Tag: CDC

New CDC Opioid Guidelines: Too Little, Too Late for Chronic Pain Patients?

Jessica Layman estimates she has called more than 150 doctors in the past few years in her search for someone to prescribe opioids for her chronic pain.

“A lot of them are straight-up insulting,” said the 40-year-old, who lives in Dallas. “They say things like ‘We don’t treat drug addicts.’”

Layman has tried a host of non-opioid treatments to help with the intense daily pain caused by double scoliosis, a collapsed spinal disc, and facet joint arthritis. But she said nothing worked as well as methadone, an opioid she has taken since 2013.

The latest phone calls came late last year, after her previous doctor shuttered his pain medicine practice, she said. She hopes her current doctor won’t do the same. “If something should happen to him, there’s nowhere for me to go,” she said.

Layman is one of the millions in the U.S. living with chronic pain. Many have struggled to get opioid prescriptions written and filled since 2016 guidelines from the Centers for Disease Control and Prevention inspired laws cracking down on doctor and pharmacy practices. The CDC recently updated those recommendations to try to ease their impact, but doctors, patients, researchers, and advocates say the damage is done.

“We had a massive opioid problem that needed to be rectified,” said Antonio Ciaccia, president of 3 Axis Advisors, a consulting firm that analyzes prescription drug pricing. “But the federal crackdowns and guidelines have created collateral damage: patients left high and dry.”

Born of an effort to fight the nation’s overdose crisis, the guidance led to legal restrictions on doctors’ ability to prescribe painkillers. The recommendations left many patients grappling with the mental and physical health consequences of rapid dose tapering or abruptly stopping medication they’d been taking for years, which carries risks of withdrawal, depression, anxiety, and even suicide.

In November, the agency released new guidelines, encouraging physicians to focus on the individual needs of patients. While the guidelines still say opioids should not be the go-to option for pain, they ease recommendations about dose limits, which were widely viewed as hard rules in the CDC’s 2016 guidance. The new standards also warn doctors about risks associated with rapid dose changes after long-term use.

But some doctors worry the new recommendations will take a long time to make a meaningful change — and may be too little, too late for some patients. The reasons include a lack of coordination from other federal agencies, fear of legal consequences among providers, state policymakers hesitant to tweak laws, and widespread stigma surrounding opioid medication.

The 2016 guidelines for prescribing opioids to people with chronic pain filled a vacuum for state officials searching for solutions to the overdose crisis, said Dr. Pooja Lagisetty, an assistant professor of medicine at the University of Michigan Medical School.

The dozens of laws that states passed limiting how providers prescribe or dispense those medications, she said, had an effect: a decline in opioid prescriptions even as overdoses continued to climb.

The first CDC guidelines “put everybody on notice,’’ said Dr. Bobby Mukkamala, chair of the American Medical Association’s Substance Use and Pain Care Task Force. Physicians reduced the number of opioid pills they prescribe after surgeries, he said. The 2022 revisions are “a dramatic change,” he said.

The human toll of the opioid crisis is hard to overstate. Opioid overdose deaths have risen steadily in the U.S. in the past two decades, with a spike early in the covid-19 pandemic. The CDC says illicit fentanyl has fueled a recent surge in overdose deaths.

Taking into account the perspective of chronic pain patients, the latest recommendations try to scale back some of the harms to people who had benefited from opioids but were cut off, said Dr. Jeanmarie Perrone, director of the Penn Medicine Center for Addiction Medicine and Policy.

“I hope we just continue to spread caution without spreading too much fear about never using opioids,” said Perrone, who helped craft the CDC’s latest recommendations.

Christopher Jones, director of the CDC’s National Center for Injury Prevention and Control, said the updated recommendations are not a regulatory mandate but only a tool to help doctors “make informed, person-centered decisions related to pain care.”

Multiple studies question whether opioids are the most effective way to treat chronic pain in the long term. But drug tapering is associated with deaths from overdose and suicide, with risk increasing the longer a person had been taking opioids, according to research by Dr. Stefan Kertesz, a professor of medicine at the University of Alabama-Birmingham.

He said the new CDC guidance reflects “an extraordinary amount of input” from chronic pain patients and their doctors but doubts it will have much of an impact if the FDA and the Drug Enforcement Administration don’t change how they enforce federal laws.

The FDA approves new drugs and their reformulations, but the guidance it provides for how to start or wean patients could urge clinicians to do so with caution, Kertesz said. The DEA, which investigates physicians suspected of illegally prescribing opioids, declined to comment.

Smith has experienced pain in her left leg since a nerve was cut during surgery years ago. But in December her pharmacy stopped filling her prescriptions for painkillers.(Andy Miller / KHN)

The DEA’s pursuit of doctors put Danny Elliott of Warner Robins, Georgia, in a horrible predicament, said his brother, Jim.

In 1991, Danny, a pharmaceutical company rep, suffered an electric shock. He took pain medicine for the resulting brain injury for years until his doctor faced federal charges of illegally dispensing prescription opioids, Jim said.

Danny turned to doctors out of state — first in Texas and then in California. But Danny’s latest physician had his license suspended by the DEA last year, and he couldn’t find a new doctor who would prescribe those medications, Jim said.

Danny, 61, and his wife, Gretchen, 59, died by suicide in November. “I’m really frustrated and angry about pain patients being cut off,” Jim said.

Danny became an advocate against forced drug tapering before he died. Chronic pain patients who spoke with KHN pointed to his plight in calling for more access to opioid medications.

Even for people with prescriptions, it’s not always easy to get the drugs they need.

Pharmacy chains and drug wholesalers have settled lawsuits for billions of dollars over their alleged role in the opioid crisis. Some pharmacies have seen their opioid allocations limited or cut off, noted Ciaccia, with 3 Axis Advisors.

Rheba Smith, 61, of Atlanta, said that in December her pharmacy stopped filling her prescriptions for Percocet and MS Contin. She had taken those opioid medications for years to manage chronic pain after her iliac nerve was mistakenly cut during surgery, she said.

Smith said she visited nearly two dozen pharmacies in early January but could not find one that would fill her prescriptions. She finally found a local mail-order pharmacy that filled a one-month supply of Percocet. But now that drug and MS Contin are not available, the pharmacy told her.

“It has been a horrible three months. I have been in terrible pain,” Smith said.

Many patients fear a future of constant pain. Layman thinks about the lengths she’d go to in order to get medication.

“Would you be willing to buy drugs off the street? Would you be willing to go to an addiction clinic and try to get pain treatment there? What are you willing to do to stay alive?” she said. “That is what it comes down to.”

Montana Considers New Wave of Legislation to Loosen Vaccination Rules

When Deb Horning’s youngest daughter was 5, she got her measles, mumps, and rubella shot like many other kindergartners. But unlike many other moms, Horning had to stay away from her daughter for a week after the shot.

Horning, 51, was diagnosed in 2014 with acute myeloid leukemia, an aggressive cancer — the five-year survival rate for those older than 20 is 27%. Horning had been through chemotherapy and a stem cell transplant, which severely weakened her immune system. Because the MMR vaccine contains live virus, she couldn’t get the vaccine herself and had to temporarily avoid her vaccinated daughter.

Now, Horning is worried about Montana legislation that could further compromise her and other immunocompromised people by making it easier for more people to opt out of routine vaccinations.

“If they do allow this, and a significant amount of people don’t vaccinate their kids, then there could be community spread,” Horning said. “And then I’m really in danger, the same as a newborn is in danger.”

In 2021, Montana passed House Bill 702the first of its kind in the nation — which prohibited discrimination based on vaccine status in settings like employment, education, and health care. In effect, it banned private businesses and local governments from requiring employees to be vaccinated, not just against covid-19 but any disease. A federal judge ruled the law unconstitutional in health care settings in a lawsuit filed by hospitals, medical providers, and nurses. Two other lawsuits challenging HB 702, one by private businesses and another by tribal nations, are pending.

This year, lawmakers have introduced proposals to expand vaccine exemptions in schools and change criteria in the workplace and the legal system.

Proponents of the school-related measures include mothers advocating for their parental rights over whether to vaccinate their children; a nurse who maintained that medical choices should be private; and a day care instructor concerned about the connection between vaccines and autism, a claim that has been discredited.

Some experts say those bills, like HB 702 from two years ago, are an overreaction to the fear and anger surrounding the covid pandemic.

Those who promote vaccine exemptions on the grounds of parental rights and individual freedom should be honest about the consequences, said Cason Schmit, an assistant professor at Texas A&M University School of Public Health. Those consequences could include more people sick and dead from preventable diseases, he said.

“We know what the outcomes of these types of laws are,” Schmit said.

According to a study published in 2019 in the Expert Review of Vaccines journal, nonmedical vaccine exemptions have increased over the past two decades in the U.S.

Medical exemptions for vaccines are granted for conditions that could result in adverse reactions to a vaccine, such as a cancer patient undergoing chemotherapy. The nonmedical type comprise religious — based on a sincerely held religious belief — and conscience exemptions — based on personal or moral beliefs.

According to Lauren Wilson, president of the Montana Chapter of the American Academy of Pediatrics, no state in the last 20 years has implemented a conscience exemption for childhood vaccines. The National Conference of State Legislatures reports philosophical exemptions in 15 states.

Currently, Montana allows exemptions based on religion but not conscience for K-12 school vaccinations, and the religious exemption must be provided on a notarized affidavit. A medical exemption must be signed by a licensed health care provider.

That would change under Senate Bill 450, sponsored by Republican Sen. Daniel Emrich, which would require schools, employers, health care providers, state agencies, and other entities to accept “without question or malice” religious or conscience exemptions pertaining to certain medications, including vaccines. Any entity that doesn’t comply would lose state funding.

Religious or conscience exemptions could be used for any of the immunizations required in the Montana code: varicella, diphtheria, pertussis, tetanus, poliomyelitis, rubella, mumps, and measles for attendance in primary schools, and influenza B before starting preschool.

SB 450 also would remove the requirement that an exemption be given on a notarized affidavit and allows that a signed letter or statement is sufficient.

Supporters say SB 450 would preserve parental rights as well as the right to choose what goes into one’s body, and provide a justification to refuse vaccination if someone is not particularly religious.

Opponents, including Montana Families for Vaccines, the Montana Medical Association, and Wilson, said states with conscience exemptions have the lowest vaccination rates.

“I think part of the problem is that vaccines have been victims of their own success,” Wilson said. “There have been many childhood illnesses that have been eliminated for more than a generation, and people don’t remember.”

Another measure, House Bill 715, would require schools to inform parents which exemptions are available through whatever communication they already provide to students about vaccines. It initially added a conscience exemption for schools, too, but that was taken out of the bill.

Republican Rep. Jennifer Carlson, the sponsor of both HB 715 and 2021’s HB 702, cast doubt on whether HB 715 would significantly affect vaccination rates. She said during a legislative hearing on Feb. 27 that the state has a 95%-97% vaccination rate despite its existing medical and religious exemptions.

In the 2018-19 school year, 96% of Montana’s kindergartners were vaccinated against measles, mumps, and rubella, while 3% were excused under religious exemptions, according to the state’s public health department. According to the Centers for Disease Control and Prevention, the share dropped to nearly 93% of Montana kindergartners in the 2020-21 school year.

Nationally, about 94% of kindergartners receive two recommended doses of MMR vaccine and 2% remain unvaccinated because of nonmedical exemptions.

Carlson emphasized that HB 715 wasn’t about covid, and that she isn’t opposed to vaccinations, saying at the hearing that she and her five children have all had their childhood vaccines.

“This bill is not a debate about the efficacy of vaccines,” Carlson said.

Dr. Marian Kummer, a retired pediatrician and Montana Families for Vaccines board member, said she worries that if HB 715 and SB 450 become law, it will leave the state vulnerable.

“The fear is what’s going to happen if they pass the personal exemption — the exemption rate will go up and that is going to put more communities at risk for outbreaks of these diseases,” Kummer said.

To maintain immunity against measles, 95% of a population needs to be fully vaccinated — having both MMR shots — against the disease. Kummer said if there are more exemptions, the state could fall below that threshold.

The 2021 legislature passed a law that eliminated the requirement that vaccine rates be reported to Montana’s Department of Public Health and Human Services and local health departments.

Democratic Rep. Ed Stafman has drafted a bill that would boost vaccine and exemption reporting. Stafman said that at some point there will be an increase in outbreaks because of increasing exemptions, and data will be crucial.

“When that outbreak happens here, we’re going to be in deep trouble,” Stafman said.

In the workplace, Senate Bill 369 would require workers’ compensation insurance to cover adverse reactions to employer-mandated vaccines.

And in the courthouse, House Bill 684 would prohibit the use of vaccination status as evidence or grounds for decisions in guardianship or custody cases. It also would make it so vaccination status can’t be used as a factor in determining criteria for adoption.

That bill’s sponsor, Republican Rep. Caleb Hinkle, said including vaccination status in evidence could lead to biased decisions because of how politicized vaccinations have become.

But Schmit of Texas A&M said the measure could handicap judges’ ability to rule what is in the best interests of a child.

Keely Larson is the KHN fellow for the UM Legislative News Service, a partnership of the University of Montana School of Journalism, the Montana Newspaper Association, and Kaiser Health News. Larson is a graduate student in environmental and natural resources journalism at the University of Montana.

Por un tecnicismo, niños necesitados podrían no tener acceso a vacunas contra el VRS

Tras casi cinco décadas de intentos, la industria farmacéutica está a punto de suministrar vacunas eficaces contra el virus respiratorio sincitial (VRS), que ha llevado al hospital a 90,000 niños en lo que va del invierno. 

Sin embargo, solo una de las vacunas está diseñada para administrarse a bebés, y un error en la redacción de la ley puede imposibilitar que los niños de bajos ingresos tengan el mismo acceso a la vacuna que los que tienen un buen seguro.

Desde 1994, la vacunación sistemática es un derecho de la infancia en el marco del programa Vacunas para los Niños, a través del cual el gobierno federal compra millones de vacunas y las suministra gratuitamente a través de pediatras y clínicas a los niños sin seguro, con seguro insuficiente o con Medicaid, que son más de la mitad de todos los menores estadounidenses.

La ley de 1993 por la que se creó el programa no incluye específicamente las inyecciones de anticuerpos, que se utilizaban raramente y solo como terapia de emergencia al momento en que se redactó el proyecto de ley.

Pero la primera inmunización que probablemente esté disponible para los bebés, llamada nirsevimab –se aprobó en Europa en diciembre y se prevé que la Administración de Drogas y Alimentos (FDA) la apruebe este verano–, no es una vacuna sino un anticuerpo monoclonal, que neutraliza los virus del VRS en el torrente sanguíneo.

La doctora Kelly Moore, presidenta del grupo de defensa Immunize.org, dijo que no hay duda que el Comité Asesor sobre Prácticas de Inmunización (ACIP) de Los Centros para el Control y la Prevención de Enfermedades (CDC) recomendará administrar el anticuerpo a los bebés. Ahora los CDC están analizando si nirsevimab sería elegible para el programa Vacunas para los Niños, dijo a KHN Kristen Nordlund, vocera de la agencia. 

No hacerlo “condenaría a miles y miles de niños a hospitalizaciones y enfermedades graves por razones semánticas, a pesar de la existencia de una inmunización que funciona igual que una vacuna estacional”, afirmó.

Funcionarios de Sanofi, que está produciendo la inyección de nirsevimab junto con AstraZeneca, se negaron a indicar un precio, pero dijeron que el rango sería similar al de un curso de vacuna pediátrica. Los CDC pagan alrededor de $650 por la vacuna de rutina más costosa, las cuatro inyecciones contra la infección neumocócica. En otras palabras, la aprobación de la FDA convertiría al nirsevimab en un fármaco de gran éxito con un valor de miles de millones anuales si se administra a una gran parte de los aproximadamente 3,7 millones de niños que nacen en el país cada año.

Pfizer y GSK están fabricando vacunas tradicionales contra el VRS y esperan la aprobación de la FDA a finales de este año. La inyección de Pfizer inicialmente se administraría a las mujeres embarazadas, para proteger a sus bebés de la enfermedad, mientras que la de GSK sería para los adultos mayores.

Las vacunas para lactantes se encuentran en fase de desarrollo, pero expertos aún están un poco nerviosos al respecto. En 1966 fracasó estrepitosamente el ensayo de una vacuna contra este virus en el que murieron dos bebés, y los inmunólogos no se ponen totalmente de acuerdo sobre la causa del desastre, según el doctor Barney Graham, científico jubilado de VRS y covid.

Después que los aislamientos y las máscaras por covid ralentizaran su transmisión durante dos años, el VRS estalló este año en todo Estados Unidos, inundando las unidades de cuidados intensivos pediátricos.

Sanofi y AstraZeneca, los fabricantes de nirvisemab, esperan que la FDA lo apruebe, que los CDC lo recomienden y que se aplique en todo el país antes del otoño para prevenir nuevas epidemias del VRS.

Su producto está diseñado para administrarse antes de la primera temporada invernal del VRS de cada bebé. En los ensayos clínicos los anticuerpos ofrecieron una protección de hasta cinco meses; la mayoría de los menores no necesitarían una segunda dosis porque el virus no es un peligro mortal para los niños sanos de más de un año, dijo Jon Heinrichs, miembro principal de la división de vacunas de Sanofi.

Si no se acepta el tratamiento con anticuerpos para el programa Vacunas para Niños, habrá un acceso limitado a la vacuna para los que no tienen seguro médico y para los beneficiarios de Medicaid, la mayoría de los cuales son negros e hispanos (que pueden ser de cualquier raza), indicó Moore. Las farmacéuticas tendrían que negociar con el programa Medicaid de cada estado para incluirlo en sus formularios.

Excluir la vacuna del programa Vacunas para Niños “sólo empeoraría las disparidades sanitarias existentes”, dijo el doctor Sean O’Leary, profesor de pediatría de la Universidad de Colorado y presidente del comité de enfermedades infecciosas de la Academia Americana de Pediatría.

El VRS afecta a bebés de todas las clases sociales, pero tiende a perjudicar más a los hogares pobres y hacinados, dijo Graham. “Los antecedentes familiares de asma o alergia lo empeoran, y si son muy prematuros”, dijo.

Aunque entre el 2% y el 3% de los lactantes son hospitalizados cada año por el virus respiratorio sincitial, hay una alta supervivencia. Pero hasta 10,000 adultos mayores mueren cada año a causa de estas infecciones. Esto cambiará con el fin de pagos de bolsillo para todas las vacunas bajo Medicare, incluida la del VRS, bajo la Ley de Reducción de la Inflación de 2022.

Jennifer Reich, socióloga de la Universidad de Colorado que estudia las actitudes en materia de vacunación, afirmó que es probable que el alto grado de indecisión sobre las vacunas reduzca su aceptación, independientemente de quién las pague.

Los nuevos tipos de vacunas, como los anticuerpos de Sanofi/AstraZeneca, suelen asustar a los padres, y es probable que la vacuna de Pfizer para las mujeres embarazadas también provoque temor.

Los responsables de salud pública “no parecen saber cómo superar la desinformación” de que las vacunas merman la fertilidad o perjudican de algún otro modo a las personas, dijo Reich.

Por otra parte, la epidemia del VRS de este año será significativa para muchas madres, dijo Heidi Larson, líder del Vaccine Confidence Project y profesora de antropología en la Escuela de Higiene y Medicina Tropical de Londres.

“Tener a un hijo hospitalizado por el VRS da miedo”, afirmó.

Aunque desafortunado, “el elevado número de niños que murieron o ingresaron en la UCI en la última temporada con VRS es, en cierto modo, útil”, dijo la doctora Laura Riley, catedrática de obstetricia y ginecología de Weill Cornell Medicine en Nueva York.         

Los especialistas de su campo no han empezado realmente a hablar de cómo informar a las mujeres sobre la vacuna, dijo Riley, presidenta del grupo de inmunización del Colegio Americano de Obstetras y Ginecólogos.

“Todo el mundo ha estado esperando a ver si se aprobaba”, señaló. “La educación tiene que empezar pronto, pero es difícil educar antes de lanzar la vacuna”.

Decisiones financieras de los hospitales juegan un papel en la escasez de camas pediátricas para pacientes con VRS

La grave escasez de camas pediátricas que azota a la nación este otoño es en parte producto de las decisiones financieras tomadas por los hospitales durante la última década, como cerrar las salas infantiles, que a menudo operan en números rojos, y ampliar la cantidad de camas disponibles para proyectos más rentables como reemplazos articulares y atención del cáncer.

Para hacer frente a la avalancha de niños enfermos por una convergencia radical de virus desagradables, especialmente el virus respiratorio sincitial (VRS), la influenza y el coronavirus, los centros médicos de todo el país han desplegado carpas de triage, retrasado cirugías electivas y trasladado fuera del estado a menores gravemente enfermos.

Un factor importante en la escasez de camas es una tendencia de muchos años entre los hospitales de eliminar las unidades pediátricas, que tienden a ser menos rentables que las de adultos, dijo Mark Wietecha, director ejecutivo de la Children’s Hospital Association.

Los hospitales optimizan los ingresos tratando de mantener sus camas llenas al 100 %, y llenas de pacientes con condiciones que las aseguradoras reembolsan bien.

“Realmente tiene que ver con los dólares”, dijo el doctor Scott Krugman, vicepresidente de pediatría del Hospital Pediátrico Herman and Walter Samuelson en Baltimore. “Los hospitales dependen de procedimientos de alto volumen y alto reembolso de seguros que paguen bien para ganar dinero”.

El número de unidades pediátricas para pacientes internados en los hospitales cayó un 19% entre 2008 y 2018, según un estudio publicado en 2021 en la revista Pediatrics. Solo este año, los hospitales han cerrado unidades pediátricas en Boston y Springfield, Massachusetts; Richmond, Virginia; y Tulsa, Oklahoma.

El aumento actual de enfermedades respiratorias peligrosas para los niños es otro ejemplo de cómo covid-19 ha alterado el sistema de atención médica. Los bloqueos y el aislamiento que marcaron los primeros años de la pandemia dejaron a los niños en gran medida sin exposición, y aún vulnerables, a virus distintos al covid durante dos inviernos, y los médicos ahora están tratando esencialmente enfermedades respiratorias de varios años.

La pandemia también aceleró los cambios en la industria de la atención de salud que han dejado a muchas comunidades con menos camas de hospital disponibles para niños gravemente enfermos, junto con menos médicos y enfermeras para atenderlos.

Cuando las unidades de cuidados intensivos se inundaron con pacientes mayores con covid en 2020, algunos hospitales comenzaron a usar camas infantiles para tratar a adultos. Muchas de esas camas pediátricas no se han repuesto, dijo el doctor Daniel Rauch, presidente del comité de atención hospitalaria de la Academia Estadounidense de Pediatría.

“Simplemente no hay suficiente espacio para todos los niños que necesitan camas”, dijo la doctora Megan Ranney, quien trabaja en varios departamentos de emergencia en Providence, Rhode Island, incluido el Hasbro Children’s Hospital. La cantidad de niños que buscaron atención de emergencia en las últimas semanas fue un 25% más alta que el récord anterior del hospital.

“Tenemos médicos que limpian las camas para que podamos acomodar a los niños más rápido”, dijo Ranney, vicedecana de la Escuela de Salud Pública de la Universidad Brown.

No hay mucho dinero en el tratamiento de niños. Alrededor del 40% de los niños estadounidenses están cubiertos por Medicaid, un programa federal y estatal conjunto para pacientes de bajos ingresos y personas con discapacidades. Las tarifas básicas de Medicaid suelen ser más de un 20% inferiores a las que paga Medicare, el programa de seguro del gobierno para adultos mayores, y son aún más bajas en comparación con los seguros privados.

Si bien la atención especializada para una variedad de procedimientos comunes para adultos, desde reemplazos de rodilla y cadera hasta cirugías cardíacas y tratamientos contra el cáncer, genera importantes ganancias para los centros médicos, los hospitales se quejan de que generalmente pierden dinero en la atención pediátrica de pacientes hospitalizados.

Cuando Tufts Children’s Hospital cerró 41 camas pediátricas este verano, los funcionarios del hospital aseguraron a los residentes que los pacientes jóvenes podrían recibir atención en el cercano Boston Children’s Hospital. Ahora, Boston Children’s está retrasando algunas cirugías electivas para dejar espacio a los niños que están gravemente enfermos.

Rauch señaló que los hospitales infantiles, que se especializan en el tratamiento de enfermedades raras y graves como el cáncer pediátrico, la fibrosis quística y los defectos cardíacos, simplemente no están diseñados para manejar la avalancha de niños gravemente enfermos de esta temporada con virus respiratorios.

Incluso antes de la trifecta viral del otoño, las unidades pediátricas se esforzaban por absorber un número creciente de jóvenes con angustia mental aguda.

Abundan las historias de niños en crisis mentales que se quedan en el limbo durante semanas en las salas de emergencia mientras esperan ser transferidos a una unidad psiquiátrica pediátrica. En un buen día, dijo Ranney, el 20% de las camas de la sala de emergencias pediátrica del Hasbro Children’s Hospital están ocupadas por niños que experimentan problemas de salud mental.

Con la esperanza de aumentar la capacidad pediátrica, el mes pasado, la Academia Estadounidense de Pediatría se unió a la Asociación de Hospitales Infantiles para pedir a la Casa Blanca que declare una emergencia nacional debido a infecciones respiratorias infantiles y proporcione recursos adicionales para ayudar a cubrir los costos de la atención.

La administración Biden ha dicho que la flexibilidad que se les ha dado a los sistemas hospitalarios y a los proveedores durante la pandemia para eludir ciertos requisitos de personal también se aplica al VRS y la gripe.

El Doernbecher Children’s Hospital de Oregon Health & Science University ha cambiado a “estándares de atención de crisis”, lo que permite que las enfermeras de cuidados intensivos traten a más pacientes de los que normalmente se les asignan. Mientras tanto, los hospitales en Atlanta, Pittsburgh y Aurora, Colorado, han recurrido al tratamiento de pacientes jóvenes en carpas desbordadas en estacionamientos.

El doctor Alex Kon, pediatra de cuidados intensivos en el Centro Médico Comunitario en Missoula, Montana, dijo que los proveedores han hecho planes para cuidar a los niños mayores en la unidad de cuidados intensivos para adultos y desviar las ambulancias a otras instalaciones cuando sea necesario. Con solo tres UCI pediátricas en el estado, eso significa que los pacientes jóvenes pueden volar hasta Seattle o Spokane, Washington o Idaho.

Hollis Lillard llevó a su hijo de 1 año, Calder, a un hospital del ejército en el norte de Virginia el mes pasado después de experimentar varios días de fiebre, tos y dificultad para respirar. Pasaron siete horas angustiosas en la sala de emergencias antes de que el hospital encontrara una cama abierta y los trasladaran en ambulancia al Centro Médico Militar Nacional Walter Reed en Maryland.

Con la terapia adecuada y las instrucciones para el cuidado en el hogar, el virus de Calder fue fácilmente tratable: se recuperó después de que le administraran oxígeno y lo trataran con esteroides, que combaten la inflamación, y albuterol, que controla los broncoespasmos. Fue dado de alta al día siguiente.

Aunque las hospitalizaciones por VRS están disminuyendo, las tasas se mantienen muy por encima de la media para esta época del año. Y es posible que los hospitales no tengan mucho alivio.

Las personas pueden infectarse con este virus más de una vez al año, y Krugman se preocupa por un resurgimiento en los próximos meses. Debido al coronavirus, que compite con otros virus, “el patrón estacional habitual de virus se ha ido por la ventana”, dijo.

Al igual que el VRS, la influenza llegó temprano esta temporada. Ambos virus suelen alcanzar su punto máximo alrededor de enero. Tres cepas de la gripe están circulando y han causado aproximadamente 8,7 millones de casos, 78,000 hospitalizaciones y 4,500 muertes, según los Centros para el Control y la Prevención de Enfermedades (CDC).

Krugman duda que la industria de la atención de salud aprenda lecciones rápidas de la crisis actual. “A menos que haya un cambio radical en la forma en que pagamos la atención hospitalaria pediátrica”, dijo Krugman, “la escasez de camas solo empeorará”.

Hospital Financial Decisions Play a Role in the Critical Shortage of Pediatric Beds for RSV Patients

The dire shortage of pediatric hospital beds plaguing the nation this fall is a byproduct of financial decisions made by hospitals over the past decade, as they shuttered children’s wards, which often operate in the red, and expanded the number of beds available for more profitable endeavors like joint replacements and cancer care.

To cope with the flood of young patients sickened by a sweeping convergence of nasty bugs — especially respiratory syncytial virus, influenza, and coronavirus — medical centers nationwide have deployed triage tents, delayed elective surgeries, and transferred critically ill children out of state.

A major factor in the bed shortage is a years-long trend among hospitals of eliminating pediatric units, which tend to be less profitable than adult units, said Mark Wietecha, CEO of the Children’s Hospital Association. Hospitals optimize revenue by striving to keep their beds 100% full — and filled with patients whose conditions command generous insurance reimbursements.

“It really has to do with dollars,” said Dr. Scott Krugman, vice chair of pediatrics at the Herman and Walter Samuelson Children’s Hospital at Sinai in Baltimore. “Hospitals rely on high-volume, high-reimbursement procedures from good payers to make money. There’s no incentive for hospitals to provide money-losing services.”

The number of pediatric inpatient units in hospitals fell 19% from 2008 to 2018, according to a study published in 2021 in the journal Pediatrics. Just this year, hospitals have closed pediatric units in Boston and Springfield, Massachusetts; Richmond, Virginia; and Tulsa, Oklahoma.

The current surge in dangerous respiratory illnesses among children is yet another example of how covid-19 has upended the health care system. The lockdowns and isolation that marked the first years of the pandemic left kids largely unexposed — and still vulnerable — to viruses other than covid for two winters, and doctors are now essentially treating multiple years’ worth of respiratory ailments.

The pandemic also accelerated changes in the health care industry that have left many communities with fewer hospital beds available for children who are acutely ill, along with fewer doctors and nurses to care for them.

When intensive care units were flooded with older covid patients in 2020, some hospitals began using children’s beds to treat adults. Many of those pediatric beds haven’t been restored, said Dr. Daniel Rauch, chair of the American Academy of Pediatrics’ committee on hospital care.

In addition, the relentless pace of the pandemic has spurred more than 230,000 health care providers — including doctors, nurses, and physician assistants — to quit. Before the pandemic, about 10% of nurses left their jobs every year; the rate has risen to about 20%, Wietecha said. He estimates that pediatric hospitals are unable to maintain as many as 10% of their beds because of staffing shortages.

“There is just not enough space for all the kids who need beds,” said Dr. Megan Ranney, who works in several emergency departments in Providence, Rhode Island, including Hasbro Children’s Hospital. The number of children seeking emergency care in recent weeks was 25% higher than the hospital’s previous record.

“We have doctors who are cleaning beds so we can get children into them faster,” said Ranney, a deputy dean at Brown University’s School of Public Health.

There’s not great money in treating kids. About 40% of U.S. children are covered by Medicaid, a joint federal-state program for low-income patients and people with disabilities. Base Medicaid rates are typically more than 20% below those paid by Medicare, the government insurance program for older adults, and are even lower when compared with private insurance. While specialty care for a range of common adult procedures, from knee and hip replacements to heart surgeries and cancer treatments, generates major profits for medical centers, hospitals complain they typically lose money on inpatient pediatric care.

When Tufts Children’s Hospital closed 41 pediatric beds this summer, hospital officials assured residents that young patients could receive care at nearby Boston Children’s Hospital. Now, Boston Children’s is delaying some elective surgeries to make room for kids who are acutely ill.

Rauch noted that children’s hospitals, which specialize in treating rare and serious conditions such as pediatric cancer, cystic fibrosis, and heart defects, simply aren’t designed to handle this season’s crush of kids acutely ill with respiratory bugs.

Even before the autumn’s viral trifecta, pediatric units were straining to absorb rising numbers of young people in acute mental distress. Stories abound of children in mental crises being marooned for weeks in emergency departments while awaiting transfer to a pediatric psychiatric unit. On a good day, Ranney said, 20% of pediatric emergency room beds at Hasbro Children’s Hospital are occupied by children experiencing mental health issues.

In hopes of adding pediatric capacity, the American Academy of Pediatrics joined the Children’s Hospital Association last month in calling on the White House to declare a national emergency due to child respiratory infections and provide additional resources to help cover the costs of care. The Biden administration has said that the flexibility hospital systems and providers have been given during the pandemic to sidestep certain staffing requirements also applies to RSV and flu.

Doernbecher Children’s Hospital at Oregon Health & Science University has shifted to “crisis standards of care,” enabling intensive care nurses to treat more patients than they’re usually assigned. Hospitals in Atlanta, Pittsburgh, and Aurora, Colorado, meanwhile, have resorted to treating young patients in overflow tents in parking lots.

Dr. Alex Kon, a pediatric critical care physician at Community Medical Center in Missoula, Montana, said providers there have made plans to care for older kids in the adult intensive care unit, and to divert ambulances to other facilities when necessary. With only three pediatric ICUs in the state, that means young patients may be flown as far as Seattle or Spokane, Washington, or Idaho.

Hollis Lillard took her 1-year-old son, Calder, to an Army hospital in Northern Virginia last month after he experienced several days of fever, coughing, and labored breathing. They spent seven anguished hours in the emergency room before the hospital found an open bed and transferred them by ambulance to Walter Reed National Military Medical Center in Maryland.

With proper therapy and instructions for home care, Calder’s virus was readily treatable: He recovered after he was given oxygen and treated with steroids, which fight inflammation, and albuterol, which counteracts bronchospasms. He was discharged the next day.

Although hospitalizations for RSV are falling, rates remain well above the norm for this time of year. And hospitals may not get much relief.

People can be infected with RSV more than once a year, and Krugman worries about a resurgence in the months to come. Because of the coronavirus, which competes with other viruses, “the usual seasonal pattern of viruses has gone out the window,” he said.

Like RSV, influenza arrived early this season. Both viruses usually peak around January. Three strains of flu are circulating and have caused an estimated 8.7 million illnesses, 78,000 hospitalizations, and 4,500 deaths, according to the Centers for Disease Control and Prevention.

Krugman doubts the health care industry will learn any quick lessons from the current crisis. “Unless there is a radical change in how we pay for pediatric hospital care,” Krugman said, “the bed shortage is only going to get worse.”

States Opting Out of a Federal Program That Tracks Teen Behavior as Youth Mental Health Worsens

As the covid-19 pandemic worsened a mental health crisis among America’s young people, a small group of states quietly withdrew from the nation’s largest public effort to track concerning behaviors in high school students.

Colorado, Florida, and Idaho will not participate in a key part of the Centers for Disease Control and Prevention’s Youth Risk Behavior surveys that reaches more than 80,000 students. Over the past 30 years, the state-level surveys, conducted anonymously during each odd-numbered year, have helped elucidate the mental health stressors and safety risks for high school students.

Each state has its own rationale for opting out, but their withdrawal — when suicides and feelings of hopelessness are up — has caught the attention of school psychologists and federal and state health officials.

Some questions on the state-level surveys — which can also ask students about their sexual orientation, gender identity, sexual activity, and drug use — clash with laws that have been passed in conservative states. The intense political attention on teachers and school curriculums has led to a reluctance among educators to have students participate in what were once considered routine mental and behavioral health assessments, some experts worry.

The reduction in the number of states that participate in the state-level CDC survey will make it harder for those states to track the conditions and behaviors that signal poor mental health, like depression, drug and alcohol misuse, and suicidal ideation, experts said.

“Having that kind of data allows us to say ‘do this, not that’ in really important ways,” said Kathleen Ethier, director of the CDC’s Division of Adolescent and School Health, which oversees the series of health surveys known as the Youth Risk Behavior Surveillance System. “For any state to lose the ability to have that data and use that data to understand what’s happening with young people in their state is an enormous loss.”

The CDC developed the Youth Risk Behavior Surveillance System in 1990 to track the leading causes of death and injury among young people. It is made up of a nationally representative poll of students in grades nine through 12 and separate state and local school district-level questionnaires. The questions focus on behaviors that lead to unintentional injuries, violence, sexually transmitted infections, pregnancy, drug and alcohol misuse, physical inactivity, and more.

The decisions by Colorado, Florida, and Idaho not to participate in the state-level questionnaires will not affect the CDC’s national survey or the local school district surveys in the states that have them.

Part of what makes the survey a powerful tool is the diversity of information collected, said Norín Dollard, a senior analyst with the Florida Policy Institute, a nonprofit research and advocacy group. “It allows for the analysis of data by subgroups, including LGBTQ+ youth, so that the needs of these students, who are at a greater risk of depression, suicide, and substance abuse than their peers, are understood and can be supported by schools and community providers,” said Dollard, who is also director of Florida Kids Count, part of a national network of nonprofit programs focused on children in the United States.

The CDC is still processing the 2021 data and has not released the results because of pandemic-related delays, said Paul Fulton, an agency spokesperson. But trends from the 2009 to 2019 national surveys showed that the mental health of young people had deteriorated over the previous decade.

“So we started planning,” Ethier said. “When the pandemic hit, we were able to say, ‘Here are the things you should be looking out for.’”

The pandemic has further exacerbated the mental health problems young people face, said Angela Mann, president of the Florida Association of School Psychologists.

Nearly half of parents who responded to a recent KFF/CNN mental health survey said the pandemic had had a negative impact on their child’s mental health. Most said they were worried that issues like self-harm and loneliness stemming from the pandemic may affect teenagers.

But the CDC’s survey has shortcomings, said health officials from some states that pulled back from it. Not all high schools are included, for example. And the sample of students from each state is so small that some state officials said their schools received little actionable data despite decades of participation.

That was the case in Colorado, which decided not to participate next year, according to Emily Fine, school and youth survey manager at the Colorado health department. Instead, she said, the state will focus on improving a separate study called Healthy Kids Colorado, which includes questions similar to those in the CDC survey and Colorado-specific questions. The Colorado survey, which has been running for about a decade, covers about 100,000 students across the state — nearly 100 times the number that participated in the CDC’s state-level survey in 2019.

Minnesota, Oregon, Washington, and Wyoming, which also have their own youth surveys, either never participated or decided to skip the previous two CDC assessments. At least seven states will not participate in the 2023 state-level survey.

Fine said the state-run option is more beneficial because schools receive their own results.

In Leadville, a Colorado mountain town, a youth coalition used results from the Healthy Kids Colorado survey to conclude that the county had higher-than-average rates of substance use. They also learned that Hispanic students in particular didn’t feel comfortable sharing serious problems like suicidal thoughts with adults, suggesting that opportunities to flag issues early were being missed.

“I feel like most kids tell the truth on those surveys, so I feel like it’s a reliable source,” said high schooler Daisey Monge, who is part of the youth coalition, which proposed a policy to train adults in the community to make better connections with young people.

Education officials in Florida and Idaho said they plan to gather more state-specific data using newly created questionnaires. But neither state has designed a new survey, and what questions will be asked or what data will be captured is not clear.

Cassandra Palelis, a spokesperson for the Florida Department of Education, said in an email that Florida intends to assemble a “workgroup” to design its new system.

In recent years, Idaho officials cited the CDC survey data when they applied for and received $11 million in grants for a new youth suicide prevention program called the Idaho Lives Project. The data showed the share of high school students who had seriously considered attempting suicide increased from 15% in 2011 to 22% in 2019.

“That is concerning,” said Eric Studebaker, director of student engagement and safety coordination for the State Department of Education. Still, he said, the state is worried about taking up class time to survey students and about overstepping boundaries by asking questions that are not parent-approved.

Whatever the rationale, youth mental health advocates call opting out shortsighted and potentially harmful as the exodus erodes the national data collection. The pandemic exacerbated mental health stress for all high school students, especially those who are members of racial or ethnic minority groups and those who identify as LGBTQ+.

But since April, at least a dozen states have proposed bills that mirror Florida’s Parental Rights in Education law, which bans instruction about sexual orientation and gender identity in kindergarten through third grade.

The law, which critics call “Don’t Say Gay,” and the intense political attention it has focused on teachers and school curriculums are having a chilling effect on all age groups, said youth advocates like Mann, the Florida school psychologist. “Some of these discussions about schools indoctrinating kids has bled into discussions about mental health services in schools,” she said.

Since the law was adopted, some Florida school administrators have removed “safe space” stickers with the rainbow flag indicating support for LGBTQ+ students. Some teachers have resigned in protest of the law, while others have expressed confusion about what they’re allowed to discuss in the classroom.

With data showing that students need more mental health services, opting out of the state-level surveys now may do more harm than good, said Franci Crepeau-Hobson, a professor of school psychology at the University of Colorado-Denver, who has used the national youth risk behavior data to analyze trends.

“It’s going to make it more difficult to really get a handle on what’s happening nationally,” she said.

KHN Colorado correspondent Rae Ellen Bichell contributed to this report.

With Polio’s Return, Here’s What Back-to-Schoolers Need to Know

Before polio vaccines became available in the 1950s, people wary of the disabling disease were afraid to allow their children outside, let alone go to school. As polio appears again decades after it was considered eliminated in the U.S., Americans unfamiliar with the dreaded disease need a primer on protecting themselves and their young children — many of whom are emerging from the trauma of the covid-19 pandemic.

What is poliomyelitis?

Polio is short for “poliomyelitis,” a neurological disease caused by a poliovirus infection. Of the three types of wild poliovirus — serotypes 1, 2, and 3 — serotype 1 is the most virulent and the most likely to cause paralysis.

Most people infected with poliovirus don’t get sick and won’t have symptoms. About a quarter of those infected might experience mild symptoms like fatigue, fever, headache, neck stiffness, sore throat, nausea, vomiting, and abdominal pain. So, as with covid-19, people who don’t have symptoms can unknowingly spread it as they interact with others. But in up to 1 in 200 people with a poliovirus infection, the virus may attack the spinal cord and brain. When it infects the spinal cord, people may develop muscle weakness or paralysis, including of the legs, arm, or chest wall. Poliovirus may also infect the brain, leading to difficulty breathing or swallowing.

People can develop post-polio syndrome decades after infection. Symptoms may include muscle pain, weakness, and wasting.

People with poliomyelitis may remain wheelchair-bound or unable to breathe without the help of a ventilator for the rest of their lives.

How does polio spread?

The virus that causes polio spreads through the “oral-fecal route,” which means it enters the body through the mouth by way of the hands, water, food, or other items contaminated with poliovirus-containing feces. Rarely, poliovirus may spread through saliva and upper respiratory droplets. The virus then infects the throat and gastrointestinal tract, spreads to the blood, and invades the nervous system.

How do doctors diagnose polio?

Poliomyelitis is diagnosed through a combination of patient interviews, physical examinations, lab testing, and scans of the spinal cord or brain. Health care providers may send feces, throat swabs, spinal fluid, and other specimens for lab testing. But because polio has been vanishingly rare in the United States for decades, doctors may not consider the diagnosis for patients with symptoms. And tests for suspected polio must be sent to the Centers for Disease Control and Prevention, since even academic centers no longer perform the tests.

How can poliovirus transmission be prevented?

The CDC recommends that all children be vaccinated against polio at ages 2 months, 4 months, 6 to 18 months, and 4 to 6 years, for a total of four doses. All 50 states and the District of Columbia require that children attending day care or public school be immunized against polio, but some states allow medical, religious, or personal exemptions. The Vaccines for Children program provides polio vaccine free of charge for children who are eligible for Medicaid, uninsured, or underinsured, or who are American Indian or Alaska Native. Most people born in the United States after 1955 likely have been vaccinated for polio. But in some areas the vaccination rates are dangerously low, such as New York’s Rockland County, where it is 60%, and Yates County, where it is 54%, because so many families there claim religious exemptions.

There are two types of polio vaccine: killed, inactivated polio vaccine (IPV) and weakened, live, oral polio vaccine (OPV). IPV is an injectable vaccine. OPV may be given by drops in the mouth or on a sugar cube, so it’s easier to administer. Both vaccines are highly effective against paralytic poliomyelitis, but OPV appears to be more effective in preventing infection and transmission.

Both the wild poliovirus and the live, weakened OPV viruses can cause infection. Because IPV is a killed virus vaccine, it cannot infect or replicate, give rise to vaccine-derived poliovirus, or cause paralytic poliomyelitis disease. The weakened, OPV viruses can mutate and regain their ability to cause paralysis — what’s called vaccine-derived poliomyelitis.

Since 2000, only IPV has been given in the United States. Two doses of IPV are at least 90% effective and three doses of IPV are at least 99% effective in preventing paralytic poliomyelitis disease. The United States stopped using OPV due to a 1-in-2,000 risk of paralysis among unvaccinated persons receiving OPV. Some countries still use OPV.

Vaccination against polio began in 1955 in the United States. Cases of paralytic poliomyelitis disease plummeted from over 15,000 a year in the early 1950s to under 100 in the 1960s and then down to fewer than 10 in the 1970s. Today, poliovirus is most likely to spread where hygiene and sanitation are poor and vaccination rates are low.

Why is polio spreading again?

The World Health Organization declared North and South America polio-free as of 1994, but in June 2022, a young adult living in Rockland County, New York, was diagnosed with serotype 2 vaccine-derived poliovirus. The patient complained of fever, neck stiffness, and leg weakness. The patient had not traveled recently outside the country and was presumably infected in the United States. The CDC has since started to monitor wastewater for poliovirus. Poliovirus genetically linked to the Rockland County case has been detected in wastewater samples from Rockland, Orange, and Sullivan counties, demonstrating community spread as far back as May 2022. Unrelated vaccine-derived poliovirus has also been detected in New York City wastewater.

How do I know if I’ve been vaccinated against polio?

There is no national database of immunization records, but all 50 states and the District of Columbia have immunization information systems with records going as far back as the 1990s. Your state or territorial health department may also have records of your vaccinations. People immunized in Arizona, the District of Columbia, Louisiana, Maryland, Mississippi, North Dakota, and Washington can access their immunization records using the MyIR Mobile app, and those who got vaccines in Idaho, Minnesota, New Jersey, and Utah can do so using the Docket app.

You may also ask your parents, your childhood pediatrician, your current doctor or pharmacist, or the K-12 schools, colleges, or universities you attended if they have records of your vaccinations. Some employers, like health care systems, may also keep records of your vaccinations in their occupational health office.

There is no test to determine if you’re immune to polio.

Do I need a polio vaccine booster if I was fully vaccinated against polio as a child?

All children and unvaccinated adults should complete the CDC-recommended four-dose series of polio vaccinations. You do not need an IPV booster if you received OPV.

Adults who are immunocompromised, traveling to a country where poliovirus is circulating, or at increased risk for exposure to poliovirus on the job, such as some lab workers and health care workers, may get a one-time IPV booster.

How is polio treated?

People with mild poliovirus infection don’t require treatment. Symptoms usually go away on their own within a couple of days.

There is no cure for paralytic poliomyelitis. Treatment focuses on physical and occupational therapy to help patients adapt and regain function.

Why hasn’t poliovirus been eradicated?

Smallpox is the only human virus to have been declared eradicated to date. A disease may be eradicated if it infects only humans, if viral infection induces long-term immunity to reinfection, and if an effective vaccine or other preventive exists. The more infectious a virus, the more difficult it is to eradicate. Viruses that spread asymptomatically are also more difficult to eradicate.

In 1988, the World Health Assembly resolved to eradicate polio by 2000. Violent conflict, the spread of conspiracy theories, vaccine skepticism, inadequate funding and political will, and poor-quality vaccination efforts slowed progress toward eradication, but before the covid pandemic, the world had gotten very close to eradicating polio. During the pandemic, childhood immunizations, including polio vaccinations, dipped in the U.S. and around the world.

To eradicate polio, the world must eradicate all wild polioviruses and vaccine-derived polioviruses. Wild poliovirus serotypes 2 and 3 have been eradicated. Wild poliovirus serotype 1, the most virulent form, remains endemic only in Pakistan and Afghanistan, but vaccine-derived polioviruses continue to circulate in some countries in Africa and other parts of the world. A staged approach involving the use of OPV, then a combination of OPV and IPV, and then IPV alone would likely be needed to finally eradicate polio from the planet.

KHN’s ‘What the Health?’: Wrapping Up Summer’s Health News

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Congress and President Joe Biden are officially on summer vacation, but they left behind a lot of health policy achievements. The president returned this week from his South Carolina beach retreat to sign the Inflation Reduction Act, which, among other things, allows Medicare to negotiate drug prices for the first time.

The law also preserves the enhanced subsidies for premiums on insurance purchased through the Affordable Care Act’s marketplaces. Congress added those more generous subsidies in 2021, but they would have expired at the end of the year.

Meanwhile, even though Democrats were unable to secure additional Medicare vision, hearing, and dental benefits into the final version of the budget bill, this week the FDA established ground rules for the sale of over-the-counter hearing aids, something ordered by Congress in 2017.

This week’s panelists are Julie Rovner of KHN, Anna Edney of Bloomberg, Alice Miranda Ollstein of Politico, and Joanne Kenen of the Johns Hopkins Bloomberg School of Public Health and Politico.

Among the takeaways from this week’s episode:

  • Despite the new law’s provisions allowing Medicare to negotiate some drug prices, enrollees will have to wait several years to see the benefits of those negotiations. That makes it challenging for Democrats to use the measure as a campaign promotion. Plus, Republicans may try to use the intervening years, while the price negotiating process is being set up, to batter Democrats’ efforts.
  • Other Medicare provisions, such as the new limit on out-of-pocket drug spending and caps on insulin spending, will provide more immediate benefits.
  • The act’s extension of ACA premium subsidies is also a hard victory to illuminate for consumers, who won’t see their costs fall and would likely have only noticed a difference if the measure had failed to pass and the program had ended.
  • Nonetheless, ad campaigns are already beginning to target the Republican opposition to popular health issues. No GOP lawmakers voted to support the measure.
  • Hearing aids fitting the new category are expected to be significantly less expensive for people with mild to moderate hearing loss. Still unanswered, however, is whether these new devices will work adequately.
  • The Centers for Disease Control and Prevention released new covid-19 guidelines last week that relax previous recommendations. The announcement highlights the growing disdain among the public for continuing the isolating prevention strategies of the past several years. But perhaps overlooked is the growing number of people suffering from long-term covid symptoms and how the condition damages their lives and the economy.
  • The CDC also announced this week that it will reorganize to better meet public health crises after a study of its covid response identified problems, especially in communicating with the public.
  • Although much of the opposition to abortion restrictions arising since the Supreme Court overturned Roe v. Wade has been propelled by women, men are also playing a role both in the politics ahead and in wide-ranging personal decisions, such as what states to choose for college or seeking vasectomies.

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

Julie Rovner: The Los Angeles Times’ “The CDC Loosened Its COVID Rules. Who Fills in This Public Health Vacuum?” by Wendy Netter Epstein and Daniel Goldberg

Alice Miranda Ollstein: MedPage Today’s “Falls From Higher Border Walls Overwhelm Trauma Services,” by Cheryl Clark

Joanne Kenen: Harper’s Magazine’s “A Hole in the Head,” by Zachary Siegel

Anna Edney: Stat’s “Parents and Clinicians Say Private Equity’s Profit Fixation Is Short-Changing Kids With Autism,” by Tara Bannow

Also mentioned in this week’s episode:

The Washington Post’s “Florida Court Rules 16-Year-Old Is Not ‘Sufficiently Mature’ for Abortion,” by Brittany Shammas and Kim Bellware

The Atlantic’s “The Pandemic’s Soft Closing,” by Katherine J. Wu

Politico’s “Tim Kaine Has Long Covid. That’s Not Moving Congress to Act,” by Alice Miranda Ollstein

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