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4 Things to Know About the J&J Covid Vaccine Pause

3 hours 10 min ago

Four months into the largest U.S. vaccine rollout in decades, it’s become clear that the messaging surrounding covid-19 vaccination efforts is as important as the science behind them.

That was true when the first covid vaccines were introduced in December at hospitals and nursing homes and even more so after the federal government on Tuesday paused the Johnson & Johnson vaccine after reports of extremely rare but very serious — in one case, fatal — side effects emerged.

Most health experts largely applauded the government for its decision, saying it showed regulators making vaccine safety their top priority. They said regulators need to strike a balance between addressing small but serious risks while encouraging millions to get inoculated to quickly end the pandemic.

“The pause is a good decision and shows the public health system is working,” said Noel Brewer, a professor in the health behavior department at the University of North Carolina-Chapel Hill.

1. What exactly happened with the J&J single shot anyway?

The Centers for Disease Control and Prevention and the Food and Drug Administration recommended Tuesday that health providers and states temporarily stop the use of J&J’s covid vaccine after reports emerged that six women in the U.S. who got the single-shot preventive developed a rare but serious blood clot. One of the women died and another is in critical condition.

All six cases occurred among women between the ages of 18 and 48, and symptoms occurred six to 13 days after vaccination, FDA and CDC officials said.

It’s the latest in a series of messaging challenges.

This pause comes less than a week after three vaccine clinics in Georgia, North Carolina and Colorado temporarily stopped using the vaccine when several people fainted or became dizzy immediately following their shots. Fainting is a known risk from all vaccines, affecting about 1 in 1,000 people, health experts say. In response to these cases, some health experts questioned whether even the short-term halt was necessary.

In addition, federal regulators are concerned that the blood clotting seen with the J&J vaccine is the same type as seen globally with AstraZeneca’s vaccine. The AstraZeneca vaccine isn’t in use in the United States but has been authorized in more than 70 countries. The European Medicines Agency recently concluded that unusual blood clots with low blood platelets should be listed as “very rare side effects” on the AstraZeneca vaccine label. While advising the public to look out for signs of clots, the European regulators said the benefits of the shot were still worth the risk.

It also comes on the heels of questions faced by J&J regarding its rollout after a Baltimore subcontractor who was making its vaccine accidentally spoiled 15 million doses earlier in April. The problems at the facility were contributing to a drop in J&J doses this month.

2. But what does all this mean in terms of my risk?

More than 560,000 Americans have died of covid in the past year — or 1 in 586 people. An individual’s risk of dying of or being hospitalized with covid is far higher than the risk of getting a rare blood clot from the J&J vaccine.

Meanwhile, the risk of getting a blood clot is also far higher if you have covid.

To put the less-than-1-in-a-million risk of getting a severe blood clot from the J&J vaccine in perspective, people face a 1-in-500,000 chance each year of being struck by lightning.

“It’s important to keep these numbers in context,” Jonathan Watanabe, a pharmacist and an associate dean in the College of Health and Sciences at the University of California-Irvine, said of the rare blood clots. “While frightening, it’s a rare event.” The risk of blood clots associated with covid infection is actually greater, he added.

The pause, which FDA officials said they expect will be a few days, will give regulators time to alert doctors to the added risk and show them how to recognize and treat the clots and make reports to the government.

The CDC will convene a meeting of the Advisory Committee on Immunization Practices today to further review these cases and assess their potential significance. The committee could recommend adding the blood clot risk to the list of warnings about the vaccine or could recommend that certain populations avoid the vaccine.

3. Why is messaging important?

How the concerns about risk are communicated could have a lasting impact on whether some people go ahead and get vaccinated.

“The messaging is very important because science alone does not get us to the outcomes we need,” said Zoë McLaren, associate professor in the School of Public Policy at the University of Maryland-Baltimore County.

McLaren said the FDA is known for being risk averse and that’s how it developed its reputation for protecting Americans’ food and drug supply. “Part of messaging is communicating to the public what the FDA is doing,” said McLaren, who was inoculated with the J&J vaccine.

J&J’s is one of three covid vaccines that have been cleared for use under an emergency authorization in the U.S. Unlike the Pfizer and Moderna vaccines, which require two doses, the J&J version requires only one shot.

According to the CDC’s vaccine tracker, nearly half of U.S. adults have been at least partially vaccinated, and the numbers have been soaring in recent weeks to an average topping 3 million doses a day.

Of the more than 190 million doses of covid vaccine administered in the U.S., about 7 million were J&J.

Nonetheless, the number of new covid infections is still rising in many states and there are concerns from CDC Director Rochelle Walensky and others about another surge as a result — in part — of people hesitating to get vaccinated.

On the bright side, though, the blood clot issue comes months after the vaccination rollout began and as Moderna and Pfizer have committed to having enough doses to vaccinate most Americans.

4. How does this play into vaccine hesitancy? Does transparency help or hurt?

The latest surveys show 13% of adults say they won’t get a covid vaccine and 15% will get one only if required by their employer or to travel.

Experts are torn on whether the J&J pause will increase hesitancy among some people or give them more confidence in how federal regulators are overseeing the vaccination effort.

Dr. Amesh Adulja, a senior scholar at the Johns Hopkins Center for Health Security, said he worries the pause will have a lasting effect. “We have a lot of vaccine hesitancy that exists, and that is only going to be magnified.”

But to Dr. Kartik Cherabuddi, an infectious-disease specialist at the University of Florida health system, this is one hurdle in the long vaccination game. He predicts the overall effect from the pause will be minimal within a few weeks as regulators and health providers put the vaccine risks in perspective for the public. He said Americans are used to being told about the health risks of drugs, as they are bombarded with television drug advertising.

Meanwhile, UC-Irvine’s Watanabe said he hopes the pause will lead to more discussions with hesitant Americans about how they have several vaccine options. Watanabe said it was wise of the FDA to show “an abundance of caution” by pausing use of the J&J vaccine now, particularly because there are two other vaccine options for Americans that can more than fill the gap.

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 Year Into Pandemic, Federal Officials Design New Mask Guidelines to Better Protect More Workers

4 hours 40 min ago

Federal officials announced new measures to help get fresh, new N95 masks to health care workers and expand their use in other industries after scientists argued that the highly protective masks are essential to keep workers safe from covid-19.

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The changes come as U.S. mask-makers say the demand from hospitals is so sluggish that they’ve laid off 2,000 workers and fear some new protective gear companies could collapse. Yet in a letter to lawmakers, hospitals cite ongoing concerns about scarce supplies, saying limits on which workers should get N95s must stay in place.

Among the new moves: The Food and Drug Administration plans to eventually revoke its approval of the widespread crisis-era practice of decontaminating N95 respirators and returning them to front-line workers to use again.

A Centers for Disease Control and Prevention official also announced a tweak to its guidelines, which used to say the protective N95 respirators were reserved for health workers. Now they are “prioritized” for those workers but will be OK for bulk sales to other employers — a step that should boost overall demand.

A group of prominent scientists had written to the White House in February, saying a broader swath of U.S. workers need more protection from the airborne virus. And on March 1, U.S. mask-makers wrote to President Joe Biden decrying a glut of nearly 300 million N95 or equivalent respirators that were made in this country and sitting unused in warehouses.

KHN also reported that in January federal officials approved the export of U.S. N95s amid mounting unsold inventory, a move a nurses union leader called “unconscionable.”

Lloyd Armbrust, president of the American Mask Manufacturers Association, took a career U-turn to launch Armbrust American and start making masks near Austin, Texas, last year, troubled by “cheap, flimsy” personal protective equipment coming in from overseas: “We … decided to take matters into our own hands.” He said that he was gratified to see federal officials respond to U.S. mask-makers’ concerns and that he expects to see sales rise in coming months.

But he said it’s been a shock for the upstart industry to try and fail over many months to break into the U.S. health care market — dominated by large group purchasing organizations — where the preference to buy from China is ingrained.

“Who knows how many health care workers are getting infected, maybe dying, because of a logistics problem that doesn’t exist,” he said. “That was very frustrating. As a human, that was hard for me to understand.”

Armbrust said about 50 U.S. mask-makers the association represents reported in a survey that they’ve collectively laid off about 2,000 workers in recent months amid sluggish demand. They expect some companies to fail.

Mike Bowen, vice president of Prestige Ameritech, another Texas-based N95 maker, said he has reduced production because he has 11 million masks on hand. “I am waiting to see if [the] FDA announcement will make hospitals buy more N95s,” he said by email. “If they do, we’ll make what they need. We have a lot of N95 manufacturing capacity.”

Yet even through last month, the American Hospital Association cited supply chain concerns in a letter to lawmakers and endorsed existing CDC guidelines that allow health workers to use a surgical mask unless performing an aerosol-generating procedure. (Although some experts now say a cough produces more aerosols than such procedures.)

Another change by the CDC would allow major retailers like Amazon to sell N95s in bulk to businesses outside the health care sector, said Maryann D’Alessandro, director of the CDC’s National Institute for Occupational Safety and Health lab for personal protective technology.

Researchers and journalists have noted elevated workplace risk to bus drivers, meatpacking employees, and those in manufacturing and food processing who labor in crowded conditions.

D’Alessandro said the agency also approved several models of durable “elastomeric” respirators that are meant to be reused, including one by 3M, and signed a contract to add 375,000 to the Strategic National Stockpile.

That move might serve to protect more health care workers in the case of a variant surge or new pandemic. Health care workers were two to five times more likely than the average person to get covid, studies have shown.

KHN and The Guardian counted more than 3,600 health care workers who died over the past 12 months, many of them people of color and most working outside of hospitals. In interviews with families and colleagues, dozens raised concerns about inadequate protective gear.

Throughout the pandemic, workers who used N95 respirators were routinely asked to put them in a brown paper sack so they could be disinfected by gas, UV light or other means and then returned to them to wear again. Nurses have complained that the respirators, which are designed to be used once, come back misshapen or with a chemical odor.

The FDA on Friday sent a letter to health care providers urging them to “transition away from crisis capacity conservation strategies,” including the disinfection and reuse of disposable N95s.

The letter is one step toward revoking the “emergency use authorizations” that allowed companies to disinfect and reuse N95s, said Suzanne Schwartz, director of the FDA’s Office of Strategic Partnerships and Technology Innovation.

“That was never intended to be anything other than a crisis measure,” Schwartz said in an interview. “We want to be sure health care facilities are getting themselves in a situation where they have respirators or reusables in stock.”

Surveys by National Nurses United from November and February show that about 80% of nurses reported using reprocessed respirators.

The changes are “tiny steps” in the right direction but fall short of what’s needed to fully protect nurses, said Jane Thomason, lead industrial hygienist for National Nurses United.

She said about half of more than 9,000 nurses surveyed report working in hospitals where patients are not universally screened for covid, presenting the potential for pre- or asymptomatic patients to infect staffers.

The CDC guidance updated in February advising health workers to use N95s or well-fitted masks to care for covid patients remains nonbinding, she said, allowing employers to outfit nurses and other health workers in surgical masks instead of more protective N95s.

The practice has been controversial even after the initial supply chain collapse. Doctors on Twitter reacted strongly to a recent debate held by the University of Calgary where two academics pointed to evidence that covid is airborne — meriting N95 protection for front-line health workers. 

Another doctor argued that the coronavirus is primarily spread by droplets — a position held by many U.S. hospital leaders

Nurses called early in the pandemic for a high level of protection against an airborne virus, but in many places have had to stage protests to get it or go without.

Since last summer, mounting evidence has shown that health care workers in surgical masks were more likely than those in respirators to catch the coronavirus. Harvard researchers and those in Israel pinpointed specific instances when a patient or visitor in a surgical mask infected health care workers who also wore a surgical mask. 

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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Analysis: I Was a Teenage Rifle Owner, Then an ER Doctor. Assault Weapons Shouldn’t Count as ‘Guns.’

4 hours 40 min ago

Many who know me might be shocked by this: I shot my first pistol when I was 8 or 9, taught by my father, a physician, aiming at targets in our basement. At summer camp, I loved riflery the way some kids loved art. Staring through the sight, down the barrel, I proved an excellent shot, gathering ever more advanced medals from the National Rifle Association. As a reward, for my 13th birthday, my uncle gave me a .22 Remington rifle.

This story also ran on The Washington Post. It can be republished for free.

I did not grow up on a farm or in a dangerous place where we needed protection. I grew up in the well-off, leafy suburb of Scarsdale, N.Y.

When I entered high school in the 1970s, I joined the riflery team and often slung my cased gun over my shoulder on my mile-long walk to school for practice. It didn’t seem dissonant that, on other mornings, I went to the train station to join protests against the Vietnam War.

Since then, the United States has undergone a cultural, definitional, practical shift on guns and what they are for.

Once mostly associated in the public mind with sport, guns in the United States are now widely regarded more as weapons to maim or kill — or to protect from the same. Guns used to be on a continuum with bows and arrows; now they seem better lumped in with grenades, mortars and bombs.

In the 1990s, by which time I was an emergency room doctor at a Level 1 trauma center in New York City, I became acquainted with the damage that small-caliber handguns could cause. When I started treating gunshot victims, I marveled at how subtle and clean the wounds often were, externally at least. Much cleaner than stabbings or car wreck injuries.

We searched for a tiny entrance wound and the larger exit wound; they were often subtle and hard to locate. If you couldn’t find the latter, you would often see the tiny metal bullet, or fragments, lodged somewhere internally on an X-ray — often not worth retrieving because it was doing no damage.

These were people shot in muggings or in drug deals gone wrong. Most of these patients had exploratory surgery, but so long as the bullet had not hit a vital organ or major vessel, people survived.

No one was blown apart.

An assault-style weapon was allegedly used last month to kill 10 people in a Boulder, Colo., supermarket, just as one has been used in more than a dozen mass-casualty shootings, leaving four or more people dead, since 2017.

Guns and the devastating injuries they cause have evolved into things I don’t recognize anymore. My Remington .22 has about as much in common with an assault-style weapon as an amoeba has with a human life. The injuries they produce don’t belong under one umbrella of “gun violence.” Though both crimes are heinous, the guy who shoots someone with an old pistol in a mugging is a different kind of perpetrator from the person who, dressed in body armor, carries a semiautomatic weapon into a theater, house of worship or school and commences a slaughter.

Certainly many American gun owners — maybe a majority of them — are still interested in skill and the ability to hit the bull’s-eye of a target (or a duck or deer, if you’re of the hunting persuasion). But the adrenaline in today’s gun culture clearly lies in paramilitary posturing, signaling to the world the ability to bring mayhem and destruction. Add a twisted mind with the urge to actually bring mayhem and destruction, and tragedy awaits.

Before Congress passed an assault weapons ban in 1994, Americans owned about 400,000 AR-15s, the most popular of these military-style weapons. Today, 17 years after Congress failed to reauthorize the ban, Americans own about 20 million AR-15-style rifles or similar weapons.

Why this change in the nature of gun ownership? Was it because 9/11 made the world a much scarier place? Was it NRA scaremongering about the Second Amendment? The advent of violent video games?

Now, not just emergency rooms but also schools and offices stage active-shooter drills. When I was an ER doctor, we, too, practiced disaster drills. A bunch of surrogate patients would be wheeled in, daubed with fake blood. Those drills seem naive in 2021 — we never envisioned the kinds of mass-shooting disasters that have now become commonplace.

And, frankly, no disaster drill really prepares an emergency room for a situation in which multiple people are shot with today’s semiautomatic weapons. You might save a few people with careful triage and preparation. Most just die.

I gave up riflery as a teenager when other options — boys, movies, travel — came along. Maybe I’ll take it up again someday, if assault-style weaponry is banned and the word “gun” again brings to mind sport and not a spinoff of war.

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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Syphilis Cases in California Drive a Record-Setting Year for STDs Nationwide

Tue, 04/13/2021 - 6:07pm

In certain circles of San Francisco, a case of syphilis can be as common and casual as the flu, to the point where Billy Lemon can’t even remember how many times he’s had it.

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“Three or four? Five times in my life?” he struggles to recall. “It does not seem like a big deal.”

At the time, about a decade ago, Lemon went on frequent methamphetamine binges, kicking his libido into overdrive and silencing the voice in his head that said condoms would be a wise choice at a raging sex party.

“It lowers your inhibitions, and also your decision-making abilities are skewed,” said Lemon, who is 50.

He’s sober now and runs the Castro Country Club in San Francisco — which is not a resort, but a place where gay men come to get help with addiction, especially meth. Lemon said syphilis comes with the territory.

“In the 12-step community, if meth was your thing, everybody had syphilis,” he said.

In 2000, syphilis rates were so low that public health officials believed eradication was on the horizon. But the rates started creeping up in 2001. From 2015 to 2019 alone, cases rose 74%. There were nearly 130,000 cases nationwide in 2019, according to data released Tuesday by the Centers for Disease Control and Prevention.

In California and the U.S., about half of syphilis cases are in men who have sex with men. More than a third of women in the West who have syphilis also use meth, which has surged in recent years. These are just some of the trends causing overall national cases of sexually transmitted diseases to hit an all-time high for the last six years in a row, reaching 2.5 million. And the consequences are now trickling down to babies, who are contracting syphilis from their mothers: Congenital syphilis rates nearly quadrupled between 2012 and 2019.

This was all before the coronavirus pandemic took hold in the U.S., and with contact tracers and testing supplies diverted from STDs to covid-19, the CDC is predicting 2020 numbers will be no better.

“We are quite worried about this and have seen this trend over time,” said Dr. Erica Pan, California’s state epidemiologist. “Unfortunately, with years of not having enough funding and infrastructure in public health, and then in this past year, of course, both at the local and state level, a lot of personnel who had been focusing on STDs and syphilis follow-up have really been redirected to the pandemic.”

There’s No Single Cause

Many factors have contributed to the rise of STDs, and syphilis in particular.

In San Francisco’s gay community, for example, the rise of mobile dating apps like Grindr and Tinder made finding a date “faster than getting pizza delivered to your home,” said Dan Wohlfeiler, an STD prevention specialist and co-founder of Building Healthy Online Communities, which uses these apps to improve gay men’s health.

When the dating apps first came on the scene around 2009, they made it harder for disease investigators to track the spread of STDs and notify people who may have been infected, because men don’t always know the names of the men they hook up with.

“They sometimes only know their online handle,” said Dr. Ina Park, associate professor at the medical school of the University of California-San Francisco and author of “Strange Bedfellows,” about the history of STDs. “And if the sex didn’t go well, then sometimes they will block the person from their app and they don’t even know how to reach that person again.”

Online dating began back in the late 1990s, around the same time effective medications to prevent the transmission of HIV became available: first, antiretrovirals that suppress the virus in those who are HIV-positive, and then later, in 2012, pre-exposure prophylaxis, or PrEP, which prevents new infections in people who are HIV-negative but considered at risk for contracting the virus.

With the risk of contracting a deadly disease falling to almost zero, condoms fell even more out of favor than they already were, said Park.

“If one man is taking PrEP and the other one is virally suppressed, there’s no HIV risk at all,” she said. “So why use condoms if you don’t mind having a touch of syphilis?”

Diagnosing Syphilis Is Tricky

While syphilis is not benign – it can cause blindness, deafness or brain damage — it is easy to treat. Typically, a shot of penicillin in the butt will cure it.

But diagnosing syphilis can be tricky, said Park, who treats patients with STDs at the San Francisco City Clinic. She often finds herself crouched low in the exam room, “lifting up their scrotum and lifting up their penis,” craning her head to get a look from all angles.

She does these gymnastics to find rashes associated with syphilis. Some are obvious, others subtle. She said doctors in regular family medicine clinics often aren’t trained on where to look, or when.

“The patient came in saying, ‘I’m tired,’” Park said, referring to a common symptom of syphilis. “How many people are going to say, ‘Take off your pants and lift up your scrotum. I want to look’? We only do that at the STD clinic because that’s what we do.”

But specialized public STD clinics, like the one where Park works, have been shutting down nationwide. One reason is persistent underfunding of public health programs, a trend laid bare during the pandemic. Another reason is the Affordable Care Act. In a strange way, the 2010 law, intended to expand access to health care, actually contributed to the closure of STD clinics.

“Honestly, I think everyone thought they weren’t going to be necessary,” Dr. Karen Smith said in 2019, when she was the director of the California Department of Public Health. She said that, once Obamacare was in place, the thought was that STD testing would happen in primary care clinics.

“We sort of all assumed that if you’ve got health insurance and you’ve got access to a doctor, that’s all that you need,” she said. “It turns out that that’s not really all that you need.”

People still had affairs they didn’t want to talk about with their family doctor. And some family doctors didn’t want to probe into patients’ sex lives. Young people, in particular, prefer clinics geared to them, out of their parents’ purview.

“That loss of anonymous care really was a problem,” Smith said.

The Syphilis Epidemic Reaches Babies, Too

When Christian Faulkenberry-Miranda decided to become a pediatrician, she never thought she’d become an expert in syphilis.

In 2010, shortly after finishing her medical training and starting work at Community Regional Medical Center in Fresno, California, she began seeing babies with a rash on their tummies that looked like a blueberry muffin. She thought it was a common viral infection, until these babies tested positive for syphilis.

In those early days, Dr. Faulkenberry-Miranda saw perhaps a few instances of congenital syphilis each year. Now she sees two cases every week. It’s important to start the 10-day antibiotic treatment right away, to avoid complications, but she still follows her patients through their first year of life, and often through childhood, to watch for vision and hearing problems, developmental delays, attention deficits and learning disabilities, all of which can result from congenital syphilis infections. In 2019, 128 cases resulted in stillbirth or neonatal death.

“The disappointing thing is that syphilis is very treatable,” she said. “This is something that’s completely preventable, with proper screening and treatment of these moms during pregnancy.”

Congenital syphilis cases hit a troubling milestone in 2019, reaching a high of 1,870 cases, an increase of 279% in five years. That is higher than the number of mother-to-child HIV cases at their peak in 1991.

“How could this be happening? Testing is cheap and widely available. The same treatment we’ve been using since the ’40s still works,” said Park, who has also seen an increase in congenital syphilis cases in San Francisco. “And yet we have this completely out-of-control epidemic among the most vulnerable babies in our society.”

Many of the women who give birth to babies with syphilis have had no prenatal care. They often use drugs — mainly methamphetamine — and are often homeless, said Smith, the former California public health director. This makes them more likely to trade sex for housing, food or drugs. Drug use, in particular, makes women less likely to recognize they’re pregnant at all, and less likely to seek health care if they do.

“They’re very concerned about what’s going to happen when they’re found to be pregnant and using drugs,” said Smith. “They’re concerned that their drug use will be reported and then … their children will be taken away.”

The complications of these women’s lives also make disease investigation and contact tracing very challenging. Veteran contact tracer Romni Neiman remembers the difficulty she has had tracking down pregnant women in her career. Neiman works for the CDC, and before she was redirected to covid last year, she worked on preventing STDs, including congenital syphilis, in California.

She remembers looking for one woman in the late ’80s in Chicago. The pregnant woman used drugs and had been exposed to syphilis. Her housing was so unstable that Neiman went to three places before finding her. The woman had no car, so Neiman offered to drive her to the clinic to get tested. The woman had no safe place to leave her toddler, because a man in the place she was staying was abusive, so Neiman took care of the child while the woman saw the doctor.

“She was just trying to do the best that she can, and she was really afraid,” Neiman recalled. “Sometimes it’s really taxing and really sad. And you come home at the end of the day and you’re like, ‘Wow. Wow.’”

Challenges like those, combined with persistent underfunding for public health, are what led to the initial spike in congenital syphilis in Fresno County in the 2010s, said Park. Local contact tracers couldn’t keep up, and the state had to step in with reinforcements.

The state is taking new measures to address the rates, said Pan, the state epidemiologist, like requiring women to be screened for syphilis twice during pregnancy instead of once. And, rather than wait for women to come in for prenatal care, the state is doing more outreach and screening pregnant women in the emergency room and in prisons and jails.

Pan believes the covid pandemic has created an opportunity to invest in a nimbler response to emerging and reemerging public health issues like syphilis.

It’s been a really long, hard year responding to this pandemic, but people have really acknowledged and realized the impact of divesting in public health infrastructure,” she said. “I hope that a lot of the resources that we hope to bring to bear in the longer term after this pandemic will benefit STDs as well.”

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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Covid Spawns ‘Completely New Category’ of Organ Transplants

Tue, 04/13/2021 - 5:00am

In a year when covid-19 shattered the pleas of so many who prayed for miracles, a Georgia man with two new lungs is among the fortunate.

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Mark Buchanan, of Roopville, received a double-lung transplant in October, nearly three months after covid left him hospitalized and sedated, first on a ventilator and then on the last-resort treatment known as ECMO.

“They said that it had ruined my lungs,” said Buchanan, 53, who was a burly power company lineman when he fell ill. “The vent and the covid ruined ’em completely.”

At the time, only a handful of U.S. hospitals were willing to take a chance on organ transplants to treat the sickest covid patients. Too little was known about the risks of the virus and lasting damage it might cause, let alone whether such patients could survive the surgery. Buchanan was turned down at Emory University Hospital in Atlanta, according to his wife, Melissa, who said doctors advised her to withdraw treatment and allow him to die peacefully.

“They were telling me to end his life. I told them absolutely not,” recalled Melissa Buchanan, 49. “We all started Googling any place that would take someone who needed a lung transplant.”

It took calls to several hospitals, plus a favor from a hometown physician, before Buchanan was accepted at the University of Florida Health Shands Hospital, 350 miles away in Gainesville, Florida. He received his new lungs Oct. 28.

Nearly six months later, the transplant landscape has radically changed. Covid-related transplants are surging as hospitals grapple with a growing subset of patients whose organs — most often hearts and lungs — are “basically destroyed by the virus,” said Dr. Jonathan Orens, a lung transplant expert at Johns Hopkins University School of Medicine in Baltimore.

Nearly 60 transplants were performed through March 31 for patients with covid-related organ disease, according to figures released Monday by the United Network for Organ Sharing, which oversees transplants in the U.S. That includes at least 54 lung and four heart transplants recorded since new codes for covid-specific diagnoses were adopted in late October. One patient received a combination heart-lung transplant. Another 26 patients eligible for covid-related lung transplants and one eligible for a heart transplant remain on waiting lists, UNOS data show.

Nearly two dozen hospitals have performed the surgeries, with new sites added every month.

“You’re seeing it move around the country, and it’s moving around pretty quick,” said Dr. David Weill, former director of the Stanford University Medical Center’s lung and heart-lung transplant program who now works as a consultant. “It’s like wildfire, where centers are saying, ‘We did our first one, too.’”

The upsurge in transplants has been fueled largely by the broad reach of the virus. As U.S. covid cases top 31 million, with more than 560,000 deaths, thousands of patients who survived particularly serious infections are left with badly damaged organs that pose life-threatening complications.

“I think this is just the beginning,” said Dr. Tae Song, surgical director of the lung transplant program at the University of Chicago Medical Center. “I expect this to be a completely new category of transplant patients.”

Tens of thousands of patients whose organs were otherwise healthy have developed severe, chronic lung disease after contracting covid. Because it’s a novel disease, exactly how many will go on to need lung transplants isn’t yet clear, said Weill, who has called for the development of a lung transplant registry to track outcomes.

So far, the rise in covid-related transplants has not dramatically affected the existing waiting lists for organs. Of the more than 107,000 patients on waiting lists, about 3,500 need hearts and more than 1,000 need lungs. Most of the rest are waiting for kidney transplants, which have not been subject to a significant increase because of covid.

Organs for transplant are allocated according to complicated metrics, including how long the patients have been waiting, how ill they are, how likely they are to survive with a transplant and how close they are to donor hospitals. The goal is to treat the most medically urgent cases first. The rules don’t necessarily bump covid patients to the front of the line, experts said, but many become sick enough to require immediate care.

That was the case for Al Brown, a 31-year-old car salesman in the Chicago suburb of Riverdale, Illinois, who caught covid in May and was diagnosed with congestive heart failure several weeks later. In September, he woke up with severe chest pains that sent him to the emergency room.

“Shortly after, they told me my heart was working at only, like, 10%,” Brown said. “It wasn’t pumping blood through my whole body.”

Medications didn’t fix the problem, so doctors offered him several choices, including a mechanical pump to help his heart temporarily — or a transplant. “They told me, basically, I was young and I had a lot of life left in me,” said Brown, the father of two young daughters. “I actually picked the option of a heart transplant.”

Brown, who had hit the gym regularly, was an ideal candidate, said Dr. Sean Pinney, co-director of the heart and vascular center at University of Chicago Medicine. “This guy was healthy except for covid, except for heart failure.” Brown received his transplant in October and continues to recuperate.

Most covid-related transplants are performed on patients whose lungs have been irreversibly weakened by the disease. Thousands of covid survivors have developed ARDS, or acute respiratory distress syndrome, which allows fluid to leak into the lungs. Others develop pulmonary fibrosis, which occurs when lung tissue becomes scarred.

“What was once a scaffold of soft, living cells turns into a stiff mesh that’s not capable of exchanging gases,” said Song.

While conditions like pulmonary fibrosis typically develop over months or years, often in response to toxins or medications, covid patients seem to get much sicker, much faster. “Instead of months, it’s more on the order of weeks,” Song said.

These patients are often placed on mechanical ventilation and then ECMO, or extracorporeal membrane oxygenation, in which a machine takes over the functions of the heart and lungs. Many become stranded on the machines, so sick that their only options are transplantation or death.

Even then, not everyone is eligible for a transplant. In many covid patients, damage isn’t limited to a single organ. Others have preexisting conditions such as diabetes or obesity that can complicate recovery from surgery or preclude it entirely. And, often, those who have been sedated for weeks or months aren’t likely to survive the trauma of transplant.

Successful transplant candidates are likely patients younger than 65 who are otherwise healthy and whose lungs will not heal on their own, said Dr. Tiago Machuca, chief of thoracic surgery at UF Health Shands Hospital, who helped draft suggested guidance for covid-related lung transplants.

“This is a very different profile of patients,” said Machuca. “These patients had normal lung function. They’re young, and now they find themselves on mechanical ventilation or ECMO, fighting for their lives.”

Mark Buchanan landed in that situation last fall after his entire family caught covid. His children, Jake, 22, and Lauren, 18, had mild cases. His wife, Melissa, was quite ill, though never hospitalized, and quickly had to turn to helping her husband.

“I had to rely solely on God and my family and friends,” she said. “It’s hard to explain how stressful it was.”

Buchanan survived the transplant and then spent three months recovering at the Florida hospital. He lost more than 70 pounds and was weak. “I couldn’t brush my teeth or feed myself,” he said. “I had to learn to eat, swallow, talk, walk all over again.”

Buchanan arrived home in January to a parade of 400 neighbors and friends. He has begun speaking to church groups and others about his fight for a transplant. Many people in his small community remain skeptical about covid. Wearing a mask and keeping his distance, he tries to set them straight.

“People still make a joke of it,” he said. “But I was in the hospital 170 days. You tell me: Is it real or not?”

Buchanan was one of at least 17 patients to receive covid-related lung transplants at Shands in the past year, the most of any hospital in the country. Machuca credits its dedicated lung unit, which had already focused on patients with complex respiratory conditions.

It remains unclear whether widespread vaccination will stem the number of covid patients who require transplants — or whether transplant candidates among survivors will continue to rise. There’s no doubt, however, that the pandemic has changed the profile of those considered for lung transplantation, Machuca said.

“Before covid, transplanting patients with acute respiratory failure was a ‘no,’” he said. “I think this is expanding the limits of what we felt was possible.”

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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Orange County Hospital Seeks Divorce From Large Catholic Health System

Tue, 04/13/2021 - 5:00am

In early 2013, Hoag Memorial Hospital Presbyterian in Orange County, California, joined with St. Joseph Health, a local Catholic hospital chain, amid enthusiastic promises that their affiliation would broaden access to care and improve the health of residents across the community.

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Eight years later, Hoag says this vision of achieving “population health” is dead, and it wants out. It is embroiled in a legal battle for independence from Providence, a Catholic health system with 51 hospitals across seven states, which absorbed St. Joseph in 2016, bringing Hoag along with it.

In a lawsuit filed in Orange County Superior Court last May, Hoag argues that remaining a “captive affiliate” of the nation’s 10th-largest health system, headquartered nearly 1,200 miles away in Washington state, constrains its ability to meet the needs of the local population.

Hoag doctors say that Providence’s drive to standardize treatment decisions across its chain — largely through a shared Epic electronic records system — often conflicts with their own judgment of best medical practices. And they recoil against restrictions on reproductive care they say Providence illegally imposes on them through its adherence to the Catholic health directives established by the United States Conference of Catholic Bishops.

“Their large widespread system is very different than the laser focus Hoag has on taking care of its community,” said Hoag CEO Robert Braithwaite. “When Hoag needed speed and agility, we got inadequate responses or policies that were just wrong for us. We found ourselves frustrated with a big health system that had a generic approach to health care.”

Providence insists it wants to stay with Hoag, a financial powerhouse — even as the two sides engage in secret settlement talks that could end the marriage.

“We believe we are better together,” said Erik Wexler, president of Providence South, which includes the group’s operations in California, Texas and New Mexico. “The best way to do that is to collaborate.” He cited joint investments in Hoag Orthopedic Institute and in Be Well OC, a kind of mental health collaborative, as fruits of the affiliation.

“If we are separate,” Wexler added, “there is a chance we may begin to cannibalize each other and drive the cost of care up.”

Research over the past several years, however, has shown that it is the consolidation of hospitals into fewer and larger groups, with greater bargaining clout, that tends to raise medical prices — often with little improvement in the quality of care.

“Mergers are a self-centered pursuit of stability by hospitals and hospital systems that hope to get so big that they can survive the anarchy of U.S. health care,” said Alan Sager, a professor at Boston University’s School of Public Health.

Wexler argued that price increases linked to consolidation are less of a worry in Orange County, geographically small but densely populated with 3.2 million residents and 28 acute care hospitals. Given the proximity of so many hospitals, Wexler said, counterproductive duplication of medical services is more of a concern.

Unlike many local community hospitals that seek larger partners to survive, Hoag, one of Orange County’s premier medical institutions, is financially robust and perfectly able to stand on its own. It has the advantage of operating in one of Orange County’s most affluent areas, with two acute care hospitals and an orthopedic specialty hospital in Newport Beach and Irvine. It is the beneficiary of numerous wealthy donors, including bond market billionaire Bill Gross and thriller novelist Dean Koontz.

In 2020, Hoag’s net assets, essentially its net worth, stood at about $3.3 billion — nearly 20% of the total for all Providence-affiliated facilities, even though Hoag has only three of the group’s 51 hospitals. Hoag generated operating income of $38 million last year, while Providence posted a $306 million operating loss.

But Providence is hardly a financial weakling. It is sitting on a mountain of unrestricted cash and investments worth $15.3 billion as of Dec. 31. And despite its hefty reserves, it received $1.1 billion in coronavirus relief grants last year under the federal CARES Act, and millions more from the Federal Emergency Management Agency.

Providence does not own Hoag, since no money changed hands and their assets were not commingled. But Providence is able to keep Hoag from walking away because it has a majority on the governing body that was set up to oversee the original affiliation with St. Joseph.

Hoag executives also express frustration at what they describe as efforts by Providence to interfere with their financial, labor and supply decisions.

Providence, in turn, worries that “if Hoag disaffiliates with Providence, it has the potential to impact our credit rating,” Wexler said.

Despite its insistence on the value of the affiliation, Providence officials are said to be willing to end the affiliation in exchange for payment of an undisclosed amount that Hoag considers unwarranted. Wexler and Hoag executives declined to comment on their discussions. A trial start date has not been set, but on April 26 the court will hear a motion from Hoag to expedite it.

While its financial fortitude distinguishes it from many other community hospitals tied to larger partners, Hoag’s experience with Providence is hardly uncommon amid widespread consolidation in the hospital industry and the growing influence of Catholic health care in the U.S.

“The bigger your parent organization becomes, the smaller your voice is within the system, and that’s part of what Hoag has been complaining about,” said Lois Uttley, director of the women’s health program at Community Catalyst, a Boston-based patient advocacy group that monitors hospital mergers.

“Compounding the problem is the fact that the system in this case is Catholic-run, because then, in addition to having an out-of-town system headquarters calling the shots, you also have to contend with governance from Catholic bishops,” Uttley said. “So you have two bosses, in a sense.”

Hoag is not the only hospital seeking to flee this dynamic. Last year, for example, Virginia Mason Memorial hospital in Yakima, Washington, said it would separate from its parent, Seattle-based Virginia Mason Health System, to avoid a pending merger with CHI Franciscan, part of the Catholic hospital giant CommonSpirit Health.

Mergers and acquisitions have led to the increasing dominance of mega hospital chains in U.S. health care over the past several years. From 2013 to 2018, the revenue of the 10 largest health systems grew 82%, compared with 45% for all other hospital groups, according to a recent study by Deloitte, the consulting and auditing firm.

Researchers expect the trend to accelerate as large health systems swallow smaller facilities economically weakened by the pandemic, and a growing trend toward outpatient care reduces demand for hospital beds.

Four of the 10 largest U.S. hospital systems are Catholic, including Chicago-based CommonSpirit Health, St. Louis-based Ascension, Livonia, Michigan-based Trinity Health and Providence. A study by Community Catalyst found that 1 in 6 acute care hospital beds are in Catholic facilities, and that 52 hospitals operating under Catholic restrictions were the sole acute care facilities in their regions last year, up from 30 in 2013.

“We need to make this a national conversation,” said Dr. Jeffrey Illeck, a Hoag OB-GYN.

He was among a group of Hoag OB-GYNs who signed a letter to then-California Attorney General Xavier Becerra in October, alleging that Providence frequently declined to authorize contraceptive treatments, such as intrauterine devices and tubal ligations — in breach of the conditions imposed by Becerra’s predecessor, Kamala Harris, when she approved the original affiliation with St. Joseph in 2013.

In March, two weeks before he was confirmed as secretary of the U.S. Department of Health and Human Services, Becerra launched an investigation into those concerns.

Wexler said he is confident the attorney general’s probe will provide “clarity that Providence has done nothing wrong.”

A particularly bitter disagreement between the two sides concerns a rupture last year within St. Joseph Heritage Healthcare, a physician group belonging to Providence that included both St. Joseph and Hoag doctors. In November, the group notified thousands of patients that their Hoag specialists were no longer part of the network and that they needed to choose new doctors.

Wexler said that was the inevitable result of a decision by the Hoag physicians to negotiate separate HMO contracts, an assertion Braithwaite contested. The move disrupted patient care just as the winter covid surge was gaining momentum, he said.

Perhaps the biggest frustration for most Hoag administrators and physicians is Providence’s desire to standardize care across all 51 hospitals through their shared Epic electronic records system.

Hoag doctors say Providence controls the contents of the Epic system and that the care protocols in it, often driven by cost considerations, frequently collide with their own clinical decisions. Any changes must be debated among all the hospitals in the system and adopted by consensus — a laborious undertaking.

Dr. Richard Haskell, a cardiologist at Hoag, recalled a dispute over intravenous Tylenol, which Hoag’s orthopedists prefer because they say it works well and furthered a concerted effort to reduce opioid addiction. Providence took IV Tylenol off its list of accepted drugs, and the Hoag orthopedists “were very upset,” Haskell said.

They eventually got it back on that list, but with the condition that they could order it only one dose at a time. That meant nurses had to call the doctor every four hours for a new order. “Doctors probably felt, ‘Screw it, I don’t want to get woken up every four hours,’ so they probably just gave them narcotics,’” Haskell said.

He said that before agreeing to adopt Providence’s Epic system, Hoag had received written assurances it could make changes that included its preferred treatment choices for various conditions. But it quickly became clear that was not going to happen, he said.

“We couldn’t make any changes at all, so we were stuck with their system,” Haskell said. “I don’t want to be in a system bogged down by bureaucracy that requires 51 hospitals to vote on it.”

Wexler said Hoag understood exactly what it had signed up for. “They knew full well that there would be a collaborative approach across all of Providence, including Hoag, to make decisions on what standardizations would happen across the entire system,” he said. “It is not easy if one hospital wants to create its own specific pathway.”

Despite Hoag’s concerns about lesser standards of care, Braithwaite could not cite an example of an adverse outcome that had resulted from it. And Hoag’s strong reputation seems untarnished, as reflected in the high rankings and awards it continues to garner — and tout on its website.

Still, the affiliation’s days seem numbered. Hoag is no longer on the Providence website or in its marketing materials, and in many cases — such as the St. Joseph Heritage schism — the two groups are already going their separate ways.

“They are certainly acting like we are competitors, and I assume that means they know the disaffiliation is imminent,” Braithwaite said.

Wexler, while reiterating that Providence wants to maintain the current arrangement, was nonetheless able to imagine a different outcome: “What we would do post-affiliation,” he said, “is to continue to look for opportunities to collaborate.”

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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Redfield Joins Big Ass Fans, Which Promotes Controversial Covid-Killing Technology

Mon, 04/12/2021 - 4:30pm

Dr. Robert Redfield, former director of the Centers for Disease Control and Prevention, has joined Big Ass Fans, lending his scientific credibility to a company division that says its ion-generating technology kills the coronavirus. The company charges $9,450 for a fan with technology that academic air quality experts question.

This story also ran on The Daily Beast. It can be republished for free.

As strategic health and safety adviser, he follows Dr. Deborah Birx, former White House coronavirus response coordinator, into the booming air purifying industry. Last month, she signed on with ActivePure, a company that also makes a pitch about virus-destroying technology, but markets some devices that run afoul of California indoor air quality rules, according to a KHN investigation.

The two bring name recognition to companies selling products that are advertised to make it safer for people to gather maskless inside schools, offices, gyms and stores. The companies market 99.9% coronavirus kill rates.

Academic indoor air quality experts who criticize certain claims about covid-killing technology say the industry-funded studies often focus on results of tests run in a space ranging in size from a shoebox to a cabinet that do not reflect the conditions in a large room. Studies backed by the industry rarely make it clear whether the touted “virus-killing” ions or molecules are doing the work, experts say, or if improvements come from a fan or filter on a device.

“There’s no other way to say it — it’s completely unproven whether these devices would work in a real-world setting,” Timothy Bertram said of devices that claim to attack molecules in midair. He is a chemistry professor who studies aerosol particles at the University of Wisconsin-Madison.

Redfield, who led the CDC during the Trump administration’s pandemic response, did not respond to requests for comment before publication. “Proper ventilation has a major role to play in mitigating transmission of COVID-19 and other respiratory pathogens,” Redfield said in a Big Ass Fans news release. “Big Ass Fans is a leader in designing airflow systems and making places where we live, work, and play, safer.”

Academic air quality experts, though, say high-profile physician sign-ons amount to celebrity endorsements.

“I’d much rather see good data transparently released than listen to Deborah Birx talk about how good this technology is when I know she isn’t an expert on air disinfection,” said William Bahnfleth, an architectural engineering professor at Penn State who studies indoor air quality and leads the American Society of Heating, Refrigerating and Air-Conditioning Engineers Epidemic Task Force.

Bertram said he studied the performance of various ion- and hydroxyl-releasing devices in classrooms and found that some emitted ozone, a gas associated with the onset or worsening of asthma. Others created other new small particles. When it came to improving ventilation, none performed as well as a HEPA filter, he said, which together with a MERV-13 filter in a heating system and increased outside ventilation is the standard recommendation. Bertram did not say which specific devices he reviewed, but said that will be detailed in a forthcoming study.

Big Ass Fans is entering the coronavirus air purifying market with brand recognition based on its uncontroversial air-moving mega-fans. Its Clean Air System fans are already used in schools and by companies such as Toyota, Tiffany & Co. and Orangetheory Fitness.

Some Clean Air System fans use UVC light, widely considered an effective air cleaning technology. Other fans use bipolar ionization, a technique that the Environmental Protection Agency warns is “an emerging technology, and little research is available that evaluates it outside of lab conditions,” adding that evidence of its effectiveness is less documented than the evidence for far more established choices like air filtration.

Big Ass Fans spokesperson Alex Risen stressed in an interview that its technology is just one layer of protection against the coronavirus. The company, headquartered in Lexington, Kentucky, says its technology “pairs scientifically proven air purifying technologies with powerful airflow solutions. This results in a system that kills 99.99% of pathogens to keep your people protected and your business booming.”

The company charges about $500 to $1,500 more for fans with Clean Air System technology.

In the pandemic, federal funding to buy such devices for schools has exploded, with roughly $193 billion available so far. Congressional Democrats are pushing for $100 billion more. With community pressure to reopen classrooms, school officials have begun to invest heavily in air cleaning technology, though some experts worry risks are not being considered.

The EPA has warned about bipolar ionization’s ability to generate ozone and other potentially harmful byproducts indoors. A study by top indoor air quality experts in the Building and Environment journal found that another company’s bipolar ionization technology created other byproducts, including toluene, which can have developmental effects after long-term inhalation exposure.

Risen, the Big Ass Fans spokesperson, stressed that its ionization technology does not emit ozone or other byproducts and is not “putting bad things into your lungs.” He said the products do not emit hydrogen peroxide. ActivePure, the air cleaning company Birx has signed on with, makes air cleaners that emit gaseous hydrogen peroxide, which it claims can seek out and destroy viruses, mold and bacteria, according to the KHN investigation.

“We know that we’re not producing any negative products,” Risen said. “We know that at the concentrations that you’re at, you’re not getting negative effects.”

Joe Urso, ActivePure Technologies CEO, said the “FDA has cleared a number of devices that emit hydrogen peroxide into the ambient air at a safe level for people to breathe, including our ActivePure Medical Guardian.”

Bahnfleth said Big Ass Fans had made more of a good faith effort with its studies than others in the market. But he added that, without measuring potential gaseous byproducts, the research was not complete.

“They still do nothing to address potential adverse impacts of chemical byproduct exposure,” said Brent Stephens, an indoor air quality expert who reviewed Big Ass Fans Clean Air System’s reports and leads the civil, architectural and environmental engineering department at the Illinois Institute of Technology.

Stephens added that the controlled testing spaces — without people or furniture or other products that would be in a classroom or office — did not reflect real-world circumstances. And he worried about the “really high” ion counts, saying he would not recommend them for occupied spaces.

Bahnfleth echoed Stephens’ concerns, pointing to a study that showed adverse health effects such as increased oxidative stress levels — which are linked to cancer and other neurological diseases — for those exposed to a high number of negative ions. Experts said more research is needed, as bipolar ionization, like that used by Big Ass Fans, produces both positive and negative ions.

Risen defended the safety of ions in an interview, noting they occur naturally.

It’s hard to tell if the fan moving the air or the bipolar ionization is having an impact on the virus in the studies provided by Big Ass Fans, said Delphine Farmer, a Colorado State University associate professor who specializes in atmospheric and indoor chemistry. Also, she said, without real-world testing, it’s unclear what sort of reaction this product could have when exposed to classroom fumes from paint, glue or markers.

“Anything that actually destroys a virus is potentially doing other chemistry as well,” she said.

Another Clean Air System study claimed a 99.999% reduction of the virus that causes covid from the air.

“When they give you 99.999%, that’s a red flag to any scientist. We don’t know anything to that degree,” Bertram said. “That’s just nuts.”

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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Brecha de género contra covid: se vacunan más mujeres que hombres

Mon, 04/12/2021 - 2:17pm

Mary Ann Steiner condujo dos horas y media desde su casa en University City, un suburbio de St. Louis, hasta la pequeña ciudad de Ozark, en Centerville, Missouri, para vacunarse contra covid-19. Después de poner su auto en fila en el estacionamiento de una iglesia, notó que las otras personas que esperaban tenían algo en común con ella.

“Todos en la corta línea eran mujeres”, dijo Steiner, de 70 años.

Su observación refleja una realidad nacional: más mujeres que hombres están recibiendo vacunas contra covid, incluso cuando más hombres mueren a causa de la enfermedad.

KHN examinó los registros de vacunación de los 50 estados y el Distrito de Columbia a principios de abril y descubrió que cada uno de los 38 que desglosan por género mostraba que más mujeres que hombres habían recibido la vacuna.

Expertos en salud pública explican esta diferencia por muchas razones, una central: las mujeres constituyen las tres cuartas partes de la fuerza laboral en la atención médica y la educación, sectores priorizados en las primeras fases de vacunación.

También, las mujeres viven más, por lo que los residentes de hogares que recibieron las vacunas en la primera ronda tendieron a ser mujeres. Pero a medida que la elegibilidad se expande a todos los adultos y a más edades, esta brecha ha continuado.

Expertos señalan los roles de las mujeres como cuidadoras y su mayor probabilidad de buscar atención médica preventiva en general como factores que contribuyen a esta brecha.

En el caso de Steiner, su hija pasó horas en el teléfono y la computadora, buscando y programando citas de vacunación para cinco familiares. “En mi familia, las mujeres son un millón de veces más proactivas para la vacunación contra covid”, dijo Steiner. “Generalmente, las mujeres son más proactivas con respecto a la salud de la familia”.

A principios de abril, las estadísticas mostraban que el desglose de la vacuna entre mujeres y hombres generalmente se acercaba al 60% y al 40%. Por ejemplo, las mujeres constituían el 58% de las vacunadas en Alabama y el 57% en Florida.

Sin embargo, los estados no miden las vacunas por género de manera uniforme. Algunos desglosan las estadísticas por dosis totales de vacunas, mientras que otros informan personas que han recibido al menos una dosis. Algunos estados también tienen una categoría separada para personas no binarias o aquellas cuyo género se desconoce.

Un puñado de estados informan estadísticas de vacunación por género a lo largo del tiempo. Esos datos muestran que aunque la elegibilidad para recibir la vacuna se ha expandido, la brecha, aunque reducida, no ha desaparecido.

En Kentucky, por ejemplo, el 64% de los residentes que habían recibido al menos una dosis de la vacuna a principios de febrero eran mujeres y el 36% eran hombres. A principios de abril, las estadísticas habían cambiado al 57% de mujeres y al 43% de hombres.

En Rhode Island, uno de los estados más avanzados en la inmunización, con casi una cuarta parte de la población completamente vacunada, la brecha se ha reducido de 30 puntos porcentuales (65% mujeres y 35% hombres) la semana del 13 de diciembre, a 18 puntos (59% mujeres y 41% hombres) la semana del 21 de marzo.

Algunos estados desglosan las cifras por edad y por género, lo que revela que la diferencia entre hombres y mujeres persiste en todos los grupos de edad.

En Carolina del Sur, por ejemplo, el desglose por género de los receptores de la vacuna al 4 de abril fue ligeramente más amplio para las personas más jóvenes: el 61% de las personas vacunadas de entre 25 y 34 años eran mujeres, en comparación con el 57% de mujeres de 65 años o más.

El doctor Elvin Geng, profesor de la Escuela de Medicina de la Universidad de Washington en St. Louis, dijo que las mujeres de todos los grupos de edad, razas y etnias generalmente usan los servicios de salud más que los hombres, que es una de las razones por la que viven más tiempo.

Arrianna Planey, profesora asistente de geografía médica en la Universidad de Carolina del Norte-Chapel Hill, dijo que a menudo son las mujeres quienes organizan las citas médicas en sus hogares por lo que puedan estar más familiarizadas con la navegación de los sistemas de salud.

Décadas de investigación han documentado cómo y por qué es menos probable que los hombres busquen atención. Un estudio de 2019 en el American Journal of Men’s Health examinó el uso de la atención médica en hombres religiosos heterosexuales y concluyó que las normas masculinas, como la percepción de que son fuertes, eran la razón principal por la que muchos hombres evitaban buscar atención medica.

Las actitudes sobre la pandemia de covid y las vacunas también afectan a quién las recibe.

La doctora Rebecca Wurtz, directora de administración y políticas de salud pública en la Universidad de Minnesota, dijo que las mujeres han tenido más probabilidades de perder sus trabajos durante la pandemia y, en muchos casos, son las que llevan la peor parte  en la enseñanza y el cuidado de los niños en el hogar.

“Las mujeres están preparadas para hacer esto incluso más que los hombres”, dijo Wurtz.

Las actitudes políticas también influyen en las opiniones de la gente sobre cómo afrontar la pandemia, dijeron expertos. Una encuesta de Gallup de 2020 encontró que tanto entre demócratas como republicanos, las mujeres eran más propensas a decir que tomaban precauciones para prevenir contraer covid, como practicar siempre el distanciamiento físico y usar máscaras.

En una encuesta nacional reciente realizada por KFF, el 29% de los republicanos y el 5% de los demócratas dijeron que definitivamente no recibirían la vacuna.

Paul Niehaus IV, de St. Louis, quien se describió a sí mismo como un libertario independiente con inclinaciones conservadoras, aseguró que no recibirá una vacuna contra covid. Dijo que el gobierno federal, junto con Big Tech y Big Pharma, están impulsando un medicamento experimental que no está completamente aprobado por la Administración de Alimentos y Medicamentos (FDA), y no confía en esas instituciones.

“Este es un problema de libertad. Es un tema de libertades civiles”, dijo Niehaus, músico independiente de 34 años. “Mi lema es ‘Deja que la gente elija'”.

Steiner, quien planea retirarse a fin de mes como editora de una revista para la Asociación de Salud Católica, dijo que estaba ansiosa por vacunarse. Tiene un trastorno inmunológico que la pone en alto riesgo de contraer una forma grave de covid, y no ha visto a algunos de sus nietos en un año y medio.

Pero dijo que algunos de los hombres de su vida estaban dispuestos a esperar más tiempo para recibir las dosis y que algunos sobrinos ni siquiera las querían. Su hermano, de 65 años, recibió la vacuna de Johnson & Johnson de un sola dosis a principios de abril después que su hija lo ayudara con la cita.

Steiner, que ahora ha recibido ambas dosis de la vacuna de Moderna, dijo que no se arrepiente de haber dado viajado cinco horas de ida y vuelta para recibir su primera dosis en febrero. (Pudo encontrar un lugar más cercano para su segunda dosis).

“Es por mi seguridad, por la seguridad de mis hijos, por la seguridad de mis vecinos, por la gente que va a mi iglesia”, dijo. “Realmente no entiendo la resistencia”.

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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‘Explained by KHN’: Health Insurance Help in Covid Relief Law

Mon, 04/12/2021 - 5:00am

The twists and turns of the American health system can sometimes leave people lost, confused and looking for answers. We’ve created a new video series — “Explained by KHN” — in which our correspondents and editors answer common health care and health policy questions. 

The $1.9 trillion covid relief package that President Joe Biden signed into law in March includes more money to help Americans pay their health insurance premiums for the next two years. KHN correspondent Emmarie Huetteman explains some of the changes that could help consumers. 

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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Categories: National News Content

Biden Seeks $400 Billion to Buttress Long-Term Care. A Look at What’s at Stake.

Mon, 04/12/2021 - 5:00am

There’s widespread agreement that it’s important to help older adults and people with disabilities remain independent as long as possible. But are we prepared to do what’s necessary, as a nation, to make this possible?

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

That’s the challenge President Joe Biden has put forward with his bold proposal to spend $400 billion over eight years on home and community-based services, a major part of his $2 trillion infrastructure plan.

It’s a “historic and profound” opportunity to build a stronger framework of services surrounding vulnerable people who need considerable ongoing assistance, said Ai-jen Poo, director of Caring Across Generations, a national group advocating for older adults, individuals with disabilities, families and caregivers.

It comes as the coronavirus pandemic has wreaked havoc in nursing homes, assisted living facilities and group homes, killing more than 174,000 people and triggering awareness of the need for more long-term care options.

“There’s a much greater understanding now that it is not a good thing to be stuck in long-term care institutions” and that community-based care is an “essential alternative, which the vast majority of people would prefer,” said Ari Ne’eman, senior research associate at Harvard Law School’s Project on Disability.

“The systems we do have are crumbling” due to underfunding and understaffing, and “there has never been a greater opportunity for change than now,” said Katie Smith Sloan, president of LeadingAge, at a recent press conference where the president’s proposal was discussed. LeadingAge is a national association of more than 5,000 nonprofit nursing homes, assisted living centers, senior living communities and home care providers.

But prospects for the president’s proposal are uncertain. Republicans decry its cost and argue that much of what the proposed American Jobs Plan contains, including the emphasis on home-based care, doesn’t count as real infrastructure.

“Though this [proposal] is a necessary step to strengthen our long-term care system, politically it will be a challenge,” suggested Joseph Gaugler, a professor at the University of Minnesota’s School of Public Health, who studies long-term care.

Even advocates acknowledge the proposal doesn’t address the full extent of care needed by the nation’s rapidly growing older population. In particular, middle-income seniors won’t qualify directly for programs that would be expanded. They would, however, benefit from a larger, better paid, better trained workforce of aides that help people in their homes — one of the plan’s objectives.

“This [plan] isn’t everything that’s needed, not by any step of the imagination,” Poo said. “What we really want to get to is universal access to long-term care. But that will be a multistep process.”

Understanding what’s at stake is essential as communities across the country and Congress begin discussing Biden’s proposal.

The services in question. Home and community-based services help people who need significant assistance live at home as opposed to nursing homes or group homes.

Services can include home visits from nurses or occupational therapists; assistance with personal care such as eating or bathing; help from case managers; attendance at adult day centers; help with cooking, cleaning and other chores; transportation; and home repairs and modifications. It can also help pay for durable medical equipment such as wheelchairs or oxygen tanks.

The need. At some point, 70% of older adults will require help with dressing, hygiene, moving around, managing finances, taking medications, cooking, housekeeping and other daily needs, usually for two to four years. As the nation’s aging population expands to 74 million in 2030 (the year all baby boomers will have entered older age), that need will expand exponentially.

Younger adults and children with conditions such as cerebral palsy, blindness or intellectual disabilities can similarly require significant assistance.

The burden on families. Currently, 53 million family members provide most of the care that vulnerable seniors and people with disabilities require — without being paid and often at significant financial and emotional cost. According to AARP, family caregivers on average devote about 24 hours a week, to helping loved ones and spend around $7,000 out-of-pocket.

This reflects a sobering reality: Long-term care services are simply too expensive for most individuals and families. According to a survey last year by Genworth, a financial services firm, the hourly cost for a home health aide averages $24. Annually, assisted living centers charge an average $51,600, while a semiprivate room in a nursing home goes for $93,075.

Medicare limitations. Many people assume that Medicare — the nation’s health program for 61 million older adults and people with severe disabilities — will pay for long-term care, including home-based services. But Medicare coverage is extremely limited.

In the community, Medicare covers home health only for older adults and people with severe disabilities who are homebound and need skilled services from nurses and therapists. It does not pay for 24-hour care or homemakers or routinely cover care from personal aides. In 2018, about 3.4 million Medicare members received home health services.

In nursing homes, Medicare pays only for rehabilitation services for a maximum of 100 days. It does not provide support for long-term stays in nursing homes or assisted living facilities.

Medicaid options. Medicaid — the federal-state health program for 72 million children and adults in low-income households — can be an alternative, but financial eligibility standards are strict and only people with meager incomes and assets qualify.

Medicaid supports two types of long-term care: home and community-based services and those provided in institutions such as nursing homes. But only care in institutions is mandated by the federal government. Home and community-based services are provided at the discretion of the states.

Although all states offer home and community-based services of some kind, there’s enormous variation in the types of services offered, who is served (states can set caps on enrollment) and state spending. Generally, people need to be frail enough to need nursing home care to qualify.

Nationally, 57% of Medicaid’s long-term care budget goes to home and community-based services — $92 billion in the 2018 federal budget year. But half of states still spend twice as much on institutional care as they do on community-based care. And 41 states have waiting lists, totaling nearly 820,000 people, with an average wait of 39 months.

Based on the best information available, between 4 million and 5 million people receive Medicaid-funded home and community-based services — a fraction of those who need care.

Workforce issues. Biden’s proposal doesn’t specify how $400 billion in additional funding would be spent, beyond stating that access to home and community-based care would be expanded and caregivers would receive “a long-overdue raise, stronger benefits, and an opportunity to organize or join a union.”

Caregivers, including nursing assistants and home health and personal care aides, earn $12 an hour, on average. Most are women of color; about one-third of those working for agencies don’t receive health insurance from their employers.

By the end of this decade, an extra 1 million workers will be needed for home-based care — a number of experts believe will be difficult, if not impossible, to reach given poor pay and working conditions.

“We have a choice to keep these poverty-wage jobs or make them good jobs that allow people to take pride in their work while taking care of their families,” said Poo of Caring Across Generations.

Next steps. Biden’s plan leaves out many details. For example: What portion of funding should go to strengthening the workforce? What portion should be devoted to eliminating waiting lists? What amount should be spent on expanding services?

How will inequities of the current system — for instance, the lack of accessible services in rural counties or for people with dementia — be addressed? “We want to see funding to states tied to addressing those inequities,” said Amber Christ, directing attorney of the health team at Justice in Aging, an advocacy organization.

Meanwhile, supporters of the plan suggest it could be just the opening of a major effort to shore up other parts of the safety net. “There are huge gaps in the system for middle-income families that need to be addressed,” said David Certner, AARP’s legislative counsel.

Reforms that should be considered include tax credits for caregivers, expanding Medicare’s home health benefit and removing the requirement that people receiving Medicare home health be homebound, said Christ of Justice in Aging.

”We should be looking more broadly at potential solutions that reach people who have some resources but not enough to pay for these services as well,” she 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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Readers and Tweeters Give Tips on Treating Diabetes and Long Covid

Mon, 04/12/2021 - 5:00am

Letters to the Editor is a periodic feature. We welcome all comments and will publish a selection. We edit for length and clarity and require full names.

Glucose Monitors Can Benefit All Types

I disagree with the negative tone of a recent KHN article about whether continuous glucose monitoring (CGM) helps non-insulin-using people with Type 2 diabetes (Type 2s) (“‘Painless’ Glucose Monitors Pushed Despite Little Evidence They Help Most Diabetes Patients,” March 16).

As a board-certified endocrinologist, I have seen firsthand significant benefits of CGM for people with diabetes, including Type 2s not using insulin. This technology provides useful real-time information about the effects of various foods and activities on glucose levels. CGM also shows how to avoid dangerous hypoglycemia, which can be a side effect of sulfonylurea drugs, frequently prescribed for non-insulin-using Type 2s. Much international research in this population, not mentioned in the article, shows benefits of CGM, including improved A1C levels and decreased hospitalizations and emergency room visits.

While no tool is right for everyone, Type 2s who want to learn about what affects their glucose levels and are willing to use information to change their behavior will often benefit significantly from CGM.

— Dr. David Klonoff, University of California-San Francisco

We talk about #valuebasedcare a lot, but we have to define value. Is it convenience, peace of mind? Or actual better #clinical value per dollar? So often there is a gray area, but too often we take the latest & greatest because it’s just that.https://t.co/vGwBnUMKER

— Dr. Christopher Chen (@DrChrisChen) March 31, 2021

— Dr. Christopher Chen, Miami

Medicare and most other health insurers will be happy to learn about “multiple finger sticks, which cost less than $1 per day …” Not even close to being true!

As a 75-year-old with Type 1 diabetes (for 14 years, the last three using CGM), I would agree with your basic premise but for the convenience. CGM is another step closer to the artificial pancreas that will hopefully save costs and lives.

My CGM system does not alert (sleeping or awake) for low blood sugar. It has also left my A1C unchanged (but it was already acceptably low). The monthly cost of CGM vs. an average of eight finger sticks a day, necessary for my severely reactive Type 1, is comparatively low.

It would be far better for reporters and diabetes patients if diabetes weren’t the endlessly complicated disease that it is.

— Phil Murray, Elk River, Minnesota

13/n In the spirit of sharing all viewpoints, here are counter-arguments to what I've shared above about #CGM in #T2D: https://t.co/XHSbg6zUlK

— Aaron Neinstein, MD (@AaronNeinstein) March 24, 2021

— Dr. Aaron Neinstein, San Francisco

You put something in your story about CGMs that is misleading. While a Dexcom CGM does not test a specific A1C, it does keep records that are shared with your endocrinologist that outline an average A1C, which for me has been off by 0.5 points, higher or lower. I am a Type 1 diabetic; but I can tell you that Type 2 diabetics can benefit from this if they watch and respond to the numbers they’re getting. They can have a clear glimpse into all that causes their glucose to rise and fall: Stress releases a hormone called cortisol that raises glucose, while anxiety burns energy and can drop it rapidly. Even coffee with no cream and sugar raises glucose.

My A1C before my CGM was always in the high 6s. My last one and the one before that? 5.6 and 5.7, which is basically a normal A1C. The CGM isn’t doing this for me … but because of the CGM, I am able to outline what exactly causes my glucose to rise and fall and how to respond to it.

Checking glucose three times a day is not an effective way to manage diabetes at all. It is far more expensive to follow sugars the way that they’ve traditionally been followed. We need to equip diabetics with better tools to monitor where their numbers are going so that they can become empowered to manage this disease effectively.

— Rhonda Ronsman, Milwaukee, Wisconsin

Initially, public perception was that children would not be infected with the #coronavirus. As a parent, I wouldn't want to risk #covid complications for my son. I recommend children take similar wellness precautions to reduce their risk for MIS-C. https://t.co/ofCqtitT9c

— MeiLan Han (@meilan_han) March 5, 2021

— Dr. MeiLan Han, Ann Arbor, Michigan

A Short Course on Treating Long Covid

Here’s some advice for those who treat people with lingering problems caused by the coronavirus (“Children’s Hospitals Grapple With Young Covid ‘Long Haulers,’” March 3). Primary care physicians and pediatricians seeing patients with symptoms subsequent to covid-19 infections, generically called “long haul” covid, should attempt to distinguish between those symptoms that are the same as those of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and those that are unique to Long Covid. For those similar to ME/CFS, the health care provider should avail themselves of the symptom management developed for ME/CFS, at least as a first approach. Symptoms lasting beyond six months of the acute infection may satisfy the criteria of ME/CFS and that diagnosis should be considered. Adult and pediatric ME/CFS primers are available both online and in hard copy for both health care provider and patient.

— Dr. Kenneth Friedman, Plantation, Florida

A lot of people rushing to reopen schools are ignoring that children are harmed by Covid too. Many kids are getting #LongCovid. #LongCovidKids"Children’s Hospitals Grapple With Young Covid 'Long Haulers'" https://t.co/MS3IKp3Mzg via @khnews

— Myra wants everyone to #GetVaccinated (@myrabatchelder) March 24, 2021

— Myra Batchelder, Brooklyn, New York

A Revealing Narrative

Thank you for bringing Paloma Marin-Nevarez’s story to us on Reveal (“‘Into the Covid ICU’: A New Doctor Bears Witness to the Isolation, Inequities of Pandemic,” March 1). I was most struck by her insightful response to your question regarding what she thinks about health care workers being regarded as heroes. I am a physician, too, and have never felt comfortable with this hero meme, but couldn’t put my finger on why. The idea that designating someone else a hero excuses the designator from doing something themselves, like wearing a mask or not eating in a restaurant, is spot-on. As Paloma said, “What the f*** are you doing?” It’s the same with our forced hero worship on those in the military. Sure, many in the military do remarkably heroic things in their line of work and risk their health, but so do miners and fishermen and oil rig workers and loggers. But what if we were more willing to sacrifice by not using as much fossil fuel or giving more of our money to international aid? Could that avert some of the necessary sacrifice of those in the military? It’s easier just to say they are heroes and move along with our lives. Thanks for making me think.

— Dr. Gerald Gollin, San Diego

Clinicians in training have had to learn the hard way this year that skilled communication with patients & families is an intervention that requires training and practice – teaching programs should listen to them: https://t.co/pZZ1IA0j0g

— Brynn Bowman, MPA (@BrynnBHealth) March 9, 2021

— Brynn Bowman, New York City

Deciphering Billing Codes

Isn’t part of the issue the Medicare Advantage Plan and their coverage (“Her Doctor’s Office Moved One Floor Up. Her Bill Was 10 Times Higher,” March 26)? I find the code J10140 is for 80 milligrams of Depo-Medrol, which has an N status indicator on the Centers for Medicare & Medicaid’s Addendum B (meaning no separate payment and no copay). The CPT code for the injection is 20610, with a T status indicator, which shows a national copay of $52.25. When I do a lookup on the original Medicare site, it shows an average out-of-pocket payment of $61. So, if the patient was paying for a Medicare Part B plan under Medicare fee-for-service, the out-of-pocket would have been $61, not $354.68. People often think that Medicare Advantage plans are “free,” but the plan’s coverage is very different from original Medicare. The standard monthly premium for enrollees is $148.50, so there is a trade-off, but it should be noted that if the patient had Medicare FFS, the hospital would have received only $61 from the patient.

— Agatha Nolen, Ph.D., FASHP, CRCR (a Healthcare Financial Management Association certified revenue cycle representative), Nashville, Tennessee

This is a completely solvable problem: "But Riley noted it’s difficult to fight powerful hospital lobbyists in a pandemic political climate…"Her Doctor’s Office Moved One Floor Up. Her Bill Was 10 Times Higher. https://t.co/15jVzA5sc5 via @khnews

— Mark Miller (@MarkMiller_DC) March 26, 2021

— Mark Miller, Washington, D.C.

I’m a senior. Even with a Medicare Advantage or supplemental plan with zero premiums, copays are unaffordable. Medical clinics often lie about charges. I ask beforehand every time, and I get everything in writing. Insurance companies give incorrect advice or flat-out lie about coverages, and the surprise can be bankrupting. I have some serious health issues but will not seek medical treatment for any of them. My family and friends are all instructed to never ever take me to a hospital because, if I live through whatever (covid, heart attack, stroke), I would never be able to pay the bill. The medical system in the USA is insanely predatory on the elderly. I no longer wish to be the victim of predators and feel that I am in a better place, even if ill, by simply avoiding it. There is no such thing in this country as honest, affordable health care. People think “Medicare-for-All” is the answer but people are wrong, based on my experience with Medicare, including a scarcity of doctors willing to accept Medicare even with so-called “good” supplemental insurance. I am choosing zero-premium Advantage and, if by some remote chance I end up sick or injured and against my will am taken for treatment to some predatory medical facility, I will choose bankruptcy to eliminate the bill. A friend was recently diagnosed with cancer — she had “good” insurance. She chose to forgo treatment, ended up in hospice, and died — by choice — there was no way she could pay for everything.

— Rox Sitterley, Corvallis, Oregon

Another absurd reason HC costs are so high. I'm not buying the hospital's reasons for facility fees. Her Doctor’s Office Moved One Floor Up. Her Bill Was 10 Times Higher. https://t.co/MIF9UiH4pa via @khnews

— Victor Vaughan (@vicgvaughan) March 27, 2021

— Vic Vaughan, Fairfield, Connecticut

Doesn't MATTER. WHICH Administration is in office…FIX THIS!!New Cost-Cutting Medicare Rule, Same Surgery, Same Place, Different Bill https://t.co/FD3fr38fBg

— Deborah Daly-Case (@DeborahDalyCase) March 24, 2021

— Deborah Daly-Case, Fullerton, California

Cut Through the Surgery Confusion

Besides getting a blood oath of admission, why not provide some guidance as to what one should do to avoid bankruptcy (“Under New Cost-Cutting Medicare Rule, Same Surgery, Same Place, Different Bill,” March 23)?! Going to the local abattoir isn’t exactly a time for one to have presence of mind.

— Jack Shaw, Littleton, Colorado

https://t.co/HFvzwXnvfjA nice goodbye present to all Orthopedic supporters of the last administration

— James Gerald Floyd (@Flobhm) March 28, 2021

— James Gerald Floyd, Orlando, Florida

Vaccine Hesitant? Consult History

This is an open letter to anyone who hesitates or chooses not to immunize themselves or their children. Teach the history of immunization. History — have you ever seen pictures of someone with smallpox? Look on the internet. Millions took the risk to be immunized, now smallpox has been eradicated in the world population. My great aunt and cousin had the opportunity to be immunized against diphtheria and were not — whatever the reason — and they both died of diphtheria, leaving a husband and small children.

Among my experiences as a student nurse was working at the pediatric hospital in Indianapolis in 1960 watching a 10-year-old with tetanus lying on his side with his body and head severely arched, a tube in his throat for breathing. Also at the hospital were large, metal, tube-like machines. Inside each machine was a child with Bulbar polio who could not breathe on their own. Their head stuck out one end of the machine, the rest of their body lay limp inside the tube, and nurses cared for them through “portholes.” They were in “iron lungs.” I also cared for children recovering from polio. I worked nights and would apply warm flannel “Kenny packs” to ease the pain in their arms and legs so they could sleep. These children were amazingly courageous.

When I had children of my own, how incredibly grateful I was that most parents had accepted the risk of an immunization for polio. Because of this, polio is almost eliminated in the United States. It causes me great emotional pain to hear of people refusing to take their part in preventing these and other illnesses.

— Donna Fellinger, Burlington, Vermont

Friends – This angers me! America needs to know about this! DC we are coming and see you in a couple of weeks! This is why @jonstewart & are a teaming up yet again! This is why failure will never be an option! https://t.co/XZULFC7dki

— @JohnFeal2 (@johnfeal2) March 21, 2021

— John Feal, Smithtown, New York

The War Behind Tax Dollars and Politics

Dr. Elisabeth Rosenthal’s article “How the US Invested in the War on Terrorism at the Cost of Public Health” (March 29) is balderdash. Criticizing the war on terror for the failure of the public health bureaucracy to protect the nation against covid is shameful and outrageous. And denouncing Donald Trump for it is like blaming Franklin Delano Roosevelt for Pearl Harbor. The progressive politics that inform the worldview of institutional health care have damaged (perhaps destroyed) the independence and reputation of medicine, and that’s something that can’t be quantified nor easily recovered.

— Stephen Power, Vacaville, California

This is the easiest read for what is also a comprehensive look at our grim public health situation. https://t.co/gvB1YI6Vjp via @khnews @RosenthalHealth

— Jordan Reese (@mediajordan) March 31, 2021

— Jordan Reese, Philadelphia

Keeping the Fact Checkers Honest

Your “fact checking” is way too kind to the Trump administration (“Biden’s Criticism of Trump Team’s Vaccine Contracts Is a Stretch,” March 8). Yes, Operation Warp Speed did trigger the enormous expenditure of research dollars that produced three U.S.-backed vaccines in record time. However, the Trump administration devoted no resources to making them available to the American population in an organized fashion, and one could speculate that the entire project was designed primarily to inflate the value of the American Big Pharma companies tasked with developing the vaccines (I’m not disparaging the companies, just the Trump administration’s motives for stoking their financial fires). And, just to show that left-leaning politics can also be gilded with conspiracy theories, I’ll offer another. Early in the fall, many of us watched a “60 Minutes” episode during which we learned that our “glorious military” would be tasked with managing vaccine delivery. That certainly was not apparent once the vaccines became available and most “connected” Americans began obsessing over obtaining their own doses via their computers and mobile devices. When the history of the pandemic is written, I would not be surprised to learn that the Trump administration was mounting a shadow plan to deliver an entirely different type of resource throughout the country — soldiers to impose and enforce martial law once he lost the election he knew he would lose unless he could hijack it.

Anyone without a flat-line cerebral cortex could have seen that vaccinating 300 million-plus Americans in just a few months would be an information technology nightmare, actually made worse by the HIPAA limitations on health information data-sharing, but Trump’s administration “wasted” no time on that project, while replacing top-level administration staffers at the Pentagon with secretive sycophants. One wonders what they were hiding from the Joe Biden transition team in a totally unprecedented rejection of the safety of our democracy between Election Day and Inauguration Day.

— Dr. James Robertson, Hamilton, Montana

The a Trump Admin also should get credit for the pre-purchase of 800 million doses of vaccine before it was even FDA approved. Fact checked. https://t.co/UsieYciYdn

— Matt Deitchle (@MattDeitchle) March 14, 2021

— Matt Deitchle, Indianapolis

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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Categories: National News Content

The Gender Vaccine Gap: More Women Than Men Are Getting Covid Shots

Mon, 04/12/2021 - 5:00am

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

Mary Ann Steiner drove 2½ hours from her home in the St. Louis suburb of University City to the tiny Ozark town of Centerville, Missouri, to get vaccinated against covid-19. After pulling into the drive-thru line in a church parking lot, she noticed that the others waiting for shots had something in common with her.

“Everyone in the very short line was a woman,” said Steiner, 70.

Her observation reflects a national reality: More women than men are getting covid vaccines, even as more men are dying of the disease. KHN examined vaccination dashboards for all 50 states and the District of Columbia in early April and found that each of the 38 that listed gender breakdowns showed more women had received shots than men.

Public health experts cited many reasons for the difference, including that women make up three-quarters of the workforce in health care and education, sectors prioritized for initial vaccines. Women’s longer life spans also mean that older people in the first rounds of vaccine eligibility were more likely to be female. But as eligibility expands to all adults, the gap has continued. Experts point to women’s roles as caregivers and their greater likelihood to seek out preventive health care in general as contributing factors.

In Steiner’s case, her daughter spent hours on the phone and computer, scoping out and setting up vaccine appointments for five relatives. “In my family, the women are about a million times more proactive” about getting a covid vaccine, Steiner said. “The females in families are often the ones who are more proactive about the health of the family.”

As of early April, statistics showed the vaccine breakdown between women and men was generally close to 60% and 40% — women made up 58% of those vaccinated in Alabama and 57% in Florida, for example.

States don’t measure vaccinations by gender uniformly, though. Some break down the statistics by total vaccine doses, for example, while others report people who have gotten at least one dose. Some states also have a separate category for nonbinary people or those whose gender is unknown.

A handful of states report gender vaccination statistics over time. That data shows the gap has narrowed but hasn’t disappeared as vaccine eligibility has expanded beyond people in long-term care and health care workers.

In Kentucky, for instance, 64% of residents who had received at least one dose of vaccine by early February were women and 36% were men. As of early April, the stats had shifted to 57% women and 43% men.

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In Rhode Island — one of the states furthest along in rolling out the vaccines, with nearly a quarter of the population fully vaccinated — the gap has narrowed from 30 percentage points (65% women and 35% men) the week of Dec. 13 to 18 points (59% women and 41% men) the week of March 21.

A few states break the numbers down by age as well as gender, revealing that the male-female difference persists across age groups. In South Carolina, for example, the gender breakdown of vaccine recipients as of April 4 was slightly wider for younger people: 61% of vaccinated people ages 25-34 were women compared with 57% female for age 65 and older.

Dr. Elvin Geng, a professor at the medical school at Washington University in St. Louis, said women of all age groups, races and ethnicities generally use health services more than men — which is one reason they live longer.

Arrianna Planey, an assistant professor who specializes in medical geography at the University of North Carolina-Chapel Hill, said it’s often women who manage medical appointments for their households so they may be more familiar with navigating health systems.

Decades of research have documented how and why men are less likely to seek care. A 2019 study in the American Journal of Men’s Health, for example, examined health care use in religious heterosexual men and concluded masculine norms — such as a perception that they are supposed to be tough — were the main reason many men avoided seeking care.

Attitudes about the covid pandemic and the vaccines also affect who gets the shots.

Dr. Rebecca Wurtz, director of public health administration and policy at the University of Minnesota, said women have been more likely to lose jobs during the pandemic, and in many cases bear the brunt of teaching and caring for children at home.

“Women are ready for this to be done even more than men are,” Wurtz said.

Political attitudes, too, play a part in people’s views on coping with the pandemic, experts said. A Gallup poll last year found that among both Democrats and Republicans, women were more likely to say they took precautions to avoid covid, such as always practicing physical distancing and wearing masks indoors when they couldn’t stay 6 feet apart from others.

In a recent national poll by KFF, 29% of Republicans and 5% of Democrats said they definitely would not get the shot.

Paul Niehaus IV of St. Louis, who described himself as an independent libertarian with conservative leanings, said he won’t get a covid vaccine. He said the federal government, along with Big Tech and Big Pharma, are pushing an experimental medicine that is not fully approved by the Food and Drug Administration, and he doesn’t trust those institutions.

“This is a freedom issue. This is a civil liberties issue,” said Niehaus, a 34-year-old self-employed musician. “My motto is ‘Let people choose.’”

Steiner, who plans to retire at the end of the month from editing a magazine for the Catholic Health Association, said she was eager to be vaccinated. She has an immune disorder that puts her at high risk for severe illness from covid and hasn’t seen some of her grandchildren in a year and a half.

But she said some of the men in her life were willing to wait longer for the shots, and a few nephews haven’t wanted them. She said her brother, 65, received the one-shot Johnson & Johnson vaccine in early April after her daughter made it easy by arranging it for him.

Steiner, who has now received both doses of the Moderna vaccine, said she doesn’t regret taking the more difficult step of traveling five hours round trip to get her first shot in February. (She was able to find a closer location for her second dose.)

“It’s for my safety, for my kids’ safety, for my neighbors’ safety, for the people who go to my church’s safety,” she said. “I really don’t understand the resistance.”

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 Document True Toll of Covid on Health Care’s Front-Line Force

Sat, 04/10/2021 - 5:00am

Senior KHN correspondent Christina Jewett spoke on Thursday with NPR’s “Morning Edition” and the PBS NewsHour about the yearlong project, “Lost on the Frontline,” in which KHN and The Guardian counted and profiled health care workers who have died of covid-19.

Midwest correspondent Lauren Weber joined WAMU’s “1A” to discuss vaccination rates on April 2.

Colorado correspondent Rae Ellen Bichell spoke with KUNC’s “Colorado Edition” about Durango’s covid cowboys enforcing mask mandates on April 1.

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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Fauci Thanks US Health Workers for Sacrifices but Admits PPE Shortages Drove Up Death Toll

Fri, 04/09/2021 - 5:00am

Dr. Anthony Fauci thanked America’s health care workers, who “every single day put themselves at risk” during the pandemic, even as he acknowledged that PPE shortages had contributed to the deaths of more than 3,600 of them.

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

“We rightfully refer to these people without hyperbole — that they are true heroes and heroines,” he said in an exclusive interview with The Guardian. The deaths of so many health workers from covid-19 are “a reflection of what health care workers have done historically, but putting themselves in harm’s way by living up to the oath they take when they become physicians and nurses,” said Fauci.

KHN and The Guardian have tracked health care workers’ deaths throughout the pandemic in the “Lost on the Frontline” database. More than 3,600 health worker deaths have been tallied in the database, considered the most authoritative accounting in the country.

Personal protective equipment — including gloves, gowns and critical masks — have been in short supply since the pandemic began and heightened the toll. The U.S. is the world’s largest importer of PPE, which made it especially vulnerable to the demand shock and export restrictions that hit the global market last spring.

“During the critical times when there were shortages was when people had to use whatever was available to them,” said Fauci. “I’m sure that increased the risk of getting infected among health care providers.”

Shortages were compounded by the federal government’s failure to maintain a national stockpile of personal protective equipment, and the Trump administration’s refusal to order more domestic manufacturing of PPE. That left health workers to use trash bags as gowns, reuse N95s for weeks and, at times, go totally without gloves.

The shortages led to protests by health workers, who said working amid the pandemic without equipment left them like “sheep going to slaughter.” Nina Forbes, a nurse at an assisted living facility, was forced to wear a trash bag at times, according to her daughter, and later died. A year into the pandemic, gowns and gloves remain in short supply, according to the Food and Drug Administration.

Nearly 560,000 Americans have died in the covid pandemic, with many more experiencing long-term symptoms of covid.

Health workers have been especially vulnerable through the pandemic, as they have treated patients through early waves when the lack of personal protective equipment was especially acute, through summer surges and a disastrous peak in the winter.

A study of health workers in the U.S. and the United Kingdom in The Lancet found health workers are three times more likely than the general public to become infected with the covid virus, with disproportionate impacts on minority health workers.

“It’s very clear when you just go to the media and see the images on television — the stress and the strain on the faces of health care providers, nurses, doctors, other people involved in the health care enterprise,” said Fauci.

Nevertheless, the U.S. government has failed to systematically count health worker deaths. Members of Congress, the Health and Human Services Department and academic reports have cited The Guardian and KHN’s reporting as the most comprehensive. A growing chorus of policy experts and unions have called for a comprehensive count of health worker deaths.

“We certainly want to find an accurate count of the people who die,” said Fauci, without noting when the government should undertake such an effort. “Certainly, that’s something I think would fall under the auspices of the federal government.”

Even as the vaccine rollout picks up speed, health workers continue to be imperiled. More than 400 died between the time the rollout began and late February. Infections among vaccinated health workers have steeply declined, but because deaths are a lagging indicator of the spread of covid, some health workers will have been sickened before widespread vaccination.

At the same time, immunity to coronaviruses generally wanes over time and variants may blunt the efficacy of some vaccines. A global shortage of vaccines means dozens of poor nations have not inoculated a single person. Advocates argue this has led to a global “vaccine apartheid,” which will contribute to the continued emergence of variants. Both scenarios could imperil health workers anew and necessitate a new round of adult mass vaccination.

Studies into the duration of immunity for vaccines, and variants’ impact on vaccines, are ongoing. “If we’re going to need to do boosting with a variant-specific boost, [we] will be prepared for it because we’re already doing a study,” Fauci said, with such research taking place at the National Institute of Allergy and Infectious Diseases, which he leads. Even so, “it looks like our ability to protect against variants with the standard vaccine might be better than we anticipated.”

Regardless of how future vaccination campaigns play out, Fauci said, U.S. policymakers should learn from what has transpired over the past year.

“We better make sure the lesson we will learn is that we will never again be in a situation where people who are putting their health and their safety on the line don’t have the appropriate equipment to protect themselves safely,” 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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‘My Children Were Priceless Jewels’: Three Families Reflect on the Health Workers They Lost

Fri, 04/09/2021 - 5:00am

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

The daughter of an internist in the Bronx, the father of a nurse practitioner in Southern California and the son of a nurse in McAllen, Texas, share how grief over their loved ones’ deaths from covid-19 has affected them.

These health care workers were profiled in KHN and The Guardian’s yearlong “Lost on the Frontline” project.

Dr. Reza Chowdhury was a beloved internist with a private practice in the Bronx and a trusted voice in New York’s Bengali community. His daughter, Nikita Rahman, said that despite underlying health issues putting him at higher risk of developing covid complications, he saw patients through mid-March last year, when he developed symptoms. He died on April 9, 2020.

Nikita Rahman, Reza Chowdhury’s daughter:

My therapist says grief is the final act of love. Every time I miss him, I think about how that is my love for him, showing up again. I like that framing of it. I think I only recently realized just how much I loved him.

He was so beloved by the community for just being a general practitioner who did his job really well and cared and was honest. He was so present and could find life and enjoyment in the little things, like taking a walk. He loved his breakfast, even if it was the same breakfast every day.

In March, I flew home from California to be with my family. I was reading about covid cases spiking in Italy and was freaking out. My mom and I tried to convince my dad, who was immunocompromised, to stay home from work. He said: “No, it’s not a big deal.”

Then in mid- to late March he started to feel sick. At that time, everyone was so worried about hospitals being over capacity that the [guidance] was not to come in unless you’re insanely sick. We eventually took him to the hospital. He was there for about 10 days and then he had a heart attack.

I’ll sometimes visit my dad’s grave by myself and bring tea, because my dad always drank tea, and read letters my friends have written over the past year. He was into growing nice grass, so whenever [my mother, brother and I] go, we bring nice grass to make sure his plot is nicely manicured. He told really good stories. I would do anything for audio recordings of him telling stories. Now I’ve started recording conversations with family members.

When someone dies, the world carries on. You’ll take a walk and you’re so upset, but people around you may be laughing or carrying on with their lives. You want the world to reflect how you feel inside. You want it to rain. Because of the pandemic, everyone’s kind of miserable. Everyone’s at home, having to process a lot. It has been nice, in a way, to be forced to sit down and process it. There’s no running away from confronting your feelings.

Nueva Parazo was a nurse practitioner in Southern California and one of scores of health care workers from the Philippines who have died of covid-19. Her father, Chito Parazo, described her as a skilled and compassionate nurse and doting daughter. She died on Sept. 5, 2020.

Chito Parazo, Nueva Parazo Singian’s father:

It’s true, life has to go on, but it will never be the same. I’m 70 years old. I have maybe 10, 15 years left. Maybe less. Of course, I’m happy I’m still alive, but for me, we’re just going through the motions of living. We lost our 9-year-old son, Xerxes, years ago in an accident and I still cannot accept the fact that he died. My children were the priceless jewels in my life, and I lost both of them.

During the early days of the pandemic, I asked [Nueva] to file a leave of absence. She said, “I cannot just turn my back on these helpless people. This is the job that I chose.”

Her youngest son brought her to the hospital on Aug. 3 because she was complaining about difficulty breathing. She probably suspected that she had contracted the virus. When my wife was admitted to the same hospital in December with covid, the staff remembered Nueva. They said: “We tried to save her, Mr. Parazo, but we couldn’t. Her lungs were so badly damaged.”

I’m so proud of her. She did her best to save people despite all the dangers she faced.

I shaved my head after Nueva died and made a vow to let it grow after the first anniversary of her death. I’ve been taking medication to combat my depression. Despite the fact that I have psoriatic arthritis in both of my knees, a bone spur in my left foot and spinal stenosis, I still go bowling to forget what happened. It’s hard, but I have to be strong for the sake of my three grandkids and my wife.

Jessica Cavazos was a nurse in McAllen, Texas, and the family member everyone turned to for sage advice and a dose of optimism. Cavazos had not seen her son, Jayden Arrington, since 2013. After she died on July 12, 2020, Arrington, 19, reunited with her family.

Jayden Arrington, Jessica Cavazos’ son:

I called her Mamo. There were some family issues that kept me from having more time with her, and that is hard for me to live with. I hadn’t seen her since I was 10. When I was 17, I called her and we spoke for two or three hours, and I assumed after I turned 18 I’d start seeing her again. She passed without having her own son with her.

Some days I can’t function or accept that some people’s expiration dates are not what you want them to be.

I’ve learned that God’s not going to give it to you how you want it. He’s going to give it to you in a way to see how you’re going to bounce back. I’ve grown over the last several months. I’ve learned how to control my feelings, and be more open to what’s given to me in life. And also be more thankful for what I have.

I see things a little differently since [my mom died]. I try to find ways where every day is a good day, where I don’t regret anything or have a negative effect on anyone. I try to keep people around me who I know can help me get through my days.

Sometime this month, I’m hoping to receive an acceptance letter [to a nursing program]. I want to become a registered nurse, just like Mamo.

These conversations have been condensed and edited.

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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They Tested Negative for Covid. Still, They Have Long Covid Symptoms.

Fri, 04/09/2021 - 5:00am

Kristin Novotny once led an active life, with regular CrossFit workouts and football in the front yard with her children — plus a job managing the kitchen at a middle school. Now, the 33-year-old mother of two from De Pere, Wisconsin, has to rest after any activity, even showering. Conversations leave her short of breath.

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Long after their initial coronavirus infections, patients with a malady known as “long covid” continue to struggle with varied symptoms such as fatigue, shortness of breath, gastrointestinal problems, muscle and joint pain, and neurological issues. Novotny has been contending with these and more, despite testing negative for covid-19 seven months ago.

Experts don’t yet know what causes long covid or why some people have persistent symptoms while others recover in weeks or even days. They also don’t know just how long the condition — referred to formally by scientists as Post-Acute Sequelae of SARS-CoV-2 infection, or PASC — lasts.

But the people who didn’t test positive for covid — due either to a lack of access to testing or a false-negative result — face difficulty getting treatment and disability benefits. Their cases are not always included in studies of long covid despite their lingering symptoms. And, sometimes as aggravating, many find that family, friends or even doctors have doubts they contracted covid at all.

Novotny, who first became ill in August, initially returned to work at the beginning of the school year, but her symptoms snowballed and, one day months later, she couldn’t catch her breath at work. She went home and hasn’t been well enough to return.

“It is sad and frustrating being unable to work or play with my kids,” Novotny said via email, adding that it’s devastating to see how worried her family is about her. “My 9-year-old is afraid that if I’m left alone, I will have a medical emergency and no one will be here to help.”

Data about the frequency of false-negative diagnostic covid tests is extremely limited. A study at the Johns Hopkins School of Medicine and Bloomberg School of Public Health, which focused on the time between exposure and testing, found a median false-negative rate of 20% three days after symptoms start. A small study in China conducted early in the pandemic found a high rate of negative tests even among patients sick enough to be hospitalized. And given the dearth of long-hauler research, patients dealing with lingering covid symptoms have organized to study themselves.

The haphazard protocols for testing people in the United States, the delays and difficulties accessing tests and the poor quality of many of the tests left many people without proof they were infected with the virus that causes covid-19.

“It’s great if someone can get a positive test, but many people who have covid simply will never have one, for a variety of different reasons,” said Natalie Lambert, an associate research professor at the Indiana University School of Medicine and director of research for the online covid support group Survivor Corps.

Lambert’s work with computational analytics has found that long haulers face such a wide variety of symptoms that no single symptom is a good screening tool for covid. “If PCR tests are not always accurate or available at the right time and it’s not always easy to diagnose based on someone’s initial symptoms, we really need to have a more flexible, expansive way of diagnosing for covid based on clinical presentations,” she said.

Dr. Bobbi Pritt, chair of the division of clinical microbiology at Mayo Clinic in Minnesota, said four factors affect the accuracy of a diagnostic test: when the patient’s sample is collected, what part of the body it comes from, the technique of the person collecting the sample and the test type.

“But if one of those four things isn’t correct,” said Pritt, “you could still have a false-negative result.”

Timing is one of the most nebulous elements in accurately detecting SARS-CoV-2. The body doesn’t become symptomatic immediately after exposure. It takes time for the virus to multiply and this incubation period tends to last four or five days before symptoms start for most people. “But we’ve known that it can be as many as 14 days,” Pritt said.

Testing during that incubation period — however long it may be — means there may not be enough detectable virus yet.

“Early on after infection, you may not see it because the person doesn’t have enough virus around for you to find,” said Dr. Yuka Manabe, an infectious-disease expert and a professor at the Johns Hopkins University School of Medicine.

Novotny woke up with symptoms on Aug. 14 and got a covid test later that day. Three days later — the same day her test result came back negative — she went to the hospital because of severe shortness of breath and chest pressure.

“The hospital chose not to test me due to test shortages and told me to presume positive,” Novotny wrote, adding that hospital staffers told her she likely tested too early and received a false negative.

As the virus leaves the body, it becomes undetectable, but patients may still have symptoms because their immune responses kicked in. At that point, “you’re seeing more of an inflammatory phase of illness,” Manabe said.

An autoimmune response, in which the body’s defense system attacks its own healthy tissue, may be behind persistent covid symptoms in many patients, though small amounts of virus hiding in organs is another explanation.

Andréa Ceresa is nearing a year of long covid and has an extensive list of symptoms, topped by gastrointestinal and neurological issues. When the 47-year-old from Branchburg, New Jersey, got sick last April, she had trouble getting a covid test. Once she did, her result was negative.

Ceresa has seen so many doctors since then that she can’t keep them straight. She considers herself lucky to have finally found some “fantastic” doctors, but she’s also seen plenty who didn’t believe her or tried to gaslight her — a frequent complaint of long haulers.

A couple of doctors told her they didn’t think her condition had anything to do with covid. One told her it was all in her head. And after a two-month wait to see one neurologist, he didn’t order any tests and simply told her to take vitamin B, leaving her “crying and devastated.”

“I think the negative test absolutely did that,” Ceresa said.

Fortunately, among a growing number of physicians specifically treating patients with long covid, positive test results aren’t vital. In the patient-led research, symptoms patients reported were not significantly different between those who had positive covid tests and those who had negative tests.

Dr. Monica Verduzco-Gutierrez, a rehabilitation and physical medicine doctor who leads University Health’s Post-COVID Recovery program in San Antonio, said about 12% of the patients she’s seen never had a positive covid test.

“The initial test, to me, is not as important as the symptoms,” Gutierrez said. “You have to spend a lot of time with these patients, provide education, provide encouragement and try to work on all the issues that they’re having.”

She said she tells people “what’s done is done” and, regardless of test status, “now we need to treat the outcome.”

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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KHN’s ‘What the Health?’: Health Care as Infrastructure

Thu, 04/08/2021 - 1:15pm

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Health care makes some surprising appearances in President Joe Biden’s $2 trillion infrastructure plan, even though more health proposals are expected in a second proposal later this month. The bill that would help rebuild roads, bridges and broadband capabilities also includes $400 billion to help pay for home and community-based care and boost the wages of those who do that very taxing work. An additional $50 billion is earmarked for replacing water service lines that still contain lead, an ongoing health hazard.

Meanwhile, more than half a million people have signed up for health insurance under the new open enrollment for the Affordable Care Act — and that was before the expanded subsidies passed by Congress in March were incorporated into the federal ACA website, healthcare.gov.

This week’s panelists are Julie Rovner of KHN, Joanne Kenen of Politico, Tami Luhby of CNN and Sarah Karlin-Smith of the Pink Sheet.

Among the takeaways from this week’s podcast:

  • When announcing the new ACA marketplace insurance numbers, federal officials said the enrollment opportunity has been particularly popular with Black residents and lower-income customers.
  • As part of its effort to spur more enrollment, the administration dramatically increased funding for marketing and outreach, including commercials during the NCAA basketball tournament. The Trump administration had cut advertising by 90%.
  • The enrollment bump came even before the new, more generous subsidies were reflected on healthcare.gov, the federal website offering health plans. Biden’s covid relief plan boosted the federal tax credits for people eligible to buy marketplace insurance, especially to middle-income families and those closer to the federal poverty level.
  • In describing Biden’s plan to enhance home and community-based health care, administration officials describe it as a jobs measure because it will help raise wages for people doing the work and help others not have to leave their jobs to care for a loved one.
  • The need for more help caring for older people has often been overlooked because policymakers do not have an easy way to pay for such programs. But as Americans live longer, officials are grappling with the difficult transition from a health system based on acute disease to one that must handle chronic health issues, too.
  • Vaccine credentials are increasingly being required before people can be admitted to public gatherings, but the U.S. does not have a standardized record-keeping system for consumers. When vaccinated, most people get a white card with handwritten details about the date and type of vaccine. Although some health systems and states are keeping records of that, not every facility has an easy way for consumers to get a new record if they lose their card. So, experts are urging them to at least take photos of the card and store that photo electronically.
  • The White House has said it is not in favor of setting up a federal vaccine passport system, and the World Health Organization also said it does not want that now. In the U.S., much of the opposition is being raised by conservatives, who object to federal mandates on issues such as health. But the WHO’s concerns stem from fears raised by groups on the left over vaccine distribution: Because so many doses have gone to First World countries, residents of poorer nations would be disadvantaged by a passport system.

Also this week, Rovner interviews KFF’s Mollyann Brodie, who, in addition to serving as executive vice president and chief operating officer for KFF, leads the organization’s public opinion and survey research activities. Brodie discusses KFF’s COVID-19 Vaccine Monitor, which has been tracking Americans’ feelings and behavior regarding the vaccine.

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

Julie Rovner: The New Yorker’s “Sweden’s Pandemic Experiment,” by Mallory Pickett

Joanne Kenen: Slate.com’s “What the Hell Are You Supposed to Do With Your Vaccine Card?” by Elena Debré

Tami Luhby: KHN’s “Despite Covid, Many Wealthy Hospitals Had a Banner Year With Federal Bailout,” by Jordan Rau and Christine Spolar

Sarah Karlin-Smith: Stat’s “Troubling Podcast Puts JAMA, the ‘Voice of Medicine,’ Under Fire for Its Mishandling of Race,” by Usha Lee McFarling

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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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Calls Mount for Biden to Track US Health Care Worker Deaths from Covid

Thu, 04/08/2021 - 5:00am

Calls are mounting for the Biden administration to set up a national tracking system of covid-19 deaths among front-line health care workers to honor the thousands of nurses, doctors and support staffers who have died and ensure that future generations are not forced to make the same ultimate — and, in many cases, needless — sacrifice.

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

Health policy experts and union leaders are pressing the White House to move quickly to fill the gaping hole left by the Trump administration through its failure to create an accurate count of covid deaths among front-line workers. The absence of reliable federal data exacerbated critical problems such as shortages of personal protective equipment that left many workers exposed, with fatal results.

In the absence of federal action, “Lost on the Frontline,” a joint project between The Guardian and KHN, has compiled the most comprehensive account of health care worker deaths in the nation. It has recorded 3,607 lost lives in the first year of the pandemic, with nurses, health care support staffers and doctors, as well as workers under 60 and people of color, affected in tragically high numbers.

The Guardian/KHN investigation, which involved more than 100 reporters, is drawing to a close this week. Pressure is now growing for the federal government to step into the breach.

Harvey Fineberg, a leading health policy expert who approved a recent National Academy of Sciences report that cited the “Frontline” project and recommended the formation of a national tracking system run by the federal government, backed the calls for change. He said his ideal solution would be a nationwide record.

“There would be a combination of a selective look backward to gain more accurate tabulations of the past burden, and a system of data-gathering looking forward to ensure more complete counts in [the] future,” he said.

Zenei Triunfo-Cortez, a president of National Nurses United, the largest body of registered nurses in the U.S., said it was unconscionable how many health care workers have died of covid-19. The KHN/Guardian interactive found that almost a third of those who died were nurses — the largest single occupation — followed by support staff members (20%) and physicians (17%).

Triunfo-Cortez said the death toll was an unacceptable tragedy aggravated by the lack of federal data, which made identifying problem areas more difficult. “We as nurses do not deserve this — we signed up to take care of patients, we did not sign up to die,” she said.

Dr. Anthony Fauci, the nation’s top expert on infectious diseases, also sees a role for federal agencies in tracking mortality among front-line health care workers. In an interview with The Guardian, he expressed a desire for a definitive picture of the human toll.

“We certainly want to find an accurate count of the people who died,” he said. “That’s something that I think would fall under the auspices of the federal government, likely Health and Human Services.”

The lack of federal intelligence on deaths among front-line health care workers was one of the running failures of the Trump administration’s botched response to the crisis. The main health protection agency, the Centers for Disease Control and Prevention, does curate some information but has itself acknowledged that its own record of 1,527 health worker fatalities — more than 2,000 fewer than the joint Guardian/KHN tally — is an undercount based on limitations in its data collection.

Overall, health care workers were revealed to be singularly at risk from the pandemic. Some studies have shown they were more than three times as likely to contract covid as was the general population.

To date, there is no sign of the Biden administration taking active steps to set up a comprehensive data system. An HHS spokesperson said the department has no plans to launch a comprehensive count. However, Triunfo-Cortez said there is a new willingness on the part of the White House and key federal agencies to listen and engage.

“We have been working with the Biden administration and they have been receptive to the changes we are proposing,” Triunfo-Cortez said. “We are hopeful that they will start to mandate the reporting of deaths, because if we don’t have that data how can we know how effective we are being in stopping the pandemic?”

The responsiveness of the new administration is likely to be heightened by the fact that Biden’s chief of staff, Ron Klain, has a track record in fighting infectious disease outbreaks. In 2014, President Barack Obama appointed him “Ebola tsar.”

In an article in The Guardian last August, Klain drew on the findings of “Lost on the Frontline” to decry the ultimate price paid by health care workers: “Although America has applauded health workers, banged pots in their honor and offered grateful video tributes, we have consistently failed them where it mattered most.”

David Blumenthal, the national coordinator for health information technology under Obama, said a national tracking system is an important step in healing the wounds of the pandemic. “So many health care workers feel as though their devotion and sacrifice weren’t valued,” he said. “We must combat the widespread fatigue and disappointment.”

KHN senior correspondent Christina Jewett contributed to this report.

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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‘Go Ahead and Vote Me Out’: What Other Places Can Learn From Santa Rosa’s Tent City

Thu, 04/08/2021 - 5:00am

SANTA ROSA, Calif. — They knew the neighborhood would revolt.

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It was early May, and officials in this Northern California city known for its farm-to-table dining culture and pumped-up housing prices were frantically debating how to keep covid-19 from infiltrating the homeless camps proliferating in the region’s celebrated parks and trails. For years, the number of people living homeless in Santa Rosa and the verdant hills and valleys of broader Sonoma County had crept downward — and then surged, exacerbated by three punishing wildfire seasons that destroyed thousands of homes in four years.

Seemingly overnight, the city’s homeless crisis had burst into view. And with the onset of covid, it posed a devastating health threat to the hundreds of people living in shelters, tents and makeshift shanties, as well as the service providers and emergency responders trying to help them.

In the preceding weeks, as covid made its first advance through California, Gov. Gavin Newsom had called on cities and counties to persuade hotel operators to open their doors to people living on the streets whose age and health made them vulnerable. But in Santa Rosa, a town that thrives on tourist dollars, city leaders knew they would never find enough owners to volunteer their establishments. City Council member Tom Schwedhelm, then serving as mayor, settled on an idea to pitch dozens of tents in the parking lot of a gleaming community center in an affluent neighborhood known as Finley Park, a couple of miles west of Santa Rosa’s central business district.

Neighborhood residents weren’t keen on the idea of accepting homeless people into their enclave of tree-lined streets and sleepy cul-de-sacs. Yet in short order, thousands of residents and businesses received letters notifying them of the city’s plans to erect 70 tents that could shelter as many as 140 people at the Finley Community Center, a neighborhood jewel that draws scores of families and fitness enthusiasts to its manicured picnic grounds, sparkling pool and tennis courts.

The backlash was fierce. For three hours on a Thursday evening in mid-May, Santa Rosa officials defended their plans as hundreds of residents flooded the phone lines to register their discontent.

“Will there be a list of everybody who decided to do this to us and our park, in case we want to vote them out?” one resident barked.

“This is a family neighborhood,” another fumed.

“How can we feel safe using our park?” others pleaded.

In Santa Rosa, like so many other communities, strenuous neighborhood objections typically would drive a stake through a proposal for homeless housing and services. Not this time. Elected officials were not asking; they were telling. The project would move ahead.

“Go ahead and vote me out,” said Schwedhelm, recounting his mindset at the time. “You want to shout at me and get angry? Go ahead. It’s important for government to listen, but the reality is these are our neighbors, so let’s help them.”

Within days, the spacious parking lot at the Finley Community Center was cordoned off with green mesh fencing. Inside, spaced 12 feet apart, were 68 blue tents, each equipped with sleeping bags and storage bin. A neat row of portable toilets lined one side of the encampment, and it was fitted throughout with hand-washing stations and misters for the summer heat.

The city contracted with Catholic Charities of Santa Rosa to manage the camp, and social workers fanned out to the city shelters and unsanctioned encampments, where they found dozens of takers. The first dozen residents were in their tents four days after the site was approved, and the population quickly swelled to nearly 70. In exchange for shelter, showers and three daily meals, camp residents agreed to an 8 p.m. curfew and a contract pledging to honor mask and physical-distancing requirements and act as good neighbors.

Santa Rosa’s tent city opened May 18. And, not too long after, something remarkable happened. Finley Park residents stopped protesting and started dropping off donations of goods — food, clothing, hand sanitizer. The tennis and pickleball courts, an afternoon favorite for retirees, were bustling again. Parents and kids once more crowded the nearby playground.

And inside that towering green perimeter, people started getting their lives together.

From May to late November, Santa Rosa would spend $680,000 to supply and manage the site, a six-month experiment that would chart a new course for the city’s approach to homeless services. As cities across California wrestle with a crisis of homelessness that has drawn international condemnation, the Santa Rosa experience suggests a way forward. Rather than engage in months of paralyzing discussion with neighborhood opponents before committing to a housing or shelter project, city officials decided their role was to lead and inform. They would identify project sites and drive forward, using neighborhood feedback to tailor improvements to a plan — but not to kill it.

It was a watershed moment of action that would echo across Sonoma County.

“We know we’re pissing off a lot of people — they’re rising up and saying, ‘Hell, no!’” said county Supervisor James Gore, president of the California State Association of Counties. “But we can’t just keep saying no. That’s been the failed housing policy of the last 30 to 40 years. Everybody wants a solution, but they don’t want to see that solution in their neighborhoods.”

‘Death by a Thousand Cuts’

About a quarter of the nation’s homeless reside in California, nearly 160,000 people living in cars, on borrowed couches, in temporary shelters or on the streets. The pandemic has exacerbated the crisis for a host of reasons, including covid-related job loss and prison releases and new capacity limits at homeless shelters.

From Los Angeles to Fresno to San Francisco and Sacramento, homeless encampments have multiplied. And without toilets or trash bins, unsanctioned encampments have become magnets for neighborhood complaints about seedy, unsanitary conditions. That leads to regular law enforcement sweeps that raze an encampment only to see it rise elsewhere.

California’s capital city offers a telling example of the dynamic. An estimated 6,000 people are living homeless in Sacramento, a population that has grown more visible since covid brought office life to a standstill. Tents and tarps crowd freeway underpasses throughout the downtown grid, accompanied by wafting piles of trash and clutter.

The mayor, Darrell Steinberg, is known as a champion on homelessness issues. During his years in the state legislature, he pushed through measures that exponentially increased funding to address homelessness and mental illness. But in more than four years as mayor he has struggled to muscle through a cohesive policy for moving people off the streets and into supportive housing.

“The problem with our approach,” Steinberg said earlier this year, “is that every time we seek to build a project, there is a neighborhood controversy. Our own constituents say, ‘Solve it, but please don’t solve it here,’ and we end up experiencing death by a thousand cuts.”

With community uproar building, he is leading the charge on a new initiative to build a continuum of city-sanctioned housing, including triage shelters, sanctioned campgrounds and permanent housing with social services. The city has allocated up to $1 million in an initial outlay for tiny homes and safe camping, but as of March had gotten consensus on just one site: a parking lot beneath a busy freeway where the city will install toilets and hand-washing stations and allow up to 150 people to set up camp.

Donta Williams, homeless the past five years, shakes his head at how long it’s taken the city to sanction a campsite. Priced out of the South Sacramento neighborhood he considers home, Williams has subsisted in a series of squalid lots, regularly packing up and moving from one to the next in response to law enforcement sweeps.

“We’ve got nowhere to go,” said Williams, 40, who is a plaintiff in a legal battle with the city over encampment sweeps. “We need housing. We need services like bathrooms and hand-washing stations. Or how about just some dumpsters so we can pick up the trash?”

A Real Job, a New Beginning

Like Sacramento, Sonoma County has battled unruly homeless encampments for years. Before the fires, the crisis was more hidden, with people sheltering in creek beds and wooded glens abutting hiking and biking trails. The wildfires of 2017, 2019 and 2020 brought many out of the backcountry. And the 5,300 homes decimated by flames meant even more people displaced.

Politicians in Sonoma County described their soul-searching over how to cut through the community gridlock when it comes to finding locations to provide housing and services.

“It’s fear and anger that you’re going to take something away from me if you build this housing — that’s a big part of it, and I saw that anger directed at me, too,” said Shirlee Zane, a vocal backer of homeless services who lost her reelection bid last year after 12 years on the county board of supervisors. “It’s a psychology we see here too often, a sense of entitlement from white middle-class people.”

In creating the Finley Park model, Santa Rosa leaders drew on a few basic tenets. Neighbors were worried about crime and drug use, so the city deployed police officers and security guards for 24/7 patrols. Neighbors worried about trash and disease; the city brought in hand-washing stations, showers and toilets. Catholic Charities enrolled dozens of camp residents in neighborhood beautification projects, giving them gift cards to stores like Target and Starbucks in exchange for picking up trash — usually $50 for a couple of hours of work.

A few times a week, a mobile clinic serviced the camp, dispensing basic health care and medications. Residents had access to virtual mental health treatment and were screened regularly for covid symptoms; only one person tested positive for the coronavirus during the 256 days the site was in operation.

“We were serious about providing access to care,” said Jennifer Ammons, a nurse practitioner who led the mobile clinic. “You can get them inhalers, take care of their cellulitis with antibiotics, get rid of their pneumonia or skin infections.”

Rosa Newman was among those who turned their lives around. Newman, 56, said she had sunk into homelessness and addiction after leaving an abusive partner years before. She moved into her designated tent in September and in a matter of days was enrolled in California’s version of Medicaid, connected to a doctor and receiving treatment for a painful bladder infection. After two months in the camp, she was able to get into subsidized housing and landed a job at a Catholic Charities homeless drop-in center.

“Before, I was so sick I didn’t have any hope. I didn’t have to show up for anything,” she said. “But now I have a real job, and it’s just the beginning.”

James Carver, 50, who for years slept in the doorway of a downtown Santa Rosa business with his wife, said he felt happy just to have a tent over his head. Channeling his energy into cleanup projects and odd jobs around camp, Carver said, his morale began to improve.

“It’s such a comfort; I’m looking for work again,” Carver, an unemployed construction worker, said in November while cleaning stacks of storage totes handed out to camp residents. “I don’t have to sleep with one eye open.”

Jennielynn Holmes, who runs Catholic Charities’ homeless services in Northern California, said the Finley Park experiment helped in ways she didn’t expect.

“This taught us valuable lessons on how to keep the unsheltered population safe, but also we were able to get people signed up for health care and ready for housing faster because we knew where they were,” Holmes said. Of the 208 people served at the site, she said, 12 were moved into permanent housing and nearly five dozen placed in shelters while they await openings.

When Santa Rosa officials conceived of the Finley site, they sold it to the community as temporary, believing covid would run its course by winter. And though covid still raged, they kept that promise and closed the site Nov. 30, then held a community meeting to get feedback. “Only three or four people called in, and they all had positive things to say,” said David Gouin, who has since retired as director of housing and community services.

Several area residents said they changed their mind about the project because of the way the site was managed.

“I was amazed I never saw anything negative at all,” said Boyd Edwards, who plays pickleball at the Finley Community Center a few times a week.

“I thought they were going to be noisy and have crap all over the place. Now, they can have it all year round for all I care,” said his friend Joseph Gernhardt.

Of the 108 calls for police service, almost all were in response to other homeless people wanting to sleep at the site when it was at capacity, records show. And there was no violent behavior, said Police Chief Rainer Navarro.

With the Finley encampment closed, Santa Rosa has expanded its primary shelter while drafting plans to set up year-round managed camps in several neighborhoods, this time with hardened structures. County supervisors, meanwhile, are using $16 million in state grants to purchase and convert two hotels into housing, and have stood their ground in pushing through two Finley Park-style managed encampments, one on county property, the other at a mountain retreat center.

The time has come, they said, to stop debating and embrace solutions.

“We have estates that sell for $20 million, and then you walk by people sleeping in tents with no access to hot food or running water,” said Lynda Hopkins, chair of the county board of supervisors. “These tiny villages — they’re not perfect, but we’re trying to provide some dignity.”

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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12 Months of Trauma: More Than 3,600 US Health Workers Died in Covid’s First Year

Thu, 04/08/2021 - 5:00am

More than 3,600 U.S. health care workers perished in the first year of the pandemic, according to “Lost on the Frontline,” a 12-month investigation by The Guardian and KHN to track such deaths.

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

Lost on the Frontline is the most complete accounting of U.S. health care worker deaths. The federal government has not comprehensively tracked this data. But calls are mounting for the Biden administration to undertake a count as the KHN/Guardian project comes to a close today.

The project, which tracked who died and why, provides a window into the workings — and failings — of the U.S. health system during the covid-19 pandemic. One key finding: Two-thirds of deceased health care workers for whom the project has data identified as people of color, revealing the deep inequities tied to race, ethnicity and economic status in America’s health care workforce. Lower-paid workers who handled everyday patient care, including nurses, support staff and nursing home employees, were far more likely to die in the pandemic than physicians were.

The yearlong series of investigative reports found that many of these deaths could have been prevented. Widespread shortages of masks and other personal protective gear, a lack of covid testing, weak contact tracing, inconsistent mask guidance by politicians, missteps by employers and lax enforcement of workplace safety rules by government regulators all contributed to the increased risk faced by health care workers. Studies show that health care workers were more than three times as likely to contract covid as the general public.

“We rightfully refer to these people without hyperbole — that they are true heroes and heroines,” said Dr. Anthony Fauci in an exclusive interview with The Guardian and KHN. The covid deaths of so many are “a reflection of what health care workers have done historically, by putting themselves in harm’s way, by living up to the oath they take when they become physicians and nurses,” he said.

Lost on the Frontline launched last April with the story of Frank Gabrin, the first known American emergency room doctor to die of covid-19. In the early days of the pandemic, Gabrin, 60, was on the front lines of the surge, treating covid patients in New York and New Jersey. Yet, like so many others, he was working without proper personal protective equipment, known as PPE. “Don’t have any PPE that has not been used,” he texted a friend. “No N95 masks — my own goggles — my own face shield.”

Gabrin’s untimely death was the first fatality entered into the Lost on the Frontline database. His story of working through a crisis to save lives shared similarities with the thousands that followed.

Maritza Beniquez, an emergency room nurse at Newark’s University Hospital in New Jersey, watched 11 colleagues die in the early months of the pandemic. Like the patients they had been treating, most were Black and Latino. “It literally decimated our staff,” she said.

Her hospital has placed 11 trees in the lobby, one for each employee who has died of covid; they have been adorned with remembrances and gifts from their colleagues.

More than 100 journalists contributed to the project in an effort to record every death and memorialize those who died. The project’s journalists filed public records requests, cross-connected governmental and private data sources, scoured obituaries and social media posts, and confirmed deaths through family members, workplaces and colleagues.

Among its key findings:

  • More than half of those who died were younger than 60. In the general population, the median age of death from covid is 78. Yet among health care workers in the database, it is only 59.
  • More than a third of the health care workers who died were born outside the United States. Those from the Philippines accounted for a disproportionate number of deaths.
  • Nurses and support staff members died in far higher numbers than physicians.
  • Twice as many workers died in nursing homes as in hospitals. Only 30% of deaths were among hospital workers, and relatively few were employed by well-funded academic medical centers. The rest worked in less prestigious residential facilities, outpatient clinics, hospices and prisons, among other places.

The death rate among health care workers has slowed dramatically since covid vaccines were made available to them in December. A study published in late March found that only four of 8,121 fully vaccinated employees at the University of Texas Southwestern Medical Center in Dallas became infected. But deaths lag behind infections, and KHN and The Guardian have tracked more than 400 health care worker deaths since the vaccine rollout began.

Many factors contributed to the high toll — but investigative reporting uncovered some consistent problems that heightened the risks faced by health workers.

The project found that Centers for Disease Control and Prevention guidance on masks — which encouraged hospitals to reserve high-performance N95 masks for intubation procedures and initially suggested surgical masks were adequate for everyday patient care — may have put thousands of health workers at risk.

The investigation exposed how the Labor Department, run by Donald Trump appointee Eugene Scalia in the early part of the pandemic, took a hands-off approach to workplace safety. It identified 4,100 safety complaints filed by health care workers to the Occupational Safety and Health Administration, the Labor Department’s workplace safety agency. Most were about PPE shortages, yet even after some complaints were investigated and closed by regulators, workers continued to die at the facilities in question.

The reporting also found that health care employers were failing to report worker deaths to OSHA. The data analysis found that more than a third of workplace covid deaths were not reported to regulators.

Among the most visceral findings of Lost on the Frontline was the devastating impact of PPE shortages.

Adeline Fagan, a 28-year-old OB-GYN resident in Texas, suffered from asthma and had a long history of respiratory ailments. Months into the pandemic, her family said, she was using the same N95 mask over and over, even during a high-risk rotation in the emergency room.

Her parents blame both the hospital administration and government missteps for the PPE shortages that may have contributed to Adeline’s death in September. Her mother, Mary Jane Abt-Fagan, said Adeline’s N95 had been reused so many times the fibers were beginning to disintegrate.

Not long before she fell ill — and after she’d been assigned to a high-risk ER rotation — Adeline talked to her parents about whether she should spend her own money on an expensive N95 with a filter that could be changed daily. The $79 mask was a significant expense on her $52,000 resident’s salary.

“We said, you buy this mask, you buy the filters, your father and I will pay for it. We didn’t care what it cost,” said Abt-Fagan.

She never had the opportunity to use it. By the time the mask arrived, Adeline was already on a ventilator in the hospital.

Adeline’s family feels let down by the U.S. government’s response to the pandemic.

“Nobody chooses to go to work and die,” said Abt-Fagan. “We need to be more prepared, and the government needs to be more responsible in terms of keeping health care workers safe.”

Adeline’s father, Brant Fagan, wants the government to begin tracking health care worker deaths and examining the data to understand what went wrong. “That’s how we’re going to prevent this in the future,” he said. “Know the data, follow where the science leads.”

Adeline’s parents said her death has been particularly painful because of her youth — and all the life milestones she never had the chance to experience. “Falling in love, buying a home, sharing your family and your life with your siblings,” said Mary Jane Abt-Fagan. “It’s all those things she missed that break a parent’s heart.”

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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This story can be republished for free (details).

Categories: National News Content