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Kaiser Permanente, Big Player in State Vaccine Effort, Has Had Trouble Vaccinating Own Members

Latest Updates From Kaiser Health News - Thu, 03/04/2021 - 1:52pm
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As managed-care giant Kaiser Permanente assumes a prominent role in California’s new covid-19 vaccination strategy, it is drawing mixed reviews from members across the country for the way it has run its own vaccine program over the past two months.

Conversations with 10 Kaiser enrollees in five states — Colorado, Washington, Virginia, Maryland and California — revealed a common frustration: difficulty snagging an appointment. Many also described receiving sporadic and sometimes confusing information from the company, though some said Kaiser has been doing better recently.

All of those who spoke to California Healthline were over age 65. Many were long-standing Kaiser members and, aside from the vaccine rollout, had mostly positive opinions of the health system. Some ended up going elsewhere for their shots; others said they would wait for Kaiser because its services were familiar to them and they felt more comfortable going there than to another site. (KHN is an editorially independent program of KFF, which is not affiliated with Kaiser Permanente.)

Kaiser’s CEO, Greg Adams, acknowledged the frustrations of his company’s California patients in a Jan. 30 email, explaining that the health system had received only a small fraction of the vaccine supply it needed.

Members did not blame Kaiser for the lack of vaccines, noting that insufficient supply has been the bane of providers across the country. But Kaiser could have been quicker to administer the vaccines it did receive and should have communicated more clearly about the shortage, they said.

Nino Maida, a San Francisco resident who’s been a Kaiser member for 14 years, said he couldn’t figure out why he was unable to get an appointment. “The frustration lasted about a month, until I got a clear indication from Kaiser that any waiting was due to a lack of vaccine,” said Maida, 74. “I thought they were being very inefficient instead of just poor at communicating.”

A Kaiser spokesperson defended the company’s communication strategy, saying that a page on its website (kp.org/covidvaccine) provides detailed answers about vaccine eligibility and appointments, and that a link prominently displayed on Kaiser’s homepage directs people there. The organization sends regular emails to members with information about their eligibility and instructions on how to set up an appointment, and call center operators also can answer members’ questions, he said.

Clearly, Kaiser Permanente isn’t the only organization encountering vaccination roadblocks. Sutter Health, the large Northern California health system, for example, may have to cancel 95,000 vaccination appointments because it doesn’t have enough vaccine on hand, company spokesperson Amy Thoma Tan said Wednesday.

But Kaiser, which is both an insurer and medical provider, has drawn particular scrutiny because of its size and because it has been chosen to play a significant part in state efforts to speed covid vaccinations.

The company, which covers 12.4 million people in the U.S., including 9.3 million Californians, was also fined nearly $500,000 for workplace safety violations early in the pandemic.

A memorandum of understanding with the state, released last week, stipulates that Kaiser will be part of a vaccination provider network assembled and overseen by Blue Shield of California, which signed a contract on Feb. 1 to administer the statewide inoculation plan. Kaiser will also serve as an adviser to Blue Shield to help the state meet its goal of expanding vaccine access to the most vulnerable communities, the memorandum says.

Under the agreement, Kaiser will receive no state funds. It will operate two mass vaccination sites — one at San Francisco’s Moscone Center, the other at California State Polytechnic University-Pomona, in Los Angeles County — and “may consider the establishment of future mass vaccination sites” that would target rural Californians and those with historically lower vaccination rates. Importantly, Kaiser will vaccinate members and nonmembers, as it has already been doing on a smaller scale.

The memorandum acknowledges the supply constraints Kaiser has faced, saying the state “shall ensure that Blue Shield understands that Kaiser is dependent on sufficient supply of the vaccine.”

Kaiser did not start vaccinating people age 65 and older — in line with state guidelines — until well after other providers had begun doing so. And some longtime Kaiser members were disappointed by the lag.

“It is not good PR to have week after week of news showing the four largest health care providers in Northern California, and Kaiser is the only one still working on staff and people over 75 years old,” said Elizabeth Wieland, 66, of Elk Grove, California, a member for 30 years.

When Kaiser sent an email to patients on Feb. 13 encouraging them to “get vaccinated somewhere outside Kaiser Permanente” if possible, it felt as if they were “throwing in the towel,” Wieland said. “It’s ‘fend for yourself.’ Not what I would have expected, but that seems to be the new normal.”

On Feb. 20, Adams sent an update to members informing them the supply outlook had improved, because “the state has increased Kaiser Permanente’s weekly vaccine allocation to better match the number of members we serve.” As a result, the CEO said, Kaiser was able to start scheduling appointments for people 65 and up.

Kaiser is also vaccinating people 65 and up in Washington state, Virginia and Georgia, a spokesperson said.

Member complaints were not only about the slow rollout. Members said that Kaiser sometimes posted key vaccination information in hard-to-find places, and that they often heard things by word of mouth before they heard it from the company. Some said that, once they managed to sign up for a vaccination, they were promised email updates that never arrived. Still others said that, after getting on Kaiser’s vaccination waiting list, they were suddenly bumped further back in the line with no explanation.

Janet Vorwerk, a retired Kaiser operating room nurse who lives in a suburb of Denver, said that when she got on Kaiser’s waiting list in January, she was No. 20,991 in line. On Feb. 15, she dropped all the way down to 9,989, then inexplicably bounced up to 11,258 two days later, which she said was “so disheartening.” As of last Friday, she was No. 10,269.

“I don’t understand how the numbers are getting jacked around, up and down,” said Vorwerk, 66. Still, she blames the circumstances more than she blames Kaiser. “I understand where they’re coming from,” she said. “You can’t pull a vaccine out of your backside. But at the same time, it would be good to have a better idea of when it might happen.”

Some members said Kaiser’s performance has improved recently.

For Tom Spradley, an 84-year old resident of Citrus Heights, California, initial frustration with Kaiser gave way to a happy ending. He said he called Kaiser for an appointment about a month ago and was on hold for two hours before giving up. He then started checking Kaiser’s vaccine page every day for updates, but said none came for several days.

Finally, he was able to get an appointment for himself and his wife at a Kaiser site in Sacramento, about 20 minutes away. The appointment, he said, was a model of efficiency. They got their first shots and were scheduled for second doses March 12.

“After a week of bad information on getting a shot, I think they have really come through, and I was really impressed by the job they did,” Spradley said.

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

[Correction: This article was updated at 3 p.m. ET on March 4, 2021, to correct the amount Kaiser Permanente was fined for workplace safety violations early in the pandemic.]

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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Trump's Deal To End War In Afghanistan Leaves Biden With 'A Terrible Situation'

WXXI US News - Thu, 03/04/2021 - 1:37pm
TERRY GROSS, HOST: This is FRESH AIR. I'm Terry Gross. One of Donald Trump's campaign promises was to end the war in Afghanistan. Last year, he negotiated an agreement with the Taliban to withdraw all U.S. forces by May 1 of 2021. That's less than two months away. Not represented in that agreement were members of the Afghan government. They're now negotiating with the Taliban. Meanwhile, President Biden, having inherited the Trump deal, faces some tough choices, as my guest, Dexter Filkins, explains in his new piece in The New Yorker. If Biden succeeds in pulling out troops, he will end a forever war. But with U.S. troops gone, civil war could flare up, the Taliban could take over and the war Americans fought could be deemed a failure. Filkins was in Afghanistan in December and January. He started reporting from Afghanistan in the '90s. He covered the wars in Iraq and Afghanistan for The New York Times and joined The New Yorker as a staff writer in 2011. He coined the phrase "The

How China's Massive Corruption Crackdown Snares Entrepreneurs Across The Country

WXXI US News - Thu, 03/04/2021 - 1:02pm
LULIANG, China — The meteoric rise of aluminum executive Zhang Zhixiong transformed his rural Chinese hamlet into a lucrative mining community. But his fall from grace was even more dramatic. In March 2018, he and 10 others were sentenced to harsh prison terms for supposedly forming a criminal organization and illegal mining, among other crimes. Zhang, chairman of Juxin Mining Co., was accused of being a crime boss and received a 25-year prison sentence. He denies the charges. Chinese state media branded him "an evil leader disguised in red clothes" — a kingpin pretending to be an upright communist citizen — and a high-profile target in a sweeping anti-corruption campaign. President Xi Jinping launched the campaign in 2018 with the slogan "Saohei chu'e," meaning "sweep away black and eliminate evil." After three years, the initiative concluded last year. China's legislature, which is convening this week, will likely hail the campaign as a smashing success: nearly 40,000 supposed

Empty Desks At U.N. Represent Millions Of Children Who Have Missed School In Pandemic

WXXI US News - Thu, 03/04/2021 - 12:38pm
As President Biden pushes to get U.S. schools fully open soon , an art exhibit aims to help people visualize what it means that they're closed. The outdoor installation, called "Pandemic Classroom," is at the United Nations in New York, and represents schools that have closed around the world because of the coronavirus. UNICEF says the exhibit is a "solemn reminder of the classrooms in every corner of the world that remain empty." The exhibit features bright blue, unused school bags sitting at 168 empty desks. Each desk represents 1 million children who have missed almost all classroom instruction because their schools were closed. UNICEF's Global Chief of Education Robert Jenkins says that "168 million is a very difficult number to kind of wrap your head around. It's just so large. So we thought this would be a useful way of at least getting some sense of what the scale of the crisis is." UNICEF says the exhibit is a "solemn reminder of the classrooms in every corner of the world that

Coming up on Connections: Thursday, March 4

WXXI US News - Thu, 03/04/2021 - 10:57am
First hour: Can "citizen panels" create more common ground on divisive issues? Second hour: Local vaccine researchers on the state of COVID-19 vaccines

NY adds vaccination sites using J & J vaccine in Western NY

WXXI US News - Thu, 03/04/2021 - 10:13am
There are new mass vaccination sites in Western New York that will help New York state expand the rollout of the Johnson & Johnson vaccine. On Thursday, Gov. Andrew Cuomo announced three new, short-term mass vaccination sites to use the J&J vaccine, including one at Genesee Community College in Batavia. The other two are at Marist College in Poughkeepsie and Jamestown Community College in Olean. Each site will administer 3,500 Johnson & Johnson vaccines. New York will partner with local medical providers in setting up the operating these sites. "The Johnson & Johnson vaccine's approval opens an important new chapter in our efforts to vaccinate all New Yorkers for COVID-19, and we're ramping it up thanks to a large initial influx of supply," Cuomo said. "These three new sites will get shots in arms on a large scale in critical parts of the state, and the vaccine's ease of storage and administration will help us simplify the process statewide.” The site at Genesee

Don't Swat This Bug. It Might Be A Robot On A Rescue Mission

WXXI US News - Thu, 03/04/2021 - 10:10am
The reason it's so hard to kill a mosquito is that they move really well. Scientists are trying to build a robot with that kind of agility. And these tiny but mighty flying robots could be used in life-and-death situations, such as finding people in a collapsed building. Kevin Chen says he spends "a lot of time looking at the flapping-wing physics, that is understanding how an insect can flap their wings and generate lift and drag forces." Chen , an assistant professor at the Massachusetts Institute of Technology, leads a team that's invented a new microdrone — not quite as tiny as a mosquito. "The weight of this robot and the physical size looks pretty much like a dragonfly," he says. YouTube The tiny drone weighs just 0.6 grams (or 0.02 ounces) — about as much as a paper clip. But like a dragonfly, it's resilient. It has a soft, muscular mechanism called an "actuator" that powers the wings for flight, that can flap nearly 500 times per second. Previously, tiny robots used rigid

Data Show India's Homegrown COVID-19 Vaccine Works — 2 Months After It Was Approved

WXXI US News - Thu, 03/04/2021 - 9:48am
It turns out a COVID-19 vaccine that stirred controversy in India may be effective after all. The Indian government approved the use of the COVAXIN vaccine, made by the Indian company Bharat Biotech, on Jan. 3 – while clinical trials were ongoing, and before efficacy data was out. Scientists, public health experts and opposition politicians expressed concern . Many called the move premature. Some accused India of acting out of nationalism. The Bharat Biotech formula has been billed as India's first "indigenous" vaccine. Critics cautioned India to wait for data from phase 3 clinical trials. Now, that data is out. Late Wednesday, Bharat Biotech released interim data showing its vaccine prevents COVID-19 in 81% of patients who receive two doses. The phase 3 clinical trial involved 25,800 subjects, making it the largest ever in India, the company said. Trials are still ongoing, and further data is needed for a "final analysis," it said. But Bharat Biotech's chairman said this interim data

Scotch Whisky, English Cheese Prices Could Ease As U.S. Halts Tariffs

WXXI US News - Thu, 03/04/2021 - 9:43am
Updated at 10:40 a.m. ET The Biden administration will suspend steep tariffs on Irish and Scotch whiskies, English cheeses and other products, after reaching an agreement with the U.K. Former President Trump had imposed the tariffs in late 2019 as part of a long-running dispute over the aviation industry. Scotch whisky and other products had been subject to a 25% tariff. But as of today, the tariffs will be suspended for at least four months. Other products, from pork to cashmere and machinery items, had also been hit by the tariffs that are now suspended. Their damage has been compounded in the past year by the COVID-19 pandemic. "Trade is key to economic recovery," U.K. Trade Secretary Liz Truss said . She noted that in the year before the tariffs, the U.S. had imported £550 million (nearly $770 million) worth of the affected U.K. goods. In Scotland, news of the deal prompted a peaty sigh of relief. "This is fabulous news, and our industry is delighted," said Scotch Whisky

New U.S. Malaria Czar: Why We Should Care About The Disease, Even In A Pandemic

WXXI US News - Thu, 03/04/2021 - 9:17am
Here's a few things you probably didn't know about malaria and the U.S. At least eight U.S. presidents had it, including George Washington (infected in Virginia), Abraham Lincoln (infected in Illinois) and John F. Kennedy (infected in the Solomon Islands during World War II). The current U.S. caseload is zero (with the exception of Americans who contract the disease abroad). The U.S. actually has a malaria czar: the U.S. Global Malaria Coordinator for the President's Malaria Initiative, overseeing an annual budget of $770 million. The goal of the initiative is to wipe out this potentially fatal disease, spread by mosquitoes, which infects some 220 million people a year. And now there's a new malaria coordinator. In February, President Joe Biden appointed Dr. Raj Panjabi, an instructor at Harvard Medical School and the founder of Last Mile Health , which aims to bring health care to hard-to-reach places. In 2017, he won the $1 million TED annual award given to an "exceptional individual

Accidentally Trashed, Thawed Or Expired: Reports Of COVID Vaccine 'Spoilage' Grow

WXXI US News - Thu, 03/04/2021 - 8:00am
As the speed of COVID vaccinations picks up, so do the reports of doses going to waste. And it's more than just a handful at the end of the day because of a few appointment cancellations. Health officials are trying to address the problems that lead to waste, but without slowing down the roll out of the lifesaving vaccinations. The incidents include the 335 discarded doses in Lee County, North Carolina that were damaged in shipping, and recent problems in Tennessee , where nearly 5,000 doses went to waste in the month of February, prompting additional federal oversight. "I definitely have been losing some sleep over this, for sure," says Beth Ann Wilmore, the nursing director at Mercy Community Healthcare in Franklin, Tennessee. She manages the COVID vaccine inventory at the nonprofit clinic, which started receiving shipments a month ago. Clinics like Mercy are accustomed to handling vaccines, but none so precious that have such special refrigeration needs. "I was definitely waking up

Major Election Reform And Voting Rights Bill Passed By The House

WXXI US News - Thu, 03/04/2021 - 7:19am
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News Brief: In-Person Classes, Capitol Security, Pope's Iraq Trip

WXXI US News - Thu, 03/04/2021 - 6:23am
Federal efforts aim to help schools reopen. Tighten security follows reports extremists may try again to breach the U.S. Capitol. Pope Francis on Friday will become the first pope to visit Iraq.

Lawmakers On Capitol Hill Criticize Biden's Order For Airstrikes Against Syria

WXXI US News - Thu, 03/04/2021 - 6:23am
NPR's Steve Inskeep talks to Democratic Sen. Chris Murphy of Connecticut about the Biden administration's decision to conduct airstrikes on targets in Syria without the approval of Congress.

Elaine Chao Used DOT Resources For Personal Errands, Family Business, IG Report Says

WXXI US News - Thu, 03/04/2021 - 6:17am
Updated at 12:22 p.m. ET In her time as former President Donald Trump's transportation secretary, Elaine Chao repeatedly used her position and agency staff to help family members who run a shipping business with ties to China, in potential violation of federal ethics laws, according to an Office of Inspector General report. The findings were uncovered in the Transportation Department's inspector general report released Wednesday that detailed the office's investigation into Chao's dealings as secretary. The inspector general referred the findings to the Justice Department in December 2020. But with the Trump administration coming to a close, the DOJ declined to open its own investigation into the matter, citing "there is not predication" to do so. Chao, who is married to Sen. Mitch McConnell, R-Ky., announced her resignation Jan. 7, saying she was deeply troubled by the previous day's mob attack on the Capitol "in a way that I simply cannot set aside." Her term was set to end at

Security Tightens Amid Reports Extremists Aim To Breach Capitol Again

WXXI US News - Thu, 03/04/2021 - 5:16am
Copyright 2021 NPR. To see more, visit https://www.npr.org.

Texas Gov. Abbott Criticized For Lifting COVID-19 Restrictions

WXXI US News - Thu, 03/04/2021 - 5:02am
Copyright 2021 NPR. To see more, visit https://www.npr.org.

Reopening of Long-Term Care Facilities Is ‘an Absolute Necessity for Our Well-Being’

Latest Updates From Kaiser Health News - Thu, 03/04/2021 - 5:00am

For nearly a year, nursing homes and assisted living centers have been mostly closed to visitors. Now, it’s time for them to open back up and relieve residents of crushing isolation, according to a growing chorus of long-term care experts, caregivers, consumer groups and physicians.

This story also ran on CNN. It can be republished for free.

They’re calling for federal health authorities to relax visitation restrictions in long-term care institutions, replacing guidance that’s been in place since September. And they want both federal and state authorities to grant special status to “essential caregivers” — family members or friends who provide critically important hands-on care — so they have the opportunity to tend to relatives in need.

Richard Fornili, 84, who lives in a nursing home in St. Marys, Georgia, supports a change in policies. He hasn’t seen any family members since last summer, when a granddaughter, her husband and her two children stood outside his window and called him on the phone. “The depression and sense of aloneness affecting my fellow residents, it’s terrible,” he said. “Having our relatives come back in to see us, it’s an absolute necessity for our well-being.”

“At this point, residents are becoming more likely to die of isolation and neglect than covid,” said Jocelyn Bogdan, program and policy specialist at the National Consumer Voice for Quality Long-Term Care, citing new data linking covid-19 vaccination to sharp declines in covid-related deaths. Her organization has launched a petition drive calling for nursing homes to safely reopen and for essential caregivers to have unrestricted access to loved ones.

Since late December, when vaccinations began, covid cases in nursing home residents have plunged 83%, while deaths have dropped by 66%, according to an analysis by KFF. As of Monday, 4.6 million residents and staff members in nursing homes and other congregate facilities had received at least one shot of the Pfizer-BioNTech or Moderna vaccine, including more than 2 million who had received a second dose.

Vaccines have “changed everything” and nursing homes are now among “the safest places you can be in your community in terms of covid,” said Ruth Katz, senior vice president of public policy at LeadingAge, an association representing more than 5,000 nonprofit nursing homes, assisted living centers and senior housing providers.

Last week, LeadingAge called for federal authorities to expand visitation in a letter to top officials at the White House, the Centers for Medicare & Medicaid Services and the Centers for Disease Control and Prevention. In an email, the American Health Care Association, which represents more than 14,000 long-term care providers, also urged CMS and the CDC to review its visitation guidance. AARP, the nation’s most powerful seniors’ lobby, chimed in with a letter noting “a critical need” for new recommendations.

Medical directors at long-term care facilities are also weighing in while sounding a cautious note in new guidance about resuming communal activities and visitation in long-term care facilities. With new covid variants circulating and significant numbers of staffers and potential visitors still unvaccinated, “we’re recommending a measured, step-wise approach,” said Dr. Swati Gaur, chair of the infection advisory committee for AMDA — the Society for Post-Acute and Long-Term Care Medicine.

Facilities that reopen to family members should do so “carefully,” she said, scheduling visits, screening those visitors for symptoms and ideally requiring a negative covid test before entry; limiting the number of visitors in a facility at any time; sending them to designated visitor sites, not residents’ rooms; and requiring the use of masks and gloves, among other precautions.

No one wants to see covid outbreaks reappear in long-term care facilities, Gaur said — the site of nearly 173,000 covid-related deaths, about 35% of the nation’s total.

CMS instructed nursing homes to lock down almost a year ago, on March 13, as the coronavirus pandemic accelerated and the CDC said no one except relatives making end-of-life visits should be let in. In September, new recommendations allowed outdoor visits, so long as safety precautions such as physical distancing were in place, and indoor visits, so long as a facility was covid-free for 14 days and the positivity rate for covid cases in the surrounding community was under 10%.

Federal recommendations apply to nursing homes. States regulate assisted living and other congregate care facilities but tend to follow the CDC’s lead. In practice, long-term care facilities vary considerably in how they implement recommended policies.

Also, federal authorities recommended that relatives be able to make “compassionate care” visits when a resident is emotionally distressed, grieving the loss of friends or family members, losing weight or adjusting poorly to the recent loss of family support. But many nursing homes continue to deny these visits, and enforcement needs to be strengthened, AARP observed in its letter.

Melody Taylor Stark said her request for a compassionate care visit with her husband, Bill Stark, was denied in October, when his congestive heart failure worsened. Bill, 84, a resident at Huntington Drive Health and Rehabilitation in Arcadia, California, for five years, was subsequently hospitalized with pneumonia. Stark said she was permitted only one 15-minute visit with him, on Nov. 17, after he returned to Huntington — the last time she saw Bill before his death on Nov. 22. The administrator at Huntington Drive did not respond to a request for comment.

The Essential Caregivers Coalition, of which Stark is a member, is asking that every long-term care resident be able to designate one or two essential caregivers who can come in and out of facilities regularly to provide hands-on care to loved ones, as they did before the pandemic. As the anniversary of lockdowns approaches, the coalition has organized email blasts and letter-writing campaigns to federal and state authorities, a traveling lawn sign campaign in more than a dozen states and gatherings at several state capitols. The campaign’s slogan: Isolation Kills, Too.

Mikko Cook, 49, of Ventura, California, is one of the group’s co-founders. Her father, Ron Von Ronne, 77, has late-stage Alzheimer’s disease and lives in a 200-bed nursing home in Albany, New York. Before the pandemic, Cook’s brother visited almost every day.

“The home was severely understaffed and when my family members would go in to take care of him, my father’s sheets would be soiled. He wouldn’t have showered. The bathroom was never clean. But they would take care of that,” Cook said.

After the lockdown, Von Ronne went more than three months without seeing or talking to family members. Over the past year, he nearly stopped communicating, was assaulted by a fellow resident and lost almost all his belongings, which were either misplaced or stolen, Cook said. Von Ronne has since had two outdoor visits with relatives, and three short visits in family members’ homes at Christmas and in January and February.

Mary Daniel, 58, founded another activist group, Caregivers for Compromise, after getting a part-time job in July at her husband’s assisted living center in Jacksonville, Florida — the only way she could see him. Steve Daniel, 67, has early-onset Alzheimer’s, and she had visited every evening before the pandemic.

After stories about her went viral, Daniel created Facebook groups in every state for caregivers who wanted more access to their loved ones. Now, Caregivers for Compromise chapters in Connecticut, Florida, Illinois, Kentucky, North Carolina, New York, Pennsylvania, Tennessee, Texas and West Virginia are active in the Isolation Kills, Too campaign.

“We’re getting impatient: Our loved ones’ quality of life is deteriorating every single day. My husband has been vaccinated and he wants to go outside and feel the sunlight on his face. It’s time to open back up and let him live whatever time he has left with freedom,” Daniel said. “You cannot protect people like him forever, from everything.”

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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Accidentally Trashed, Thawed or Expired: Reports of Covid Vaccine Spoilage

Latest Updates From Kaiser Health News - Thu, 03/04/2021 - 5:00am

As the speed of covid vaccinations picks up, so do the reports of doses going to waste. And it’s more than just a handful at the end of the day because of a few appointment cancellations. Health officials are trying to rein in waste without slowing down vaccinations.

This story is from a partnership that includes NPRNashville Public Radio and KHN.  It can be republished for free.

The incidents range from 335 discarded doses in Lee County, North Carolina, that were damaged in shipping, to nearly 5,000 doses that went to waste in Tennessee in February, prompting additional federal oversight. 

“I definitely have been losing some sleep over this, for sure,” said Beth Ann Wilmore, nursing director at Mercy Community Healthcare in Franklin, Tennessee. She manages the covid vaccine inventory at the nonprofit clinic, which started receiving shipments a month ago.

Clinics like Mercy are accustomed to handling vaccines, but none so precious as those for covid, which have special refrigeration needs.

“I was definitely waking up in the middle of the night wondering how the temperatures were doing, and thinking, ‘OK, I hope it’s good, and it’s not giving me a flag or anything.’”

Many community health centers are receiving the Moderna vials, which are easier to handle than the Pfizer-BioNTech vaccine but still tricky. The vials last 30 days after they’re out of the deep freeze, compared with only about five for Pfizer. But once the seal on the vial is broken, there are just six hours to use the shots. 

So far, no waste has occurred at Mercy. But Wilmore has heard horror stories from around the state. 

In neighboring Murfreesboro, Tennessee, the local school district received a thousand doses for a teacher vaccination event the last weekend of February. But they were put in an unapproved freezer. The temperature sensor on the shipment flashed an error code. Out of caution, they were advised to throw them all away.

“It hurts my heart,” said Dr. Lisa Piercey, health commissioner of Tennessee, which has disclosed one of the country’s biggest spikes in reported spoilage. 

She said the losses are painful because the shots are “priceless” in the midst of this deadly pandemic. But it’s one risk of having so many places to get the vaccine. 

To increase access and equity, there are now more than 700 vaccination sites across Tennessee, with more planned to open as vaccine shipments grow in the coming weeks.

“It definitely raises the level of concern when you have more partners — particularly partners that are not under your direct control,” she said.

Even Tennessee’s large, urban health departments — which operate independently of the state health department — are running into trouble. 

In Knoxville, a thousand doses were thrown out, apparently confused for a related shipment of dry ice. In Memphis, the county health director has resigned after being slow to disclose that nearly 2,500 doses were allowed to expire on several occasions — related to winter weather as well as poor management in the county’s pharmacy. 

The state has called in staff from the Centers for Disease Control and Prevention to monitor vaccine distribution in Shelby County and stepped up audits for all local health departments in the state.

There are so many opportunities for doses to go bad. In West Palm Beach, Florida, the power on a mobile refrigerator was turned off. In Connecticut, a fridge door didn’t close properly, though the doses were salvaged in time in consultation with Moderna.

Health officials have gone to great lengths to avoid wasting doses, like an impromptu mass vaccination event in Nashville’s homeless shelters after winter storms canceled hundreds of appointments. 

Dr. Kelly Moore, deputy director of the Immunization Action Coalition, said a little spoilage is expected. It’s still well less than 1% of doses, even in states like Tennessee and Florida that have disclosed big losses. 

“I would be more worried if I saw reports of zero doses wasted,” Moore said, because then her concern would be a lack of transparency.

“You want to see some waste because that means people are paying attention and that real-world accidents happen and that they’re being responded to properly,” she said. “You just don’t want to see negligence.”

There’s hope that mishaps will be easier to avoid with the newly authorized Johnson & Johnson vaccine. Aside from being a single dose, it can last in a normal refrigerator for months. 

This story was produced in partnership with Nashville Public Radio, NPR 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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Coronavirus Deranges the Immune System in Complex and Deadly Ways

Latest Updates From Kaiser Health News - Thu, 03/04/2021 - 5:00am

This story also ran on USA Today. It can be republished for free.

There’s a reason soldiers go through basic training before heading into combat: Without careful instruction, green recruits armed with powerful weapons could be as dangerous to one another as to the enemy.

The immune system works much the same way. Immune cells, which protect the body from infections, need to be “educated” to recognize bad guys — and to hold their fire around civilians.

In some covid patients, this education may be cut short. Scientists say unprepared immune cells appear to be responding to the coronavirus with a devastating release of chemicals, inflicting damage that may endure long after the threat has been eliminated.

“If you have a brand-new virus and the virus is winning, the immune system may go into an ‘all hands on deck’ response,” said Dr. Nina Luning Prak, co-author of a January study on covid and the immune system. “Things that are normally kept in close check are relaxed. The body may say, ‘Who cares? Give me all you’ve got.’”

While all viruses find ways to evade the body’s defenses, a growing field of research suggests that the coronavirus unhinges the immune system more profoundly than previously realized.

Some covid survivors have developed serious autoimmune diseases, which occur when an overactive immune system attacks the patient, rather than the virus. Doctors in Italy first noticed a pattern in March 2020, when several covid patients developed Guillain-Barré syndrome, in which the immune systems attacks nerves throughout the body, causing muscle weakness or paralysis. As the pandemic has surged around the world, doctors have diagnosed patients with rare, immune-related bleeding disorders. Other patients have developed the opposite problem, suffering blood clots that can lead to stroke.

All these conditions can be triggered by “autoantibodies” — rogue antibodies that target the patient’s own proteins and cells.

In a report published in October, researchers even labeled the coronavirus “the autoimmune virus.”

“Covid is deranging the immune system,” said John Wherry, director of the Penn Medicine Immune Health Institute and another co-author of the January study. “Some patients, from their very first visit, seem to have an immune system in hyperdrive.”

Although doctors are researching ways to overcome immune disorders in covid patients, new treatments will take time to develop. Scientists are still trying to understand why some immune cells become hyperactive — and why some refuse to stand down when the battle is over.

Key immune players called “helper T cells” typically help antibodies mature. If the body is invaded by a pathogen, however, these T cells can switch jobs to hunt down viruses, acting more like “killer T cells,” which destroy infected cells. When an infection is over, helper T cells usually go back to their old jobs.

In some people with severe covid, however, helper T cells don’t stand down when the infection is over, said James Heath, a professor and president of Seattle’s Institute for Systems Biology.

About 10% to 15% of hospitalized covid patients Heath studied had high levels of these cells even after clearing the infection. By comparison, Heath found lingering helper T cells in fewer than 5% of covid patients with less serious infections.

In affected patients, helper T cells were still looking for the enemy long after it had been eliminated. Heath is now studying whether these overzealous T cells might inflict damage that leads to chronic illness or symptoms of autoimmune disease.

“These T cells are still there months later and they’re aggressive,” Heath said. “They’re on the hunt.”

Friendly Fire

Covid appears to confuse multiple parts of the immune system.

In some patients, covid triggers autoantibodies that target the immune system itself, leaving patients without a key defense against the coronavirus.

In October, a study published in Science led by Rockefeller University’s Jean-Laurent Casanova showed that about 10% of covid patients become severely ill because they have antibodies against an immune system protein called interferon.

Disabling interferon is like knocking down a castle’s gate. Without these essential proteins, invading viruses can overwhelm the body and multiply wildly.

New research shows that the coronavirus may activate preexisting autoantibodies, as well as prompt the body to make new ones.

In the January study, half of the hospitalized covid patients had autoantibodies, compared with fewer than 15% of healthy people. While some of the autoantibodies were present before patients were infected with SARS-CoV-2, others developed over the course of the illness.

Other research has produced similar findings. In a study out in December, researchers found that hospitalized covid patients harbored a diverse array of autoantibodies.

While some patients studied had antibodies against virus-fighting interferons, others had antibodies that targeted the brain, thyroid, blood vessels, central nervous system, platelets, kidneys, heart and liver, said Dr. Aaron Ring, assistant professor of immunology at Yale School of Medicine and lead author of the December study, published online without peer review. Some patients had antibodies associated with lupus, a chronic autoimmune disorder that can cause pain and inflammation in any part of the body.

In his study, Ring and his colleagues found autoantibodies against proteins that help coordinate the immune system response. “These are the air traffic controllers,” Ring said. If these proteins are disrupted, “your immune system doesn’t work properly.”

Covid patients rife with autoantibodies tended to have the severest disease, said Ring, who said he was surprised at the level of autoantibodies in some patients. “They were comparable or even worse than lupus,” Ring said.

Although the studies are intriguing, they don’t prove that autoantibodies made people sicker, said Dr. Angela Rasmussen, a virologist affiliated with Georgetown’s Center for Global Health Science and Security. It’s possible that the autoantibodies are simply markers of serious disease.

“It’s not clear that this is linked to disease severity,” Rasmussen said.

The studies’ authors acknowledge they have many unanswered questions.

“We don’t yet know what these autoantibodies do and we don’t know if [patients] will go on to develop autoimmune disease,” said Dr. PJ Utz, a professor of immunology and rheumatology at Stanford University School of Medicine and a co-author of Luning Prak’s paper.

But recent discoveries about autoantibodies have excited the scientific community, who now wonder if rogue antibodies could explain patients’ differing responses to many other viruses. Scientists also want to know precisely how the coronavirus turns the body against itself — and how long autoantibodies remain in the blood.

‘An Unfortunate Legacy’

Scientists working round-the-clock are already beginning to unravel these mysteries.

A study published online in January, for example, found rogue antibodies in patients’ blood up to seven months after infection.

Ring said researchers would like to know if lingering autoantibodies contribute to the symptoms of “long covid,” which afflicts one-third of covid survivors up to nine months after infection, according to a new study in JAMA Network Open.

“Long haulers” suffer from a wide range of symptoms, including debilitating fatigue, shortness of breath, cough, chest pain and joint pain, according to the Centers for Disease Control and Prevention. Other patients experience depression, muscle pain, headaches, intermittent fevers, heart palpitations and problems with concentration and memory, known as brain fog.

Less commonly, some patients develop an inflammation of the heart muscle, abnormalities in their lung function, kidney issues, rashes, hair loss, smell and taste problems, sleep issues and anxiety.

The National Institutes of Health has announced a four-year initiative to better understand long covid, using $1.15 billion allocated by Congress.

Ring said he’d like to study patients over time to see if specific symptoms might be explained by lingering autoantibodies.

“We need to look at the same patients a half-year later and see which antibodies they do or don’t have,” he said. If autoantibodies are to blame for long covid, they could “represent an unfortunate legacy after the virus is gone.”

Widening the Investigation

Scientists say the coronavirus could undermine the immune system in several ways.

For example, it’s possible that immune cells become confused because some viral proteins resemble proteins found on human cells, Luning Prak said. It’s also possible that the coronavirus lurks in the body at very low levels even after patients recover from their initial infection.

“We’re still at the very beginning stages of this,” said Luning Prak, director of Penn Medicine’s Human Immunology Core Facility.

Dr. Shiv Pillai, a Harvard Medical School professor, notes that autoantibodies aren’t uncommon. Many healthy people walk around with dormant autoantibodies that never cause harm.

For reasons scientists don’t completely understand, viral infections appear able to tip the scales, triggering autoantibodies to attack, said Dr. Judith James, vice president of clinical affairs at the Oklahoma Medical Research Foundation and a co-author of Luning Prak’s study.

For example, the Epstein-Barr virus, best known for causing mononucleosis, has been linked to lupus and other autoimmune diseases. The bacteria that cause strep throat can lead to rheumatic fever, an inflammatory disease that can cause permanent heart damage. Doctors also know that influenza can trigger an autoimmune blood-clotting disorder, called thrombocytopenia.

Researchers are now investigating whether autoantibodies are involved in other illnesses — a possibility scientists rarely considered in the past.

Doctors have long wondered, for example, why a small number of people — mostly older adults — develop serious, even life-threatening reactions to the yellow fever vaccine. Three or four out of every 1 million people who receive this vaccine — made with a live, weakened virus — develop yellow fever because their immune systems don’t respond as expected, and the weakened virus multiplies and causes disease.

In a new paper in the Journal of Experimental Medicine, Rockefeller University’s Casanova has found that autoantibodies to interferon are once again to blame.

Casanova led a team that found three of the eight patients studied who experienced a dangerous vaccine reaction had autoantibodies that disabled interferon. Two other patients in the study had genes that disabled interferon.

“If you have these autoantibodies and you are vaccinated against yellow fever, you may end up in the ICU,” Casanova said.

Casanova’s lab is now investigating whether autoantibodies cause critical illness from influenza or herpes simplex virus, which can cause a rare brain inflammation called encephalitis.

Calming the Autoimmune Storm

Researchers are looking for ways to treat patients who have interferon deficiencies — a group at risk for severe covid complications.

In a small study published in February in the Lancet Respiratory Medicine, doctors tested an injectable type of interferon — called peginterferon-lambda — in patients with early covid infections.

People randomly assigned to receive an interferon injection were four times more likely to have cleared their infections within seven days than the placebo group. The treatment, which used a type of interferon not targeted by the autoantibodies Casanova discovered, had the most dramatic benefits in patients with the highest viral loads.

Lowering the amount of virus in a patient may help them avoid becoming seriously ill, said Dr. Jordan Feld, lead author of the 60-person study and research director at the Toronto Centre for Liver Disease in Canada. In his study, four of the placebo patients went to the emergency room because of breathing issues, compared with only one who received interferon.

“If we can bring the viral levels down quickly, they might be less infectious,” Feld said.

Feld, a liver specialist, notes that doctors have long studied this type of interferon to treat other viral infections, such as hepatitis. This type of interferon causes fewer side effects than other varieties. In the trial, those treated with interferon had similar side effects to those who received a placebo.

Doctors could potentially treat patients with a single injection with a small needle — like those used to administer insulin — in outpatient clinics, Feld said. That would make treatment much easier to administer than other therapies for covid, which require patients to receive lengthy infusions in specialized settings.

Many questions remain. Dr. Nathan Peiffer-Smadja, a researcher at the Imperial College London, said it’s unclear whether this type of interferon does improve symptoms.

Similar studies have failed to show any benefit to treating patients with interferon, and Feld acknowledged that his results need to be confirmed in a larger study. Ideally, Feld said, he would like to test interferon in older patients to see whether it can reduce hospitalizations.

“We’d like to look at long haulers, to see if clearing the virus quickly could lead to less immune dysregulation,” Feld said. “People have said to me, ‘Do we really need new treatments now that vaccines are rolling out?’ Unfortunately, we do.”

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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