Tag: CDC

‘We’re Flying Blind’: CDC Has 1M Bird Flu Tests Ready, but Experts See Repeat of Covid Missteps

It’s been nearly three months since the U.S. government announced an outbreak of the bird flu virus on dairy farms. The World Health Organization considers the virus a public health concern because of its potential to cause a pandemic, yet the U.S. has tested only about 45 people across the country.

“We’re flying blind,” said Jennifer Nuzzo, director of the Pandemic Center at the Brown University School of Public Health. With so few tests run, she said, it’s impossible to know how many farmworkers have been infected, or how serious the disease is. A lack of testing means the country might not notice if the virus begins to spread between people — the gateway to another pandemic.

“We’d like to be doing more testing. There’s no doubt about that,” said Nirav Shah, principal deputy director of the Centers for Disease Control and Prevention. The CDC’s bird flu test is the only one the Food and Drug Administration has authorized for use right now. Shah said the agency has distributed these tests to about 100 public health labs in states. “We’ve got roughly a million available now,” he said, “and expect 1.2 million more in the next two months.”

But Nuzzo and other researchers are concerned because the CDC and public health labs aren’t generally where doctors order tests from. That job tends to be done by major clinical laboratories run by companies and universities, which lack authorization for bird flu testing.

As the outbreak grows — with at least 114 herds infected in 12 states as of June 18 — researchers said the CDC and FDA are not moving fast enough to remove barriers that block clinical labs from testing. In one case, the diagnostics company Neelyx Labs was on hold with a query for more than a month.

“Clinical labs are part of the nation’s public health system,” said Alex Greninger, assistant director of the University of Washington Medicine Clinical Virology Laboratory. “Pull us into the game. We’re stuck on the bench.”

The CDC recognized the need for clinical labs in a June 10 memo. It calls on industry to develop tests for the H5 strain of bird flu virus, the one circulating among dairy cattle. “The limited availability and accessibility of diagnostic tests for Influenza A(H5) poses several pain points,” the CDC wrote. The points include a shortage of tests if demand spikes.

Researchers, including former CDC director Tom Frieden and Anthony Fauci, who led the nation’s response to covid, cite testing failures as a key reason the U.S. fared so poorly with covid. Had covid tests been widely available in early 2020, they say, the U.S. could have detected many cases before they turned into outbreaks that prompted business shutdowns and cost lives.

In an article published this month, Nuzzo and a group of colleagues noted that the problem wasn’t testing capability but a failure to deploy that capability swiftly. The U.S. reported excess mortality eight times as high as other countries with advanced labs and other technological advantages.

A covid test vetted by the WHO was available by mid-January 2020. Rather than use it, the United States stuck to its own multistage process, which took several months. Namely, the CDC develops its own test then sends it to local public health labs. Eventually, the FDA authorizes tests from clinical diagnostic labs that serve hospital systems, which must then scale up their operations. That took time, and people died amid outbreaks at nursing homes and prisons, waiting on test results.

In contrast, South Korea immediately rolled out testing through private sector laboratories, allowing it to keep schools and businesses open. “They said, ‘Gear up, guys; we’re going to need a ton of tests,’” said Frieden, now president of the public health organization Resolve to Save Lives. “You need to get commercials in the game.”

Nuzzo and her colleagues describe a step-by-step strategy for rolling out testing in health emergencies, in response to mistakes made obvious by covid. But in this bird flu outbreak, the U.S. is weeks behind that playbook.

Ample testing is critical for two reasons. First, people need to know if they’re infected so that they can be quickly treated, Nuzzo said. Over the past two decades, roughly half of about 900 people around the globe known to have gotten the bird flu died from it.

Although the three farmworkers diagnosed with the disease this year in the United States had only mild symptoms, like a runny nose and inflamed eyes, others may not be so lucky. The flu treatment Tamiflu works only when given soon after symptoms start.

The CDC and local health departments have tried to boost bird flu testing among farmworkers, asking them to be tested if they feel sick. Farmworker advocates list several reasons why their outreach efforts are failing. The outreach might not be in the languages the farmworkers speak, for example, or address such concerns as a loss of employment.

If people who live and work around farms simply see a doctor when they or their children fall ill, those cases could be missed if the doctors send samples to their usual clinical laboratories. The CDC has asked doctors to send samples from people with flu symptoms who have exposure to livestock or poultry to public health labs. “If you work on a farm with an outbreak and you’re worried about your welfare, you can get tested,” Shah said. But sending samples to public health departments requires knowledge, time, and effort.

“I really worry about a testing scheme in which busy clinicians need to figure this out,” Nuzzo said.

A man wearing apron standing in a cow milking shed walks away from the camera. To his right are rows of cows hooked up to milking machines.
The Centers for Disease Control and Prevention and local health departments have tried to boost bird flu testing among farmworkers, yet the U.S. has tested only about 45 people. With so few tests run, it’s difficult to know how many farmworkers have been infected, or how serious the disease is.(Mint Images RF/Getty Images)

The other reason to involve clinical laboratories is so the nation can ramp up testing if the bird flu is suddenly detected among people who didn’t catch it from cattle. There’s no evidence the virus has started to spread among people, but that could change in coming months as it evolves.

The fastest way to get clinical labs involved, Greninger said, is to allow them to use a test the FDA has already authorized: the CDC’s bird flu test. On April 16 the CDC opened up that possibility by offering royalty-free licenses for components of its bird flu tests to accredited labs.

Several commercial labs asked for licenses. “We want to get prepared before things get crazy,” said Shyam Saladi, chief executive officer of the diagnostics company Neelyx Labs, which offered covid and mpox tests during shortages in those outbreaks. His experience over the past two months reveals the types of barriers that prevent labs from moving swiftly.

In email exchanges with the CDC, shared with KFF Health News, Saladi specifies the labs’ desire for licenses relevant to the CDC’s test, as well as a “right to reference” the CDC’s data in its application for FDA authorization.

That “right to reference” makes it easier for one company to use a test developed by another. It allows the new group to skip certain analyses conducted by the original maker, by telling the FDA to look at data in the original FDA application. This was commonplace with covid tests at the peak of the pandemic.

At first, the CDC appeared eager to cooperate. “A right of reference to the data should be available,” Jonathan Motley, a patent specialist at the CDC, wrote in an email to Saladi on April 24. Over the next few weeks, the CDC sent him information about transferring its licenses to the company, and about the test, which prompted Neelyx’s researchers to buy testing components and try out the CDC’s process on their equipment.

But Saladi grew increasingly anxious about the ability to reference the CDC’s data in the company’s FDA application. “Do you have an update with respect to the right of reference?” he asked the CDC on May 13. “If there are any potential sticking points with respect to this, would you mind letting us know please?”

He asked several more times in the following weeks, as the number of herds infected with the bird flu ticked upward and more cases among farmworkers were announced. “Given that it is May 24 and the outbreak has only expanded, can CDC provide a date by which it plans to respond?” Saladi wrote.

The CDC eventually signed a licensing agreement with Neelyx but informed Saladi that it would not, in fact, provide the reference. Without that, Saladi said, he could not move forward with the CDC’s test — at least not without more material from the agency. “It’s really frustrating,” he said. “We thought they really intended to support the development of these tests in case they are needed.”

Shah, from the CDC, said test manufacturers should generate their own data to prove that they’re using the CDC’s test correctly. “We don’t have a shortage such that we need to cut corners,” he said. “Quality reigns supreme.”

The CDC has given seven companies, including Neelyx, licenses for its tests — although none have been cleared to use them by the FDA. Only one of those companies asked for the right of reference, Shah said. The labs may be assisted by additional material that the agency is developing now, to allow them to complete the analyses — even without the reference.

“This should have happened sooner,” Saladi told KFF Health News when he was told about the CDC’s pending additional material. “There’s been no communication about this.”

Greninger said the delays and confusion are reminiscent of the early months of covid, when federal agencies prioritized caution over speed. Test accuracy is important, he said, but excessive vetting can cause harm in a fast-moving outbreak like this one. “The CDC should be trying to open this up to labs with national reach and a good reputation,” he said. “I fall on the side of allowing labs to get ready — that’s a no-brainer.”

Clinical laboratories have also begun to develop their own tests from scratch. But researchers said they’re moving cautiously because of a recent FDA rule that gives the agency more oversight of lab-developed tests, lengthening the pathway to approval. In an email to KFF Health News, FDA press officer Janell Goodwin said the rule’s enforcement will occur gradually.

However, Susan Van Meter, president of the American Clinical Laboratory Association, a trade group whose members include the nation’s largest commercial diagnostic labs, said companies need more clarity: “It’s slowing things down because it’s adding to the confusion about what is allowable.”

Creating tests for the bird flu is already a risky bet, because demand is uncertain. It’s not clear whether this outbreak in cattle will trigger an epidemic or fizzle out. In addition to issues with the CDC and FDA, clinical laboratories are trying to figure out whether health insurers or the government will pay for bird flu tests.

These wrinkles will be smoothed eventually. Until then, the vanishingly slim numbers of people tested, along with the lack of testing in cattle, may draw criticism from other parts of the world.

“Think about our judgment of China’s transparency at the start of covid,” Nuzzo said. “The current situation undermines America’s standing in the world.”

Bird Flu Tests Are Hard To Get. So How Will We Know When To Sound the Pandemic Alarm?

Stanford University infectious disease doctor Abraar Karan has seen a lot of patients with runny noses, fevers, and irritated eyes lately. Such symptoms could signal allergies, covid, or a cold. This year, there’s another suspect, bird flu — but there’s no way for most doctors to know.

If the government doesn’t prepare to ramp up H5N1 bird flu testing, he and other researchers warn, the United States could be caught off guard again by a pandemic.

“We’re making the same mistakes today that we made with covid,” Deborah Birx, who served as former President Donald Trump’s coronavirus response coordinator, said June 4 on CNN.

To become a pandemic, the H5N1 bird flu virus would need to spread from person to person. The best way to keep tabs on that possibility is by testing people.

Scientifically speaking, many diagnostic laboratories could detect the virus. However, red tape, billing issues, and minimal investment are barriers to quickly ramping up widespread availability of testing. At the moment, the Food and Drug Administration has authorized only the Centers for Disease Control and Prevention’s bird flu test, which is used only for people who work closely with livestock.

State and federal authorities have detected bird flu in dairy cattle in 12 states. Three people who work on separate dairy farms tested positive, and it is presumed they caught the virus from cows. Yet researchers agree that number is an undercount given the CDC has tested only about 40 people for the disease.

“It’s important to know if this is contained on farms, but we have no information because we aren’t looking,” said Helen Chu, an infectious disease specialist at the University of Washington in Seattle who alerted the country to covid’s spread in 2020 by testing people more broadly.

Reports of untested sick farmworkers — as well as a maternity worker who had flu symptoms — in the areas with H5N1 outbreaks among cattle in Texas suggest the numbers are higher. And the mild symptoms of those who tested positive — a cough and eye inflammation, without a fever — are such that infected people might not bother seeking medical care and, therefore, wouldn’t be tested.

The CDC has asked farmworkers with flu symptoms to get tested, but researchers are concerned about a lack of outreach and incentives to encourage testing among people with limited job security and access to health care. Further, by testing only on dairy farms, the agency likely would miss evidence of wider spread.

“It’s hard to not compare this to covid, where early on we only tested people who had traveled,” said Benjamin Pinsky, medical director of the clinical virology laboratory at Stanford University. “That left us open to not immediately recognizing that it was transmitting among the community.”

In the early months of covid, the rollout of testing in the United States was catastrophically slow. Although the World Health Organization had validated a test and other groups had developed their own using basic molecular biology techniques, the CDC at first insisted on creating and relying on its own test. Adding to delays, the first version it shipped to state health labs didn’t work.

The FDA lagged, too. It didn’t authorize tests from diagnostic laboratories outside of the CDC until late February 2020.

On Feb. 27, 2020, Chu’s research lab detected covid in a teenager who didn’t meet the CDC’s narrow testing criteria. This case sounded an alarm that covid had spread below the radar. Scaling up to meet demand took time: Months passed before anyone who needed a covid test could get one.

Chu notes this isn’t 2020 — not by a long shot. Hospitals aren’t overflowing with bird flu patients. Also, the country has the tools to do much better this time around, she said, if there’s political will.

For starters, tests that detect the broad category of influenzas that H5N1 belongs to, called influenza A, are FDA-approved and ubiquitous. These are routinely run in the “flu season,” from November to February. An unusual number of positives from these garden-variety flu tests this spring and summer could alert researchers that something is awry.

Doctors, however, are unlikely to request influenza A tests for patients with respiratory symptoms outside of flu season, in part because health insurers may not cover them except in limited circumstances, said Alex Greninger, assistant director of the clinical virology laboratory at the University of Washington.

That’s a solvable problem, he added. At the peak of the covid pandemic, the government overcame billing issues by mandating that insurance companies cover tests, and set a lucrative price to make it worthwhile for manufacturers. “You ran into a testing booth on every other block in Manhattan because companies got $100 every time they stuck a swab in someone’s nose,” Greninger said.

Another obstacle is that the FDA has yet to allow companies to run their influenza A tests using eye swabs, although the CDC and public health labs are permitted to do so. Notably, the bird flu virus was detected only in an eye swab from one farmworker infected this year — and not in samples drawn from the nose or throat.

Overcoming such barriers is essential, Chu said, to ramp up influenza A testing in regions with livestock. “The biggest bang for the buck is making sure that these tests are routine at clinics that serve farmworker communities,” she said, and suggested pop-up testing at state fairs, too.

In the meantime, novel tests that detect the H5N1 virus, specifically, could be brought up to speed. The CDC’s current test isn’t very sensitive or simple to use, researchers said.

Stanford, the University of Washington, the Mayo Clinic, and other diagnostic laboratories that serve hospital systems have developed alternatives to detecting the virus circulating now. However, their reach is limited, and researchers stress a need to jump-start additional capacity for testing before a crisis is underway.

“How can we make sure that if this becomes a public health emergency we aren’t stuck in the early days of covid, where things couldn’t move quickly?” Pinsky said.

A recent rule that gives the FDA more oversight of lab-developed tests may bog down authorization. In a statement to KFF Health News, the FDA said that, for now, it may allow tests to proceed without a full approval process. The CDC did not respond to requests for comment.

But the American Clinical Laboratory Association has asked the FDA and the CDC for clarity on the new rule. “It’s slowing things down because it’s adding to the confusion about what is allowable,” said Susan Van Meter, president of the diagnostic laboratory trade group.

Labcorp, Quest Diagnostics, and other major testing companies are in the best position to manage a surge in testing demand because they can process hundreds per day, rather than dozens. But that would require adapting testing processes for their specialized equipment, a process that consumes time and money, said Matthew Binnicker, director of clinical virology at the Mayo Clinic.

“There’s only been a handful of H5N1 cases in humans the last few years,” he said, “so it’s hard for them to invest millions when we don’t know the future.”

The government could provide funding to underwrite its research, or commit to buying tests in bulk, much as Operation Warp Speed did to advance covid vaccine development.

“If we need to move to scale this, there would need to be an infusion of money,” said Kelly Wroblewski, director of infectious disease programs at the Association of Public Health Laboratories. Like an insurance policy, the upfront expense would be slight compared with the economic blow of another pandemic.

Other means of tracking the H5N1 virus are critical, too. Detecting antibodies against the bird flu in farmworkers would help reveal whether more people have been infected and recovered. And analyzing wastewater for the virus could indicate an uptick in infections in people, birds, or cattle.

As with all pandemic preparedness efforts, the difficulty lies in stressing the need to act before a crisis strikes, Greninger said.

“We should absolutely get prepared,” he said, “but until the government insures some of the risk here, it’s hard to make a move in that direction.”

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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