county employees have opted for testing instead of vaccination.

“Why did I compromise? Because I felt, well, we had to do something,” Pitts said. “A lot of times, politics is the art of compromise.”

According to Pitts’ office, Fulton County saw its largest increase in vaccinations since May in September, when the vaccine-or-test policy was implemented. The vaccination rate now hovers around 72%.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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What Happens After a Campus Suicide Is a Form of Prevention, Too

Latest Updates From Kaiser Health News - Fri, 11/19/2021 - 5:00am

If you or someone you know is in crisis, call the National Suicide Prevention Lifeline at 1-800-273-8255 or text HOME to the Crisis Text Line at 741741.

CHAPEL HILL, N.C. — Ethan Phillips was 13 years old when he first heard the term “suicide contagion.”

It’s the scientific concept that after one person dies by suicide, others in the community may be at higher risk.

Phillips learned the phrase growing up in Fairfax County, Virginia, where more than a dozen teens and preteens died by suicide while he was in middle school. It came up again when a high school classmate killed himself. By the time Phillips entered college at the University of North Carolina-Chapel Hill in 2019, he’d developed “an unfortunate level of experience” in dealing with the topic, he said.

So this fall, when Phillips — now a junior and head of the student government’s wellness and safety division — heard that two students had died by suicide on campus within 48 hours, he knew what to do. Along with his peers in student government, Phillips shared mental health resources on social media, developed email templates for students to request accommodations from professors and held a meeting of various mental health clubs on campus to coordinate their response. His focus was first on communicating quickly and clearly, and second on informing students about mental health resources available to help them deal with their grief.

Those are two crucial steps in a growing area of study known as “suicide postvention.” Just as there’s research on the prevention of mental health crises and interventions for people who are actively suicidal, research is also developing around the steps that can be taken after a suicide to help communities grieve, restore a sense of stability and limit the risk of more deaths.

It’s an area of particular interest for colleges, as suicide is the second-leading cause of death for U.S. teenagers and young adults, and these are the groups most likely to experience contagion. With the covid-19 pandemic exacerbating depression and thoughts of suicide, several universities have needed postvention strategies over the past year and a half.

Saint Louis University, Dartmouth College and West Virginia University have lost multiple students to suicide during the pandemic. At UNC, the two deaths in October came after a suicide death and suicide attempt in September, according to the campus police log. A national survey in the spring by the American College Health Association found 1 in 4 students had screened positive for suicidal thoughts and 2% had attempted suicide in the past 12 months.

“Knowing this, we have to be even more alert,” said John Dunkle, former director of counseling services at Northwestern University and a senior director with the nonprofit Jed Foundation, which works to prevent youth suicide. “Getting that postvention plan in place before a tragedy occurs is really critical.”

Schools should know how they will communicate the news, identify students at greatest risk of harming themselves, deploy counseling resources and determine whether to hold memorials, he said.

Julie Cerel, director of the Suicide Prevention and Exposure Lab at the University of Kentucky, said her research shows that, on average, 135 people are affected by each suicide. Postvention strategies can prevent suicides among that group, she said.

Yet creating a postvention plan is a challenging task, involving the uncomfortable topic of death, thorny legal questions of liability and the sometimes conflicting desires of the deceased student’s family and the campus population.

Phillips saw these complexities when he was in middle and high school. So when UNC leaders took a day and a half to release a statement on the October suicides, he understood why.

Still, he saw the repercussions of that delay in the college community. Rumors swirled on social media and people wondered if the university was ignoring the issue. “Where it showed its negative effects most acutely were in faculty who did not know what was occurring on campus,” Phillips said. Some were caught off guard by students’ grief and anger at the university or requests for extensions on assignments.

UNC declined to answer questions about its response to the suicides and whether it has a postvention plan. On Nov. 15, the university did hold a one-day mental health summit “for faculty, staff and student leaders” to address campus culture, crisis services and prevention. In a written statement, the university said it also plans to launch a campuswide mental health campaign to make students and other community members aware of the signs and symptoms of mental health distress, and inform them of the different ways they can reach out to each other and to university services for support.

Dunkle said communication is among the trickiest pieces of postvention. While students want information immediately, universities can be hamstrung by pending death investigations or a family’s wishes for privacy. Officials also must avoid sharing details, like the manner of suicide, as that can increase contagion.

What’s most important, Dunkle said, is to provide mental health resources.

After the suicides, UNC’s communication to students listed the campus counseling center, the dean of students office, peer support services and national hotlines. The school also created temporary support centers with counselors throughout campus.

But since the centers were open only during the daytime, Phillips said, some students found it difficult to go between classes.

Christopher Grohs, a student in occupational therapy and director of health and wellness for the graduate and professional student government, echoed that concern. Many graduate students have told him they don’t know where the counseling center is on UNC’s 729-acre campus or how to use it. “A big barrier to using a resource is being able to locate it,” Grohs said.

This on-the-ground understanding is why students should be consulted when universities develop postvention plans, said Amy Gatto, a senior manager at Active Minds, a nonprofit focused on mental health for young adults. “They’re going to be able to give more valuable feedback than just a committee of staff members.”

At Johnson C. Smith University — a small, historically Black college in Charlotte, North Carolina — counseling services director Tierra Parsons said she looks for opportunities to survey students and adjust services accordingly. Over the years, students have suggested they’d like more virtual and text-based options, she said. In fall 2020, the school brought on telehealth provider TimelyMD. This year, it asked social work graduate students to spend their internship hours in undergraduate residence halls to be available to students where they live.

“We want to be where students need us, and sometimes that requires coming out from behind the desk,” Parsons said.

Equally important as campuswide outreach is directly contacting those who were closest to the student who died, mental health experts say.

At the University at Albany in New York, the counseling center creates a list of these students and fast-tracks them to an urgent consult if they reach out, said center director Karen Sokolowski. If the students don’t reach out, counselors contact them to talk about grief and ask whether they need extensions on homework or time away from school.

Students should also be asked about their access to lethal means, said Qwynn Galloway-Salazar, student division chair for the American Association of Suicidology. Depending on their answers, the university could distribute gun locks, talk about safe storage of medications or, more generally, limit access to the top floors of tall buildings. After a series of suicides at Cornell, the university added safety nets to local bridges.

Another important postvention step can be limiting memorials. Although students need opportunities to grieve, experts say memorials sometimes glamorize suicide and lead others with suicidal thoughts to see death as a way to receive love and attention. Instead, they suggest directing students to volunteer or donate to a cause they care about in their classmate’s memory.

At UNC, in the days after the two suicides, members of the campus Active Minds chapter wrote more than 150 notes of affirmation and distributed them with lists of mental health resources, said club co-president Evan Aldridge. Other students wrote messages in chalk outside the student union reminding peers “it’s OK to rest” and “you are so loved.”

Although those messages have faded in the weeks since, the students’ postvention efforts have not.

Phillips said they should continue for years, just as they have where he grew up. “I don’t know that we’re ever out of postvention.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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A Covid Head-Scratcher: Why Lice Lurk Despite Physical Distancing

Latest Updates From Kaiser Health News - Fri, 11/19/2021 - 5:00am

PARKER, Colo. — The Marker family opened their door on a recent evening to a woman dressed in purple, with a military attitude to cleanliness.

Linda Holmes, who has worked as a technician with LiceDoctors for five years, came straight from her day job at a hospital after she got the call from a dispatcher that the Marker family needed her ASAP.

According to those in the world of professional nitpicking, Pediculus humanus capitis, the much-scorned head louse, has returned.

“It’s definitely back,” said Kelli Boswell, owner of Lice & Easy, a boutique where people in the Denver area can get deloused, a process that can range from minutes to hours depending on the method and the infestation. “It’s a sign that things are coming back to normal.”

Colds and more serious bugs like respiratory syncytial virus, better known by the shorthand RSV, are also back. That may leave some to wonder: With all the covid prevention measures in place, how are kids sharing these things?

Like the coronavirus, all these bugs depend on human sociability. Unfortunately, the measures that many reopened schools have taken to prevent the transmission of covid-19 — masks, hand-washing, vaccination — do little to deter the spread of the head louse. However, physical distancing, such as spacing desks 3 feet apart, should be helping, if it’s actually happening.

Lice are, in theory, harder to spread than the SARS-CoV-2 virus because proximity alone isn’t enough: They usually need head-to-head contact. If a kid gets lice, odds are it means that kid spent some quality time close enough to another kid for the parasite to make its move. (Researchers tend to agree that transmission via inanimate objects like combs and hats is minimal.)

The head louse is not known for its fortitude or athletic prowess. It’s basically the couch potato of pests. Adults can’t survive more than a day or two without snacking on blood. Their eggs can’t hatch without the warmth of a human head, and will die within about a week if not in those cozy conditions. The bugs can’t jump or fly — only crawl. The one thing going for the head louse is its highly specialized claws, evolved to grasp human hair.

Unlike the body louse, the head louse isn’t known to spread disease. An infestation doesn’t indicate anything about a person’s hygiene. (In fact, the lore of delousers says that the bugs prefer clean hair because it’s more grabbable.) And despite common misconceptions, they can colonize people of all ages, races and ethnicities.

Covid lockdowns were not great from a louse-world-domination standpoint. But the critters have been bonding with us for tens of thousands of years. A little lockdown wasn’t going to end the romance.

Federico Galassi, a researcher with Argentina’s Pest and Insecticide Research Center, found that strict early covid lockdowns did, indeed, lead to a decline in head lice among kids in Buenos Aires, but the bugs came nowhere close to being eliminated. His study found prevalence dropped from about 70% to about 44%.

And one thing is clear: When people shut their doors and hunkered down in early lockdowns, the lice were right there hunkered down with us. When SaLeah Snelling reopened the doors of her Lice Clinics of America salon in Boise, Idaho, in May, she said, “the cases of head lice were heavier than we’ve ever seen.” And it wasn’t just one or two people in the household with lice, but the entire household.

Now, Galassi and American louse workers say, infestation rates are back to pre-lockdown norms, despite school covid protections.

Nix, a brand of anti-louse products, publishes a map that claims lice are bad right now in Houston, most of Alabama and New Mexico, plus Tulsa, Oklahoma. The map directs people to locations that carry its products since many parents use a DIY approach once they spy the critter on a child’s head.

Richard Pollack, chief scientific officer with pro-bono pest-identification service IdentifyUS, said most claims about louse prevalence are “marketing nonsense” from a largely unregulated industry focused on apparent infestations that often turn out to be just dandruff, glitter, hair spray, grass-dwelling springtail insects, innocuous fungus or even cookie crumbs.

It’s possible that the recent increase in business for professional nitpickery suggests that people are now comfortable seeking help outside the home rather than its being a sign of a surge in the bugs.

While little research exists to confirm whether there is a rise in lice, Boswell, Pollack and even the National Association of School Nurses agree: The bugs aren’t likely spreading in the classroom because in-school louse transmission is considered rare. Instead, Boswell said, it’s more likely that as other activities resumed — sleepovers, play dates, summer camp, family gatherings — the bugs prospered once more.

Pollack once wrote in a presentation slide, “Head lice indicate that the child has friends.” Preschoolers tend to get the infestations the most “because they’re more cuddly,” said Julia Wilson, co-owner of Rocky Mountain Lice Removal in Lafayette, Colorado. But she has also noticed a rise among teenagers, which she ascribes to taking selfies with pals.

“You say to them, ‘Have you touched heads?’ and the teenager’s like, ‘No, never,’” said Wilson. “And then all of a sudden, they’re literally taking a selfie photo with their friends.”

The Marker family isn’t sure where third grader Huntley’s lice originated. Perhaps a close friend or her dance team? The Markers spent more than $200 to get the four-person household checked — eyebrows and Dad’s beard included. Her dad and her preschool-aged brother were free of nits. But Holmes did find a couple of nits on Huntley’s mom, Paris.

“You can just burn my whole head right now,” said Paris.

After combing each head carefully, Holmes ended the session by hugging her customers goodbye, proof that she trusts her work.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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KHN’s ‘What the Health?’: Boosting Confusion

Latest Updates From Kaiser Health News - Thu, 11/18/2021 - 3:00pm

Can’t see the audio player? Click here to listen on Acast. You can also listen on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

With covid caseloads rising across much of the country, several governors and mayors are unilaterally expanding access to booster shots, getting out ahead of federal health officials.

Speaking of federal health officials, President Joe Biden has finally selected a nominee to head the Food and Drug Administration. If confirmed by the Senate, it would be Dr. Robert Califf’s second stint at the agency that oversees an estimated one fifth of all products sold in the United States. Califf previously served — for less than a year — under President Barack Obama.

Califf’s nomination, however, could be complicated by the news of a dramatic increase in Medicare premiums for 2022, prompted largely by the FDA’s approval of a controversial drug to treat Alzheimer’s disease not yet been proved effective.

This week’s panelists are Julie Rovner of KHN, Tami Luhby of CNN, Sarah Karlin-Smith of the Pink Sheet and Rachel Cohrs of Stat.

Among the takeaways from this week’s episode:

  • Democratic leaders in the House say they expect to vote soon on a bill funding Biden’s climate change and social policy agenda. Even some moderates, who have been concerned about the price tag, suggest that passage looks likely. But the Congressional Budget Office has not yet released its full estimates of the cost of some of the more controversial health items in the bill, and those numbers could prompt calls for revisions.
  • Califf appears on track for Senate confirmation because he is expected to get support from most Democrats and some Republicans. Several Democrats, however, have already criticized the nomination, complaining the FDA was not tough enough on the drugmakers behind the opioid epidemic and needs a leader who will change that culture.
  • At the Department of Health and Human Services, at least three Senate-confirmed positions dealing with social services remain unfilled. Those include the assistant secretary for the Administration for Children and Families, a commissioner for the Administration for Native Americans and a commissioner for that agency’s children, youth and families bureau.
  • Medicare officials announced the standard monthly premium for the Part B program, which covers doctor and other outpatient medical services, would rise next year by more than $20. Part of that increase is a hedge in case Medicare decides to cover the cost of a new controversial Alzheimer’s drug, Aduhelm.
  • Aduhelm is priced at $56,000 a year and involves other costs related to testing for side effects. Although the drug would likely be used by a small number of beneficiaries, its high cost influenced the sharp increase in premiums, Medicare officials said.
  • If Medicare opts not to cover Aduhelm, it’s not clear if or how beneficiaries might recoup the money spent on the premiums.
  • The FDA appears to be moving toward the Biden administration’s desire to make all American adults eligible for additional covid vaccine shots, known as boosters. Some scientists within the administration have been reluctant to take that step, but new evidence provided by the drugmakers bolsters the effort to get younger people extra doses.
  • The move by states and cities to make younger adults eligible for the boosters may not be legal under the special-use authorization the FDA gave several of the vaccines. But it hasn’t been challenged.
  • Confusion over who is eligible for the shots may undermine the federal government’s efforts to assure the country that the covid vaccines are effective and a good choice. Still, people hesitant to get the shots do not appear to be convinced by many arguments.
  • Biden’s order that large workplaces establish vaccine mandates is on hold as it is being challenged in federal court. The issue will likely end up before the Supreme Court, and some advocates for workers fear that the justices could use the case as an opportunity to roll back federal protections in the workplace.

Also this week, Rovner interviews Dan Weissmann, host of the “An Arm and a Leg” podcast, about his new project, a “first-aid kit” newsletter to help consumers make better decisions about their own health care.

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read, too:

Julie Rovner: The Atlantic’s “Why Health-Care Workers Are Quitting in Droves,” by Ed Yong.

Also, Stat’s “The Catholic Hospital System Ascension Is Running a Wall Street-Style Private Equity Fund,” by Rachel Cohrs.

Tami Luhby: Politico’s “‘We Don’t Fix This Because We Just Don’t Care About Old People,’” by Joanne Kenen.

Sarah Karlin-Smith: KHN and InvestigateTV’s “As Big Pharma and Hospitals Battle Over Drug Discounts, Patients Miss Out on Millions in Benefits,” by Sarah Jane Tribble and Emily Featherston.

Rachel Cohrs: Modern Healthcare’s “Why the Justice Department Is Targeting Private Equity,” by Tara Bannow.

To hear all our podcasts, click here.

And subscribe to KHN’s What the Health? on Spotify, Apple Podcasts, Stitcher, Pocket Casts or wherever you listen to podcasts.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

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