Category: Health Care

Journalists Put Polio, Price Transparency, and a Personal Covid Battle in Perspective

KHN senior correspondent Arthur Allen discussed New York’s polio case with WBEZ’s “Reset With Sasha-Ann Simons” on Aug. 2.


KHN senior correspondent Julie Appleby discussed health insurance price transparency rules that took effect July 1 on WJR’s “The Pre W. Smith Show” on July 28.


KHN senior editor Andy Miller discussed his experience with covid-19 on WGUA’s “The Health Report” on Aug. 1.


Journalists Put Polio, Price Transparency, and a Personal Covid Battle in Perspective

KHN senior correspondent Arthur Allen discussed New York’s polio case with WBEZ’s “Reset With Sasha-Ann Simons” on Aug. 2.


KHN senior correspondent Julie Appleby discussed health insurance price transparency rules that took effect July 1 on WJR’s “The Pre W. Smith Show” on July 28.


KHN senior editor Andy Miller discussed his experience with covid-19 on WGUA’s “The Health Report” on Aug. 1.


A GOP Talking Point Suggests Birth Control Is Not at Risk. Evidence Suggests Otherwise.

“In no way, shape, or form is access to contraception limited or at risk of being limited.”

Rep. Kat Cammack (R-Fla.), co-chair, Congressional Pro-Life Caucus on the floor of the U.S. House, July 21, 2022

Republicans who oppose abortion have new talking points — birth control will remain easily available in the wake of the Supreme Court’s decision overturning the federal right to abortion, and when Democrats say otherwise, they are just trying to scare voters.

Variations on this claim were made by a series of Republicans on the House floor July 21 during debate on a bill that would add a right to contraception to federal law. Democrats advanced the bill as a way to ensure the availability of birth control before some abortion opponents have a chance to see whether the Supreme Court will overturn that right, too.

“This bill is completely unnecessary,” said Rep. Kat Cammack (R-Fla.), a co-chair of the Congressional Pro-Life Caucus. “In no way, shape, or form is access to contraception limited or at risk of being limited. The liberal majority is clearly trying to stoke fears and mislead the American people, once again, because in their minds stoking fear is clearly the only way that they can win.”

We reached out to Cammack’s office to inquire about the basis for this statement but did not receive a response.

Similar claims were made in the Senate as it declined to take up the House bill on July 27. “This idea that we ought to spend scarce time here in the Congress, which we have in limited supply, reaffirming rights that already exist is a clear political narrative designed to divert the American people’s attention from things that really are at risk,” said Sen. John Cornyn (R-Texas).

However, a review of documents and current efforts in some states to change laws indicates there is significant evidence that birth control — or at least some forms of it — may be at risk legally. So we dug in.

At the Supreme Court

The cornerstone for this concern can be found in Justice Clarence Thomas’ concurring opinion in Dobbs v. Jackson Women’s Health Organization, the case that overturned Roe v. Wade’s guarantee of access to abortion. Thomas suggested that having found no constitutional right to abortion, the court should next “reconsider all of this court’s substantive due process precedents, including Griswold.” That is a reference to Griswold v. Connecticut, the 1965 case that established a right for married couples to use contraception (single people were granted that right in a separate case in 1972). In Griswold, the court found that the “due process” clause of the 14th Amendment protects the right to privacy.

True, Thomas represents only one vote on the court, and the number of his fellow justices who share his opinion that the birth control case should be reversed is unclear. But the Supreme Court has already allowed some employers to decline to offer their workers contraceptive coverage based on their opposition to abortion. At issue in the 2014 Hobby Lobby case was the religious belief of the owners of the craft store chain that some forms of contraception — including the “morning-after” pill and two types of intrauterine devices — could produce early abortions by preventing the implantation of a fertilized egg. The court decided the government could not force the contraceptive coverage requirement from the Affordable Care Act on employers with those beliefs.

Scientific evidence suggests that neither the morning-after pill (which is a higher dose of a hormone used in regular birth control pills) nor IUDs stop the implantation of a fertilized egg and therefore do not cause abortions. Still, the court ruled that the owners’ religious beliefs trumped the government’s interest in workers getting contraceptive coverage.

“That legal blurring of distinct scientific boundaries between abortion and birth control threatens contraceptive access in the United States,” wrote professors Rachel VanSickle-Ward and Kevin Wallsten in The Washington Post. They predicted that some states “will probably ban some forms of contraception outright, using the discredited idea that contraceptives act as abortifacients.”

State Action

Confusion about how some forms of contraception work has led to efforts in several states to ban certain types of birth control. The most frequently targeted form of birth control is the morning-after pill, which can prevent pregnancy if taken within a few days of unprotected sex but which cannot interrupt an established pregnancy. It is not the same as the abortion pill, a regimen of two other medications that do end a pregnancy up to 10 weeks of gestation.

And even if the birth control methods did prevent a fertilized egg from implanting in a woman’s uterus, that would not be an abortion, at least not according to the medical community. Although many religious groups and abortion opponents argue that human life begins when the egg is fertilized, there is a consensus among doctors, scientists, and legal experts that pregnancy begins at implantation. And, they point out, an abortion is the termination of a pregnancy. Roughly half of all fertilized eggs never implant.

Even before Roe was overturned, lawmakers in Idaho called for hearings to ban emergency contraception, and Missouri lawmakers tried to bar Medicaid from paying for the morning-after pill and IUDs.

Anti-abortion groups are pushing the idea. “Plan B is Capable of Causing an Early Abortion,” said a fact sheet from Students for Life of America, referring to the name of a brand of the morning-after pill. Model legislation from the National Right to Life Committee would ban abortion from the moment of fertilization, not implantation.

The bottom line, wrote professors VanSickle-Ward and Wallsten before the decision overturning Roe was even final, is that “the court doesn’t have to formally end legal protection for contraception use.”

“If it allows plaintiffs to call contraception abortion, and Dobbs ends legal protection for abortion, then contraception is at risk.”

Our Ruling

It is true that, so far, no state has banned forms of contraception. But the threat appears very real. And the absolute nature of Cammack’s statement — saying there’s “no way, shape, or form” that access to contraception is at risk — is not accurate. We rate the statement False.

SourceS

Congressional Record, July 21, 2022, Pages H6927-H6940

Supreme Court, Dobbs v. Jackson Women’s Health Organization, June 24, 2022

Supreme Court, Burwell v. Hobby Lobby Stores, June 30, 2014

Supreme Court, Griswold v. Connecticut, June 7, 1965

Stateline, “Some States Already Are Targeting Birth Control,” May 19, 2022

The 19th, “With Abortion Rights in Limbo, Conservative Lawmakers Are Eyeing Restrictions on IUDs and Plan B,” May 25, 2022

The Daily Beast, “Why Can’t the FDA Fix Outdated Birth Control Labels,” updated July 12, 2017

Journal of Contraception, “Mechanism of Action of Emergency Contraception,” July 12, 2010

KHN, “FAQ: High Court’s Hobby Lobby Ruling Cuts Into Contraceptive Mandate,” June 30, 2014

KHN, “Misinformation Clouds America’s Most Popular Emergency Contraception,” June 7, 2022

National Right to Life, “National Right to Life Committee Proposes Legislation to Protect the Unborn Post-Roe,” June 15, 2022

NPR, “Abortion Foes Push To Redefine Personhood,” June 1, 2011

Students for Life, Facts About Plan B, accessed Aug. 1, 2022

The Washington Post, “If the Supreme Court Undermines Roe v. Wade, Contraception Could Be Banned,” updated May 3, 2022

In California, Abortion Could Become a Constitutional Right. So Could Birth Control.

SACRAMENTO, Calif. — Californians will decide in November whether to lock the right to abortion into the state constitution.

If they vote “yes” on Proposition 1, they will also lock in a right that has gotten less attention: the right to birth control.

Should the measure succeed, California would become one of the first states — if not the first — to create explicit constitutional rights to both abortion and contraception.

The lawmakers and activists behind the constitutional amendment said they hope to score a one-two punch: protect abortion in California after the U.S. Supreme Court ended the federal constitutional right to abortion under Roe v. Wade, and get ahead of what they see as the next front in the reproductive rights fight: birth control.

“The United States Supreme Court said that the privacy and liberty protections in the United States Constitution did not extend to abortion,” said UCLA law professor Cary Franklin, an expert in constitutional law and reproductive rights who has testified before the California legislature in support of the amendment. “If they said ‘no’ on abortion, they’re probably going to say ‘no’ on birth control because that has a similar history.”

In June, the U.S. Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization ended the federal right to abortion and left states to regulate the service. In his concurring opinion, Justice Clarence Thomas said the court should revisit other cases that have created protections for Americans based on an implicit right to privacy in the U.S. Constitution, such as the 1965 case Griswold v. Connecticut, which established a federal right to contraception for married people — which was later extended to unmarried people.

Some congressional Democrats are now trying to codify the right to contraception in federal law. In July, the U.S. House of Representatives passed the Right to Contraception Act, which would give patients the right to access and use contraception and providers the right to furnish it. But the bill has little chance of success in the U.S. Senate, where Republicans have already blocked it once.

Protecting access to contraception is popular with voters. A national poll from Morning Consult and Politico conducted in late July found that 75% of registered voters support a federal law that protects a right to birth control access.

California isn’t the only state where voters are considering reproductive rights in their constitutions.

On Tuesday, Kansas voters decisively rejected a constitutional amendment that would have allowed state lawmakers to ban or dramatically restrict abortion. It failed by nearly 18 percentage points.

Kentucky voters will face a similar decision in November with a proposed constitutional amendment that would declare that the state’s constitutional right to privacy does not cover abortion.

Vermont is going in the opposite direction. Voters there will weigh a ballot measure in November that would add a right to “personal reproductive autonomy” to the state constitution, though it does not explicitly mention abortion or contraception. In Michigan, a proposed constitutional amendment that would guarantee a right to both abortion and contraception is expected to qualify for the November ballot.

In California, Proposition 1 would prevent the state from denying or interfering with “an individual’s reproductive freedom in their most intimate decisions, which includes their fundamental right to choose to have an abortion and their fundamental right to choose or refuse contraceptives.”

The proposed constitutional amendment doesn’t go into detail about what enshrining the right to contraception in the state constitution would mean.

California already has some of the strongest contraceptive-access laws in the country — and lawmakers are considering more proposals this year. For instance, state-regulated health plans must cover all FDA-approved contraception; pharmacists must dispense emergency contraception to anyone with a prescription, regardless of age; and pharmacists can prescribe birth control pills on the spot. State courts have also interpreted California’s constitution to include a right to privacy that covers reproductive health decisions.

The amendment, if adopted, could provide a new legal pathway for people to sue when they’re denied contraceptives, said Michele Goodwin, chancellor’s professor of law at the University of California-Irvine.

If a pharmacist refused to fill a birth control prescription or a cashier declined to ring up condoms, she said, customers could make a case that their rights had been violated.

Making the rights to abortion and contraception explicit in the state constitution — instead of relying on a right to privacy — would also protect against shifting political winds, said state Senate leader Toni Atkins (D-San Diego), who was the director of a women’s health clinic in the 1980s. Although California’s lawmakers and executive officers are solid supporters of abortion rights, she said, the composition of the legislature and courts’ interpretation of laws could change.

“I want to know for sure that that right is protected,” Atkins said at a legislative hearing in June. “We are protecting ourselves from future courts and future politicians.”

The amendment would solidify California’s role as a reproductive rights sanctuary as much of the country chips away at birth control availability, Goodwin added.

Experts said two forms of birth control that are vulnerable to restrictions in other states are intrauterine devices, or IUDs, and emergency contraception like Plan B. These methods are often incorrectly conflated with abortion pills, which end a pregnancy instead of preventing it.

Nine states have laws that restrict emergency contraception — for example, by allowing pharmacies to refuse to dispense it or excluding it from state family planning programs — according to the Guttmacher Institute, a research organization that supports abortion rights. In Alabama and Louisiana this year, abortion opponents introduced legislation that would restrict or ban abortion, and would also apply to emergency contraception.

“We’re seeing an erosion of abortion access that is playing out in statehouses across the country that have and will continue to target contraceptive care as well,” said Audrey Sandusky, senior director of policy and communications for the National Family Planning and Reproductive Health Association.

Susan Arnall, vice president of California’s Right to Life League, said the proposed amendment is symbolic and merely echoes current laws. Arnall thinks the campaign is mostly about Democratic politicians trying to score political points.

“It just allows the pro-abort legislators to trumpet and give them talking points about how they’re doing something about the overturn of Roe v. Wade,” she said. “It is political virtue signaling. I don’t think it does much of anything else.”

Goodwin argues that the measure’s symbolism is significant and overdue. She pointed to the Civil War era, when enslaved people in Southern states could look to free states for spiritual hope and material help. “Symbolically, what that meant is a kind of beacon of hope, that those places did exist, where one’s humanity could be regarded,” Goodwin said.

But California’s reputation as a haven for contraceptive availability may not be fully warranted, said Dima Qato, an associate professor at the University of Southern California School of Pharmacy. In her 2020 study of contraceptive access in Los Angeles County, which has some of the highest rates of teen and unintended pregnancy in the country, Qato found that only 10% of pharmacies surveyed offered pharmacist-prescribed birth control. Pharmacies in low-income and minority communities were the least likely to offer the service, Qato said, worsening disparities instead of solving them.

Qato supports the constitutional amendment but said California should focus on improving and enforcing the laws it already has.

“We don’t need more laws when we don’t address the root cause of a lack of effectiveness of these laws in these communities,” Qato said. “Lack of enforcement and accountability disproportionately impacts communities of color.”

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

Skin Cancer Is a Risk No Matter the Skin Tone. But It May Be Overlooked in People With Dark Skin.

Brykyta Shelton found herself standing in a checkout line of a big-box retailer, uncomfortably aware as a woman ahead of her stared at her sandaled feet.

Shelton had been taking medication for months for what her doctor said was toenail fungus, but one nail still looked gross.

After Shelton completed her purchase, the woman pulled her aside and said that, while she wasn’t a doctor, she thought Shelton was dealing with something more serious than fungus.

“She’s like: ‘I know I’m just a random stranger, but please, go get it checked out by someone else,’” said Shelton, who lives in a Maryland suburb of  Washington, D.C.

Shelton, now 42, took the advice.

The initial lab work didn’t give a clear diagnosis, but her new doctor said he was confident she had acral lentiginous melanoma, a form of skin cancer. Additional testing proved him right. While rare, it is the most common subtype of melanoma in Black people, like Shelton. It is the disease that killed reggae star Bob Marley at age 36, and is most often found on skin less frequently exposed to the sun, such as the hands, the soles of the feet, and under nails. Researchers do not understand what causes acral lentiginous melanoma, and they don’t know how to prevent it. It is often overlooked in skin checks or misdiagnosed.

Skin cancer, in general, is often missed or misdiagnosed in Black patients.

Historically, Black people and those with dark skin have been left out of efforts to combat skin cancer. Long neglected by sunscreen manufacturers and a medical community lagging in diversity and cultural competency — the acknowledgment of a patient’s heritage, beliefs, and values — many have not been informed about sun safety or how to check their skin for signs of damage or cancer.

To be sure, skin cancer rates are lower for people with dark skin tones. Melanoma is more than 20 times as common in white people as in African Americans, with an overall lifetime risk of 1 in 38 for white people compared with 1 in 1,000 for Black people. Melanin does provide some protection against sun damage, so those with more of it — those with darker skin — are better protected than those with fairer skin.

But overall, Black patients are more likely to be diagnosed with various forms of skin cancer at more advanced stages and have a higher mortality rate, said Dr. Janiene Luke, with the Skin of Color Society, a nonprofit that works to educate doctors and the public on skin health.

The five-year melanoma survival rate among non-Hispanic Black people is 66%, compared with 90% for non-Hispanic white people, according to a report by the Centers for Disease Control and Prevention. And 1 in 3 Black men or women diagnosed with melanoma in the U.S. die of the disease, compared with at least 1 in 7 for non-Hispanic white people, says the American Cancer Society.

Given the known disparities in outcomes, Dr. Valerie Harvey, president of the Skin of Color Society, said two areas of research are needed: studying educational initiatives to see if awareness might lead to earlier diagnosis and improved survival; and determining risk factors in patients with dark skin, especially factors leading to the occurrence of melanoma in places less exposed to the sun.

Improving cultural competency and diversity within dermatology is just one step toward improving diagnosis and outcomes. According to the most recent data, fewer than 3% of dermatologists nationwide are Black. Orthopedics is the only medical specialty with a smaller share.

Dermatology has traditionally been one of the most competitive specialties in medicine, said Dr. Michelle Henry, a clinical instructor of dermatology at Weill Cornell Medicine. In addition to stiff academic requirements, admission to dermatology programs also depends on connecting with mentors and extensive networking, which can be expensive. And that, Henry said, has traditionally created barriers for Black medical students who want to pursue dermatology.

“There are so many hurdles that make it difficult for a lot of students of color to do the things that they need to do in such an uber-exclusive and small space,” she said.

Recent initiatives to help students overcome those barriers are beginning to work, said Dr. Susan Taylor, vice chair for diversity, equity, and inclusion in the dermatology department at the University of Pennsylvania and founder of the Skin of Color Society. Initiatives from the American Academy of Dermatology include holistic reviews of residency applications, mentorships, and programs to increase interest among and prepare high school students for college and medical school.

Medical app company VisualDX is working to reduce disparities in medicine through Project Impact by creating a catalog of images reflecting various diseases in different skin colors. Skin cancers may appear different on fairer skin than on darker skin, and because doctors may have been trained only with fair-skin depictions, the chance for misdiagnosis in people with dark skin increases.

Change has also come to the sunscreen industry.

Jorge Martínez-Bonilla, senior vice president and partner with Chicago market research company C + R Research, said failures within the medical community to provide adequate skin care for people with dark skin mirror the lack of availability of sunscreens to meet patients’ needs, especially for Black people.

“What that has done is that it has pushed Black entrepreneurs, from one day to the next, to come up with their own solutions and their own products,” Martínez-Bonilla said. “Not only from the lack of availability, but because these are the people who know their needs best.”

Katonya Breaux is one of those entrepreneurs. She wasn’t thrilled when, in her 30s and 40s, she noticed she was getting moles on her face and neck similar to those she’d seen on older family members while she was growing up. She assumed it was just part of aging. But her dermatologist said it was sun damage.

“I was, literally, shocked. I was like: ‘But I’m Black,’” she said, adding that she had no experience with sunscreen growing up. “It was so foreign to me. I believed we just didn’t need it.”

After struggling to find a sunscreen that didn’t leave a residue or feel like it was burning her skin, she worked with a chemist who helped her create a tinted mineral-based sunscreen. At first, she intended it just for her personal use, but she ultimately launched Unsun Cosmetics. The Los Angeles-based company educates about skin care and sells products designed for consumers with dark skin.

Shontay Lundy also struggled to find a sunscreen that didn’t “leave a blue, purple, or other-colored hue on my skin.” Until, she said, “I realized it didn’t exist.”

So, in 2016, she developed products that left no residue, ultimately launching Black Girl Sunscreen.

Education is fundamental to her company’s advertising, Lundy said. “Our mission is to equip people of all ages and skin tones with the right sunscreen products to take their skin health seriously and protect themselves from sun damage.”

Shelton, whose chance encounter in a store’s checkout line led to her cancer diagnosis, said she has become an evangelist for skin self-checks and sunscreen, and is now known at her local pool as “the sunblock lady.” The kind of skin cancer she had may not have stemmed from sun exposure, but it increased her awareness about skin damage and other types of skin cancers.

She has been cancer-free since the doctor successfully removed the tumor on her toe and she underwent chemotherapy and radiation. But the experience was traumatic.

“It’s life-altering,” she said.

Still, she said, she’s resumed an active and full life. She said she will forever be grateful to the stranger who pulled her aside that day, as well as the doctor who disbelieved the first set of labs that came back, opting instead to trust his instincts to immediately begin treatment.

Tips for Avoiding Skin Cancer for All Skin Tones

• Avoid direct sun, especially between 10 a.m. and 4 p.m. Keep babies out of the sun entirely.

• Use a broad-spectrum sunscreen with an SPF of 30 or higher every day. Reapply every two hours or after swimming or activity/sweating.

• Don’t leave sunscreen in the car, because temperature fluctuations can cause it to break down and become less effective.

• Wear clothing that covers arms and legs.

• Wear a broad-brimmed hat to protect the face, ears, and neck.

• Wear UV-blocking sunglasses.

• Avoid indoor tanning beds.

• Examine skin from head to toe every month. Look for dark spots or patches, or growths that are growing, bleeding, or changing; sores that are slow to heal, or heal and return; patches of skin that feel rough and dry; and dark lines underneath or around fingernails or toenails. Be diligent in checking nail beds, palms, soles of the feet, the head, lower legs, the groin, and other places that get little sun. Contact a doctor if you have any concerns.

• See a board-certified dermatologist at least once a year for a full-body examination.

Sources: Skin Cancer Foundation, American Academy of Dermatology, Dr. Janiene Luke, Dr. Michelle Henry, Katonya Breaux

Cognitive Rehab May Help Older Adults Clear Covid-Related Brain Fog

Eight months after falling ill with covid-19, the 73-year-old woman couldn’t remember what her husband had told her a few hours before. She would forget to remove laundry from the dryer at the end of the cycle. She would turn on the tap at a sink and walk away.

Before covid, the woman had been doing bookkeeping for a local business. Now, she couldn’t add single-digit numbers in her head.

Was it the earliest stage of dementia, unmasked by covid? No. When a therapist assessed the woman’s cognition, her scores were normal.

What was going on? Like many people who’ve contracted covid, this woman was having difficulty sustaining attention, organizing activities, and multitasking. She complained of brain fog. She didn’t feel like herself.

But this patient was lucky. Jill Jonas, an occupational therapist associated with the Washington University School of Medicine in St. Louis who described her to me, has been providing cognitive rehabilitation to the patient, and she is getting better.

Cognitive rehabilitation is therapy for people whose brains have been injured by concussions, traumatic accidents, strokes, or neurodegenerative conditions such as Parkinson’s disease. It’s a suite of interventions designed to help people recover from brain injuries, if possible, and adapt to ongoing cognitive impairment. Services are typically provided by speech and occupational therapists, neuropsychologists, and neurorehabilitation experts.

In a recent development, some medical centers are offering cognitive rehabilitation to patients with long covid (symptoms that persist several months or longer after an infection that can’t be explained by other medical conditions). According to the Centers for Disease Control and Prevention, about 1 in 4 older adults who survive covid have at least one persistent symptom.

Experts are enthusiastic about cognitive rehabilitation’s potential. “Anecdotally, we’re seeing a good number of people [with long covid] make significant gains with the right kinds of interventions,” said Monique Tremaine, director of neuropsychology and cognitive rehabilitation at Hackensack Meridian Health’s JFK Johnson Rehabilitation Institute in New Jersey.

Among the post-covid cognitive complaints being addressed are problems with attention, language, information processing, memory, and visual-spatial orientation. A recent review in JAMA Psychiatry found that up to 47% of patients hospitalized in intensive care with covid developed problems of this sort. Meanwhile, a new review in Nature Medicine found that brain fog was 37% more likely in nonhospitalized covid survivors than in comparable peers who had no known covid infections.

Also, there’s emerging evidence that seniors are more likely to experience cognitive challenges post-covid than younger people — a vulnerability attributed, in part, to older adults’ propensity to have other medical conditions. Cognitive challenges arise because of small blood clots, chronic inflammation, abnormal immune responses, brain injuries such as strokes and hemorrhages, viral persistence, and neurodegeneration triggered by covid.

Getting help starts with an assessment by a rehabilitation professional to pinpoint cognitive tasks that need attention and determine the severity of a person’s difficulties. One person may need help finding words while speaking, for instance, while another may need help with planning and yet another may not be processing information efficiently. Several deficits may be present at the same time.

Next comes an effort to understand how patients’ cognitive issues affect their daily lives. Among the questions that therapists will ask, according to Jason Smith, a rehabilitation psychologist at the University of Texas Southwestern Medical Center in Dallas: “Is this [deficit] showing up at work? At home? Somewhere else? Which activities are being affected? What’s most important to you and what do you want to work on?”

To try to restore brain circuits that have been damaged, patients may be prescribed a series of repetitive exercises. If attention is the issue, for instance, a therapist might tap a finger on the table once or twice and ask a patient to do the same, repeating it multiple times. This type of intervention is known as restorative cognitive rehabilitation.

“It isn’t easy because it’s so monotonous and someone can easily lose attentional focus,” said Joe Giacino, a professor of physical medicine and rehabilitation at Harvard Medical School. “But it’s a kind of muscle building for the brain.”

A therapist might then ask the patient to do two things at once: repeat the tapping task while answering questions about their personal background, for instance. “Now the brain has to split attention — a much more demanding task — and you’re building connections where they can be built,” Giacino continued.

To address impairments that interfere with people’s daily lives, a therapist will work on practical strategies with patients. Examples include making lists, setting alarms or reminders, breaking down tasks into steps, balancing activity with rest, figuring out how to conserve energy, and learning how to slow down and assess what needs to be done before taking action.

A growing body of evidence shows that “older adults can learn to use these strategies and that it does, in fact, enhance their everyday life,” said Alyssa Lanzi, a research assistant professor who studies cognitive rehabilitation at the University of Delaware.

Along the way, patients and therapists discuss what worked well and what didn’t, and practice useful skills, such as using calendars or notebooks as memory aids.

“As patients become more aware of where difficulties occur and why, they can prepare for them and they start seeing improvement,” said Lyana Kardanova Frantz, a speech therapist at Johns Hopkins University. “A lot of my patients say, ‘I had no idea this [kind of therapy] could be so helpful.’”

Johns Hopkins has been conducting neuropsychiatric exams on patients who come to its post-covid clinic. About 67% have mild to moderate cognitive dysfunction at least three months after being infected, said Dr. Alba Miranda Azola, co-director of Johns Hopkins’ Post-Acute COVID-19 Team. When cognitive rehabilitation is recommended, patients usually meet with therapists once or twice a week for two to three months.

Before this kind of therapy can be tried, other problems may need to be addressed. “We want to make sure that people are sleeping enough, maintaining their nutrition and hydration, and getting physical exercise that maintains blood flow and oxygenation to the brain,” Frantz said. “All of those impact our cognitive function and communication.”

Depression and anxiety — common companions for people who are seriously ill or disabled — also need attention. “A lot of times when people are struggling to manage deficits, they’re focusing on what they were able to do in the past and really mourning that loss of efficiency,” Tremaine said. “There’s a large psychological component as well that needs to be managed.”

Medicare usually covers cognitive rehabilitation (patients may need to contribute a copayment), but Medicare Advantage plans may differ in the type and length of therapy they’ll approve and how much they’ll reimburse providers — an issue that can affect access to care.

Still, Tremaine noted, “not a lot of people know about cognitive rehabilitation or understand what it does, and it remains underutilized.” She and other experts don’t recommend digital brain-training programs marketed to consumers as a substitute for practitioner-led cognitive rehabilitation because of the lack of individualized assessment, feedback, and coaching.

Also, experts warn, while cognitive rehabilitation can help people with mild cognitive impairment, it’s not appropriate for people who have advanced dementia.

If you’re noticing cognitive changes of concern, ask for a referral from your primary care physician to an occupational or speech therapist, said Erin Foster, an associate professor of occupational therapy, neurology, and psychiatry at Washington University School of Medicine in St. Louis. Be sure to ask therapists if they have experience addressing memory and thinking issues in daily life, she recommended.

“If there’s a medical center in your area with a rehabilitation department, get in touch with them and ask for a referral to cognitive rehabilitation,” said Smith, of UT Southwestern Medical Center. “The professional discipline that helps the most with cognitive rehabilitation is going to be rehabilitation medicine.”

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

A GOP Talking Point Suggests Birth Control Is Not at Risk. Evidence Suggests Otherwise.

“In no way, shape, or form is access to contraception limited or at risk of being limited.”

Rep. Kat Cammack (R-Fla.), co-chair, Congressional Pro-Life Caucus on the floor of the U.S. House, July 21, 2022

Republicans who oppose abortion have new talking points — birth control will remain easily available in the wake of the Supreme Court’s decision overturning the federal right to abortion, and when Democrats say otherwise, they are just trying to scare voters.

Variations on this claim were made by a series of Republicans on the House floor July 21 during debate on a bill that would add a right to contraception to federal law. Democrats advanced the bill as a way to ensure the availability of birth control before some abortion opponents have a chance to see whether the Supreme Court will overturn that right, too.

“This bill is completely unnecessary,” said Rep. Kat Cammack (R-Fla.), a co-chair of the Congressional Pro-Life Caucus. “In no way, shape, or form is access to contraception limited or at risk of being limited. The liberal majority is clearly trying to stoke fears and mislead the American people, once again, because in their minds stoking fear is clearly the only way that they can win.”

We reached out to Cammack’s office to inquire about the basis for this statement but did not receive a response.

Similar claims were made in the Senate as it declined to take up the House bill on July 27. “This idea that we ought to spend scarce time here in the Congress, which we have in limited supply, reaffirming rights that already exist is a clear political narrative designed to divert the American people’s attention from things that really are at risk,” said Sen. John Cornyn (R-Texas).

However, a review of documents and current efforts in some states to change laws indicates there is significant evidence that birth control — or at least some forms of it — may be at risk legally. So we dug in.

At the Supreme Court

The cornerstone for this concern can be found in Justice Clarence Thomas’ concurring opinion in Dobbs v. Jackson Women’s Health Organization, the case that overturned Roe v. Wade’s guarantee of access to abortion. Thomas suggested that having found no constitutional right to abortion, the court should next “reconsider all of this court’s substantive due process precedents, including Griswold.” That is a reference to Griswold v. Connecticut, the 1965 case that established a right for married couples to use contraception (single people were granted that right in a separate case in 1972). In Griswold, the court found that the “due process” clause of the 14th Amendment protects the right to privacy.

True, Thomas represents only one vote on the court, and the number of his fellow justices who share his opinion that the birth control case should be reversed is unclear. But the Supreme Court has already allowed some employers to decline to offer their workers contraceptive coverage based on their opposition to abortion. At issue in the 2014 Hobby Lobby case was the religious belief of the owners of the craft store chain that some forms of contraception — including the “morning-after” pill and two types of intrauterine devices — could produce early abortions by preventing the implantation of a fertilized egg. The court decided the government could not force the contraceptive coverage requirement from the Affordable Care Act on employers with those beliefs.

Scientific evidence suggests that neither the morning-after pill (which is a higher dose of a hormone used in regular birth control pills) nor IUDs stop the implantation of a fertilized egg and therefore do not cause abortions. Still, the court ruled that the owners’ religious beliefs trumped the government’s interest in workers getting contraceptive coverage.

“That legal blurring of distinct scientific boundaries between abortion and birth control threatens contraceptive access in the United States,” wrote professors Rachel VanSickle-Ward and Kevin Wallsten in The Washington Post. They predicted that some states “will probably ban some forms of contraception outright, using the discredited idea that contraceptives act as abortifacients.”

State Action

Confusion about how some forms of contraception work has led to efforts in several states to ban certain types of birth control. The most frequently targeted form of birth control is the morning-after pill, which can prevent pregnancy if taken within a few days of unprotected sex but which cannot interrupt an established pregnancy. It is not the same as the abortion pill, a regimen of two other medications that do end a pregnancy up to 10 weeks of gestation.

And even if the birth control methods did prevent a fertilized egg from implanting in a woman’s uterus, that would not be an abortion, at least not according to the medical community. Although many religious groups and abortion opponents argue that human life begins when the egg is fertilized, there is a consensus among doctors, scientists, and legal experts that pregnancy begins at implantation. And, they point out, an abortion is the termination of a pregnancy. Roughly half of all fertilized eggs never implant.

Even before Roe was overturned, lawmakers in Idaho called for hearings to ban emergency contraception, and Missouri lawmakers tried to bar Medicaid from paying for the morning-after pill and IUDs.

Anti-abortion groups are pushing the idea. “Plan B is Capable of Causing an Early Abortion,” said a fact sheet from Students for Life of America, referring to the name of a brand of the morning-after pill. Model legislation from the National Right to Life Committee would ban abortion from the moment of fertilization, not implantation.

The bottom line, wrote professors VanSickle-Ward and Wallsten before the decision overturning Roe was even final, is that “the court doesn’t have to formally end legal protection for contraception use.”

“If it allows plaintiffs to call contraception abortion, and Dobbs ends legal protection for abortion, then contraception is at risk.”

Our Ruling

It is true that, so far, no state has banned forms of contraception. But the threat appears very real. And the absolute nature of Cammack’s statement — saying there’s “no way, shape, or form” that access to contraception is at risk — is not accurate. We rate the statement False.

SourceS

Congressional Record, July 21, 2022, Pages H6927-H6940

Supreme Court, Dobbs v. Jackson Women’s Health Organization, June 24, 2022

Supreme Court, Burwell v. Hobby Lobby Stores, June 30, 2014

Supreme Court, Griswold v. Connecticut, June 7, 1965

Stateline, “Some States Already Are Targeting Birth Control,” May 19, 2022

The 19th, “With Abortion Rights in Limbo, Conservative Lawmakers Are Eyeing Restrictions on IUDs and Plan B,” May 25, 2022

The Daily Beast, “Why Can’t the FDA Fix Outdated Birth Control Labels,” updated July 12, 2017

Journal of Contraception, “Mechanism of Action of Emergency Contraception,” July 12, 2010

KHN, “FAQ: High Court’s Hobby Lobby Ruling Cuts Into Contraceptive Mandate,” June 30, 2014

KHN, “Misinformation Clouds America’s Most Popular Emergency Contraception,” June 7, 2022

National Right to Life, “National Right to Life Committee Proposes Legislation to Protect the Unborn Post-Roe,” June 15, 2022

NPR, “Abortion Foes Push To Redefine Personhood,” June 1, 2011

Students for Life, Facts About Plan B, accessed Aug. 1, 2022

The Washington Post, “If the Supreme Court Undermines Roe v. Wade, Contraception Could Be Banned,” updated May 3, 2022

KHN’s ‘What the Health?’: Kansas Makes a Statement


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.


Voters in Kansas told the rest of the country this week that they don’t want their state to ban abortion. In a nearly 60%-40% split, voters turned back an effort by anti-abortion activists to amend the state constitution to remove its right to abortion, which would have allowed the legislature to ban the procedure.

Meanwhile, in Washington, Congress is in its pre-recess push to pass legislation. A bill to provide health benefits to veterans injured by breathing in toxic substances from military burn pits finally made it to President Joe Biden’s desk. But talks continue on the Democrats’ health care-climate-tax bill that would, among other things, allow Medicare to negotiate some prescription drug prices and extend expanded subsidies for insurance under the Affordable Care Act.

This week’s panelists are Julie Rovner of KHN, Tami Luhby of CNN, Sandhya Raman of CQ Roll Call, and Rachel Cohrs of Stat.

Among the takeaways from this week’s episode:

  • At least four other states — California, Kentucky, Montana, and Vermont — will have abortion questions on their ballots in November. Michigan is likely to have one, too, but the petitions required are still being certified.
  • The Department of Justice has sued Idaho, arguing that its nearly-total abortion ban — set to take effect later in August — conflicts with federal law guaranteeing patients access to emergency medical care. If the case were to be appealed all the way to the Supreme Court, it could endanger the emergency care law, which has not faced that sort of legal challenge before.
  • Biden signed an executive order this week that among other things could allow Medicaid to cover the travel expenses of women seeking out-of-state abortion care if their state restricts it. But the White House did not provide many details about how such a program would work or be paid for. The so-called Hyde Amendment, named for abortion opponent Rep. Henry Hyde, who died in 2007, forbids federal funding of most abortions. Supporters of the president’s move suggested that restriction applies only to medical care and not transportation, but any effort by Medicaid to set up such a transportation program would likely be litigated.
  • New data released this week by the Department of Health and Human Services finds that the number of uninsured Americans has fallen to an all-time low of 8%. That estimate comes as the Senate is considering funding to continue enhanced premium subsidies for people who buy insurance on the Affordable Care Act’s marketplaces. If that legislation falters, the number of people without insurance is expected to rise sharply, as premiums will become unaffordable for many.
  • Biden’s rebound of covid-19 symptoms reminds the country that the standards on when a patient has recovered are not firm and raises questions about how patients should handle reentry after battling the disease.

Also this week, Rovner interviews KHN’s Bram Sable-Smith, who reported and wrote the latest KHN-NPR “Bill of the Month” installment about a single-car accident that resulted in three wildly different ambulance bills. If you have an enormous or outrageous medical bill you’d like to send us, you can do that here.

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

Julie Rovner: KHN’s “They Lost Medicaid When Paperwork Was Sent to an Empty Field, Signaling the Mess to Come,” by Brett Kelman

Rachel Cohrs: The Washington Post’s “Thousands of Lives Depend on a Transplant Network in Need of ‘Vast Restructuring,’” by Joseph Menn and Lenny Bernstein

Tami Luhby: KHN’s “Hospices Have Become Big Business for Private Equity Firms, Raising Concerns About End-of-Life Care,” by Markian Hawryluk

Sandhya Raman: KHN’s “Nursing Homes Are Suing the Friends and Family of Residents to Collect Debts,” by Noam N. Levey


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’s ‘What the Health?’: Kansas Makes a Statement


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.


Voters in Kansas told the rest of the country this week that they don’t want their state to ban abortion. In a nearly 60%-40% split, voters turned back an effort by anti-abortion activists to amend the state constitution to remove its right to abortion, which would have allowed the legislature to ban the procedure.

Meanwhile, in Washington, Congress is in its pre-recess push to pass legislation. A bill to provide health benefits to veterans injured by breathing in toxic substances from military burn pits finally made it to President Joe Biden’s desk. But talks continue on the Democrats’ health care-climate-tax bill that would, among other things, allow Medicare to negotiate some prescription drug prices and extend expanded subsidies for insurance under the Affordable Care Act.

This week’s panelists are Julie Rovner of KHN, Tami Luhby of CNN, Sandhya Raman of CQ Roll Call, and Rachel Cohrs of Stat.

Among the takeaways from this week’s episode:

  • At least four other states — California, Kentucky, Montana, and Vermont — will have abortion questions on their ballots in November. Michigan is likely to have one, too, but the petitions required are still being certified.
  • The Department of Justice has sued Idaho, arguing that its nearly-total abortion ban — set to take effect later in August — conflicts with federal law guaranteeing patients access to emergency medical care. If the case were to be appealed all the way to the Supreme Court, it could endanger the emergency care law, which has not faced that sort of legal challenge before.
  • Biden signed an executive order this week that among other things could allow Medicaid to cover the travel expenses of women seeking out-of-state abortion care if their state restricts it. But the White House did not provide many details about how such a program would work or be paid for. The so-called Hyde Amendment, named for abortion opponent Rep. Henry Hyde, who died in 2007, forbids federal funding of most abortions. Supporters of the president’s move suggested that restriction applies only to medical care and not transportation, but any effort by Medicaid to set up such a transportation program would likely be litigated.
  • New data released this week by the Department of Health and Human Services finds that the number of uninsured Americans has fallen to an all-time low of 8%. That estimate comes as the Senate is considering funding to continue enhanced premium subsidies for people who buy insurance on the Affordable Care Act’s marketplaces. If that legislation falters, the number of people without insurance is expected to rise sharply, as premiums will become unaffordable for many.
  • Biden’s rebound of covid-19 symptoms reminds the country that the standards on when a patient has recovered are not firm and raises questions about how patients should handle reentry after battling the disease.

Also this week, Rovner interviews KHN’s Bram Sable-Smith, who reported and wrote the latest KHN-NPR “Bill of the Month” installment about a single-car accident that resulted in three wildly different ambulance bills. If you have an enormous or outrageous medical bill you’d like to send us, you can do that here.

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

Julie Rovner: KHN’s “They Lost Medicaid When Paperwork Was Sent to an Empty Field, Signaling the Mess to Come,” by Brett Kelman

Rachel Cohrs: The Washington Post’s “Thousands of Lives Depend on a Transplant Network in Need of ‘Vast Restructuring,’” by Joseph Menn and Lenny Bernstein

Tami Luhby: KHN’s “Hospices Have Become Big Business for Private Equity Firms, Raising Concerns About End-of-Life Care,” by Markian Hawryluk

Sandhya Raman: KHN’s “Nursing Homes Are Suing the Friends and Family of Residents to Collect Debts,” by Noam N. Levey


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.

La “dolorosa y aterradora” experiencia de un californiano hasta que le diagnosticaron viruela del simio

Dos días después de regresar de Nueva York a su hogar en California, a Kevin Kwong le picaban tanto las manos que se despertaba del dolor. Pensó que era eczema.

“Todo empeoró rápidamente”, dijo el residente de Emeryville. “Aparecieron más manchas, en la cara, y empezaron a salir fluidos. La erupción se extendió a mis codos, manos y tobillos”.

Después de seis citas virtuales con médicos y enfermeras, una llamada a una línea de atención de enfermería, una visita a una clínica de urgencias, dos a una sala de emergencia y dos diagnósticos incorrectos, un especialista en enfermedades infecciosas le diagnosticó a Kwong, de 33 años, viruela del simio (del mono o símica) a principios de julio.

A pesar de hacerse dos pruebas, nunca dio positivo.

Como el número de casos se ha disparado en Estados Unidos en el último mes, el sistema de salud pública se esfuerza por difundir el peligro del virus y distribuir un suministro limitado de vacunas a las personas vulnerables.

Pero el problema va más allá. Las personas que pueden estar infectadas se enfrentan a callejones sin salida, retrasos, diagnósticos incorrectos y tratamientos inadecuados mientras navegan por un sistema de atención de salud poco preparado y mal informado.

Este virus, poco conocido, hace que los hospitales se apresuren a enseñar al personal de urgencias a identificarlo y analizarlo correctamente. El doctor Peter Chin-Hong, especialista en enfermedades infecciosas de la Universidad de California-San Francisco que finalmente diagnosticó a Kwong, dijo que su caso fue un punto de inflexión para su hospital.

“Kevin llegó en mitad de la noche, cuando no había muchos recursos disponibles. Así que creo que después de su caso, nos estamos educando mejor sobre la enfermedad. Pero creo que los médicos no siempre saben qué hacer”, señaló Chin-Hong.

La viruela del simio es causada por un virus de la misma familia que la viruela, aunque no es tan transmisible ni mortal. Normalmente, los pacientes tienen fiebre, dolores musculares y luego una erupción en la cara, la boca, las manos y posiblemente los genitales que puede durar varias semanas.

El brote actual se propaga por contacto de persona a persona, como tocar una herida o intercambiar saliva u otros fluidos corporales. Las personas también pueden infectarse al tocar objetos o superficies, como juguetes sexuales o sábanas, compartidos con alguien con la enfermedad.

El primer caso de viruela del simio en Estados Unidos se notificó el 17 de mayo, y desde entonces el número se ha elevado hasta más de 6,300 casos probables o confirmados que representan a casi todos los estados, además de Washington, DC, y Puerto Rico.

El gobernador de California, Gavin Newsom, declaró el 1 de agosto el estado de emergencia para coordinar la respuesta y reforzar las iniciativas de vacunación del estado. Alrededor de la mitad de los 1,135 casos en California se han concentrado en la zona de la Bahía de San Francisco.

Aunque cualquiera puede infectarse, el brote parece haber afectado en gran medida a los hombres que tienen relaciones sexuales con hombres. Kwong explicó que probablemente contrajo la viruela del mono en un encuentro sexual durante los eventos del New York Pride.

“Este es el primer brote multicontinental de la historia, así que no va a desaparecer sin más”, afirmó Andrew Noymer, profesor de la Universidad de California-Irvine que estudia las enfermedades infecciosas.

“Esto no va a explotar como covid, pero este brote va a tener su recorrido”, añadió. “Puede que sea como la sífilis y permanezca”.

Pero la mayoría de los médicos no saben cómo reconocerlo. A finales de junio, cuando Kwong empezó a experimentar los síntomas, la mayoría de los médicos y enfermeras con los que habló durante las visitas virtuales ni siquiera mencionaron la viruela del mono. Eso no le sorprende al doctor Timothy Brewer, profesor de medicina y epidemiología de la UCLA.

“Aunque he trabajado de forma intermitente en varios países del África subsahariana durante los últimos 25 años, nunca he tratado un caso de viruela del simio”, explicó Brewer. “Antes de este brote, era una enfermedad muy inusual”.

Una erupción limitada a la zona genital o rectal puede confundirse con una infección de transmisión sexual. Pero, según Brewer, incluso si los médicos no han sido capacitados para reconocer la viruela del simio, sus consejos a los pacientes podrían ayudar a contener la propagación.

“Deberían aconsejar que no se tenga actividad sexual hasta que sus lesiones estén curadas y tratadas”, apuntó Brewer.

Aunque muchos casos son leves y se resuelven por sí solos, algunos se agravan rápidamente, como el de Kwong.

“Tu cuerpo está siendo invadido por esta cosa que no entiendes. Y no tienes a dónde ir, así que es doloroso y aterrador”, dijo Kwong.

Al principio, Kwong trató la erupción con los esteroides tópicos que utiliza para el eczema. Cuando eso no funcionó, tuvo una cita en línea con una enfermera que le diagnosticó herpes y le recetó un medicamento antiviral.

En las horas siguientes, la erupción se extendió rápidamente a más partes de su cuerpo. Alarmado, Kwong fue a una clínica de urgencias. El médico coincidió con el diagnóstico de herpes y añadió otro: sarna, una erupción causada por ácaros que se introducen en la piel. “Mis manchas se concentraban en las manos, las muñecas, los pies y los codos, que son lugares privilegiados para la sarna”, contó Kwong.

Este médico pensó en la viruela del mono, pero las manchas de Kwong estaban agrupadas y tenían un aspecto diferente al de las imágenes de la erupción con las que este médico estaba familiarizado. “Dependiendo de dónde estuviera con mis síntomas, y de con quién hablara, recibía respuestas diferentes”, dijo Kwong.

Durante el fin de semana del 4 de julio, “intenté contactar a médicos, conocía a amigos de amigos que eran dermatólogos”, agregó. “Cada vez que hablaba con alguien, empeoraba rápidamente. Y era realmente extraño”.

Durante otra cita virtual, en mitad de la noche, una enfermera se dio cuenta de que la erupción se había extendido hacia los ojos y le dijo que fuera a la sala de emergencias de inmediato. Fue allí, en el Alta Bates Summit Medical Center de Oakland, donde los médicos dijeron que Kwong podría tener viruela del simio.

“Estuvieron investigando mientras yo estaba en la habitación, y llamaron a los Centros para el Control y la Prevención de Enfermedades (CDC). Como paciente, sentía que no sabía qué me estaba pasando, pero no me di cuenta de la poca información con que contaban los profesionales y de lo poco preparados que estaban ellos también”, expresó.

Pasó 12 horas en la sala de emergencias, donde las enfermeras le hicieron una prueba de viruela del simio. Le dijeron que volviera si tenía fiebre o empezaba a vomitar.

“En ese momento, me sentía muy mal. Tenía llagas en la parte posterior de la garganta, en la boca, por todo el cuerpo”, dijo. “Simplemente deliraba porque no podía dormir más de una o dos horas seguidas”.

Más tarde, esa misma noche, Kwong decidió ir al Centro Médico de la Universidad de California-San Francisco (UCSF). Se había enterado por un amigo de que el UCSF Health estaba tratando casos de viruela símica, y una enfermera de atención virtual le había dicho que fuera allí.

Cuando llegó, lo separaron de los demás pacientes, le dieron oxicodona para el dolor y le hicieron una prueba de viruela del simio.

Al día siguiente, Chin-Hong empezó a tratar a Kwong de viruela del simio. “Pensé, vaya, esta es una enfermedad muy, muy extendida”, contó Chin-Hong. “He visto otros casos de viruela del mono antes, pero muy concentrados. Diría que Kevin está probablemente en el 5% superior de la gravedad de las enfermedades”.

Como la erupción estaba cerca de los ojos de Kwong, Chin-Hong temía que pudiera quedarse ciego si no se trataba la enfermedad. Le recetó Tecovirimat, un medicamento antiviral con la marca TPOXX, que ha recibido la autorización especial de la FDA para tratar la viruela del mono en determinadas circunstancias.

Tras el primer día de tratamiento, Kwong notó que la erupción había dejado de extenderse. En los dos días siguientes, los cientos de manchas hinchadas se aplanaron en discos rojos. “Me sorprendió lo rápido que mejoró Kevin. Era como un turbo-cohete en el camino de la recuperación”, explicó Chin-Hong.

Cuando Kwong empezó a curarse, recibió el primer resultado de la prueba: negativo. Luego el segundo: negativo.

Chin-Hong dijo que era posible que losque tomaron las muestras de las lesiones no hubieran frotado con la suficiente fuerza como para obtener células vivas para la prueba.

“Como médico, es muy difícil obtener una buena muestra en este tipo de lesiones porque el paciente suele sentir dolor. Y no te gusta ver a la gente sufrir”, comentó Chin-Hong.

Casos como el de Kwong pueden pasar desapercibidos si las pruebas no se realizan correctamente. El recurso en línea para los médicos que proporcionan los CDC es adecuado, dijo Brewer, pero solo si se toma el tiempo para leer las 59 páginas.

Los médicos necesitan recoger al menos dos muestras de varios lugares del cuerpo del paciente, añadió. Según Brewer, la clave es tomar muestras de las lesiones “en diferentes etapas de desarrollo” y no concentrarse solo en los primeros bultos.

Durante dos semanas, Kwong tomó seis pastillas antivirales al día para eliminar el virus de su cuerpo. Ya no necesita medicación para el dolor. “Mi cara fue la primera en curarse, lo que me ayudó mucho a ser capaz de reconocerme en el espejo”, dijo Kwong.

Contó que, ahora que ha pasado más de un mes desde que comenzó su calvario, las manos y los pies se están curando por fin. Las cutículas y la piel de las manos se desprendieron y están en proceso de regeneración, mientras que las uñas se han vuelto negras y han empezado a caerse.

Kwong dijo que el daño psicológico tardará más en superarse. “Me siento menos invulnerable, porque fue una enfermedad que me debilitó muy rápidamente. Así que sigo trabajando en mi estado mental más que en el físico”.

Esta historia es parte de una alianza que incluye a KPCC, NPR y KHN.