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California and Texas Took Different Routes to Vaccination. Who’s Ahead?

Kaiser Health News - 8 hours 29 min ago

California and Texas, the country’s two most populous states, have taken radically different approaches to the pandemic and the vaccination campaign to end it.

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California has trumpeted its reliance on science and policies it says are aimed at improving social equity.

Texas state officials have emphasized individual rights and protecting the economy, often ignoring public health warnings but encouraging vaccination — while calling it a personal choice.

Yet California’s commitment to equity doesn’t appear to have put the state ahead of Texas in vaccinating Latinos, who make up roughly 40% of the population in both states. Latinos have suffered disproportionately from covid because the poorest tend to live in crowded housing, get less quality health care and have been more likely to work outside the home.

In California, 22% of Hispanics had been vaccinated as of April 12; in Texas, 21%.

Texas, in general, has done much better than California at reaching highly vulnerable groups during the first months of vaccine distribution, according to a recent analysis by the Centers for Disease Control and Prevention. Texas was seventh on the list; California was fifth from last.

Overall, however, California’s pandemic metrics have been better. As it opened vaccine eligibility to all ages on April 15, 49% of Californians 16 and older were either partially or fully vaccinated, compared with 43% of Texans.

The two states were neck and neck until a harsh winter storm in February knocked out power for a week in much of Texas. “We never really recovered after that, and exactly why, beyond our size, is not entirely clear,” said Dr. Peter Hotez, dean for the National School of Tropical Medicine at Baylor College of Medicine.

California is also doing much better when it comes to driving down infections. The state’s seven-day average is 52.7 cases and 1.8 deaths per 100,000 as of April 15, with a seven-day average positivity rate of 1.5%. Texas, meanwhile, is at 73.3 cases and 1.5 deaths per 100,000, with a seven-day average positivity rate of 7%.

The states’ leaders have reacted differently to those metrics. California Gov. Gavin Newsom has set June 15 as the day to end most pandemic restrictions, barring major setbacks, but he plans to continue to require mask-wearing in public and in high-risk workplaces. Meanwhile, Texas Gov. Greg Abbott on March 10 allowed all businesses to fully reopen and lifted a statewide mask mandate.

The concept of individual freedom plays well in Texas politics and has been front and center throughout the pandemic and the vaccine rollout. While encouraging Texans to protect themselves against the spread of the coronavirus, state officials at the same time have fought local authorities’ efforts to enforce such measures.

While Newsom instituted one of the earliest and strictest state lockdowns in the country on March 19, Texas Attorney General Ken Paxton initially called local mask mandates and business restrictions “unlawful and unenforceable.” Abbott finally instituted a mask mandate and other restrictions in July after a surge of the disease. Those measures met opposition within his own party, with Texas Republican Chair Allen West leading a protest outside the governor’s mansion in October.

Against this tense political backdrop, Texas state leaders have been softer in their vaccination messaging compared with California. Both governors received their vaccinations on live TV, but each has offered different messaging about how their constituents should view the shots.

In an April 8 tweet, Abbott celebrated the state’s reaching 13 million vaccinations, adding, “These vaccine shots are always voluntary.” That soft-pedaled message also comes through in Abbott’s stance on masks. Despite lifting the order in early March, the governor still urges residents to use them.

Public health experts in Texas have been frustrated by what they see as a half-hearted endorsement of public health measures. “It’s psychotic to have to listen to two very different messages,” said Dr. Andrea Caracostis, CEO of the HOPE Clinic in Houston, which serves minorities and immigrants. “Vaccines were not made just for your individual protection. They were made for community benefit. It is a message that has been lost in our society.”

Newsom, on the other hand, talks about vaccines in terms of responsibility to others. “Getting vaccinated is a vital step we can take to protect ourselves, our loved ones and our community, and brings us that much closer to ending this pandemic,” Newsom said on April 1, when he received his vaccination.

Newsom’s oft-repeated “north star” value is equity — the notion that the well-being of those hurt most by the pandemic should be essential to the battle against it. Starting March 4, his administration allocated 40% of its vaccines to neighborhoods that have seen 40% of covid cases and deaths. California has also invested $52.7 million to fund more than 300 “trusted messenger” community organizations to do outreach on vaccines. He didn’t make the general public eligible for vaccination until April 15 in order to prioritize more vulnerable and at-risk groups. Texas, meanwhile, fully opened the vaccine spigot on March 29.

California’s struggles to vaccinate racial and ethnic minorities and the most vulnerable, despite intense public health investment and attention to these communities, raises questions about the state’s vaccine eligibility decisions, said Elizabeth Wrigley-Field, assistant professor of sociology at the University of Minnesota.

Both Texas and California, like many states, first vaccinated health care workers and long-term care residents, populations that are majority white. But in Texas, people with underlying medical conditions — like Type 2 diabetes, sickle cell disease or obesity — also became eligible for a shot Dec. 29.

In California, people with underlying medical conditions weren’t added to the eligibility list until mid-March, and the list of underlying conditions was much more stringent than Texas’ guidelines.

“That gap between January and mid-March, that’s kind of the story to me,” Wrigley-Field said.

California officials decided Jan. 13 to prioritize people over 65. Many over-65 whites were at substantially lower risk than younger people of color, said Wrigley-Field, who argues that that age-based eligibility benefited older, white populations at the expense of younger people of color who were more at risk of covid hospitalization and death.

Prioritizing those over 65 immediately put Hispanics at a 2-to-1 disadvantage to whites, concluded Thomas Selden, based on research conducted with co-authors at the Agency for Healthcare Research and Quality (their conclusions don’t necessarily represent AHRQ or HHS). Priority tiers for those with certain diseases and essential workers would have benefited the poor and Hispanics, respectively, and pushing them down the list “could be one of the factors why we’re seeing lower rates for these groups,” he said.

Hispanics ages 20-54 in California were 8.5 times more likely to die of covid than whites of the same age from March to July, according to a University of Southern California study.

In mid-February, first responders and workers in education, food and agriculture became eligible for vaccination in California. County health departments were permitted to set their own schedules, however, and in Los Angeles these essential workers weren’t eligible until March 1 due to limited vaccine supply.

In effect, from December until March there was no eligibility tier that prioritized groups that were predominantly Latino or Black in the state’s largest county and the epicenter of the state’s covid cases and deaths.

The state’s approach harmed efforts to reach out to Latinos, some county health departments say. In Kern County, Latinos make up 53% of the population and 57% of covid cases, but got only 36% of the vaccines administered as of April 15. Confusion over the essential-worker eligibility tiers caused many to think it wasn’t their “turn,” said Brynn Carrigan, the county public health director.

Dr. Tomás Aragón, state public health officer and director of the California Department of Public Health, defended the state’s initial age-based approach and said it was a strategy to make sure Latinos were prioritized. He noted that, while Latinos accounted for 48% of the state’s covid deaths, the majority of those deaths occurred in people over 65.

“We are in a significantly better place today than many states, not just because our vaccine strategy saved lives and kept people out of hospitals, but also because we focused on proven public health interventions, such as masking, distancing, hand washing and tracing,” Aragón said in an emailed statement.

Vaccine hesitancy among racial and ethnic minorities has faded as educational outreach has ramped up, access has improved, and more people see friends and neighbors safely get the shot. Vaccine hesitancy instead appears high among Republicans, particularly white evangelicals, according to several polls.

But confidence in vaccines is growing even among Republicans, according to a poll recently conducted by Frank Luntz and released by the de Beaumont Foundation. It showed that 38% of Trump voters and 48% of Biden voters were more likely to get vaccinated than they were in March.

While some experts said consistent messaging from politicians would be helpful, time and experience watching friends and family safely receive vaccinations as well as communication with trusted individuals — particularly personal doctors — is the most effective way to overcome lingering concerns about the shots.

“What’s going to change that is getting vaccine more readily available to primary care providers … who they trust and get their questions answered, because I think they are vaccine-hesitant versus anti-vaccination,” said Dr. David Lakey, chief medical officer at the University of Texas System.

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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Doctors Scramble to Understand Long Covid, but Causes and Prognosis Are Elusive

Kaiser Health News - 8 hours 29 min ago

One night in March 2020, Joy Wu felt like her heart was going to explode. She tried to get up and fell down. She didn’t recognize friends’ names in her list of phone contacts. Remembering how to dial 9-1-1 took “quite a bit of time,” she recalled recently.

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Wu, 38, didn’t have a fever, cough or sore throat — the symptoms most associated with covid-19 at the time — so doctors at the hospital told her she was having a panic attack. But later she developed those symptoms, along with difficulty breathing, fatigue and neurological issues.

Wu, of San Carlos, California, believes she had covid — although, like many others who were unable to get tested early in the pandemic, she never got an official diagnosis. And, she said, its aftereffects continue to plague her.

Wu has struggled to get help from doctors, even those who take her symptoms seriously. “There’s no actual treatment,” she said, for people experiencing these lasting symptoms, often referred to as long covid. When seeking help, “you’re basically a guinea pig at this point.”

For people suffering with lingering, debilitating symptoms months after a bout with covid, pinning down a definition for long covid may seem pointless. They just want relief.

“I don’t care if it’s covid or some other illness,” Wu said. “I want to get better.”

But to public health experts, medical researchers and health care providers, understanding the causes, risk factors and spectrum of symptoms is vital.

“There’s no single sign or lab test that can distinguish this syndrome from something else,” said Dr. John Brooks, chief medical officer for the Centers for Disease Control and Prevention’s covid response. “Having something that we can use to define a [long-covid] case is critical” for tracking how many people get it and how well they do, and to establish research criteria for clinical trials.

It’s no easy task. There is no typical covid “long hauler.” After an infection, some people’s initial symptoms don’t abate, while other people develop entirely new symptoms that may affect multiple organs and systems. Studies have documented hundreds of lingering problems, but intense fatigue; chest pain; memory and concentration problems, often referred to as “brain fog”; shortness of breath; and a loss of taste and smell are common.

Having been hospitalized or placed on a ventilator isn’t a reliable sign that someone will develop the condition. Many young, previously healthy people who had a mild initial infection are battling long covid. Some people’s symptoms drag on for months after their acute infection, while others’ symptoms ebb and flow on a “corona coaster” of relapse and recovery.

In February, the National Institutes of Health announced a $1.15 billion, four-year initiative to study the causes and prevention of long covid. The new research will bolster the growing number of studies that have already been published.

Younger and Sicker

A year ago, when the novel coronavirus was surging through New York, Mount Sinai Health System created an app to monitor covid patients at home, said David Putrino, the system’s director of rehabilitation innovation. By early May it was apparent that roughly 10% of these non-hospitalized patients weren’t getting better, he said. Many were younger and, until they got sick, healthier than the average covid patient. And they were struggling with new symptoms they hadn’t experienced in their original illness, such as heart palpitations and extreme fatigue.

An interdisciplinary team started to see these patients at what later became the Center for Post-Covid Care. Up to 30% of the patients have persistent symptoms that are a continuation of those they experienced when they were acutely ill, Putrino said. The other 70% tend to have novel symptoms that are specific to long covid.

Mount Sinai’s clinic, which manages the care of about 900 long covid patients, is one of several dozen across the country devoted to covid recovery, though the parameters for which patients they treat vary. Many involve multiple medical specialties, while others are dedicated to neurological or pulmonary symptoms or the aftereffects of ICU stays. Some require the patient to have a positive diagnostic or antibody test.

Putrino noted that some symptoms that covid long haulers complain of are similar to those that affect people with “post-viral syndrome” who are recovering from serious infections like Ebola and Zika.

Such viral infections can cause severe inflammation and residual symptoms that last for months or years, said Dr. Steven Deeks, a professor of medicine at the University of California-San Francisco who is tracking people with long-covid symptoms.

Other researchers have suggested that long covid may actually encompass a number of separate syndromes, including post-intensive care syndrome, post-traumatic stress disorder or myalgic encephalomyelitis, sometimes called chronic fatigue syndrome. Still others note that some long covid symptoms look like dysautonomia, a term for disorders of the autonomous nervous system, which regulates breathing and heart rate, among other things.

Whatever “long covid” ultimately comes to mean, it continues to surprise medical experts. If someone has a serious bout of pneumonia, an infection that inflames the air sacs in the lungs, it’s not surprising if they have a bad cough for a few months as their body slowly heals, said Brooks, of the CDC.

But with a covid infection, sometimes that cough doesn’t go away for many months, and along with it someone might have brain fog. Another might develop encephalitis, a swelling of the brain.

“This is not a cluster [of symptoms] that we see after a typical viral respiratory infection,” Brooks said.

A Push by Patients

There are several working theories about what causes long covid.

Some studies suggest that the virus or remnants of it may lurk in the body and continue to stimulate the immune system. Or the virus may have been cleared, but “the immune system keeps fighting against a perceived enemy, because it hasn’t gotten the word that the war is over,” said Dr. Michael Saag, a professor of medicine and infectious diseases at the University of Alabama-Birmingham who participated in a two-day workshop sponsored by NIH in December. Or tissues may have been damaged during the initial immune response, causing long-term symptoms.

Despite the imprimatur of respected researchers and public health experts, skeptics remain. Some doctors complain that the diagnosis is being propelled by interest groups rather than science. Others compare it to other chronic conditions, like fibromyalgia, for which there are no definitive diagnostic tests. Some suggest it is a psychosomatic illness.

Patients and their advocates played a crucial role in drawing attention to and gaining acceptance of long covid.

After contracting covid in March 2020, Diana Berrent started Survivor Corps as a Facebook support group; it has grown into a broader advocacy organization for covid patients, with more than 150,000 members.

“Most of the people who we see suffering from long-term covid were not the ones who were in the hospital and on ventilators,” Berrent said. “These are people who mostly had what I had — what I call the ‘Tylenol and Gatorade’ variety of covid,” which they coped with at home.

Much like patients with myalgic encephalomyelitis/chronic fatigue syndrome, people with long covid say finding supportive medical providers is a problem, said Emily Taylor, director of advocacy and community relations at the group Solve M.E. It recently co-founded the Long Covid Alliance with 21 other organizations to draw attention to post-viral illnesses.

Long covid presents an opportunity to find answers not only for long covid but also for a range of conditions that have struggled for research dollars and support.

“The post-viral research community is all coming together now to address covid,” Taylor said. “Frankly, there’s no other option.”

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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After Accident, Patient Crashes Into $700,000 Bill for Spine Surgery

Kaiser Health News - 8 hours 29 min ago

Mark Gottlieb’s life changed in an instant when another driver crashed into his car, damaging four vertebrae in his upper spine and smashing six teeth.

In the months following that January 2019 crash, Gottlieb got the teeth crowned and, for debilitating neck pain, tried injections, chiropractic care and physical therapy. The treatments were all covered by his car insurance.

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New Jersey law, as in 12 other states, requires drivers to buy personal injury protection, or PIP, coverage to pay medical expenses. Gottlieb had the maximum: $250,000.

Unfortunately, Gottlieb’s pain persisted. “Nothing was working. The only other thing was surgery,” he said.

Though he wanted his operation performed near his home, Gottlieb said, staff members at the Bergen Pain Management clinic, where he was receiving care, insisted he go to Hudson Regional Hospital in Secaucus. On April 3, 2020, Gottlieb underwent a complex type of fusion surgery on the herniated discs in his cervical spine. He went home the same day.

His pain improved a bit. Then the bills came.

The Patient: Mark Gottlieb, 59, a marketing consultant in Little Ferry, New Jersey, covered for $250,000 in medical costs by his Geico car insurance. He also has an Aetna health insurance policy, which is secondary.

Medical Service: Anterior cervical discectomy and fusion, a type of neck surgery to replace damaged discs with bone grafts or implants to stabilize the spine.

Service Provider: Hudson Regional Hospital, a stand-alone, for-profit facility in Secaucus, New Jersey, and Bergen Pain Management in Paramus, New Jersey.

Total Bill: Taken together, the hospital and surgeon billed Gottlieb more than $700,000. The hospital billed $445,995 for the surgery, an amount reduced by Geico to $103,778. Bergen Pain Management billed an additional $264,444 for the main surgeon. Based on a review, Geico reduced that to $141,548. It paid $52,365 toward that before Gottlieb’s medical coverage in his auto policy was exhausted. Then it was up to his health insurer or Gottlieb to deal with the rest.

What Gives: When injuries are the result of auto accidents, car insurance is primarily responsible to negotiate and pay the insurance portion of medical bills. That creates a host of financial landmines for patients.

Gottlieb hit all of them.

With the high charges common in the U.S. for treatment, accident victims can easily exhaust the policy limits of even generous personal injury coverage, leaving some vulnerable to huge bills.

Although it’s rare to hear car insurers complain that they paid a hospital or doctor too much, auto insurers “typically pay more for some of the same services” than health insurers, said Robert Passmore, a vice president at the American Property Casualty Insurance Association, a trade group.

That’s in part because auto insurers generally don’t have broad networks of medical providers who have agreed to negotiated discounts off their billed charges, as do health insurers. So patients end up “out of network,” subject to whatever list price the provider charges.

Gottlieb said he checked with Geico before his surgery but was told it had no information for him about networks. With about $190,000 remaining in his PIP fund at the time, he was not too worried. He said efforts to get cost estimates were unsuccessful.

Instead of network rates, car insurers generally use other payment calculations. Some states set specific payments on fee schedules. But not every medical billing code is listed and, in those cases, they sometimes pay whatever the provider bills.

In this case, that was a lot: Gottlieb’s hospital and surgeon’s charges, even after being reduced by Geico, were about eight times as high as what Medicare would have paid.

While Geico generally pays rates set by the state (which are dramatically lower than what was charged), Gottlieb’s bill included a bunch of billing codes not on the state schedule. For most, the insurer paid exactly what was charged. For example, Geico allowed the full price of $65,125 charged by the surgeon for the removal of a damaged disc and paid the hospital $39,195 for nine surgical screws.

By September — with bills from his various providers still rolling in — Gottlieb’s PIP fund ran out after the remaining $52,365 was paid to Bergen Pain Management, short of the $141,548 Geico had recommended as reimbursement for the surgeon.

Insurance pays bills as they are submitted, which is often not in the order in which the treatment was rendered.

“It appears that Bergen Pain Management is still entitled to the $89,183 balance of the billing from your procedure,” Geico wrote in a September letter to Gottlieb, which added that he could submit that balance to his health insurer or pay it himself.

When he submitted the surgeon’s bill to Aetna, he discovered neither the doctor nor hospital was in his insurance network. He had not checked before the operation since he never dreamed that outpatient surgery would exhaust the auto policy.

That means Aetna did not have a negotiated rate with his providers, which might have knocked the charges down dramatically.

Instead, Aetna said it would allow an out-of-network payment of $4,051 for the surgeon, according to a Jan. 28 email to Gottlieb. In a written statement to KHN, Aetna spokesperson Ethan Slavin said that amount was based on Gottlieb’s policy terms, which set physician payments about 10% above Medicare rates for out-of-network care.

Because he had not yet met his annual out-of-network deductible, Gottlieb himself would have to pay the $4,051. He withdrew his request for Aetna to pay. Because out-of-network surgeons frequently go after patients to pay the balance of such bills, Gottlieb is waiting to see if Bergen Pain Management — which has already been paid $52,365 for the surgery — will come after him for more.

Neither the Bergen clinic nor the surgeon has sent him to collections or sued for the amount. Neither responded to multiple emails and phone calls placed by KHN seeking comment.

In a written statement, Hudson Regional spokesperson Ron Simoncini said the hospital “charged the state-mandated fee” where applicable, and where there was no such mandate, “the charges were reasonable.” It is not seeking additional payment.

Citing policyholder privacy, Geico declined to answer KHN’s questions, including how it determines what it will pay.

Did the auto insurer pay too much?

Geico had set an allowable reimbursement of $141,548 as the surgeon’s fee.

“That is an outrageously high surgeon’s fee for this type of surgery,” said Dr. Eeric Truumees, a professor at Dell Medical School at the University of Texas-Austin.

“I do a tremendous amount of complex cervical spine surgery and never had a fee that high even for complex surgery that takes 10 hours,” said Truumees, president of the North American Spine Society. He had no direct knowledge of Gottlieb’s case.

Altogether, Geico recommended and partly paid $245,326 to the hospital and surgeon for the procedure.

In contrast, Medicare would have paid about $29,500 for the entire procedure, with about $1,800 of that going to the surgeon and the rest to the hospital, according to researchers at Rand Corp. who analyzed Gottlieb’s bills at KHN and NPR’s request.

The surgeon’s bill was also high compared with what private insurance usually pays, according to Barry Silver of Healthcare Horizons Consulting Group in Knoxville, Tennessee. Silver compared Gottlieb’s bills with hundreds of similar claims from two carriers that administer employer-based health insurance nationwide. The total Geico paid the hospital was in line with what employers paid and was actually less than the two highest fees seen in his data. But the highest allowed charge in Silver’s database for the surgeon’s fee was $87,549, far less than the $141,458 Geico recommended.

Resolution: Gottlieb remains in the dark about whether Bergen Pain Management will seek the remaining $89,000 toward his bill.

Previously, Gottlieb sued the driver who caused the accident — and won a substantial “pain and suffering” court settlement. He wants to preserve it for future medical needs.

He has filed numerous complaints about his bills with state regulators, lawmakers and his insurers. Aetna sent his surgeon’s bill to its internal Special Investigations Unit following his complaint.

But, “based on our investigation, we determined there was no further need for action,” spokesperson Slavin said.

The Takeaway: Most people are unaware that auto insurance kicks in first after an accident and that it works very differently from health insurance — so you have to pay attention to how the policies coordinate.

That’s especially true if the accident requires major treatment.

If you have a low amount of personal injury coverage in your car policy, your medical bills may well kick over to your health policy. So when you sign up for nonemergency treatment — especially if it’s extensive, like surgery — it’s important to make sure the providers are in your health insurer’s network.

Some auto insurers have networks. Ask whether yours does.

Try to get cost estimates in writing for nonemergency care and compare that with what you have left in your auto policy coverage.

“If it’s more than you have left, it may be possible to negotiate with the hospital or doctor to reduce their charges,” said Silver at Healthcare Horizons.

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

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

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Mass. Eye And Ear Agrees To Pay $2.7M To Resolve Fraud Complaint

CommonHealth (WBUR) - Wed, 04/21/2021 - 8:11am

Prosecutors say Massachusetts Eye and Ear improperly billed government health care programs for certain office visits, defrauding the country of more than a million dollars.

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Strides Against HIV/AIDS Falter, Especially in the South, as Nation Battles Covid

Kaiser Health News - Wed, 04/21/2021 - 5:00am

Facing a yearlong siege from the coronavirus, the defenses in another, older war are faltering.

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For the last two decades, HIV/AIDS has been held at bay by potent antiviral drugs, aggressive testing and inventive public education campaigns. But the COVID-19 pandemic has caused profound disruptions in almost every aspect of that battle, grounding outreach teams, sharply curtailing testing and diverting critical staff away from laboratories and medical centers.

The exact impact of one pandemic on the other is still coming into focus, but preliminary evidence is disturbing experts who have celebrated the enormous strides in HIV treatment. While the shift in priorities is nationwide, delays in testing and treatment carry particularly grievous risks in Southern states, now the epicenter of the nation’s HIV crisis.

“This is a major derailing,” said Dr. Carlos del Rio, a professor of medicine at Emory University in Atlanta and head of the Emory AIDS International Training and Research Program. “There will be damage. The question is, how much?”

Clinics have limited in-person visits and halted routine HIV screening in doctors’ offices and emergency rooms, with physicians relying instead on video calls with patients, a futile alternative for those who are homeless or fear family members will discover their status. Rapid-testing vans that once parked outside nightclubs and bars and handed out condoms are mothballed. And, in state capitals and county seats, government expertise has been singly focused on the all-hands-on-deck COVID response.

Concrete signs of the impact on HIV surveillance abound: One large commercial lab reported nearly 700,000 fewer HIV screening tests across the country — a 45% drop — and 5,000 fewer diagnoses between March and September 2020, compared with the same period the year before. Prescriptions of PrEP, a preexposure prophylaxis that can prevent HIV infection, have also fallen sharply, according to new research presented at a conference last month. State public health departments have recorded similarly steep declines in testing.

That dearth in new data has led to a precarious, unknowable moment: For the first time in decades, the nation’s lauded HIV surveillance system is blind to the virus’s movement.

Nowhere will the lack of data be felt more profoundly than in the South: The region accounts for 51% of all new infections, eight of the 10 states with the highest rates of new diagnoses, and half of all HIV-related deaths, according to the most recent data available from the Centers for Disease Control and Prevention.

Even before the COVID pandemic, Georgia had the highest rate of new HIV diagnoses of any state, though lower than that of Washington, D.C. The Georgia Department of Public Health recorded a 70% drop in testing last spring compared with spring 2019.

The slowdown in HIV patient services “could be felt for years,” said Dr. Melanie Thompson, principal investigator of the AIDS Research Consortium of Atlanta.

She added, “Every new HIV infection perpetuates the epidemic and will likely be passed to one or more people in the months to come if people are not diagnosed and offered HIV treatment.”

Coronavirus testing has commandeered the machines previously used for HIV/AIDS testing, further straining surveillance efforts. The polymerase chain reaction — or PCR — machines used to detect and measure the genetic material in the human immunodeficiency virus are the same machines that run COVID tests around-the-clock.

Over the decades, as HIV migrated inland from coastal cities like San Francisco, Los Angeles and New York, it took root in the South, where poverty is endemic, lack of health coverage is commonplace, and HIV stigma is pervasive.

“There is the stigma that’s real. There is legacy racism,” said Dr. Thomas Giordano, medical director of Thomas Street Health Center in Houston, one of the largest HIV clinics in the U.S. The state’s political leaders, he said, view HIV as “a disease of the poor, of Blacks, Latinos and gay. It’s just not mainstream at the state level.”

Black people represent 13% of the U.S. population but about 40% of HIV cases — and deaths. In many Southern states, the disparities are stark: In Alabama, Black residents account for 27% of the population and 70% of new diagnoses; in Georgia, Black people make up 33% of residents and 69% of people with HIV.

HIV clinics that serve low-income patients also face limitations using video and phone appointments. Clinic directors say poor patients often lack data plans and many homeless patients simply don’t have phones. They also must contend with fear. “If a friend gave you a room to sleep and your friend finds out you have HIV, you might lose that place to sleep,” said del Rio of Emory University.

Texting can be tricky, too. “We have to be cautious about text messages,” said Dr. John Carlo, chief executive officer of PRISM Health Care North Texas in Dallas. “If someone sees their phone, it can be devastating.”

In Mississippi, HIV contact tracing — which was used as a model for some local efforts to track the coronavirus — has been limited by COVID-related travel restrictions meant “to protect both staff and client,” said Melverta Bender, director of the STD/HIV office at the Mississippi State Department of Health.

Of all regions in the U.S., the South has the weakest health safety nets. And Southern states have far fewer resources than states like California and New York. “Our public health infrastructures have been chronically underfunded and undermined over the decades,” said Thompson, the Atlanta researcher. “So we stand to do worse by many metrics.”

Georgia’s high HIV infection rate and the state’s slow pace of COVID vaccinations “are not unrelated,” Thompson said.

The porous safety net extends to health insurance, a vital need for those living with HIV. Nearly half of Americans without health coverage live in the South, where many states have not expanded Medicaid under the Affordable Care Act. That leaves many people with HIV to rely on the federal Ryan White HIV/AIDS Program and state-run AIDS drug assistance programs, known as ADAPs, which offer limited coverage.

“As a matter of equity, insurance is critical for people to live and thrive with HIV,” said Tim Horn, director of health care access at NASTAD, the National Alliance of State and Territorial AIDS Directors. Ryan White and ADAPs “are not equipped to provide that full sweep of comprehensive care,” he said.

Roshan McDaniel, South Carolina’s ADAP program manager, says 60% of South Carolinians enrolled in ADAP would qualify if her state expanded Medicaid. “The first few years, we thought about it,” said McDaniel. “We don’t even think about it nowadays.”

Enrollment in the Ryan White program jumped during the early months of the pandemic when state economies froze and Americans hunkered down amid a grinding pandemic. Data from state health departments reflect the increased need. In Texas, enrollment in the state’s AIDS drug program increased 34% from March to December 2020. In Georgia, enrollment jumped by 10%.

State health officials attribute the increased enrollment to pandemic-related job losses, especially in states that didn’t expand Medicaid. Antiretroviral treatment, the established regimen that suppresses the amount of virus in the body and prevents AIDS, costs up to $36,000 a year, and medication interruptions can lead to viral mutations and drug resistance. But qualifying for state assistance is difficult: Approval can take up to two months, and missing paperwork can lead to canceled coverage.

Federal health experts say Southern states have generally lagged behind getting patients into medical care and suppressing their viral loads, and people with HIV infections tend to go undiagnosed longer there than in other regions. In Georgia, for example, nearly 1 out of 4 people who learned they were infected developed AIDS within a year, indicating their infections had long gone undiagnosed.

As vaccinations become widely available and restrictions ease, HIV clinic directors are scouring their patient lists to determine who they need to see first. “We are looking at how many people haven’t seen us in over a year. We think it’s over several hundred. Did they move? Did they move providers?” said Carlo, the doctor and health care CEO in Dallas. “We don’t know what the long-term consequences are going to be.”

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: Health Care

Another Soda Tax Bill Dies. Another Win for Big Soda.

Kaiser Health News - Wed, 04/21/2021 - 5:00am

SACRAMENTO — A rogue industry. A gun to our head. Extortion.

This story also ran on San Francisco Chronicle. It can be republished for free.

That’s how infuriated lawmakers described soft drink companies — and what they pulled off in 2018 when they scored a legislative deal that bars California’s cities and counties from imposing taxes on sugary drinks.

Yet, despite its tarnished reputation, the deep-pocketed industry continues to exert its political influence in the nation’s most populous state, spending millions of dollars on politically connected lobbyists and doling out campaign contributions to nearly every state lawmaker.

The result? Bills long opposed by Coca-Cola Co., PepsiCo and other beverage companies continue to flounder. Just two weeks ago, a measure that would have undone the 2018 deal that lawmakers so vehemently protested was shelved without a hearing.

“Big Soda is a very powerful lobby,” said Eric Batch, vice president of advocacy at the American Heart Association, which has petitioned lawmakers nationwide to crack down on sugar-laden drinks that health advocates say contribute to diabetes, obesity and other costly medical conditions.

“They’ve spent a lot of money in California to stop groups like ours from passing good policy,” Batch added. “And they’ve been doing it for a long time.”

In the past four years, soft drink companies spent about $5.9 million lobbying California lawmakers and giving to their campaigns or favorite charities. A California Healthline analysis of campaign finance records from Jan. 1, 2017, to Dec. 31, 2020, found that the American Beverage Association, Coca-Cola and Pepsi have given to nearly every state officeholder — from Gov. Gavin Newsom to roughly five-sixths of the 120-member legislature.

The American Beverage Association declined an interview request to discuss its political giving and this year’s bill that would have upended the soda tax moratorium it helped orchestrate. Coca-Cola and Pepsi did not return requests seeking comment.

In 2018, the industry spent $8.9 million to boost a statewide ballot measure sponsored by the California Business Roundtable that would have made it more difficult for cities and counties to levy taxes — not just taxes on sugary drinks — by requiring them to be approved by two-thirds of voters instead of a simple majority. Fearful that local governments could face a higher voting threshold for taxes and fees that would fund libraries, public safety and other services, lawmakers at the time said they had no choice but to negotiate with the industry.

In a deal that several lawmakers described as “extortion” and a “Sophie’s Choice,” the legislature agreed to pass a bill banning new local taxes on sugary drinks until Jan. 1, 2031, if the industry and other supporters dropped the ballot measure. Then-Gov. Jerry Brown, who had dined with industry executives several weeks before, signed the bill.

The California deal was a coup for Big Soda, which doesn’t appear to have paid a political price: Legislation that would have imposed a state tax on sugary drinks died a year later, as did a bill that would have required health warning labels on sugary drinks and another that would have banned sodas in grocery store checkout aisles.

This year’s bill, which would have reinstated cities and counties’ ability to put soda taxes before voters, is all but dead.

“They’re gaming the political system,” said Assembly member Adrin Nazarian (D-North Hollywood), the author of AB 1163. Nazarian said he hopes to revive the measure before April 30, the deadline for policy committees to hear legislation for the year.

“It’s one thing for us to make a bad policy decision once,” he said. “It’s another thing to give a signal to all the industries that will then utilize this loophole against us. How many more times are we going to be doing this?”

Public health advocates point to such taxes as a way to cut consumption of soda, sports drinks, fruit juices and other sweet beverages, citing studies that show the more they cost, the less people buy them. On average, a can of soda contains 10 teaspoons of sugar, nearly the entire recommended daily amount for someone who eats 2,000 calories a day. Some energy drinks contain twice that.

Four California cities — Albany, Berkeley, Oakland and San Francisco — had soda taxes in place before the 2018 legislative deal that were allowed to remain. Boulder, Colorado; Philadelphia; Seattle; and the Navajo Nation also have soda taxes, with proposals under consideration in Rhode Island and Washington, D.C.

The revenue stream from the taxes could help fund financially strapped public health departments depleted by the covid pandemic, health advocates say.

For example, last year San Francisco directed $1.6 million of its soda tax revenue to local programs that feed residents affected by school closures and job losses. Seattle tapped its soda tax revenue to give grocery vouchers to its hardest-hit residents.

Nazarian said he expected his attempt to undo the soda tax moratorium to be an uphill battle, but he is frustrated the bill was denied even one hearing.

Nazarian, like lawmakers before him, is butting up against a strong anti-tax environment in U.S. politics, said Tatiana Andreyeva, director of economic initiatives at the University of Connecticut’s Rudd Center for Food Policy & Obesity. So, while more than 40 countries have imposed national taxes on sugary drinks — including the United Kingdom, Mexico, Portugal and South Africa — national and state efforts have stalled here.

There’s also the political might of the soda industry.

“Look at how much money they spend fighting all these bills that have been proposed,” said Andreyeva, who has studied the soda industry since 2007. “We have seen dozens and dozens of bills at the state and local level. There’s always a lot of opposition by the industry. They are well-funded, they will organize and it’s very hard.”

In California, soft drink companies spent $4.4 million in the past four years lobbying lawmakers and state officials, treating them to dinners and sporting events. They hired veteran political firms staffed by former government employees who know how the Capitol works and often already have relationships with lawmakers and their aides.

For instance, until earlier this year the American Beverage Association had Fredericka McGee on its payroll as its top California lobbyist. She had worked for five Assembly speakers. Now, McGee is chief of staff to Los Angeles County Supervisor Holly Mitchell, a former state legislator who in 2018 was the chair of the powerful Senate Budget Committee, which oversaw the deal banning new local soda taxes.

In addition to lobbying, the industry spent just over $1.5 million on contributions to lawmakers, including big checks written to charities on their behalf.

The largest contributions flowed to the lawmakers with the most influence.

Pepsi and Coca-Cola gave a total of $25,000 to charities in the name of Assembly Speaker Anthony Rendon, according to the state Fair Political Practices Commission, which tracks the donations, known as “behested payments.” That’s on top of the $35,900 Rendon collected in his campaign account from the industry over the past four years.

Senate President Pro Tem Toni Atkins cashed $26,000 in campaign checks from Coca-Cola and Pepsi, and accepted a $5,000 donation to one of her charities from Coke’s bottling plant in her San Diego district.

In an emailed statement, Rendon described the issue of sugary drinks as complex and said he co-authored legislation in 2015 that would have imposed a tax on distributors of sugary drinks. It died in committee.

“I want us to do something to reduce the consumption of sweetened beverages,” Rendon said. “These bills have been hard to pass, but I think it’s simplistic to pin it on contributions.”

Atkins did not comment on Big Soda’s political power but said in an emailed statement she would review Nazarian’s bill “on its merits” if it comes before the Senate.

Nazarian’s bill is on hold in the Assembly Revenue and Taxation Committee, led by Autumn Burke (D-Inglewood). A spokesperson for Burke did not return calls and emails requesting comment.

Burke also received money from soda companies, collecting about $22,000 from Coca-Cola, Pepsi and the American Beverage Association from 2017 through 2020.

Public health groups aren’t willing to admit defeat and are mobilizing a grassroots effort to get a hearing for Nazarian’s bill. They say California must address the disproportionate health effects of sugary drinks on Black and Latino communities, which covid-19 only exacerbated.

“If the members of the legislature were looking at data and using data as the decision-making criteria for whether we should allow a ban on local taxes to be lifted, they would have to support that,” said Michael Dimock, president of Roots of Change, a program of the Public Health Institute. “But they are not looking at the data. Something else is influencing them.”

Elizabeth Lucas of KHN contributed to this report.

Methodology

How California Healthline compiled data about soda companies’ political spending

Among the ways soft drink companies exert influence on the political process are contributing money to campaigns; hiring lobbyists; plying elected officials with drinks, meals and event tickets; and making charitable contributions on the behalf of lawmakers.

Using the California secretary of state’s website, California Healthline downloaded campaign contributions made by the American Beverage Association PAC, Coca-Cola Co. and PepsiCo — the three largest contributors from Jan. 1, 2017, to Dec. 31, 2020.

To track lobbying, we created a spreadsheet of expenses reported on lobbying disclosure forms, also available on the secretary of state’s website, by the American Beverage Association, Coca-Cola and Pepsi. We found details about how much the industry paid lobbying firms and which lawmakers, or members of their staff, accepted gifts.

To find how much these entities gave in charitable contributions, California Healthline pulled data on “behested payments” from the California Fair Political Practices Commission website. These are payments special interests can make to a charity or organization on behalf of a lawmaker. Sometimes, a few of these payments also show up on lobbying forms. We compared the behested payments with the lobbying reports to ensure we did not double-count money.

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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Listen: A Rookie Doctor Starts Her Career, Forged by the Pandemic

Kaiser Health News - Wed, 04/21/2021 - 5:00am

On this week’s episode of “America Dissected,” host Dr. Abdul El-Sayed spoke with Dr. Paloma Marin-Nevarez, an emergency medicine resident at UCSF Fresno, and KHN senior correspondent Jenny Gold about the challenges Marin-Nevarez faced as a new doctor learning the ropes during a devastating pandemic.

Each July, thousands of new physicians begin their on-the-job training at hospitals across the U.S. Marin-Nevarez began caring for severely ill covid patients just a few months after the beginning of the pandemic.

“We were pretty much just abducted from med school, ripped out of our med school community and just thrown into our residencies,” she told El-Sayed.

Because of covid precautions, many of the socializing and orientation traditions for new doctors were set aside. Soon, Marin-Nevarez was working more than 80 hours a week in a new, unfamiliar city. “So it was an isolating time,” she said.

The trio’s conversation begins at 9:59 of the podcast.

Gold’s audio story, produced in collaboration with the Reveal podcast, follows Marin-Nevarez during her first emotional months as a doctor, surrounded by death as she counseled families who had lost loved ones. Her time caring for patients in the ICU also highlighted the inequality of the pandemic, with Latino, Black and Native American people dying of covid-19 at much higher rates than white people.

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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Censorship or Misinformation? DeSantis and YouTube Spar Over Covid Roundtable Takedown.

Kaiser Health News - Wed, 04/21/2021 - 5:00am

In early April, YouTube took down a video featuring Florida Gov. Ron DeSantis and a group of controversial scientists at a March 18 coronavirus roundtable. The online video platform, owned by Google, cited as its rationale that the video contained false statements about the efficacy of children’s mask-wearing.

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

The decision has drawn public blowback on social media and from DeSantis himself.

DeSantis held another public roundtable on April 12 (which is currently available on YouTube), along with three of the same scientists who participated in the March 18 session, during which he blasted YouTube for taking down the earlier video, calling the action “censorship.”

He said Google and YouTube have not acted as “repositories of truth and scientific inquiry” throughout the covid pandemic but instead as “enforcers of a narrative.”

“What we’re witnessing is Orwellian,” DeSantis said. ‘It’s a Big Tech corporate media collusion.”

And when polled by DeSantis during the second roundtable, the scientists defended the video, saying it should have been left up so that it could contribute to scientific debate. We checked with DeSantis’ office for more information and were referred to an April 12 press release, which summarized the events of the day’s roundtable.

In an emailed statement, a YouTube spokesperson pointed to the platform’s policies on medical misinformation about covid: “We removed this video because it included content that contradicts the consensus of local and global health authorities regarding the efficacy of masks to prevent the spread of COVID-19. We allow videos that otherwise violate our policies to remain on the platform if they contain sufficient educational, documentary, scientific, or artistic context. Our policies apply to everyone, and focus on content regardless of the speaker or channel.”

The video, though no longer on that platform, can still be viewed on The Florida Channel, a website that posts recordings of Florida governmental proceedings.

So who exactly are these scientific panelists and what was said during the roundtable? And have social media companies ramped up efforts to crack down on medical misinformation recently?

Let’s break it down.

DeSantis’ Panel Reflected Controversial Herd Immunity Movement

The scientists who spoke at DeSantis’ roundtable and gave their opinions about masks and lockdowns were Dr. Scott Atlas of Stanford University, Sunetra Gupta of Oxford University, Dr. Jay Bhattacharya of Stanford University and Martin Kulldorff of Harvard University.

Three of the scientists, Gupta, Bhattacharya and Kulldorff, were the primary authors of the Great Barrington Declaration, a contentious document that circulated in October. In it, the scientists argued that lockdowns should end, most people should resume their daily lives and only the most vulnerable should take precautions against covid. The document asserted that members of the public who resumed normal lives would then build up their immunity to covid through exposure to natural infection.

The Great Barrington Declaration received immediate criticism from scientists, including the top U.S. health official, Dr. Anthony Fauci; World Health Organization Director-General Tedros Adhanom Ghebreyesus; and the United Kingdom’s health secretary, Matt Hancock.

Atlas was part of President Donald Trump’s White House covid team and was reported to have promoted herd immunity views to the former president. After the reports about Atlas, Trump and his press team later walked back the idea that the White House was considering any type of herd immunity strategy to combat the pandemic.

Atlas’ tenure at the White House was also dogged by other controversies, including Twitter removing one of his tweets because it contained false information about face masks, and his urging of Michigan residents to go against Gov. Gretchen Whitmer’s public health recommendations. Atlas stepped down from the White House team in December.

The Panel’s Factual Mistake and Why YouTube Took It Down 

During DeSantis’ almost two-hour March 18 covid roundtable, the governor and the scientists discussed a range of topics, including the efficacy of lockdowns and face masks for children.

According to YouTube, the video was removed because it violated the company’s policy on medical misinformation. YouTube says it doesn’t allow content that poses a serious risk of egregious harm, such as videos that contradict the consensus of local and global health authorities regarding the efficacy of masks.

The clips YouTube cited as violating its medical misinformation policy involved specific instances in which DeSantis and the scientists said face masks were not necessary for children — statements the platform said were contrary to recommendations from U.S. public health authorities. Here are the specific clips in the format provided by YouTube:

  • “Dr. Gupta mentioned about, you know, not putting masks on kids that’s not effective, not necessary. Uh, Martin, do you agree in school there’s no need for them to be wearing face masks?” — Gov. DeSantis
  • “Uh, children should not wear face masks, no. They don’t need it for their own protection and they don’t need it for protecting other people either.” — Kulldorff
  • “… and I think it is developmentally inappropriate and it just doesn’t help on the disease spread. I think it’s absolutely not the right thing to do. … I think [the data] is a little bit, uh, clearer because we’ve had a year of experience. If we went back a year, a lot of the experts would say that wearing masks for the general public is not evidence-based.” — Dr. Bhattacharya
  • “There’s no scientific rationale or logic to have children wear masks in schools.” — Dr. Atlas

The Centers for Disease Control and Prevention recommends that children 2 years old and older wear masks. The agency also recommends that children wear masks in schools, child care settings and any environment when they are around people who don’t live in their home.

“We know children of all ages are at risk for being infected with SARS-CoV-2 and are capable of transmitting the virus. This is particularly true of older children, especially middle-school and high-school aged kids,” Josh Michaud, associate director of global health policy at KFF, wrote in an email. “We also know that masking, when employed widely and effectively, helps reduce the risk of transmission of the virus.”

Studies back this up.

The CDC published a study in February showing that different types of masks block cough particles and double-masking is the most effective at doing so. Another experiment from that study showed that a person in a mask emits fewer aerosol particles that can be passed on to an unmasked person. A multitude of reports also show, generally, that mask-wearing is effective at reducing the risk of spreading or catching other respiratory diseases.

Other studies have shown that children carry almost as much coronavirus in their upper-respiratory tract as adults, despite often having no or mild symptoms. And it is possible for children to pass the virus on to adults.

Also, multiple studies of schools that reopened in fall 2020 and had high compliance with mask-wearing have been shown to have low numbers of covid transmission. And the American Academy of Pediatrics said mask-wearing will not make it more difficult for children to breathe, nor will it interfere with a child’s lung development.

Are Tech Companies Actually Increasing Their Crackdowns?

DeSantis’ protests regarding the removal of his roundtable from YouTube echo those of Trump, who railed against tech companies and their policies during his presidency.

Trump was eventually de-platformed from other online entities such as Twitter and Facebook, among others, following the Jan. 6 insurrection at the U.S. Capitol. Conservatives have since complained they’re being censored on social media platforms.

After the YouTube video removal, DeSantis used the opportunity to promote censorship bills that are moving through his state’s legislature and would prevent social media companies from blocking politicians from their platforms in Florida. (State attempts to regulate social media companies will face constitutional hurdles, including First Amendment protections, the Tampa Bay Times reported.)

Social media platforms including YouTube, Facebook, Instagram and Twitter have introduced covid misinformation policies since the pandemic started, and even updated those policies in the past couple of months to take a harder line in removing posts and notifying users. However, the companies state that they aren’t targeting certain users when removing content, but rather anyone who spreads misinformation.

According to data shared by YouTube in March, the company has removed more than 800,000 videos containing coronavirus misinformation since February of last year. Facebook reported in February that the company and its sister platform, Instagram, had removed more than 1 million pieces of covid misinformation in the last three months of 2020. And last month, Twitter said it had removed more than 8,400 tweets and challenged 11.5 million accounts since the implementation of the covid guidance.

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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Experts, Advocates Suggest Outdoor Mask Mandates Be Lifted Soon

CommonHealth (WBUR) - Tue, 04/20/2021 - 12:07pm

A conservative group on Tuesday called on Massachusetts' governor to lift the state's outdoor mask-wearing mandate. The calls come as medical experts in New England acknowledge it soon might be safe enough for states to lift mask requirements when outdoors.

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Experts Say COVID Dreams Reflect Evolution Of Pandemic

CommonHealth (WBUR) - Tue, 04/20/2021 - 6:55am

No one is experiencing the pandemic in exactly the same way, but we share many common fears and anxieties — even when we’re asleep. As the pandemic goes on, dream experts say the evolution of COVID-19 tells us a lot about our waking life, too.

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Births Dipped After First Pandemic Surge In Mass., But Impact Is Uneven

CommonHealth (WBUR) - Tue, 04/20/2021 - 6:20am

There were fewer babies born nine or 10 months after the first COVID-19 surge in Massachusetts. The drop is most pronounced at some hospitals that serve lower-income patients. Births ticked up in March but researchers do not expect deliveries to fully rebound statewide this year or next.

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Many Parents Want Their Teens To Get The COVID Vaccine. Others Aren't So Sure

CommonHealth (WBUR) - Tue, 04/20/2021 - 6:19am

Teens 16 and older can get the Pfizer COVID vaccine, but not all parents want their children to get the shot.

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From Rotten Teeth to Advanced Cancer, Patients Feel the Effects of Treatment Delays

Kaiser Health News - Tue, 04/20/2021 - 5:00am

With medical visits picking up again among patients vaccinated against covid-19, health providers are starting to see the consequences of a year of pandemic-delayed preventive and emergency care as they find more advanced cancer and rotting and damaged teeth, among other ailments.

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

Dr. Brian Rah, chair of the cardiology department at Montana’s Billings Clinic, was confused in the early days of the covid pandemic. Why the sudden drop in heart attack patients at the Billings Clinic? And why did some who did come arrive hours after first feeling chest pains?

Two patients, both of whom suffered greater heart damage by delaying care, provided what came to be typical answers. One said he was afraid of contracting covid by going to the hospital. The other patient went to the emergency room in the morning, left after finding it too crowded, and then returned that night when he figured there would be fewer patients — and a lower risk of catching covid.

“For a heart attack patient, the first hour is known as the golden hour,” Rah said. After that, the likelihood of death or a lifelong reduction in activities and health increases, he said.

Dr. JP Valin, executive vice president and chief clinical officer at SCL Health of Colorado and Montana, said he is “kept awake at night” by delays in important medical tests. “People put off routine breast examinations, and there are going to be some cancers hiding that are not going to be identified, potentially delaying intervention,” he said.

Valin is also concerned that patients aren’t seeking timely treatment when suffering appendicitis symptoms like abdominal pain, fever and nausea. A burst appendix generally involves more risk and a week’s hospitalization, instead of one day of treatment for those who get care quickly, he said.

Dr. Fola May, a gastroenterologist who is also quality director and a health equity researcher at UCLA Health, worries about the consequences of an 80% to 90% drop in colonoscopies performed by the health system’s doctors during the first months of covid.

“All of a sudden we were downplaying health measures that are usually high-priority, such as trying to prevent diseases like cancer, to manage the pandemic,” May said.

Along with exacerbating existing health problems, the covid pandemic has also caused a host of new medical issues in patients. The American population will be coming out of the pandemic with teeth worn down from grinding, back problems from slouching at makeshift home-work stations and mental health problems from a combination of isolation and being too close to family.

Dr. Despina Markogiannakis, a dentist in Chevy Chase, Maryland, said patients don’t argue when she tells them they have been grinding or clenching their teeth and might require a root canal procedure, dental implant or night guard.

“These are people stuck at home all day and feeling lonely and feeling a little depression. It is induced by the world we live in and all the changes in our lives,” said Markogiannakis.

A recent American Dental Association survey found that more than 70% of member dentists reported an increase in patients grinding or clenching their teeth since covid. More than 60% reported an increase in other stress-related conditions, such as chipped and cracked teeth.

Dr. Gerard Mosby, a Detroit pediatrician, finds his young patients are suffering more stress, depression and weight gain than before the pandemic. They are confined in their homes, and many are living in multigenerational homes or foster homes or have experienced covid illnesses or death among family members.

“Since their ability to get out is limited, they can’t vent to friends or other family members. Also, most will not have access to mental health for grief counseling,” Mosby said.

Nancy Karim, a Bridgeport, Connecticut, licensed professional counselor and art therapist, said that, in addition to struggling with isolation, her patients are conversely stressed by living too closely with people without the benefit of breaks on work and school days.

Meanwhile, optometrist Matthew Jones, who practices in Blytheville and Osceola, Arkansas, reports worsening eye conditions for patients, some of whom stopped taking drops during covid for conditions like glaucoma. He’s also seeing much more eyestrain “because people are spending so much time in front of a computer screen” and recommends eyeglasses that filter out blue light to his patients.

Physical therapy needs are also on the rise.

“Patients that have transitioned to remote work are typically working with poor ergonomic set-ups and spending a lot more time sitting,” said Kaylee Smith, founder and president of Smith Physical Therapy and Performance Studio in San Diego.

“I am seeing more pain and injuries related to poor posture (i.e., neck pain, low back pain, etc.) and a significant increase in patients coming in with tight hips related to increased sitting time,” Smith said in an email.

Some providers report they are finally nearing pre-covid patient levels, but others still face covid resistance.

“Although we have seen an improvement over the past six weeks, it’s still not much,” said Neville Gupta of Gupta Gastro in Brooklyn and Far Rockaway, New York. “Our patients are still avoiding getting the care they need, no matter the safety precautions in place.”

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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After a Deadly Year on the Roads, States Push for Safety Over Speed

Kaiser Health News - Tue, 04/20/2021 - 5:00am

As more Americans start commuting to work and hitting the roads after a year indoors, they’ll be returning to streets that have gotten deadlier.

Last year, an estimated 42,000 people died in motor vehicle crashes and 4.8 million were injured. That represents an 8% increase over 2019, the largest year-over-year increase in nearly a century — even though the number of miles driven fell by 13%, according to the National Safety Council.

The emptier roads led to more speeding, which led to more fatalities, said Leah Shahum, executive director of the Vision Zero Network, a nonprofit organization that works on reducing traffic deaths. Ironically, congested traffic, the bane of car commuters everywhere, had been keeping people safer before the pandemic, Shahum said.

“This is a nationwide public health crisis,” said Laura Friedman, a California Assembly member who introduced a bill this year to reduce speed limits. “If we had 42,000 people dying every year in plane crashes, we would do a lot more about it, and yet we seem to have accepted this as collateral damage.”

California and other states are grappling with how to reduce traffic deaths, a problem that has worsened over the past 10 years but gained urgency since the onset of the covid-19 pandemic. Lawmakers from coast to coast have introduced dozens of bills to lower speed limits, set up speed camera programs and promote pedestrian safety.

The proposals reflect shifting perspectives on how to manage traffic. Increasingly, transportation safety advocates and traffic engineers are calling for roads that get drivers where they’re going safely rather than as fast as possible.

Lawmakers are listening, though it’s too soon to tell which of the bills across the country will eventually become law, said Douglas Shinkle, who directs the transportation program at the National Conference of State Legislatures. But some trends are starting to emerge.

Some states want to boost the authority of localities to regulate traffic in their communities, such as giving cities and counties more control over speed limits, as legislators have proposed in Michigan, Nebraska and other states. Some want to let communities use speed cameras, which is under consideration in Massachusetts, Rhode Island, Florida and elsewhere.

Connecticut is considering a pedestrian safety bill that incorporates multiple concepts, including giving localities greater authority to lower speeds, and letting some municipalities test speed cameras around schools, hospitals and work zones.

“For decades really we’ve been building roads and highways that are suitable and somewhat safe for motorists,” said Connecticut Sen. Will Haskell (D-Westport), who chairs the committee overseeing the bill. “We also have to recognize that some people in the state don’t own a car, and they have a right to move safely throughout their community.”

A huge jump in road fatalities started showing up in the data “almost immediately” after the start of the pandemic, despite lockdown orders that kept people home and reduced the number of drivers on the road, said Tara Leystra, the National Safety Council’s state government affairs manager.

“A lot of states are trying to give more flexibility to local communities so they can lower their speed limits,” Leystra said. “It’s a trend that started before the pandemic, but I think it really accelerated this year.”

In California, citations issued by the state highway patrol for speeding over 100 miles per hour roughly doubled to 31,600 during the pandemic’s first year.

Friedman, a Democrat from Burbank, wants to reform how California sets speed limits on local roads.

California uses something called the “85th percentile” method, a decades-old federal standard many states are trying to move away from. Every 10 years, state engineers survey a stretch of road to see how fast people are driving. Then they base the speed limit on the 85th percentile of that speed, or how fast 85% of drivers are going.

That encourages “speed creep,” said Friedman, who chairs the state Assembly’s transportation committee. “Every time a survey is done, a lot of cities are forced to raise speed limits because people are driving faster and faster and faster,” she said.

Even before the pandemic, a California task force had recommended letting cities have more flexibility to set their speed limits, and a federal report found the 85th percentile rule similarly inadequate to set speeds. But opposition to the rule is not universal. In New Jersey, for instance, lawmakers introduced a bill this legislative session to start using it.

Friedman’s bill, AB 43, would allow local authorities to set some speed limits without using the 85th percentile method. It would require traffic surveyors to consider areas like work zones, schools and senior centers, where vulnerable people may be using the road, when setting speed limits.

In addition to lowering speed limits, lawmakers also want to better enforce them. In California, two bills would reverse the state’s ban on automated speed enforcement by allowing cities to start speed camera pilot programs in places like work zones, on particularly dangerous streets and around schools.

But after a year of intense scrutiny on equity — both in public health and in law enforcement — lawmakers acknowledge they need to strike a delicate balance between protecting at-risk communities and overpolicing them.

Though speed cameras don’t discriminate by skin color, bias can still enter the equation: Wealthier areas frequently have wide streets and walkable sidewalks, while lower-income ones are often crisscrossed by freeways. Putting cameras only on the most dangerous streets could mean they end up mostly in low-income areas, Shahum said.

“It tracks right back to street design,” she said. “Over and over again, these have been neighborhoods that have been underinvested in.”

Assembly member David Chiu (D-San Francisco), author of one of the bills, said the measure includes safeguards to make the speed camera program fair. It would cap fees at $125, with a sliding scale for low-income drivers, and make violations civil offenses, not criminal.

“We know something has to be done, because traditional policing on speed has not succeeded,” Chiu said. “At the same time, it’s well documented that drivers of color are much more likely to be pulled over.”

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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UVA Health Will Wipe Out Tens of Thousands of Lawsuits Against Patients

Kaiser Health News - Tue, 04/20/2021 - 5:00am

University of Virginia Health System, which for years has sued thousands of patients annually for unpaid bills, said Monday it will cancel a massive backlog of court judgments and liens resulting from those lawsuits dating to the 1990s.

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

Combined with reforms UVA announced in 2019, the move is likely to benefit tens of thousands of families and make UVA Health’s collections policies much more generous than those of many hospital systems, said scholars who study health care finance. The decision to wipe out liens that can drain home equity years after a hospital visit is extremely rare, they said.

UVA had been suing patients for decades, many with unpaid bills in the tens or hundreds of thousands of dollars, KHN reported in 2019. Once the health system won cases in court, it could seize wages and the value of patient homes when they were sold. UVA limited its collections lawsuits after KHN’s investigation.

“This is very significant and a much-needed and overdue step,” said Erin Fuse Brown, a law professor at Georgia State University who studies hospital billing. “I don’t know if I’ve heard of that [lien abolition] happening anywhere else.”

But most families who have already surrendered money to UVA as a result of lawsuits or liens will not get their money back.

UVA will release all liens and judgments filed against all households making less than 400% of federal poverty guidelines, or $106,000 for a family of four, which should account for most of them, said Douglas Lischke, the system’s chief financial officer.

“This is a proud moment for us,” he said in an interview. “We want our financial care to be as good as our clinical care.”

“I am proud to see UVA Health System taking real steps to scale back aggressive medical collections and address the pain they’ve caused,” said Virginia Gov. Ralph Northam, a pediatric neurologist. 

Doris Hutchinson was surprised two years ago to find a UVA lien related to a relative’s bill on her mother’s Charlottesville, Virginia, home. The medical system demanded $39,000 from the family before the house could be sold. The money was placed in escrow.

Three weeks ago, she learned the judgment would be canceled and the money released.

“I’ll be excited about that,” said Hutchinson, who said she needs the funds to help pay for her grandchildren’s college education and replace income from her husband, who died two years ago. “I’m also happy for everybody else” who gets UVA bill relief, she said.

UVA will also stop blocking enrollment for university students with outstanding balances at the health system, university spokesperson Brian Coy said Monday. Keeping students from completing their education because they owed hospital bills was another practice revealed by KHN.

KHN reported in 2019 that UVA Health had sued patients 36,000 times over six years for more than $100 million, often for amounts far higher than what an insurer would have paid for their care. In response to the articles, the system suspended lawsuits against patients and wage garnishments, increased discounts for the uninsured and broadened financial assistance, including for cases dating to 2017.

The system named an advisory council of UVA officials and community leaders to consider permanent changes. The council delivered recommendations in October.

Like most hospitals, UVA wasn’t using property liens to foreclose on patients’ homes. But it was seizing money owed — plus 6% interest — from home equity when home sales went to settlement.

In response to KHN’s investigation, UVA said in 2019 it would improve financial assistance but continue to use the courts to recover money owed from families making more than 400% of the poverty threshold.

While unusual, UVA’s decision to substantially reduce lawsuits and erase liens stops short of moves recently made by VCU Health, its sister system based at another state university. VCU pledged to stop suing all patients and, in a process taking more than a year in courthouses across Virginia, is abolishing all old judgments and liens regardless of a family’s income.

“This seems like many steps in the right direction” for UVA, said Jenifer Bosco, an attorney at the National Consumer Law Center who specializes in health care. “There is always more that could be done. But providing assistance to families with income of up to 400% of the poverty level is a great step.”

The number of outstanding UVA Health judgments is unknown. For its part, VCU eventually found about 80,000 statewide. In Virginia, liens expire after 20 years, but UVA was taking the trouble to renew claims dating to the 1990s, KHN found.

Canceling them should take more than a year, Lischke said. UVA’s changes to billing and collections, including improvements to financial assistance announced in late 2019, will cost the system about $12 million a year, he said.

UVA’s move is far more beneficial to its patients and its region than other so-called community benefits that many nonprofit hospitals offer to justify their tax-exempt status, said Ge Bai, associate professor at Johns Hopkins Bloomberg School of Public Health.

Instead of testing services or medical education that are often hospital marketing campaigns in disguise, “this action is a concrete effort to relieve the financial burden of the community,” she said. “It also improves mental health. It relieves the stress.”

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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Humana Health Plan Overcharged Medicare by Nearly $200 Million, Federal Audit Finds

Kaiser Health News - Tue, 04/20/2021 - 12:01am

A Humana Inc. health plan for seniors in Florida improperly collected nearly $200 million in 2015 by overstating how sick some patients were, according to a new federal audit, which seeks to claw back the money.

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

The Health and Human Services Office of Inspector General’s recommendation to repay, if finalized, would be “by far the largest” audit penalty ever imposed on a Medicare Advantage company, said Christopher Bresette, an HHS assistant regional inspector general.

“This [money] needs to come back to the federal government,” he said in an interview.

Humana sharply disputed the findings of the audit, which was set for public release Tuesday. A spokesperson for the company said Humana will work with Medicare officials “to resolve this review,” and noted the recommendations “do not represent final determinations, and Humana will have the right to appeal.”  

Medicare Advantage, a fast-growing private alternative to original Medicare, has enrolled more than 26 million people, according to America’s Health Insurance Plans, an industry trade group. Humana, based in Louisville, Kentucky, is one of the largest of these insurers, with about 4 million members.

While popular with seniors, Medicare Advantage has been the target of multiple government investigations, Department of Justice and whistleblower lawsuits and Medicare audits that concluded some plans boosted their government payments by exaggerating the severity of illnesses they treated. One 2020 report estimated improper payments to the plans topped $16 billion the previous year.

But efforts to recover even a tiny fraction of the overpayments in past years have stalled amid intense industry opposition to the government’s audit methods.

Now the OIG is rolling out a series of audits that could for the first time put health plans on the hook for refunding tens of millions of dollars or more to Medicare. The OIG is planning to release five to seven similar audits within the next year or two, officials said.

The Humana audit, conducted from February 2017 to August 2020, tied overpayments to medical conditions that pay health plans extra because they are costly to treat, such as some cancers or diabetes with serious medical complications.

Auditors examined a random sample of 200 patients’ medical charts to make sure that the patients had the diseases the health plans were paid to treat, or that the conditions were as severe as the health plan claimed.

For instance, Medicare paid $244 a month, or $2,928 for the year, for one patient said to be suffering from serious complications of diabetes. But medical records Humana supplied failed to confirm that diagnosis, meaning the health plan should have received $163 less per month for the patient’s care, or $1,956 for the year, according to the audit.

Similarly, Medicare paid $4,380 too much in 2015 for treatment of a patient whose throat cancer had been resolved, according to the audit. In other cases, however, auditors said Medicare underpaid Humana by thousands of dollars because the plan submitted incorrect billing codes.

In the end, auditors said Medicare overpaid Humana by $249,279 for the 200 patients whose medical charts were closely examined in the sample. Auditors used a technique called extrapolation to estimate the prevalence of such billing errors across the health plan.

“As a result, we estimated that Humana received at least $197.7 million in net overpayments for 2015,” the audit states, adding that Humana’s policies to prevent these errors “were not always effective” and need improvement.

The OIG notified Humana of its findings in September 2020, according to the audit. A final decision on collecting the money rests with the Centers for Medicare & Medicaid Services, or CMS, which runs Medicare Advantage. Under federal law, the OIG is responsible for identifying waste and mismanagement in federal health care programs but can only recommend repayment. CMS had no comment.

Though controversial, extrapolation is commonly used in medical fraud investigations — except for investigations into Medicare Advantage. Since 2007, the industry has criticized the extrapolation method and, as a result, largely avoided accountability for pervasive billing errors.

Industry protests aside, OIG officials say they are confident their enhanced audit tools will withstand scrutiny. “I believe what we have here is solid,” OIG official Bresette said.

Michael Geruso, an associate professor of economics at the University of Texas-Austin, who has researched Medicare Advantage, said extrapolation “makes perfect sense,” so long as it is based on a random sample.

“It seems like this is a healthy step forward by the OIG to protect the U.S. taxpayer,” he said.

The OIG used the extrapolation technique for the first time in a February audit of Blue Cross and Blue Shield of Michigan that uncovered $14.5 million in overpayments for 2015 and 2016. In response, Blue Cross said it would take steps to ferret out payment mistakes from other years and refund $14.5 million. Blue Cross spokesperson Helen Stojic said that process “is still pending.”

But Humana, with a lot more money on the line, is fighting back. Humana “takes great pride in what the company believes to be its industry-leading approach” to ensuring proper billing, Sean O’Reilly, a company vice president, wrote in a December 2019 letter to the OIG that blasted the audit.

O’Reilly wrote that Humana “has never received feedback from CMS that its program is deficient in any respect.”

The nine-page letter argues that the audit “reflects misunderstandings related to certain statistical and actuarial principles, and legal and regulatory requirements.” Requiring Humana to repay the money “would represent a serious departure from the statutory requirements underlying the [Medicare Advantage] payment model,” the company said.

Humana did persuade the OIG to shave off about $65 million from its initial estimate of the overpayment. In 2015, Medicare paid the plan about $5.6 billion to treat about 485,000 members, mostly in South Florida.

Humana is not alone in disapproving of the audits.

AHIP, the industry trade group, has long opposed extrapolation of payment errors, and in 2019 called a CMS proposal to start doing it “fatally flawed.” The group did not respond to requests for comment.

Health care industry consultant Richard Lieberman said insurers remain “vehemently opposed” and will likely head to court to try to sidestep any multimillion-dollar penalties.

Lieberman noted that CMS has “waffled” in deciding how to protect tax dollars as Medicare Advantage plans have grown rapidly and cost taxpayers more than $200 billion a year. CMS says it has yet to complete its own audits dating to 2011, which are years overdue.

The dispute has been largely invisible to patients, who are not directly affected by overpayments to the plans. Many seniors sign up because Medicare Advantage offers benefits not included in original Medicare and may cost them less out-of-pocket, though it restricts their choice of doctors.

But some critics argue that inaccurate medical files pose a risk of improper treatment. Dr. Mario Baez, a Florida physician and whistleblower, said seniors can be “placed in harm’s way due to false information in their medical records.”

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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Monday Marks First Day For All Adults In Mass. To Get Vaccine

CommonHealth (WBUR) - Mon, 04/19/2021 - 5:54pm

WBUR's Ally Jarmanning went to the Hynes Convention Center -- a mass vaccination site -- on Monday to talk to people about getting the vaccine, and reported for All Things Considered. 

Categories: Health Care

Expertos en salud pública temen que los fondos desaparezcan con el fin de la pandemia

Kaiser Health News - Mon, 04/19/2021 - 10:34am

En respuesta a la pandemia de covid-19, el Congreso ha invertido decenas de miles de millones de dólares en los departamentos de salud pública estatales y locales, pagando por máscaras, rastreadores de contactos y campañas educativas para persuadir a las personas de que se vacunen.

Sus funcionarios, que han manejado presupuestos famélicos durante años, están felices de tener este dinero adicional. Sin embargo, les preocupa que esta ayuda pueda desaparecer pronto, a medida que la pandemia se repliega, continuando con un ciclo de altas y bajas en la financiación, que ha plagado al sistema de salud pública de los Estados Unidos durante décadas.

Advierten que, si los presupuestos se recortan de nuevo, la nación podría volver a donde estaba antes de covid: sin preparación para enfrentar una crisis de salud.

“Necesitamos fondos con los que podamos contar año tras año”, dijo la doctora Mysheika Roberts, comisionada de salud de Columbus, Ohio.

Cuando Roberts comenzó en Columbus en 2006, una subvención de preparación para emergencias alcanzó para pagarle a más de 20 empleados. Cuando llegó la pandemia de coronavirus, alcanzó para cerca de 10. Con el dinero de ayuda que llegó el año pasado, el departamento pudo tener más equipos de respuesta a covid. Pero, aunque la financiación ha ayudado a la ciudad a hacer frente a la crisis inmediata, Roberts se pregunta si la historia se repetirá.

Una vez que termine la pandemia, los funcionarios de salud pública temen tener que volver a reunir dinero de múltiples fuentes para brindar servicios básicos a sus comunidades, como pasó después del 9/11, el SARS y el Ebola.

Cuando el virus del Zika transmitido por mosquitos atravesó Sudamérica en 2016, causando graves defectos de nacimiento en recién nacidos, los congresistas no pudieron ponerse de acuerdo sobre cómo y cuánto gastar en los Estados Unidos.

Para los esfuerzos de prevención, como la educación y la eliminación de mosquitos, los Centros para el Control y la Prevención de Enfermedades (CDC) tomaron dinero que estaba destinado al Ebola y de los fondos para los departamento de salud estatales y locales. El Congreso finalmente asignó $1.1 mil millones para el Zika. Pero, para entonces, la temporada de mosquitos ya había pasado en gran parte del país.

“Algo sucede, repartimos un montón de dinero, y luego, en uno o dos años, volvemos a nuestros presupuestos reducidos y no podemos hacer las cosas mínimas que tenemos que hacer día tras día, y mucho menos estar preparados para la próxima emergencia ”, dijo Chrissie Juliano, directora ejecutiva de Big Cities Health Coalition, que representa a líderes de más de dos docenas de departamentos de salud pública.

El financiamiento para el Public Health Emergency Preparedness, que paga por las capacidades de emergencia para los departamentos de salud estatales y locales, se redujo aproximadamente a la mitad entre los años fiscales 2003 y 2021, tomando en cuenta la inflación, según Trust for America’s Health, una organización de investigación y defensa de la salud pública.

Incluso el Fondo Federal de Prevención y Salud Pública, que se estableció con la Ley de Cuidado de Salud a Bajo Precio (ACA) para proporcionar $2 mil millones al año para la salud pública, fue allanado en busca de efectivo durante la última década. Si no se hubiera tocado ese dinero, eventualmente los departamentos habrían obtenido $12,4 mil millones adicionales.

Varios legisladores, con la senadora nacional Patty Murray (demócrata de Washington) a la cabeza, buscan poner fin a este círculo vicioso con una legislación que eventualmente proporcionaría $4,500 millones anuales en fondos básicos de salud pública. Los departamentos de salud llevan a cabo funciones gubernamentales esenciales, como administrar la seguridad del agua, emitir certificados de defunción, rastrear enfermedades de transmisión sexual, y estar listos para brotes de enfermedades infecciosas.

El gasto en estos departamentos estatales se redujo en un 16% per cápita de 2010 a 2019, y el gasto en los departamentos de salud locales bajó un 18%, reveló en julio una investigación de KHN y The Associated Press (AP).

Se perdieron al menos 38,000 empleos de salud pública a nivel estatal y local entre la recesión de 2008 y 2019. Hoy en día, se contrata a muchos trabajadores de salud pública de manera temporal o a tiempo parcial. A algunos se les paga tan mal que califican para beneficios del gobierno. Esos factores reducen la capacidad de los departamentos para retener personas con experiencia.

Para peor, la pandemia ha generado un éxodo de funcionarios de salud pública debido al acoso, la presión política y el agotamiento. Un análisis de un año realizado por AP y KHN reveló que al menos 248 líderes de departamentos de salud estatales y locales renunciaron, se retiraron o fueron despedidos entre el 1 de abril de 2020 y el 31 de marzo de 2021. Casi uno de cada 6 estadounidenses perdió a un líder de salud pública local durante la pandemia.

Expertos dicen que es el mayor éxodo de líderes de salud pública en la historia de los Estados Unidos.

Brian Castrucci, director ejecutivo de la Beaumont Foundation, que aboga por la salud pública, llama a la enorme afluencia de efectivo del Congreso en respuesta a la crisis un “vendaje temporal” porque no restaura los cimientos quebrados de la salud pública.

“Me preocupa que al final vayamos a contratar un montón de rastreadores de contactos, para despedirlos poco después”, dijo Castrucci. “Continuamos pasando de un desastre a otro sin siquiera hablar de la infraestructura real”.

Castrucci y otros dicen que necesitan dinero confiable para profesionales altamente capacitados, como epidemiólogos (detectives de enfermedades basados ​​en datos) y para actualizaciones tecnológicas que ayudarían a rastrear brotes y brindar información al público.

En Ohio, el sistema informático utilizado para informar casos al estado es anterior a la invención del iPhone. Funcionarios estatales dijeron durante años que querían mejorarlo, pero no hubo ni dinero ni voluntad política. Muchos departamentos en todo el país han tenido que confiar en las máquinas de fax para reportar casos de covid.

Durante la pandemia, el auditor del estado de Ohio descubrió que casi el 96% de los departamentos de salud locales encuestados tenían problemas con el sistema de notificación de enfermedades del estado. Roberts dijo que los trabajadores que entrevistaban a los pacientes tenían que navegar por varias páginas de preguntas, una tarea pesada cuando se manejan 500 casos al día.

El sistema estaba tan desactualizado que parte de la información solo se podía ingresar en un cuadro de comentarios que después no se podía encontrar, y los funcionarios luchaban para extraer datos del sistema para informar al público, como cuántas personas que dieron positivo en la prueba habían asistido a un marcha de Black Lives Matter, que el verano pasado fue una pregunta clave para comprender si las protestas contribuían a la propagación del virus.

Ohio está trabajando en un nuevo sistema, pero a Roberts le preocupa que, sin un presupuesto confiable, el estado tampoco pueda mantenerlo actualizado.

“Vas a necesitar actualizar eso”, dijo Roberts. “Y vas a necesitar dólares para respaldarlo”.

En Washington, Patty Hayes, la directora de salud pública de Seattle y el condado de King, dijo que todo el tiempo le preguntan por qué no hay un solo sitio centralizado para registrarse para una cita de vacunación. La respuesta se reduce al dinero: años de financiación insuficiente dejaron a los departamentos de todo el estado con sistemas informáticos anticuados que no estaban a la altura de la tarea cuando llegó covid.

Hayes recuerda un tiempo en el que su departamento realizaba simulacros de vacunación masiva, pero ese sistema se desmanteló cuando el dinero se agotó después de que se desvaneció el fantasma del 9/11.

Hace aproximadamente seis años, un análisis encontró que a su departamento le faltaban alrededor de $25 millones del dinero que necesitaba anualmente para el trabajo básico de salud pública. Hayes dijo que el año pasado demostró que esa cifra estaba subestimada. Por ejemplo, el cambio climático está generando más preocupaciones de salud pública, como el efecto en los residentes cuando el humo de los incendios forestales cubrió gran parte del noroeste del Pacífico en septiembre.

Funcionarios de salud pública en algunas áreas pueden tener dificultades para defender un financiamiento más estable porque una gran parte del público ha cuestionado, y a menudo ha sido abiertamente hostil, con los mandatos del uso de máscaras y las restricciones a los negocios impuestas a lo largo de la pandemia.

En Missouri, algunos comisionados del condado, frustrados por las restricciones de salud pública, retuvieron dinero de los departamentos.

En el condado de Knox, en Tennessee, el alcalde Glenn Jacobs narró un video publicado en el otoño que mostraba una foto de funcionarios de salud después de hacer referencia a “fuerzas siniestras”. Más tarde, alguien pintó con spray la palabra “MUERTE” en el edificio del departamento. La Junta de Salud fue despojada de sus poderes en marzo y se le otorgó una función asesora. Un vocero de la oficina del alcalde se negó a comentar sobre el video.

“Esto va a cambiar la posición de la salud pública y lo que podemos y no podemos hacer en todo el país”, dijo la doctora Martha Buchanan, jefa del Departamento de Salud. “Sé que lo va a cambiar aquí”.

Una investigación de KHN y AP en diciembre encontró que al menos 24 estados estaban elaborando una legislación que limitaría o eliminaría los poderes de salud pública.

De nuevo en Seattle, las empresas locales han aportado dinero y personal a los sitios de vacunación. Microsoft aloja a uno de estos sitios, mientras que Starbucks ofreció experiencia en servicio al cliente para ayudar a diseñarlos. Hayes está agradecida, pero se pregunta por qué una función del gobierno crítica no contó con los recursos que necesitaba durante una pandemia.

Si la salud pública hubiera recibido financiamiento confiable, su personal podría haber estado trabajando de manera más efectiva con los datos, y podría haber estado preparándose para las amenazas emergentes en el estado donde se confirmó el primer caso de covid del país.

“Mirarán hacia atrás a esta respuesta a la pandemia en este país como un gran ejemplo del fracaso de un país en priorizar la salud de sus ciudadanos, porque no hubo compromiso con la salud pública”, dijo. “Eso será parte de la historia”.

La corresponsal senior de KHN Anna Maria Barry-Jester y la corresponsal de Montana Katheryn Houghton colaboraron con este informe.

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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Public Health Experts Worry About Boom-Bust Cycle of Support

Kaiser Health News - Mon, 04/19/2021 - 10:01am

Congress has poured tens of billions of dollars into state and local public health departments in response to the covid-19 pandemic, paying for masks, contact tracers and education campaigns to persuade people to get vaccinated.

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

Public health officials who have juggled bare-bones budgets for years are happy to have the additional money. Yet they worry it will soon dry up as the pandemic recedes, continuing a boom-bust funding cycle that has plagued the U.S. public health system for decades. If budgets are slashed again, they warn, that could leave the nation where it was before covid: unprepared for a health crisis.

“We need funds that we can depend on year after year,” said Dr. Mysheika Roberts, the health commissioner of Columbus, Ohio.

When Roberts started in Columbus in 2006, an emergency preparedness grant paid for more than 20 staffers. By the time the coronavirus pandemic hit, it paid for about 10. Relief money that came through last year helped the department staff up its covid response teams. While the funding has helped the city cope with the immediate crisis, Roberts wonders if history will repeat itself.

After the pandemic is over, public health officials across the U.S. fear, they’ll be back to scraping together money from a patchwork of sources to provide basic services to their communities — much like after 9/11, SARS and Ebola.

When the mosquito-borne Zika virus tore through South America in 2016, causing serious birth defects in newborn babies, members of Congress couldn’t agree how, and how much, to spend in the U.S. for prevention efforts, such as education and mosquito abatement. The Centers for Disease Control and Prevention took money from its Ebola efforts, and from state and local health department funding, to pay for the initial Zika response. Congress eventually allocated $1.1 billion for Zika, but by then mosquito season had passed in much of the U.S.

“Something happens, we throw a ton of money at it, and then in a year or two we go back to our shrunken budgets and we can’t do the minimum things we have to do day in and day out, let alone be prepared for the next emergency,” said Chrissie Juliano, executive director of the Big Cities Health Coalition, which represents leaders of more than two dozen public health departments.

Funding for Public Health Emergency Preparedness, which pays for emergency capabilities for state and local health departments, dropped by about half between the 2003 and 2021 fiscal years, accounting for inflation, according to Trust for America’s Health, a public health research and advocacy organization.

Even the federal Prevention and Public Health Fund, established with the Affordable Care Act to provide $2 billion a year for public health, was raided for cash over the past decade. If the money hadn’t been touched, eventually local and state health departments would have gotten an additional $12.4 billion.

Several lawmakers, led by Democratic U.S. Sen. Patty Murray of Washington, are looking to end the boom-bust cycle with legislation that would eventually provide $4.5 billion annually in core public health funding. Health departments carry out essential government functions — such as managing water safety, issuing death certificates, tracking sexually transmitted diseases and preparing for infectious outbreaks.

Spending for state public health departments dropped by 16% per capita from 2010 to 2019, and spending for local health departments fell by 18%, KHN and The Associated Press found in a July investigation. At least 38,000 public health jobs were lost at the state and local level between the 2008 recession and 2019. Today, many public health workers are hired on a temporary or part-time basis. Some are paid so poorly they qualify for public aid. Those factors reduce departments’ ability to retain people with expertise.

Compounding those losses, the pandemic has prompted an exodus of public health officials because of harassment, political pressure and exhaustion. A yearlong analysis by the AP and KHN found at least 248 leaders of state and local health departments resigned, retired or were fired between April 1, 2020, and March 31, 2021. Nearly 1 in 6 Americans lost a local public health leader during the pandemic. Experts say it is the largest exodus of public health leaders in American history.

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Brian Castrucci, CEO of the de Beaumont Foundation, which advocates for public health, calls Congress’ giant influx of cash in response to the crisis “wallpaper and drapes” because it doesn’t restore public health’s crumbling foundation.

“I worry at the end of this we’re going to hire up a bunch of contact tracers — and then lay them off soon thereafter,” Castrucci said. “We are continuing to kind of go from disaster to disaster without ever talking about the actual infrastructure.”

Castrucci and others say dependable money is needed for high-skill professionals, such as epidemiologists — data-driven disease detectives — and for technology upgrades that would help track outbreaks and get information to the public.

In Ohio, the computer system used to report cases to the state predates the invention of the iPhone. State officials had said for years they wanted to upgrade it, but they lacked the money and political will. Many departments across the country have relied on fax machines to report covid cases.

During the pandemic, Ohio’s state auditor found that nearly 96% of local health departments it surveyed had problems with the state’s disease reporting system. Roberts said workers interviewing patients had to navigate several pages of questions, a major burden when handling 500 cases daily.

The system was so outdated that some information could be entered only in a non-searchable comment box, and officials struggled to pull data from the system to report to the public — such as how many people who tested positive had attended a Black Lives Matter rally, which last summer was a key question for people trying to understand whether protests contributed to the virus’s spread.

Ohio is working on a new system, but Roberts worries that, without a dependable budget, the state won’t be able to keep that one up to date either. 

“You’re going to need to upgrade that,” Roberts said. “And you're going to need dollars to support that.”

In Washington, the public health director for Seattle and King County, Patty Hayes, said she is asked all the time why there isn’t a single, central place to register for a vaccine appointment. The answer comes down to money: Years of underfunding left departments across the state with antiquated computer systems that were not up to the task when covid hit.

Hayes recalls a time when her department would conduct mass vaccination drills, but that system was dismantled when the money dried up after the specter of 9/11 faded.

Roughly six years ago, an analysis found that her department was about $25 million short of what it needed annually for core public health work. Hayes said the past year has shown that’s an underestimate. For example, climate change is prompting more public health concerns, such as the effect on residents when wildfire smoke engulfed much of the Pacific Northwest in September.

Public health officials in some areas may struggle to make the case for more stable funding because a large swath of the public has questioned — and often been openly hostile toward — the mask mandates and business restrictions that public health officials have imposed through the pandemic.

In Missouri, some county commissioners who were frustrated at public health restrictions withheld money from the departments.

In Knox County, Tennessee, Mayor Glenn Jacobs narrated a video posted in the fall that showed a photo of health officials after referencing “sinister forces.” Later, someone spray-painted “DEATH” on the department office building. The Board of Health was stripped of its powers in March and given an advisory role. A spokesperson for the mayor’s office declined to comment on the video.

“This is going to change the position of public health and what we can and cannot do across the country,” said Dr. Martha Buchanan, the head of the health department. “I know it’s going to change it here.”

A KHN and AP investigation in December found at least 24 states were crafting legislation that would limit or remove public health powers.

Back in Seattle, locally based companies have pitched in money and staff members for vaccine sites. Microsoft is hosting one location, while Starbucks offered customer service expertise to help design the sites. Hayes is grateful, but she wonders why a critical government function didn’t have the resources it needed during a pandemic.

If public health had been getting dependable funding, her staff could have been working more effectively with the data and preparing for emerging threats in the state where the first U.S. covid case was confirmed.

“They'll look back at this response to the pandemic in this country as a great example of a failure of a country to prioritize the health of its citizens, because it didn't commit to public health,” she said. “That will be part of the story.”

KHN senior correspondent Anna Maria Barry-Jester and Montana correspondent Katheryn Houghton 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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Categories: Health Care

Everyone 16-Plus In Mass. Can Now Sign Up For A Vaccine Appointment

CommonHealth (WBUR) - Mon, 04/19/2021 - 9:28am

Monday marks the day every adult in Massachusetts is eligible for a COVID shot. After months of having eligibility limited to certain age groups, occupations and health factors, everyone 16 and older can sign up to be vaccinated.

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