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Center on Budget and Policy Priorities - Fri, 01/14/2022 - 3:00pm
This week at CBPP, we focused on federal taxes, state budgets and taxes, family income support, housing, and the economy. On federal taxes, Chuck Marr urged Congress to act following the expiration of the expanded Child Tax Credit monthly payments. On state budgets and taxes, Wesley Tharpe explained why states should reject baseless claims for tax cuts. On family income support, Diana Azevedo-McCaffrey and Ali Safawi emphasized that states should invest more TANF dollars in basic assistance to promote equity, and summarized those findings in a policy brief. We also updated our fact sheet on
Categories: Benefits, Poverty

States Should Reject Baseless Claims for Tax Cuts

Center on Budget and Policy Priorities - Fri, 01/14/2022 - 10:55am
For decades, wealthy interests, large corporations, and their allies in state capitols have pushed tax cuts that haven’t yielded the promised economic benefits but instead have undermined state revenue systems. This has harmed programs that help families with low to moderate incomes, expand opportunity in communities of color, and support crucial services including public schools and colleges, parks, public health, and infrastructure. Despite already extreme levels of economic inequality and robust corporate profits, these folks are back this year with hat in hand. States shouldn’t take the
Categories: Benefits, Poverty

On this Day: The Danish Queen Margarethe II – 50 Years as Head of State

In Custodia Legis - Fri, 01/14/2022 - 8:00am

Queen Margarethe II waves to the crowd. Photo by Flickr user Mifl68, April 16, 2015. Used under license CC BY-NC-ND 2.0..

Today, January 14, 2022, the Danish Queen Margarethe II (Margrethe Alexandrine Þorhildur Ingrid) celebrates 50 years on the Danish throne. However, she was not born the heir apparent to the throne, but became Crown Princess of Denmark at the age of 13 when the Danish Parliament adopted an act of succession (Tronfølgelov) that allowed daughters to inherit the throne.

The Succession Act of 1953 was, as laws often are, a law written out of necessity. Margarethe was at that time the oldest of three royal siblings, all girls, born to King Frederik IX and Queen Ingrid. Queen Ingrid was 43 years old and the royal couple had given up hope of a male heir. However, perhaps the Danish Parliament held on to some hope that the stork would still bless the royal couple with a crown prince, as the law was made male-preference primogeniture, meaning that while daughters now had a place in line to the throne, even an older daughter’s place was still behind any younger brother.

Not until 2009 did an amendment make the succession act gender-neutral, meaning that the first-born of a Head of State would become the first in line to the throne regardless of his or her gender. At that time, Queen Margarethe’s eldest son, Crown Prince Frederik, already had two children: Prince Christian (born in 2005) and Princess Isabella (born in 2007). Their positions in line to the throne were not affected by the succession law as Christian was older than Isabella, but her younger brother Prince Vincent (born in 2011) would have succeeded her in line to the throne had it not been for the legislative change in 2009. Born minutes before his twin-sister Princess Josephine, Vincent holds the third position among the four siblings.

Adoption of the 1953 Succession Act

When adopted in 1953, changing the succession order required a constitutional amendment. The Danish Constitution of 1953 entered into force on the same day as the separate Succession Act. As required by the Constitution, the Danish people were consulted on the future of the country in a national referendum held in 1953.

In 2009, the new succession act did not require a constitutional amendment as the Constitution already allowed for female succession to the throne. (§ 2 Danish Constitution.)

Royal Duties and Requirements

As a queen-to-be, Margarethe assumed many duties when she turned 18, such as assuming a seat at the State Council (Statsråd) on April 16, 1958. The State Council, which includes the Head of State, crown prince or crown princess, and all the government ministers, “negotiates all laws and important government measures.” (§17 stk. 2 Danish constitution.)

Her position as crown princess also meant that her engagement to Comte Henri de Laborde de Monpezat (later Prince Henrik) in 1966 had to be approved by the king and the Danish Parliament.  (§ 5 Succession Act.) The wedding took place in 1967 at the Holmen Church. The newlyweds took up residency at Marselisborg Palace, before Margarethe’s father’s sudden death on January 14, 1972.

Upon the king’s death, Margarethe became queen by a royal public proclamation, without a coronation. Ahead of the proclamation, she had to choose a royal motto, and chose: “God’s help, the love of The People, Denmark’s strength.” Queen Margarethe also chose to be titled Queen Margarethe the second, recognizing the role of Queen Margaret (the first) (Margaret Valdemarsdatter) who presided over Denmark, Norway, and Sweden in the Kalmar Union between 1397 and 1412.

The Role of the Head of State (Queen or King)

In 1849, Denmark became a constitutional monarchy, when King Frederik VII signed a constitution that defined and limited his powers. The constitution was later amended in 1866 and 1915. Today, the role of the Head of State is to “represent Denmark abroad and to be a figurehead at home,” which includes participating during the formation of government by formally appointing the government, receiving state visitors, conferring “Royal Warrants” and heading and awarding the Royal Orders of Chivalry. In addition, as Head of State it is the Queen’s duty to sign all Danish laws. (§14 Danish Constitution.)

Other duties include giving speeches to the public. The annual New Year’s speech is broadcast live by Danish media and typically viewed by millions of Danes, but the corona speech that she held in March 2020 broke all records, with more than 3.4 million viewers. The Queen’s speeches are available on the royal palace website.

Names Fit for a Queen 

Although the Danish Name Act (Navneloven) does not specify special provisions for royalty, there are some rules that apply solely to royals, including that only royals may have a number designation following their name, thus, no little Johnny III. Margarethe is only the second Queen Margarethe, but her son will be Frederik X and her grandson will one day be Christian XI. In fact, being named Frederik or Christian, is a royal tradition. Ever since Christian II, who reigned from 1513 to 1523, the kings of Denmark have been named either Frederik or Christian. If the tradition is to be continued, Christian will have to name his firstborn son Frederik or his firstborn daughter Margaret.

Unlike most Danes, Queen Margarethe has four given names: Margrethe Alexandrine Þorhildur Ingrid. Þorhildur, an Icelandic name, was chosen in recognition of Iceland, which was part of the Danish kingdom when Margarethe was born in 1940. Formally, the queen does not have a last name but is part of the House of Glücksborg. She is also known to her closest family as Daisy, after the Danish flower and has been called the “World’s coolest queen.”

A Royal Ending and Royal Resting Place

Starting in the 1400s, all Danish regents have been buried in the Roskilde Cathedral, and plans have been made for Queen Margarethe to rest there as well. Her late husband, Prince Henrik, however, refused to be buried with her on the account of his dissatisfaction over his royal title and royal duties, arguing that because he was not an equal to the queen in life, he should not be an equal to her in death. Prince Henrik was instead cremated and some of his ashes were spread over Danish waters while some were buried in an urn in a private garden in the Fredensborg Palace.

Still Going Strong

The queen is currently the second longest-serving regent in Denmark, second only to King Christian IV, who served for 60 years. Some of the programmed celebrations in her honor have been postponed due to the surge of COVID-19 in Denmark, but the queen continues to be very popular among the Danes, celebrated for her artistic talents, and she has publicly communicated that she has no plans on stepping down early. For those interested in reading more about Queen Margarethe, the Royal House of Denmark has published a special site commemorating the queen’s 50-year reign.

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Categories: Research & Litigation

Financial Planning for People With Chronic Diseases

Medicare -- New York Times - Fri, 01/14/2022 - 5:00am
Financial planning for people with chronic diseases is complicated and multifaceted. Start by building a team of people to help.
Categories: Elder, Medicare

With No End in Sight to Pandemic Life, Parents Find Disruption Is the New Normal

Kaiser Health News - Fri, 01/14/2022 - 5:00am

As my kindergartner fumbled with his shoes, I stood at our door sifting through the mental parenting checklist newly lodged in my brain: backpack. Sweatshirt. Snacks. Sunscreen. Water bottle. KN95 mask. Vaccination card.

Jesse asked for his cloth mask, and I explained again that if he wore that one he’d need to have on a surgical mask, too, which could make it hard to run around at recess. So I did my best to twist the elastic ear loops on the KN95 into a size that would fit his cherubic face, and we headed out the door.

When we got to Will Rogers Learning Community, our school in Santa Monica, California, the entry path was split into two lines by a velvet rope. Kids and parents clustered at the rope entrance examining a paper with large print poised on a music stand. It listed the classes with covid cases, whose kids had to be tested to enter school. Those kids were shunted to the right, into the cafeteria where staff members were helping them stick swabs up their tiny noses. The rest of the kids headed into the building.

This is parenting in Southern California in the days of omicron, swimming in an ocean of angst, with currents constantly shifting direction, an awkward soup of fear, determination and gratitude for those doing the hard work of keeping schools working.

The messiness is evident in the nation’s second-largest school district, Los Angeles Unified, where roughly 520,000 kids started pouring back into schools Jan. 11 for the first time in three weeks.

“There is a lot of urgency in keeping schools open,” says Manuel Pastor, a sociologist who directs University of Southern California’s Equity Research Institute. Indeed, under a California law that took effect in July, Los Angeles can’t switch to distance learning unless there is a severe staffing shortage. Yet at the same time, the schools have strengthened safety measures that were already among the strictest in the country, upgrading masking and testing requirements.

The push-pull is essential because physical attendance is vitally important to the kids already disadvantaged because they speak other languages at home, or have parents who can’t or don’t help with their lessons, Pastor said. Yet these same kids are more likely to create risks if they bring the virus home, because their families are more likely to live in crowded homes, their parents are more likely to be essential workers, and they are more likely to have unvaccinated siblings or relatives.

“It’s kind of the worst of both possible worlds in terms of challenges in remote learning and the challenges with going back to school,” he said.

Before students could return on Jan. 11, they had to participate in baseline testing, either through a home rapid test a few days before school started — which can sometimes give false-negative results — or a PCR test at a stationary site. Some 65,000 kids tested positive before school reopened; another 85,000 or so were also absent the first day, partly, perhaps, because of parental fear of the virus.

Testing was the easiest part about getting back into school, according to many families. There were 60 locations for students to pick up free tests. The district already had the largest weekly coronavirus testing program in the nation, testing every staff member and student every week.

Children in quarantine won’t have the option to Zoom into their classrooms, however. Schools have not trained their teachers to simultaneously teach to in-room and online students. Officials say that with the district’s modified quarantine rules — which call for only students who test positive or have active symptoms of illness to stay home — those who are quarantined should be recovering, anyway, and are likely to return in a few days.

Even for those who got into school, the transition was not always smooth. On the morning schools reopened their doors, Daily Pass, the app where students upload their test results, crashed.

So instead of flashing their phones at the schoolhouse door, kids formed lines around schools and underwent a highly unscientific process to vet their state of infectiousness. Some schools went back to asking screening questions to students and parents.

Interim Superintendent Megan Reilly apologized for the Daily Pass glitches. “I knew that today was not going to be a day that we didn’t have some bumps along the road,” she said at a news conference.

Meanwhile, administrative staff members were brought in to substitute for 2,000 or so teachers (out of 25,000) who were out with covid or caring for someone infected with the virus. On Jan. 12, a school board member substituted in a classroom, and another classroom had an LAUSD architect helping out. Jenna Schwartz, an LAUSD parent who co-founded the group Parents Supporting Teachers, said the district is bringing in thousands of staffers to help out. That isn’t as bad as it sounds, she said.

“The narrative is that bus drivers will be teaching algebra, but the truth is, there are a huge amount of credentialed teachers that work in admin now,” she said. “One of the perks of having bureaucracy is that there are a huge amount of people who can fill in.”

The district’s modified quarantine policy says that if there is an exposure in a classroom, students can remain in school while asymptomatic, testing on the fifth day after a suspected exposure.

But not every school is implementing that policy, and some schools, like public charters, have leeway to make their own decisions. Paulina Jones’ 6-year-old daughter, a kindergartner at Citizens of the World Hollywood charter school, was sent home with the rest of her class for 10 days due to an exposure the first week back in school.

That’s why Jones was driving to work on Jan. 11, to a construction site where she is a manager, with her daughter in the back seat. Jones fears it’s a scenario that will keep happening, over and over. “Half the school is under quarantine right now,” she said.

Between the long winter break and this quarantine, her daughter has had only one in-person instructional day in a month. And the Zoom instruction just doesn’t work for this age group, Jones said.

“It’s extremely stressful for me to have her at work with me, but it’s more beneficial than taking 10 days off of work,” she said. “We all have to make hard decisions right now, and I have to support my family.”

There’s a weariness to the waves of illness, Jones said. “If there was an end in sight, I would take time off of work, but there’s no end in sight.”

Pastor said the situation echoes the early days of 2020, but with a noticeable difference: “There’s no talk of a shutdown. There’s just talk about managing the illness so we don’t overwhelm hospitals and health care,” he said. “There are going to be a lot of scary moments for parents.”

The words echoed in my head as I watched Jesse, fitted with his new KN95, teeter as he settled his backpack onto his small frame, then gallop off toward the right lane to enter school. As he disappeared into the school gates, I could hear him chattering to another kid: “I’m ready.”

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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Categories: Health Care

As Omicron Surges, Effort to Vaccinate Young Children Stalls

Kaiser Health News - Fri, 01/14/2022 - 5:00am

Two months after Pfizer’s covid vaccine was authorized for children ages 5 to 11, just 27% have received at least one shot, according to Jan. 12 data from the Centers for Disease Control and Prevention. Only 18%, or 5 million kids, have both doses.

The national effort to vaccinate children has stalled even as the omicron variant upends schooling for millions of children and their families amid staffing shortages, shutdowns and heated battles over how to safely operate. Vaccination rates vary substantially across the country, a KHN analysis of the federal data shows. Nearly half of Vermont’s 5- to 11-year-olds are fully vaccinated, while fewer than 10% have gotten both shots in nine mostly Southern states.

Pediatricians say the slow pace and geographic disparities are alarming, especially against the backdrop of record numbers of cases and pediatric hospitalizations. School-based vaccine mandates for students, which some pediatricians say are needed to boost rates substantially, remain virtually nonexistent.

You have these large swaths of vulnerable children who are going to school,” said Dr. Samir Shah, a director at Cincinnati Children’s Hospital Medical Center. Compounding the problem is that states with low vaccination rates “are less likely to require masking or distancing or other nonpartisan public health precautions,” he said.

In Louisiana, where 5% of kids ages 5 to 11 have been fully vaccinated, Gov. John Bel Edwards, a Democrat, added the shot to the list of required school immunizations for the fall, over the objections of state legislators, who are mostly Republicans. The District of Columbia and California, where about 1 in 5 elementary school kids are fully vaccinated, have added similar requirements. But those places are exceptions — 15 states have banned covid vaccine mandates in K-12 schools, according to the National Academy for State Health Policy.

Mandates are one of multiple “scientifically valid public health strategies,” Shah said. “I do think that what would be ideal; I don’t think that we as a society have a will to do that.”

Vaccine demand surged in November, with an initial wave of enthusiasm after the shot was approved for younger children. But parents have vaccinated younger kids at a slower pace than 12- to 15-year-olds, who became eligible in May. It took nearly six weeks for 1 in 5 younger kids to get their first shot, while adolescents reached that milestone in two weeks.

Experts cite several factors slowing the effort: Because kids are less likely than adults to be hospitalized or die from the virus, some parents are less inclined to vaccinate their children. Misinformation campaigns have fueled concerns about immediate and long-term health risks of the vaccine. And finding appointments at pharmacies or with pediatricians has been a bear.

“One of the problems we’ve had is this perception that kids aren’t at risk for serious illness from this virus,” said Dr. Yvonne Maldonado, chair of the American Academy of Pediatrics Committee on Infectious Diseases. “That’s obviously not true.”

Parents are left to weigh which is more of a threat to their children: the covid virus or the vaccine to prevent the virus. Overwhelmingly, research shows, the virus itself presents a greater danger.

Kids can develop debilitating long-covid symptoms or a potentially fatal post-covid inflammatory condition. And new research from the CDC found that children are at significantly higher risk of developing diabetes in the months after a covid infection. Other respiratory infections, like the flu, don’t carry similar risks.

Katharine Lehmann said she had concerns about myocarditis — a rare but serious side effect that causes inflammation of the heart muscle and is more likely to occur in boys than girls — and considered not vaccinating her two sons because of that risk. But after reading up on the side effects, she realized the condition is more likely to occur from the virus than the vaccine. “I felt safe giving it to my kids,” said Lehmann, a physical therapist in Missouri, where 20% of younger kids have gotten at least one dose.

Recent data from scientific advisers to the CDC found that myocarditis was extremely rare among vaccinated 5- to 11-year-olds, identifying 12 reported cases as of Dec. 19 out of 8.7 million administered doses.

The huge variations in where children are getting vaccinated reflect what has occurred with other age groups: Children have been much less likely to get shots in the Deep South, where hesitancy, political views and misinformation have blunted adult vaccination rates as well. Alabama has the lowest vaccination rate for 5- to 11-year-olds, with 5% fully vaccinated. States with high adult vaccine rates such as Vermont, Massachusetts, Connecticut and Maine have inoculated the greatest shares of their children.

Even within states, rates vary dramatically by county based on political leanings, density and access to the shot. More than a quarter of kids in Illinois’ populous counties around Chicago and Urbana are fully vaccinated, with rates as high as 38% in DuPage County. But rates are still below 10% in many of the state’s rural and Republican-leaning counties. In Maryland, where 1 in 4 kids are fully vaccinated, rates range from more than 40% in Howard and Montgomery counties, wealthy suburban counties, to fewer than 10% along parts of the more rural Eastern Shore.

Nationally, a November KFF poll found that 29% of parents of 5- to 11-year-olds definitely won’t vaccinate their children and that an additional 7% would do so only if required. Though rates were similar for Black, white and Hispanic parents, political differences and location divided families. Only 22% of urban parents wouldn’t vaccinate their kids, while 49% of rural parents were opposed. Half of Republican parents said they definitely wouldn’t vaccinate their kids, compared with just 7% of Democrats.

The White House said officials continue to work with trusted groups to build vaccine confidence and ensure access to shots. “As we’ve seen with adult vaccinations, we expect confidence to grow and more and more kids to be vaccinated across time,” spokesperson Kevin Munoz said in a statement.

The Hunt for Shots

Just before her younger son’s 5th birthday, Lehmann was eager to book covid vaccine appointments for her two boys. But their pediatrician wasn’t offering them. Attempts to book time slots at CVS and Walgreens before her son turned 5 were unsuccessful, even if the appointment occurred after his late-November birthday.

“It was not easy,” she said. Wanting to avoid separate trips for her 10-year-old and 5-year-old, she nabbed appointments at a hospital a half-hour away.

“Both of my kids have gotten all their vaccines at the pediatrician, so I was kind of shocked. That would have certainly been easier,” Lehmann said. “And the kids know those nurses and doctors, so I think it would have helped to not have a stranger doing it.”

The Biden administration has pointed parents to retail pharmacies and 122 children’s hospitals with vaccine clinics. Nationwide, more than 35,000 sites, including pediatricians, federally qualified health centers and children’s hospitals have been set up to vaccinate young kids, according to the administration. Yet administering the covid vaccine to children presents obstacles that haven’t been as prominent for other inoculations.

Enrolling pediatricians in the covid-19 vaccine program is a challenge because of the application process, reporting requirements for administered doses, and staffing, said Claire Hannan, executive director of the Association of Immunization Managers.

“Many of them are short-staffed right now and don’t necessarily have huge capacity to serve,” she said. Plus, “it’s not as easy to engage the schools in school-based clinics in certain areas just due to the political environment.” Health centers, government officials and other groups have set up more than 9,000 school vaccination sites for 5- to 11-year-olds nationwide.

The CDC’s long-standing program, Vaccines for Children, provides free shots for influenza, measles, chickenpox and polio, among others. Roughly 44,000 doctors are enrolled in the program, which is designed to immunize children who are eligible for Medicaid, are uninsured or underinsured, or are from Native or Indigenous communities. More than half of the program’s providers offer covid shots, although the rates vary by state.

Pharmacies have been heavily used in Illinois, where 25% of 5- to 11-year-olds are fully vaccinated.

Dr. Ngozi Ezike, a pediatrician and the director of the Illinois Department of Public Health, said 53% of shots administered to younger children as of Jan. 5 were done at pharmacies. Twenty percent occurred at private clinics, 7% at local health departments, 6% at federally qualified health centers and 5% at hospitals.

“You need all pieces of the pie” to get more kids vaccinated, Ezike said.

Kids Respond to ‘the Greater Good’

The Levite Jewish Community Center in Birmingham, Alabama, tried to boost vaccinations with a party, offering games and treats, even a photo booth and a DJ, along with shots given by a well-known local pharmacy. Brooke Bowles, the center’s director of marketing and fund development, estimated that about half a dozen of the 42 people who got a dose that mid-December day were kids.

Bowles was struck that children were more likely to roll up their sleeves when their parents emphasized the greater good in getting vaccinated. “Those children were just fantastic,” she said. In parts of the Deep South like this one, pro-vaccine groups face a tough climb — as of Jan. 12, only 7% of Jefferson County’s children had gotten both shots.

The greater good is what pediatricians have emphasized to parents who are on the fence.

“Children are vectors for infectious disease,” said Dr. Eileen Costello, chief of ambulatory pediatrics at Boston Medical Center. “They’re extremely generous with their microbes,” spreading infections to vulnerable relatives and community members who may be more likely to end up in the hospital.

Seventy-eight percent of the hospital’s adult patients have received at least one dose. For children 5 and up, the figure is 39%, with younger children having lower rates than adolescents, Costello said. Particularly amid an onslaught of misinformation, “it has been exhausting to have these long conversations with families who are so hesitant and reluctant,” she said.

Still, she can point to successes: A mother who lost a grandparent to covid was nonetheless reluctant to vaccinate her son with obesity and asthma whom Costello was seeing for a physical. The mother ultimately vaccinated all four of her children after Costello told her that her son’s weight put him at higher risk for severe illness.

“That felt like a triumph to me,” Costello said. “I think her thinking was, ‘Well, he’s a kid — he’s going to be fine.’ And I said, ‘Well, he might be fine, but he might not.’”

Methodology

Vaccination numbers are from the Centers for Disease Control and Prevention as of Jan. 12.

National vaccination rates are calculated by the CDC and include vaccinations provided by federal programs such as the Indian Health Service and the Department of Defense, as well as U.S. territories. To compare the vaccination rollout for kids and adolescents, we counted day 0 as the day the CDC approved the vaccine for each age group: May 12, 2021, for 12- to 15-year-olds and Nov. 2, 2021, for 5- to 11-year-olds.

The CDC provides vaccination numbers at the state and county level. These numbers do not include the small fraction of children who were vaccinated by federal programs. To calculate rates for 5- to 11-year-olds, we divided by the total number of kids ages 5 to 11 in each state or county.

To calculate the number of children ages 5 to 11 in each state, we used the U.S. Census Bureau’s 2019 Population Estimates Program “single year of age” dataset, the latest release available. For county-level data, we used the National Center for Health Statistics’ Bridged Race Population Estimates, which contain single-year-of-age county-level estimates. We selected the 2019 estimates from the 2020 vintage release so the data would reflect the same year as the state-level estimates.

Vaccination data by age is unavailable for Idaho, counties in Hawaii and several California counties. For county-level vaccination data, we excluded states in which the county was unknown for at least 10% of the kids vaccinated in that state.

Visit the Github repository to read more about and download the data.

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

Justices Block Broad Worker Vaccine Requirement, Allow Health Worker Mandate to Proceed

Kaiser Health News - Thu, 01/13/2022 - 4:27pm

The Supreme Court on Thursday blocked a key Biden administration covid-19 initiative — putting a stop, for now, to a rule requiring businesses with more than 100 workers to either mandate that employees be vaccinated against covid or wear masks and undergo weekly testing. The rule, which covers an estimated 80 million workers, took effect earlier this week.

At the same time, however, the justices said that a separate rule requiring covid vaccines for an estimated 10 million health workers at facilities that receive funding from Medicare and Medicaid could go forward. The justices removed a temporary halt imposed by a lower court late last year that affected health care facilities in half the states.

In emergency oral arguments held Jan. 7, a majority of the justices seemed dubious that the federal government, through the Occupational Safety and Health Administration, had broad enough authority to require vaccines or tests for the bulk of the nation’s private workforce, particularly for a threat that is not job-specific.

Said the unsigned majority opinion: “A vaccine mandate is strikingly unlike the workplace regulations that OSHA has typically imposed. A vaccination, after all, ‘cannot be undone at the end of the workday.’”

Liberals on the court — where anti-covid policies are even stricter than those up for debate in the case — were outraged at the majority decision, arguing that just because a threat exists outside the workplace as well as inside, that should not prevent the federal safety agency from regulating it.

Justices Stephen Breyer, Elena Kagan and Sonia Sotomayor wrote in a signed opinion, “When we are wise, we know not to displace the judgments of experts, acting within the sphere Congress marked out and under Presidential control, to deal with emergency conditions. Today, we are not wise.” In the second pair of cases also argued Jan. 7, the justices weighed whether the federal government could place conditions on payments for Medicare and Medicaid to help ensure the safety of the patients whose care is being underwritten.

The health worker rule, said the opinion, also unsigned, “fits neatly within the language of the statute. After all, ensuring that providers take steps to avoid transmitting a dangerous virus to their patients is consistent with the fundamental principle of the medical profession: first, do no harm.”

Four conservative justices — Clarence Thomas, Samuel Alito, Neil Gorsuch and Amy Coney Barrett — dissented in the health worker case, arguing in their signed opinion that “to the extent the rule has any connection to the management of Medicare, and Medicaid, it is at most a ‘tangential’ one.”

President Joe Biden lamented the court’s decision on the rule for large workplaces. “As a result of the Court’s decision, it is now up to States and individual employers to determine whether to make their workplaces as safe as possible for employees, and whether their businesses will be safe for consumers during this pandemic by requiring employees to take the simple and effective step of getting vaccinated,” he said in a statement.

The OSHA rules are opposed by many business groups, led by the small business advocacy organization the National Federation of Independent Business. It argued that allowing the rules to take effect would leave businesses “irreparably harmed,” both by the costs of compliance and the possibility that workers would quit rather than accept the vaccine.

The challenge to the Medicare and Medicaid rules, by contrast, came mostly from states, rather than the hospitals, nursing homes and other facilities most directly affected. State officials charge that the rules would jeopardize the ability of health care providers, particularly those in rural areas, to retain enough staffers to care for patients.

This story is developing and will be updated.

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

Una prueba rápida negativa no significa que se está libre de covid

Kaiser Health News - Thu, 01/13/2022 - 2:40pm

Julie Ann Justo, farmacéutica clínica de enfermedades infecciosas para un sistema hospitalario de Carolina del Sur, esperaba que la semana de Navidad finalmente fuera el momento en que su familia pudiera reunirse de manera segura.

Antes de la celebración, los familiares elegibles se vacunaron y tuvieron sus refuerzos. Se aislaron y usaron máscaras. Y muchos confiaron en los resultados negativos de las pruebas rápidas de covid que se hicieron antes de la reunión que convocó a 35 personas en el sur de Florida.

Pero en menos de una semana, Justo y al menos 13 miembros de su familia dieron positivo para covid, y muchos sintieron los síntomas típicos de un virus de las vías respiratorias superiores, como dolor de garganta y secreción nasal.

Como muchos otros, la familia de Justo aprendió por las malas que un solo resultado negativo de una prueba casera no es garantía de que una persona no esté enferma ni porte el virus.

Eso es aún más cierto con la variante omicron, que es muy contagiosa. Las pruebas pueden hacerse demasiado pronto, antes de que haya suficiente virus presente para detectarlo, o demasiado tarde, después de que una persona ya haya contagiado a otras.

Y se supone que la mayoría de los tests deben usarse en pares, para hacerse dos pruebas con unos días de diferencia cada una. Pero muchas marcas traen un solo kit, y el costo más la escasez generan que muchos se hagan solo un test.

Si bien expertos dicen que las pruebas de antígenos caseras siguen siendo una herramienta útil, agregan que pueden brindar una falsa confianza.

Algunas personas ven erróneamente a las pruebas caseras “como una tarjeta de libertad”, dijo el doctor William Schaffner, especialista en enfermedades infecciosas en la Escuela de Medicina de la Universidad Vanderbilt, en Nashville, Tennessee. “Soy negativo, así que ya no tengo de que preocuparme”.

“Omicron es tan transmisible que es un desafío usar cualquier tipo de estrategia de prueba en términos ir o no ir a reuniones y tener éxito”, dijo el doctor Patrick Mathias, vicepresidente de operaciones clínicas del departamento de medicina de laboratorio y patología de la Escuela de Medicina de la Universidad de Washington.

Las pruebas rápidas son bastante buenas para detectar correctamente la infección en personas con síntomas, agregó Mathias, con un rango de precisión del 70% a casi el 90%, un estimado de varios estudios.

Otras investigaciones, algunas anteriores a la circulación de las variantes actuales o que se realizaron en entornos más controlados, han mostrado tasas más altas, pero, aún así, las pruebas todavía pueden pasar por alto a algunas personas infectadas.

Esto aumenta el riesgo de propagación, y la posibilidad crece dramáticamente dependiendo de la cantidad de personas que asisten a un evento.

Las pruebas rápidas son menos precisas en personas sin síntomas.

Para los asintomáticos, las pruebas rápidas “en promedio, detectan correctamente la infección aproximadamente el 50% de las veces”, dijo Shama Cash-Goldwasser, asesora de Prevent Epidemics at Resolve to Save Lives, un grupo sin fines de lucro dirigido por el ex director de los CDC, Tom Frieden.

Mirando hacia atrás, Justo dijo que su familia hizo todo lo que pudo, pero reconoce que dos cosas los pusieron en mayor riesgo: no todos los miembros de la familia se hicieron la prueba antes de reunirse debido a la escasez de kits. Y asistieron varios niños menores de 5 años que aún no son elegibles para la vacuna. Más tarde, fueron de los primeros en mostrar síntomas.

“Probablemente dependimos demasiado de las pruebas rápidas negativas para reunirnos en interiores, sin otras capas de protección”, dijo.

“Una cosa crítica es el momento en el que se hace la prueba”, dijo Schaffner. Si se hace la prueba demasiado pronto, como uno o dos días luego de la exposición, los resultados pueden no ser precisos. Del mismo modo, la prueba varios días antes de un evento no dirá mucho sobre quién puede ser infeccioso el día de la fiesta.

Schaffner y otros recomiendan comenzar las pruebas tres días después de una exposición conocida o, si uno se siente enfermo, unos días después del inicio de los síntomas. Siempre es una buena idea usar ambas pruebas en el kit, según las instrucciones, la segunda de 24 a 36 horas después de la primera. Para un evento, hay que asegurarse que una de las pruebas se haga el día del evento.

Las pruebas de antígenos funcionan buscando proteínas específicas del virus, que deben estar presentes en cantidades adecuadas para que la prueba las detecte. (Las pruebas PCR de laboratorio son más precisas porque pueden detectar cantidades más pequeñas del virus, pero tardan más en arrojar resultados).

Los marcadores de covid pueden permanecer como remanentes mucho después de que el virus vivo haya desaparecido, por lo que algunos científicos cuestionan el uso de pruebas, ya sean de antígeno o PCR, como una medida para saber cuándo los pacientes pueden terminar su aislamiento, particularmente si buscan acortar el período recomendado.

Los CDC recomiendan cinco días de aislamiento, que pueden terminar si los síntomas desaparecen o se resuelven, sin fiebre.

Algunos pacientes darán positivo 10 días o más después de los primeros síntomas, aunque es poco probable que sigan siendo infecciosos para entonces.

Aún así, eso significa que muchas personas están usando las pruebas rápidas de manera inapropiada, no solo confiando demasiado en ellas como protección contra covid, sino también como un indicador de cuándo ha terminado una infección.

Las pruebas caseras rápidas deben usarse durante varios días para aumentar las posibilidades de obtener un resultado preciso.

“Cada prueba individual no tiene mucho valor como las pruebas en serie”, dijo el doctor Zishan Siddiqui, director médico del Baltimore Convention Center Field Hospital y profesor asistente de medicina en la Universidad Johns Hopkins. Y, porque el test es menos certero en personas sin síntomas, dijo que las personas asintomáticas no deberían depender de una sola prueba rápida para reunirse con amigos o familiares sin otras medidas de mitigación.

Un estudio examinó a 30 adultos vacunados en diciembre de 2021. “La mayoría de los casos de omicron fueron infecciosos durante varios días antes de ser detectables mediante pruebas rápidas de antígenos”, encontró el estudio. La investigación aún no ha sido revisada por pares.

Los falsos negativos también son más probables cuando hay propagación comunitaria y la circulación del virus es rampante, como es el caso ahora en la mayoría de los estados.

“Si hay mucha propagación comunitaria, eso aumenta la probabilidad de que tengas covid”, dijo Cash-Goldwasser. Sin embargo, las pruebas, estadísticamente, seguirán pasando por alto un cierto porcentaje de los realmente infectados. Con un mayor número de personas probablemente infectadas, y el mismo porcentaje de posibilidades de casos perdidos, aumenta el número absoluto de falsos negativos, explicó.

Entonces, en este momento, “si tienes un resultado negativo, es importante desconfiar más”, dijo.

Las vacunas, los refuerzos, el uso de máscaras, el distanciamiento social, la ventilación y las pruebas por separado son soluciones imperfectas para prevenir infecciones. Pero en capas, pueden servir como una barrera más efectiva, dijo Schaffner.

“La prueba rápida es útil”, su propia familia los usó antes de reunirse para el Día de Acción de Gracias y Navidad, “pero es una barrera con agujeros”, agregó.

La familia Justo probó esas capas, pero quedaron huecos por los que pasó el virus. Si bien la mayoría de los familiares tuvieron síntomas leves, Justo dijo que le faltó el aire, se sintió fatigada y tuvo dolores de cabeza, musculares, y náuseas. Pasaron unos 10 días antes de que se sintiera mejor.

“Ciertamente pasé mucho tiempo revisando lo que podríamos haber hecho de manera diferente, pero la realidad fue que hicimos lo mejor que pudimos”, dijo Justo. “Afortunadamente nadie necesitó ir al hospital, y lo atribuyo a las vacunas. Por eso estoy agradecida”.

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

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KHN’s ‘What the Health?’: Dealing With Drug Prices

Kaiser Health News - Thu, 01/13/2022 - 2:30pm

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

Medicare officials have preliminarily decided to restrict reimbursement for Aduhelm, the controversial Alzheimer’s drug, to only patients participating in approved clinical trials. The FDA approved the drug in 2021 over objections of the agency’s outside advisers, who complained the evidence of Aduhelm’s efficacy is thin. But the prospect of wide use of the drug — originally priced at $56,000 a year — helped prompt the largest-ever increase in Medicare Part B premiums. Now the Department of Health and Human Services is looking at whether it can reduce that increase before 2023.

Meanwhile, covid confusion continues, as the Biden administration belatedly seeks to expand testing and the availability of higher-quality masks, and the Supreme Court delays an emergency decision on the administration’s rules on vaccine requirements for workers.

This week’s panelists are Julie Rovner of KHN, Joanne Kenen of Politico and the Johns Hopkins Bloomberg School of Public Health, Sarah Karlin-Smith of the Pink Sheet and Rachel Cohrs of Stat.

Among the takeaways from this week’s episode:

  • The wait for a Supreme Court decision on whether President Joe Biden’s plan to mandate vaccinations of all health care workers and require vaccines or testing of those employed by most big businesses is adding more confusion to the chaos surrounding the pandemic right now. Already there are complaints that advice on testing is not clear, that federal officials are split in their recommendations on quarantines, and that statistics on the number of cases and hospitalizations are inaccurate.
  • Biden has announced that private insurance companies will reimburse patients for up to eight at-home tests a month for individuals who want them. But one big group left out of that directive are Medicare beneficiaries. Despite the obvious need for tests in this vulnerable population, that omission may be because of strict federal laws on what can be provided to beneficiaries.
  • Advocacy groups and public health experts are pressuring the federal government to provide better guidance to the public about what are the best masks to use. Many people have switched from the cloth masks used early in the pandemic to N95 or KN95 masks, which provide better protection but are often harder to wear. Still, federal officials insist that the best mask is the one a person will wear properly and for the required period. If a person is more likely to use a cloth mask regularly and doesn’t like to keep a better-quality mask on, she is better off using the cloth mask, they point out.
  • Dr. Rochelle Walensky, head of the Centers for Disease Control and Prevention, is among the officials taking heat for not effectively communicating with the public. Officials clearly have made missteps, but the change in covid variants surging through the country has also called for changes in messaging, which has confused many people.
  • Medicare’s announcement this week proposing to restrict coverage of Aduhelm, the controversial new drug to treat Alzheimer’s disease, suggests officials overseeing the health care program were not in sync with the FDA, which gave the drug limited approval late last year. Medicare will pay for the drug only for beneficiaries enrolled in clinical studies that Medicare approves. That will help test the effectiveness and safety of the drug.
  • The decision on Aduhelm, however, could lead to inequity problems since those managing clinical trials often have difficulty recruiting a diverse clientele.
  • The limits on coverage also could prompt Medicare to move more quickly on the call by Health and Human Services Secretary Xavier Becerra to revise premiums for this year. Medicare announced in the fall that premiums would rise by nearly 15% because of concerns about the annual cost of Aduhelm, which at the time was priced at $56,000. The drugmaker slashed the price in half later.

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

Julie Rovner: The AP’s “Flush With COVID-19 Aid, Schools Steer Funding to Sports,” by Collin Binkley and Ryan J. Foley

Joanne Kenen: The New York Times’ “Covid Test Misinformation Spikes Along With Spread of Omicron,” by Davey Alba

Rachel Cohrs: KHN and Fortune’s “App Attempts to Break Barriers to Bankruptcy for Those in Medical Debt,” by Blake Farmer

Sarah Karlin-Smith: Stat’s “‘I’m Going to Prove You Wrong’: How a D.C. Power Couple Used an ALS Diagnosis to Create a Political Juggernaut,” by Lev Facher

To hear all our podcasts, click here.

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

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

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What Patients Can Learn With Confidence From One Negative Rapid Test (Hint: Very Little)

Kaiser Health News - Thu, 01/13/2022 - 1:39pm

Julie Ann Justo, an infectious disease clinical pharmacist for a South Carolina hospital system, hoped Christmas week would finally be the time her family could safely gather for a reunion.

Before the celebration, family members who were eligible were vaccinated and boosted. They quarantined and used masks in the days leading up to the event. And many took solace in negative results from rapid covid-19 tests taken a few days before the 35-person indoor gathering in South Florida to make sure no one was infectious.

But within a week, Justo and at least 13 members of her extended family tested positive for covid, with many feeling typical symptoms of an upper respiratory virus, such as a sore throat and a runny nose.

Like many other Americans, Justo’s family learned the hard way that a single negative result from an at-home rapid test, which takes about 15 minutes, is no guarantee that a person is not ill or carrying the virus.

There are just so many variables. Testing may come either too soon, before enough virus is present to detect, or too late, after a person has already spread the virus to others.

And most rapid tests, even according to their instructions, are meant to be used in pairs — generally a day or two apart — for increased accuracy. Despite that, a few brands are sold one to a box and, with the tests sometimes expensive and in short supply, families are often relying on a single screening.

While home antigen testing remains a useful — and underutilized — tool to curb the pandemic, experts say, it is often misused and may provide false confidence.

Some people mistakenly look at the home tests “like a get-out-of-jail-free card,” said Dr. William Schaffner, a specialist in infectious diseases at the Vanderbilt University School of Medicine in Nashville, Tennessee. “‘I’m negative, so I don’t have to worry anymore.’”

That is even more true now that the new more transmissible variant dominates the country.

“Omicron is so transmissible that it is challenging to use any kind of testing strategy in terms of get-togethers and be successful,” said Dr. Patrick Mathias, vice chair of clinical operations for the Department of Laboratory Medicine & Pathology at the University of Washington School of Medicine.

Rapid tests are pretty good at correctly detecting infection in people with symptoms, Mathias said, with a 70% to nearly 90% range of accuracy estimated in several studies. Other studies, some that predate current variants or were performed under more controlled settings, have shown higher rates, but, even then, the tests can still miss some infected people. That raises the risk of spread, with the chance rising dramatically as the number of people attending an event grows.

Results of antigen tests are less accurate for people without symptoms.

For the asymptomatic, the rapid tests, “on average, [correctly] detect infection roughly 50% of the time,” said Shama Cash-Goldwasser, an adviser for Prevent Epidemics at Resolve to Save Lives, a nonprofit group run by Dr. Tom Frieden, a former director of the Centers for Disease Control and Prevention.

Looking back, Justo said her family took precautions, but she acknowledges missteps that put them at increased risk: Not all family members were tested before getting together because of a shortage of test kits. Some members of her family who could find rapid tests tested just once because of the need to ration tests. And in attendance were several children under age 5 who are not yet eligible for a covid vaccine. They were later among the first to show symptoms.

“We probably were relying too heavily on negative rapid tests in order to gather indoors with others without other layers of protections,” she said.

Even if everyone tested properly before the party, health experts said, it wouldn’t mean all attendees are “safe” from getting covid. Testing merely reduces the risk of exposure; it doesn’t eliminate it.

Other factors in assessing risk at a gathering: Is everyone vaccinated and boosted, which can help reduce the likelihood of infection? Did attendees properly follow all the steps outlined in the test kits’ instructions, which can differ by brand? Did anyone test too early after exposure or, conversely, not close enough to the event?

One critical detail “is the timing of the test,” said Schaffner at Vanderbilt. Another, he said, is how well the tests can spot true positives and true negatives.

Test too early, such as within a day or two of exposure, and results won’t be accurate. Similarly, testing several days before an event won’t tell you much about who might be infectious on the day of the gathering.

Schaffner and others recommend that self-testing start three days after a known exposure or, if one feels ill, a few days after the onset of symptoms. Because the timeline for detecting an infection is uncertain, it’s always a good idea to use both tests in the kit, as instructed — the second one 24 to 36 hours after the first. For an event, make sure one of the tests is performed on the day of the gathering.

Antigen tests work by looking for proteins from the surface of the virus, which must be present in adequate amounts for a test to spot. (Lab-based PCR tests, or polymerase chain reaction tests, are more accurate because they can detect smaller amounts of the virus, but they take longer to get results, possibly even days, depending on the backlog at the labs.)

Covid markers may linger as remnants long after live virus is gone, so some scientists question the use of tests — whether antigen or PCR — as a metric for when patients can end their isolation, particularly if they are looking to shorten the recommended period. The CDC recommends five days of isolation, which can end if their symptoms are gone or resolving, with no fever.

Some patients will test positive 10 days or more after their first symptoms, although it is unlikely they remain infectious by then.

Still, that means many people are using the rapid tests inappropriately — not only over-relying on them as a safeguard against covid, but also as a gauge for when an infection is over.

Rapid home tests need to be used over multiple days to increase the chance of an accurate result.

“Each individual test does not have much value as serial testing,” said Dr. Zishan Siddiqui, chief medical officer at the Baltimore Convention Center Field Hospital and an assistant professor of medicine at Johns Hopkins University. And, because the tests are less reliable in those without symptoms, he said, asymptomatic people should not be relying on a single rapid test to gather with friends or family without taking other mitigation measures.

Worse still, a recent study looking at the omicron variant found that rapid tests could not detect the virus in the first two days of infection, even though lab-based PCR tests did find evidence of covid.

The study examined 30 vaccinated adults in December 2021. “Most omicron cases were infectious for several days before being detectable by rapid antigen tests,” according to the study, which has not been peer-reviewed.

False negatives are also more likely when the extent of the disease in a certain area, called community spread, is rampant, which is true for most of the United States today.

“If there’s a lot of community spread, that increases the likelihood that you have covid” at a gathering, explained Cash-Goldwasser, since one or more attendees who tested negative may have received a false result. Positivity rates are running over 25% now in some U.S. cities, indicating a lot of virus is circulating.

So, right now, “if you get a negative result, it’s important to be more suspicious,” she said.

Vaccinations, boosters, masking, physical distancing, ventilation and testing separately are all imperfect strategies to prevent infection. But layered together, they can serve as a more effective barrier, Schaffner said.

“The rapid test is useful” — his own family used them before gathering for Thanksgiving and Christmas — “but it’s a barrier with holes in it,” he added.

The virus moved through those gaps to crash the party and infect the Justo family. While most of the attendees largely had mild symptoms, Justo said she was short of breath, fatigued and experienced headaches, muscle pain and nausea. It took about 10 days before she felt better.

“I certainly spent a lot of time going back to what we could have done differently,” Justo said. “Thankfully no one needed to go to the hospital, and I attribute that to the vaccinations — and for that I am grateful.”

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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Hospitales enfrentan más casos de covid en personas ya hospitalizadas, con menos personal

Kaiser Health News - Thu, 01/13/2022 - 12:24pm

El 11 de enero, la Clínica Cleveland de Weston, en el sur de la Florida, estaba tratando a 80 pacientes con covid-19, 10 veces más que a fines diciembre. Casi la mitad fueron hospitalizados ​​por otras razones médicas.

El aumento impulsado por la extremadamente infecciosa variante omicron abrumó al hospital de 206 camas: ahora tiene 250. El aumento de casos se produjo cuando el hospital ya enfrentaba una grave escasez de personal, con enfermeras y otros cuidadores ausentes por covid.

El desafío es encontrar espacio para tratar de manera segura a todos los pacientes con covid mientras se mantiene a salvo al personal y al resto de los pacientes, explicó el doctor Scott Ross, director médico.

“No es un problema de PPE”, dijo, refiriéndose a los equipos de protección personal como máscaras, “ni un problema de oxígeno, o de ventiladores. Es un problema de volumen y de asegurarnos de tener suficientes camas y cuidadores para los pacientes”.

A nivel nacional, los casos de covid y las hospitalizaciones están en sus niveles más altos desde que comenzó la pandemia. Sin embargo, a diferencia de los aumentos repentinos anteriores por covid, una gran parte de los pacientes con covid llegan al hospital por otras razones.

Las infecciones están exacerbando algunas condiciones médicas y dificultando la reducción de la propagación de covid dentro de las paredes del hospital, especialmente porque los pacientes se presentan en etapas más tempranas y más infecciosas de la enfermedad.

Aunque la variante omicron generalmente produce casos más leves, agregar la gran cantidad de estas hospitalizaciones “incidentales” a las causadas directamente por covid podría ser un punto de inflexión para un sistema de atención médica que tambalea a medida que continúa la batalla contra la pandemia.

El aumento de las tasas de covid en la comunidad también se traduce en un aumento de las infecciones entre los trabajadores de salud, lo que desequlibra más al ya abrumado sistema.

Los funcionarios y el personal de 13 sistemas hospitalarios de todo el país dijeron que la atención de pacientes infectados que necesitan otros servicios médicos es un desafío y, a veces, requiere protocolos diferentes.

El doctor Robert Jansen, director médico de Grady Health System, en Atlanta, Georgia, dijo que la tasa de infección en su comunidad no tenía precedentes. Grady Memorial Hospital pasó de 18 pacientes con covid el 1 de diciembre a 259 la semana del 3 de enero.

Aproximadamente del 80% al 90% de esos pacientes tienen covid como su diagnóstico principal o tienen una condición de salud, como enfermedad de células falciformes o insuficiencia cardíaca, que ha empeorado por covid, dijo Jansen.

Aunque menos de sus pacientes han desarrollado neumonía causada por covid que durante los picos más importantes a principios del año pasado, los líderes de Grady están lidiando con un gran número de trabajadores de salud con covid. En un momento, dijo Jansen, 100 enfermeras y otros 50 miembros del personal estaban ausentes por enfermedad.

En uno de los sistemas hospitalarios más grandes de Nueva Jersey, Atlantic Health System, donde aproximadamente la mitad de los pacientes con covid ingresaron por otras razones, no todos aquellos con covid incidental pueden trasladarse a las salas de covid, dijo el director ejecutivo Brian Gragnolati. Necesitan servicios especializados para sus otras afecciones, por lo que el personal del hospital toma precauciones especiales, como usar PPE de mayor nivel cuando trata a pacientes con covid en lugares como un ala cardíaca.

En el Hospital Jackson Memorial de Miami, donde aproximadamente la mitad de los pacientes con covid están allí principalmente por otros motivos de salud, a todos los pacientes internados​​ por covid, ya sea que tengan síntomas o no, se los trata en una parte del hospital reservada para pacientes con la infección, dijo el doctor Hany Atallah, director médico.

Independientemente de si los pacientes son admitidos por covid, o con covid, aún ponen a prueba la capacidad del hospital para operar, dijo el doctor Alex Garza, jefe de incidentes de la Fuerza de Tareas Metropolitana contra la Pandemia de St. Louis, una colaboración de los sistemas de atención médica más grandes del área. Estimó que del 80% al 90% de los pacientes en los hospitales de la región están ahí por covid.

En Weston, Florida, la Clínica Cleveland también está teniendo dificultades para dar de alta a los pacientes con covid en hogares de adultos mayores o centros de rehabilitación porque muchos lugares no pueden atender a más pacientes con covid, dijo Ross.

El hospital también está teniendo dificultades para enviar a los pacientes a casa, por temor a que pongan en riesgo a las personas con las que viven.

Todo esto significa que hay una razón por la que los hospitales les dicen a las personas que se mantengan alejadas de la sala de emergencias a menos que sea realmente una emergencia, dijo el doctor Jeremy Faust, médico de emergencias en el Brigham and Women’s Hospital de Boston.

La gran cantidad de pacientes que se presentan y no saben que tienen covid durante este aumento aterrador, dijo Faust. A medida que llegan más casos incidentales a los hospitales, representan un mayor riesgo para el personal y otros pacientes del hospital porque generalmente se encuentran en una etapa más contagiosa de la enfermedad, antes de que comiencen los síntomas, dijo Faust.

En las anteriores oleadas de covid, las personas estaban siendo hospitalizadas en las fases media y posterior de la enfermedad.

En el análisis de datos federales de Faust, el 7 de enero mostró el segundo número más alto de casos de covid de “inicio en el hospital” desde que comenzó la pandemia. Pero estos datos representan solo a las personas que estuvieron en el hospital durante 14 días antes de dar positivo por covid, dijo Faust, por lo que es probable que se haya subestimado.

Una serie de investigación de KHN reveló múltiples lagunas en la supervisión del gobierno al responsabilizar a los hospitales por las altas tasas de pacientes con covid que fueron diagnosticados al ser admitidos, incluido que los sistemas de informes federales no registran públicamente los casos de covid contraídos en hospitales.

“Las personas en el hospital son vulnerables por muchas razones”, dijo el doctor Manoj Jain, especialista en enfermedades infecciosas en Memphis, Tennessee. “Todas sus enfermedades subyacentes existentes con múltiples condiciones médicas, todo eso los pone en un riesgo mucho mayor”.

La sala de emergencias en particular es una zona de peligro potencial en medio de la actual avalancha de casos, agregó Garza. Recomendó que los pacientes usen máscaras de alta calidad, como una KN95 o un respirador N95. Según The Washington Post, los Centros para el Control y la Prevención de Enfermedades (CDC) están sopesando si recomendar que todos los estadounidenses utilicen estas máscaras durante la crisis de omicron.

“Es física y matemáticas”, explicó Garza. “Si tienes mucha gente concentrada en un área y una carga viral alta, la probabilidad de que te expongas a algo así si no llevas la protección adecuada es mucho mayor”.

Si los pacientes no pueden tolerar una N95 durante todo un día, Faust dice que deben usarlas cuando están en contacto con el personal del hospital, los visitantes u otros pacientes.

El doctor Dallas Holladay, médico de medicina de emergencia del sistema de Servicios de Salud Samaritan de Oregon, dijo que debido a la escasez de enfermeras, más pacientes se agrupan en habitaciones de hospital. Esto aumenta su riesgo de infección.

El doctor Abraar Karan, becario de enfermedades infecciosas en Stanford, cree que todos los trabajadores de salud deberían tener el mandato de usar N95 para cada interacción con el paciente, no solo máscaras quirúrgicas, considerando el aumento en el riesgo de exposición a covid.

Pero en ausencia de mandatos de máscaras de mayor calidad para el personal, recomendó que los pacientes pidan a sus proveedores que usen un N95.

“¿Por qué deberíamos responsabilizar a los pacientes para que se protejan de los trabajadores de salud?”, se preguntó. “Es tan equivocado”.

Es posible que algunos trabajadores del hospital no sepan que se están enfermando e infectando. E incluso si lo saben, en algunos estados, incluidos Rhode Island y California, los que no presentan síntomas pueden ser llamados a trabajar nuevamente debido a la escasez de personal.

A Faust le gustaría ver una actualización de la capacidad de prueba para los trabajadores de salud y otros miembros del personal.

En Stanford, se recomiendan las pruebas periódicas, dijo Karan, y están disponibles para el personal. Pero esa es una excepción a la regla: Jain dijo que algunos hospitales se han resistido a las pruebas de rutina del personal, tanto por la fuga de recursos del laboratorio como por los posibles resultados.

“Los hospitales no quieren saber”, dijo. “Simplemente no tenemos el personal”.

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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Martin Luther King, Jr. Memorial in DC – Pic of the Week

In Custodia Legis - Thu, 01/13/2022 - 10:30am

Monday is Martin Luther King, Jr. Day, a federal holiday first celebrated 36 years ago in 1986. Our pic of the week is from the Martin Luther King, Jr. Memorial in Washington, D.C.

Martin Luther King, Jr. memorial. Photo by Robert Brammer.

This 30-foot tall granite memorial, sculpted in Dr. King’s likeness, sits at 1964 Independence Avenue, S.W., the address referencing the year the Civil Rights Act of 1964 became law. It was dedicated in 2011, on the 48th anniversary of the March on Washington.

Etched into the side of the statue are the words, “Out of the mountain of despair, a stone of hope.” These words come from Dr. King’s “I Have A Dream” speech and “serve as the theme of the overall design of the memorial, which realizes the metaphorical mountain and stone.” Dr. King’s memorial is the first to honor an African American individual on the National Mall.

Martin Luther King, Jr. memorial. Photo by Robert Brammer.

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Categories: Research & Litigation

With Monthly Payments Stalled, Congress Needs to Act

Center on Budget and Policy Priorities - Thu, 01/13/2022 - 5:00am
Unlike in previous months, millions of families won’t receive a Child Tax Credit payment on the 15th of January due to Congress’s failure so far to extend last year’s temporary expansion of the tax credit. The monthly payments have enabled parents to cover basic costs ranging from food to electric bills, reducing families’ stress and leaving fewer children hungry when they go to bed at night. It’s been a remarkable success and, if continued, is projected to reduce child poverty by more than 40 percent as compared to child poverty levels in the absence of the expansion. But the payments will be
Categories: Benefits, Poverty

Incidental Cases and Staff Shortages Make Covid’s Next Act Tough for Hospitals

Kaiser Health News - Thu, 01/13/2022 - 5:00am

The Cleveland Clinic in Weston, Florida, on Jan. 11 was treating 80 covid-19 patients — a tenfold increase since late December. Nearly half were admitted for other medical reasons.

The surge driven by the extremely infectious omicron variant helped push the South Florida hospital with 206 licensed beds to 250 patients. The rise in cases came as the hospital struggled with severe staff shortages while nurses and other caregivers were out with covid.

The challenge is finding room to safely treat all the covid patients while keeping staffers and the rest of patients safe, said Dr. Scott Ross, chief medical officer.

“It’s not a PPE issue,” he said, referring to personal protective equipment like masks, “nor an oxygen issue, nor a ventilator issue. It’s a volume issue and making sure we have enough beds and caregivers for patients.”

Nationally, covid cases and hospitalizations are at their highest levels since the pandemic began. Yet, unlike previous covid surges, large portions of the patients with covid are coming to the hospital for other reasons. The infections are exacerbating some medical conditions and making it harder to reduce covid’s spread within hospital walls, especially as patients show up at earlier, more infectious stages of the disease.

Although the omicron variant generally produces milder cases, adding the sheer number of these “incidental” hospitalizations to covid-caused hospitalizations could be a tipping point for a health care system that is reeling as the battle against the pandemic continues. Rising rates of covid in the community also translate to rising rates among hospital staffers, causing them to call out sick in record numbers and further stress an overwhelmed system.

Officials and staff at 13 hospital systems around the country said that caring for infected patients who need other medical services is challenging and sometimes requires different protocols.

Dr. Robert Jansen, chief medical officer at Grady Health System in Atlanta, said the infection rate in his community was unprecedented. Grady Memorial Hospital went from 18 covid patients on Dec. 1 to 259 last week.

Roughly 80% to 90% of those patients either have covid as their primary diagnosis or have a health condition — such as sickle cell disease or heart failure — that has been exacerbated by covid, Jansen said.

Although fewer of their patients have developed pneumonia caused by covid than during the major spikes early last year, Grady’s leaders are grappling with high numbers of health care workers out with covid. At one point last week, Jansen said, 100 nurses and as many as 50 other staff members were out.

In one of New Jersey’s largest hospital systems, Atlantic Health System, where about half the covid patients came in for other reasons, not all of those with incidental covid can be shifted into the covid wards, CEO Brian Gragnolati said. They need specialized services for their other conditions, so hospital staffers take special precautions, such as wearing higher-level PPE when treating covid patients in places like a cardiac wing.

At Miami’s Jackson Memorial Hospital, where about half the covid patients are there primarily for other health reasons, all patients admitted for covid — whether they have symptoms or not — are treated in a part of the hospital reserved for covid patients, said Dr. Hany Atallah, chief medical officer.

Regardless of whether patients are admitted for or with covid, the patients still tax the hospital’s ability to operate, said Dr. Alex Garza, incident commander of the St. Louis Metropolitan Pandemic Task Force, a collaboration of the area’s largest health care systems. He estimated that 80% to 90% of patients in the region’s hospitals are there because of covid.

In Weston, Florida, the Cleveland Clinic is also having a hard time discharging covid patients to nursing homes or rehabilitation facilities because many places aren’t able to handle more covid patients, Ross said. The hospital is also having difficulty sending patients home, out of concern they would put those they live with at risk.

All this means there’s a reason that hospitals are telling people to stay away from the ER unless it’s truly an emergency, said Dr. Jeremy Faust, an emergency medicine physician at Brigham and Women’s Hospital in Boston.

The sheer number of patients who are showing up and don’t know they have covid during this surge is frightening, Faust said. As more incidental cases pour into hospitals, they pose a greater risk to staffers and other hospital patients because they are typically at a more contagious stage of the disease — before symptoms begin, Faust said. In previous covid waves, people were being hospitalized in the middle and later phases of the illness.

In Faust’s analysis of federal data, Jan. 7 showed the second-highest number of “hospital onset” covid cases since the pandemic began, behind only an October 2020 outlier, he said. But this data accounts for only people who were in the hospital for 14 days before testing positive for covid, Faust said, so it’s likely an undercount.

A KHN investigative series revealed multiple gaps in government oversight in holding hospitals accountable for high rates of covid patients who didn’t have the diagnosis when they were admitted, including that federal reporting systems don’t publicly note covid caught in individual hospitals.

“People in the hospital are vulnerable for many reasons,” said Dr. Manoj Jain, an infectious disease specialist in Memphis, Tennessee. “All of their existing underlying illnesses with multiple medical conditions — all of that puts them at much greater risk.”

The ER in particular is a potential danger zone amid the current crush of cases, Garza said. He recommended that patients wear high-quality masks, like a KN95, or an N95 respirator. According to The Washington Post, the Centers for Disease Control and Prevention is weighing whether to recommend that all Americans upgrade their masks during the omicron surge.

“It’s physics and math,” Garza said. “If you’ve got a lot of people concentrated in one area and a high viral load, the probability of you being exposed to something like that if you’re not wearing adequate protection are much higher.”

If patients can’t tolerate an N95 for an entire day, Faust urges them to wear upgraded masks whenever they come into contact with hospital staffers, visitors or other patients.

Dr. Dallas Holladay, an emergency medicine physician for Oregon’s Samaritan Health Services system, said that because of nursing shortages, more patients are being grouped together in hospital rooms. This raises their infection risk.

Dr. Abraar Karan, an infectious diseases fellow at Stanford, believes all health care workers should be mandated to wear N95s for every patient interaction, not just surgical masks, considering the rise in covid-exposure risk.

But in the absence of higher-quality mask mandates for staffers, he recommended that patients ask that their providers wear an N95.

“Why should we be putting the onus on patients to protect themselves from health care workers when health care workers are not even going to be doing that?” he asked. “It’s so backwards.”

Some hospital workers may not know they are getting sick — and infectious. And even if they do know, in some states, including Rhode Island and California, health care workers who are asymptomatic can be called back to work because of staffing shortages.

Faust would like to see an upgrade of testing capacity for health care workers and other staff members.

At Stanford, regular testing is encouraged, Karan said, and tests are readily available for staffers. But that’s an exception to the rule: Jain said some hospitals have resisted routine staff testing — both for the lab resource drain and the possible results.

“Hospitals don’t want to know,” he said. “We just don’t have the staff.”

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

Long-Excluded Uterine Cancer Patients Are Step Closer to 9/11 Benefits

Kaiser Health News - Thu, 01/13/2022 - 5:00am

Tammy Kaminski can still recall the taste of benzene, a carcinogenic byproduct of burning jet fuel. For nine months after the 9/11 attacks, she volunteered for eight hours every Saturday at St. Paul’s Chapel, just around the corner from ground zero in New York City. She breathed in cancer-causing toxic substances, like fuel fumes and asbestos, from the smoke that lingered and the ash that blanketed the pop-up clinic where first responders could grab a meal, take a nap or get medical care.

But in 2015, when Kaminski, a chiropractor who lives in West Caldwell, New Jersey, was diagnosed with uterine cancer, she didn’t get the same help that other volunteers did. Although Kaminski, 61, and her doctors believe the cancer is linked to her time volunteering after 9/11, the federal health insurance and monitoring program would not cover her treatments for endometrial cancer — or those of anyone exposed to toxic substances from the attacks who then developed that form of uterine cancer.

That could change soon. In November, an advisory committee unanimously approved a recommendation to add uterine cancer to the list of diseases covered by the program for first responders and people who were in the vicinity of the terrorist attacks. It’s the fourth-most-common cancer among women. But, according to the advisory committee, it’s the only cancer the program doesn’t cover. The program’s administrator is expected to make a final ruling by mid-2022.

The hormone-related cancer can develop after someone is exposed to the kind of endocrine-disrupting chemicals, including benzene, that were found in the dust that lingered in Lower Manhattan for months after the 9/11 attacks. Such chemicals are disproportionately harmful to women, according to the American College of Obstetricians and Gynecologists.

The World Trade Center Health Program determines which conditions it will cover primarily using longitudinal data from patients in its registry. Enrollees do not have to prove their medical conditions were caused by the attacks and the aftermath; instead, the program studies which conditions are most prevalent among the members.

But that creates a math problem: Although the Centers for Disease Control and Prevention estimates that at least 500,000 people were exposed to toxic substances from the attacks, women make up only 22% of the program’s 109,500 enrollees.

Most of those registered were first responders, a field dominated by men. Although the people who were in and around ground zero, including residents, students and office workers, represent a larger portion of the total number of people directly affected by 9/11 than first responders, they are vastly underrepresented in the program for both treatment and data collection. Called “survivors” by the program, they make up just 28% of enrollees.

It can never be proved that Kaminski’s cancer originated from that exposure on her volunteer shifts. But advocates and experts who have urged that uterine cancer be included in the program say not enough women are enrolled in it for data to be collected on hormonally driven health conditions of women in general or for their potential correlation to 9/11.

“They didn’t collect data on uterine cancer because they couldn’t,” Kaminski said. “How can you say there’s no data when you didn’t record it?”

Dr. Iris Udasin, medical director of Rutgers University’s chapter of the World Trade Center Health Program, said the exclusion does not necessarily suggest that women’s health wasn’t prioritized. She said it was more a side effect of how cancers were added to the list — individually, based on the predominantly male group of first responders who were originally tracked for health conditions.

But she’s been pushing for it to be covered based on new evidence that endocrine-disrupting chemicals increase the risk of hormone-related tumors, including uterine cancer.

Udasin pointed out that one form of uterine cancer is already covered by the program, under a “rare cancer” category. Uterine cancer has two types: endometrial, the kind Kaminski had, and uterine sarcoma. Sarcoma accounts for just 10% of all uterine cancers and is grouped with other rare cancers covered by the program. Adding the more common form requires the formal review now underway.

“This cancer that fell through the cracks can now be covered,” Udasin said. “At least, I hope that’s what will happen.”

Uterine cancer research has long been underfunded, said Dr. Suneel Kamath, an oncologist at the Cleveland Clinic Cancer Center who studies cancer funding.

According to Kamath, three broad groups of cancers are generally given short shrift: gastrointestinal, such as stomach and pancreas cancers; genitourinary, such as adrenal and prostate cancer; and gynecological, such as uterine cancer. “And uterine, honestly, is probably among the lowest, from the data that I’ve found,” he said.

The lack of funding, Kamath said, stems partly from the stigma attached to what many patients see as “down-there cancers.” Even some physicians denigrate early diagnosis because of uterine cancer’s relatively high survival rate and minimize discussing or prioritizing such cancers. But Kamath’s research shows little correlation among cancer incidence, its death rate and the amount of funding cancers receive. And once a cancer is on the funder-and-donor track, it tends to dominate marketing, messaging and even clinical trial attention.

Nearly 70,000 women are diagnosed with uterine cancer each year, and rates have been rising over the past two decades. The survival rate is relatively high compared with other cancers, Kamath said, but drops off steeply with late diagnosis.

That can cause a false sense of security among general practitioners, who might not act aggressively at the first signs of symptoms. “But, obviously, that’s not the right way to think about it. Really we should be getting to the diagnosis as fast as possible,” Kamath said. “It’s really key, maybe more so than other diseases, that we catch this at a highly curable stage.”

It’s a nasty cycle in the World Trade Center Health Program too, said Kimberly Flynn, who leads several health advocacy groups for people who lived and worked around ground zero. She’s seen the lack of research lead to a lack of longitudinal data, which in turn has been used to justify excluding uterine cancer from the program.

When the federal committee agreed to consider adding it, Flynn hit the pavement with her two- decades-strong contact list to identify survivors and first responders who had been diagnosed with uterine cancer but had been denied coverage. Of the eight cases she found, four were on the program’s radar. One of the eight people has since died of uterine cancer.

Kaminski’s cancer is in remission after a hysterectomy and chemotherapy.

“We don’t need research to tell us there is health inequity,” Flynn said at the recent advisory committee meeting. “We need research to rectify the existing health inequity.”

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

Watch and Listen: Examining the Risks of Covid’s Spread Within Hospitals

Kaiser Health News - Thu, 01/13/2022 - 5:00am

KHN Midwest correspondent Lauren Weber appeared on Newsy’s “Evening Debrief” program to discuss her recent investigative series on the risks of covid’s spread within hospitals.

The series, reported with Christina Jewett, documented how more than 10,000 patients were diagnosed with covid after being hospitalized for other medical conditions in 2020 — and how multiple gaps in government oversight fail to hold hospitals accountable for high rates of such infections. Patients and their loved ones have few options to seek improvements to infection control policies after states passed a raft of liability shield laws nationwide.

Weber also spoke on Washington, D.C., radio station WAMU’s “1A” about the issue, among other pandemic-related topics. Listen to the news roundup.

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

La máscara de tela, ¿es lo suficientemente buena contra omicron?

Kaiser Health News - Wed, 01/12/2022 - 10:00am

La super contagiosa variante omicron se está extendiendo por los Estados Unidos, provocando un dramático aumento de casos y saturando muchos sistemas hospitalarios. Además de instar a los estadounidenses a vacunarse y recibir el refuerzo, funcionarios de salud pública recomiendan que las personas cambien sus máscaras de tela por máscaras médicas de mayor calidad.

¿Qué significa exactamente esta sugerencia?

En una audiencia reciente del Comité de Salud, Educación, Trabajo y Pensiones del Senado, altos funcionarios de salud pública lucieron diferentes tipos de máscaras. La doctora Rochelle Walensky, directora de los Centros para el Control y la Prevención de Enfermedades (CDC), tenía una máscara quirúrgica debajo de una máscara de tela, mientras que el doctor Anthony Fauci, asesor médico jefe del presidente, usaba un respirador N95.

Algunos gobiernos locales y organizaciones tienen sus propias normas. El condado de Los Ángeles, por ejemplo, requerirá a partir del 17 de enero que los empleadores proporcionen máscaras N95 o KN95 a los empleados.

A fines de diciembre, la Clínica Mayo comenzó a exigir que todos los visitantes y pacientes usaran máscaras quirúrgicas en lugar de las versiones de tela. La Universidad de Arizona prohibió las máscaras de tela y pidió a todos en el campus que usen cubrebocas de mayor calidad.

Las preguntas sobre la protección que brindan las máscaras contra covid, ya sean de tela, quirúrgicas o de grado médico de alta gama, han sido tema de debate y discusión desde los primeros días de la pandemia.

Pero, a medida que cambia la ciencia, también cambian los puntos de vista.

Los CDC no han actualizado su guía de máscaras desde octubre de 2021, antes de que surgiera omicron. Esa guía no recomienda el uso de un respirador N95, solo establece que las máscaras deben tener al menos dos capas, ajustarse bien y contener un alambre que ajuste en la nariz. Los informes de prensa indican que la agencia pronto podría recomendar el uso regular de un respirador N95 o KN95.

Múltiples expertos agradecerían el cambio, diciendo que éste es el momento adecuado. Pero no desestiman las máscaras de telas, porque, dicen que usar una máscara de tela es mejor que no usar ninguna.

“Por lo que sabemos sobre cómo se transmite covid y sobre omicron, usar una máscara de mayor calidad es realmente fundamental para detener la propagación de esta variante”, dijo la doctora Megan Ranney, decana académica de la Escuela de Salud Pública de la Universidad Brown.

Un estudio a gran escala en el mundo real realizado en Bangladesh y publicado en septiembre de 2021 mostró que las máscaras quirúrgicas son más efectivas para prevenir la transmisión de covid-19 que las máscaras de tela.

Por lo tanto, una estrategia fácil para mejorar la protección es colocar una máscara quirúrgica debajo de la tela, lo que brinda una mejor capa de protección. Las máscaras quirúrgicas se pueden comprar en internet a un precio relativamente bajo y se pueden reutilizar durante aproximadamente una semana.

Ranney dijo que aconseja a las personas que optan por usar capas que se pongan la máscara de mejor calidad, como la quirúrgica, más cerca de la cara, y la de menor calidad en el exterior.

Si hay que reciclar, el doctor Stephen Luby, profesor de enfermedades infecciosas en la Universidad de Stanford y uno de los autores del estudio de máscaras de Bangladesh, dijo que también se puede lavar sus máscaras quirúrgicas y reutilizarlas.

“Durante el estudio, les dijimos a los participantes que podían lavar las máscaras quirúrgicas con detergente para ropa y agua, y reutilizarlas”, dijo Luby. “Pierdes algo del efecto de la carga electrostática, pero aún así superaron a las máscaras de tela”. (Parte de la forma en que las máscaras quirúrgicas filtran eficazmente las partículas es a través de la carga electrostática en la máscara).

Pero expertos sostienen que usar una máscara KN95 o una N95 es la mejor protección contra omicron, ya que estas máscaras son muy efectivas para filtrar partículas virales.

El “95” en los nombres se refiere a la eficacia de filtración del 95% de las máscaras contra partículas de cierto tamaño. Las máscaras N95 están reguladas por el Instituto Nacional de Seguridad y Salud Ocupacional, mientras que las KN95 están reguladas por el gobierno chino y las KN94 por el gobierno de Corea del Sur.

Al comienzo de la pandemia, se instó a los estadounidenses a no comprar máscaras quirúrgicas o N95, para garantizar que hubiera un suministro suficiente para los trabajadores de salud. Pero ahora hay suficientes para todos.

Por lo tanto, si la persona tiene los recursos para actualizar a una máscara N95, KN95 o KN94, definitivamente debe hacerlo, dijo la doctora Leana Wen, profesora de política y gestión de la salud en la Universidad George Washington. Si bien estos modelos son más caros y pueden ser más incómodos, la inversión vale la pena por la seguridad que brindan, explicó.

“Es un virus mucho más contagioso, por lo que hay un margen de error mucho menor con respecto a las actividades que antes podías hacer sin infectarte”, dijo Wen. “Tenemos que aumentar nuestra protección en todos los sentidos, porque ahora, por omicron, todo es más riesgoso”.

Wen también dijo que aunque estas máscaras se caracterizan por ser de un solo uso, a menos que se encuentre en un entorno de atención médica, las KN95 y las N95 se pueden usar más de una vez. Ella misma utiliza su KN95 durante más de una semana.

Otra cosa importante a tener en cuenta es que hay muchas falsificaciones de máscaras N95 y KN95 que se venden en línea, por lo que los consumidores deben tener cuidado al pedirlas y asegurarse de obtenerlas solo de un proveedor legítimo.

Los CDC mantienen una lista de respiradores N95 aprobados por NIOSH. Wirecutter y The Strategist han publicado guías para comprar máscaras KN95 y KN94 aprobadas. Ranney también recomienda consultar el sitio web, Project N95, o el canal de YouTube “Mask Nerd” del ingeniero Aaron Collins.

Pero, si incluso actualización las máscaras, todavía se está preocupado por omicron, lo primero que se puede hacer es vacunarse y recibir el refuerzo (booster), dijo el doctor Neal Chaisson, profesor asistente de medicina en la Clínica Cleveland.

“Se ha hablado mucho de que las personas que han sido vacunadas se infectan con omicron”, dijo Chaisson. “Pero he estado trabajando en terapia intensiva y probablemente el 95% de los pacientes que estamos atendiendo en este momento no siguieron el consejo de vacunarse”.

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

Left Behind: Medicaid Patients Say Rides to Doctors Don’t Always Come

Kaiser Health News - Wed, 01/12/2022 - 5:00am

Tranisha Rockmore and her daughter Karisma waited at an Atlanta children’s hospital in July for their ride home.

Karisma had been at Children’s Healthcare of Atlanta to have her gastrostomy tube fixed, Rockmore said. The 4-year-old, who has several severe medical conditions, has insurance coverage from Medicaid, which provides transportation to and from nonemergency medical appointments through private vendors.

After being told that a ride would not be available for hours, Rockmore said, she finally gave up and called her sister to drive them home to the South Georgia town of Ashburn, more than 160 miles away.

She said it wasn’t the first time she had run into trouble with the Medicaid transportation service.

“Sometimes they don’t ever come,” said Rockmore, who doesn’t own a car. Many rides have been canceled recently, she said; the company told her it couldn’t find drivers. “Sometimes they make me feel like they don’t care if my child gets to the doctor or not.”

Rockmore’s remarks would no doubt resonate with the Medicaid beneficiaries, relatives and advocacy groups across the country upset about problems patients have getting transportation for medical appointments. Not only are some shuttle drivers no-shows, but some patients have been injured during rides because their wheelchairs were not properly secured, according to lawsuits filed in Georgia and other states.

States are required to set up transportation to medical appointments for adults, children and people with disabilities in the Medicaid health insurance program. Transportation brokers — such as Modivcare, which Rockmore used — have subcontracts with local providers, often small “mom and pop” operations, to shuttle patients to and from needed appointments, including for dialysis, adult day care, and mental health and treatment for substance use disorders.

It’s a lucrative business, with transportation management contracts that can be worth tens of millions of dollars for companies. The two companies that have contracts in Georgia have given extensively to political campaigns of elected officials in the state. The firms, Modivcare and Southeastrans, have also faced complaints, lawsuits and state government fines in Georgia and elsewhere. The two companies maintain, though, that the complaints relate to a tiny percentage of rides provided.

Medicaid nonemergency transportation “is absolutely a national challenge,’’ said Matt Salo, executive director of the National Association of Medicaid Directors. “This is something practically all the states we talk to are dealing with. I don’t think anyone has figured this out.”

Beth Holloway, 47, of Wharton, New Jersey, said she has had multiple problems with rides. “Sometimes they arrive late, other times not at all,” said Holloway, who has cerebral palsy and lives independently. “I’ve been stranded at doctors’ offices for hours, sometimes out in the elements.”

In Los Angeles, Rose Ratcliff and several other patients filed a lawsuit in 2017 against Modivcare, then known as LogistiCare; other local transportation brokers; and the insurers that run the state Medicaid program, known as Medi-Cal in California.

The pending suit alleges that Ratcliff and other patients like her missed crucial dialysis appointments and faced unsafe conditions during transport. It calls Modivcare the “broken link” in the Medicaid transportation chain and claims the company did not adequately respond to complaints from clients like Ratcliff.

Katherine Zerone, a spokesperson for Modivcare, said the company does not comment on pending litigation. In an initial legal response, it said the problems were linked to the independent transportation vendors and their employees, not Modivcare/LogistiCare.

After complaints were made about Southeastrans’ service across Indiana, the state appointed a special legislative commission to review the company’s performance. Indiana now publishes detailed complaint data for the Atlanta-based company each month.

In August, James Mills, a Bloomington man who uses a wheelchair, filed a lawsuit alleging that the company had violated the Americans with Disabilities Act and other civil rights laws by not providing a wheelchair-accessible vehicle to transport him to and from his appointments. The lawsuit alleges that because of the lack of wheelchair accommodation, Mills missed needed medical care and was even kicked off the patient lists of some of his local doctors.

“While we’re unable to comment on pending litigation, we’re aware of the matter and strongly disagree with the allegations,’’ said Christopher Lee, an attorney for Southeastrans, which operates in seven states and Washington, D.C.

Two decades ago, Georgia was one of the first states to start using transportation brokers to manage its Medicaid transportation program. The two longtime providers in the state — Modivcare and Southeastrans — will receive a total of $127.6 million from the state this fiscal year. They are paid a per-member monthly rate that averages $5.60 in Georgia, regardless of how many rides, if any, a Medicaid user takes. The state was expected to announce new contracts for Medicaid transportation this month.

Georgia assessed a total of $4.4 million in penalties to the two companies over the period from January 2018 to December 2020 for failing to pick up patients on time and other problems. However, the state Medicaid agency essentially gave them discounts, charging the two companies only $1.2 million during that period, according to state Department of Community Health letters obtained through an open records request. In extending the brokers’ contracts in the 2018 fiscal year, the state Medicaid agency agreed to cap damages at 25% of the assessed amount, Department of Community Health spokesperson Fiona Roberts said.

Modivcare said it’s the largest transportation broker nationally, controlling about 40% of the market. The publicly traded company based in Colorado provides Medicaid transportation in more than 20 states.

Modivcare and other companies say only a tiny fraction of the rides they provide lead to complaints. “Our first priority is safe and reliable transportation,” Zerone said. In Georgia, 99.8% of its trips are complaint-free, she said.

Andrew Tomys, Georgia state director for Southeastrans, said 99.9% of the trips his company services in the state are “free of valid complaints.”

Both Modivcare and Southeastrans say they investigate each complaint to determine whether it’s valid. In Georgia, Modivcare reported to the Department of Community Health more than 3,200 late rides or no-shows over a year out of around 2.3 million rides. Southeastrans reported just over 900 such problems out of around 1.4 million rides.

But patients and their advocates say that in many cases problems aren’t reported, or complaints are ignored.

Georgia should peg any new contracts to timely rides, ease of use for beneficiaries and the overall ride experience, said Melissa Haberlen DeWolf, policy director of the advocacy group Voices for Georgia’s Children.

In recent election cycles, Southeastrans and Modivcare — through its former corporate name LogistiCare — have been generous donors to Georgia Republicans, who have controlled state offices in the state for nearly two decades.

Southeastrans, as a company, has donated $126,000 to Georgia Republican campaigns and committees since 2017, according to documents on the Georgia Government Transparency and Campaign Finance Commission website.

Additionally, Southeastrans’ co-founder and CEO, Steve Adams, has given at least $86,000 to Georgia Republican candidates for state office and to the state Republican Party since 2017, according to state filings. During that same period, Adams donated $3,800 to two state Democratic candidates.

“As a minority-owned business headquartered in Georgia for over 20 years, Southeastrans and its owner have contributed to a diverse mix of local causes and organizations,” Lee said.

Modivcare, through LogistiCare, has given $48,350 to Georgia Republican candidates in state races since 2017, according to the Georgia Government Transparency and Campaign Finance Commission. It gave $750 to former Democratic state Rep. Pat Gardner, also according to the commission. Modivcare’s Zerone did not answer questions about the company’s political giving because she said it would be “competitive information.”

Such contributions can help companies buy access to government officials, said Paul S. Ryan, a vice president at the government watchdog group Common Cause.

“Anytime a special interest doing business with the government can make big contributions to public officials handing out contracts or making other government decisions, it’s a cause for concern,” he said. “Average, everyday Americans can’t buy the same influence.”

Tranisha Rockmore said she’s so fed up that she wants to get a car so she can avoid the transportation problems. “I’m to the point where I feel like they don’t care about my daughter,” she said. “You don’t just do people’s kids like that.”

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

Ask KHN-PolitiFact: Is My Cloth Mask Good Enough? The 2022 Edition

Kaiser Health News - Wed, 01/12/2022 - 5:00am

The highly transmissible omicron variant is sweeping the U.S., causing a huge spike in covid-19 cases and overwhelming many hospital systems. Besides urging Americans to get vaccinated and boosted, public health officials are recommending that people upgrade from their cloth masks to higher-quality medical-grade masks.

But what does this even mean?

At a recent Senate Health, Education, Labor and Pensions Committee hearing, top public health officials displayed different types of masking. Dr. Rochelle Walensky, director of the Centers for Disease Control and Prevention, wore what appeared to be a surgical mask layered under a cloth mask, while Dr. Anthony Fauci, chief medical adviser to the president, wore what looked like a KN95 respirator.

Some local governments and other organizations are offering their own policies. Los Angeles County, for instance, will require as of Jan. 17 that employers provide N95 or KN95 masks to employees. In late December, the Mayo Clinic began requiring all visitors and patients to wear surgical masks instead of cloth versions. The University of Arizona has banned cloth masks and asked everyone on campus to wear higher-quality masks.

Questions about the level of protection against covid that masks provide — whether cloth, surgical or higher-end medical grade — have been a subject of debate and discussion since the earliest days of the pandemic. We looked into the question last summer. And as science changes and variants emerge with higher transmissibility, so do opinions.

The Centers for Disease Control and Prevention has not updated its mask guidance since October, before the omicron variant emerged. That guidance doesn’t recommend the use of an N95 respirator but states only that masks should be at least two layers, well-fitting and contain a nose wire.

Multiple experts we consulted said that the current CDC guidance does not go far enough. They also agreed on another point: Wearing a cloth mask is better than not wearing a mask at all, but if you can upgrade — or layer cloth with surgical — now is the time.

Although cloth masks may appear to be more substantial than the paper surgical mask option, surgical masks as well as KN95 and N95 masks are infused with an electrostatic charge that helps filter out particles.

“From the perspective of knowing how covid is transmitted, and what we know about omicron, wearing a higher-quality mask is really critical to stopping the spread of omicron,” said Dr. Megan Ranney, academic dean for the School of Public Health at Brown University.

A large-scale real-world study conducted in Bangladesh and published in December showed that surgical masks are more effective at preventing covid transmission than cloth masks.

So, one easy strategy to improve protection is to layer a surgical mask underneath cloth. Surgical masks can be bought relatively cheaply online and reused for about a week.

Ranney said she advises people who opt for layering to put the better-quality mask, such as the surgical mask, closest to your face, and put the lesser-quality mask on the outside.

If you’re really pressed for resources, Dr. Stephen Luby, a professor specializing in infectious diseases at Stanford University and one of the authors of the Bangladesh mask study, said surgical masks can be washed and reused, if finances are an issue. Nearly two years into the pandemic, such masks are cheap and plentiful in the U.S. and many retailers make them available free of charge to customers as they enter businesses.

“During the study, we told the participants they could wash the surgical masks with laundry detergent and water and reuse them,” Luby said. “You lose some effect of the electrostatic charge, but they still outperformed cloth masks.”

Still, experts maintain that wearing either a KN95 or an N95 respirator is the best protection against omicron, since these masks are highly effective at filtering out viral particles. The “95” in the names refers to the masks’ 95% filtration efficacy against certain-sized particles. N95 masks are regulated by the National Institute for Occupational Safety and Health, while KN95s are regulated by the Chinese government and KF94s by the South Korean government.

Americans were initially urged not to buy either surgical or N95 masks early in the pandemic to ensure there would be a sufficient supply for health care workers. But now there are enough to go around.

So, if you have the resources to upgrade to an N95, a KN95 or a KF94 mask, you should absolutely do so, said Dr. Leana Wen, a professor of health policy and management at George Washington University. Although these models are more expensive and can be more uncomfortable, they are worth the investment for the safety they provide, she said.

“[Omicron is] a much more contagious virus, so there is a much lower margin of error in regards to the activities you were once able to do without getting infected,” Wen said. “We have to increase our protection in every way, because everything is riskier now.”

Wen also said that though these masks are characterized as one-use, unless you are in a health care setting, KN95s and N95s can be worn more than once. She uses one of her personal KN95s for more than a week at a time.

Another important thing to note is there are many counterfeit N95 and KN95 masks being sold online, so consumers must be careful when ordering them and be sure to get them only from a legitimate, trusted vendor.

The CDC maintains a list of NIOSH-approved N95 respirators. Wirecutter and The Strategist have both published guides to purchasing approved KN95 and KF94 masks. Ranney also recommends consulting the website Project N95 or engineer Aaron Collins’ “Mask Nerd” YouTube channel.

And remember, the risk of transmission depends not just on the mask you wear but also the masking practices of others in the room — so going into a meeting or restaurant where others are unmasked or wearing only cloth masks increases the odds of getting infected, no matter how careful you are. This chart demonstrates the huge differences.

Even with a mask upgrade, if you are still worried about omicron and, in particular, a serious case of covid, the No. 1 thing you can do to protect yourself is get vaccinated and boosted, said Dr. Neal Chaisson, an assistant professor of medicine at the Cleveland Clinic.

“There’s been a lot of talk about people who have been vaccinated getting omicron,” said Chaisson. “But I’ve been working in the ICU and probably 95% of the patients that we’re taking care of right now did not take the advice to get vaccinated.”

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

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This story can be republished for free (details).

Categories: Health Care

Medicare Proposes to Cover Aduhelm Only for Patients in Clinical Trials

Medicare -- New York Times - Tue, 01/11/2022 - 4:35pm
If the preliminary decision is finalized this spring, it would sharply limit the number of patients who use the expensive drug.
Categories: Elder, Medicare
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