COVID-19 Public Health Emergency Extended In The US

Covid-19 public health emergency extended in the US - CNNSource: CNN Health, by Deidre McPhillips

 

The Biden administration on Friday extended the Covid-19 public health emergency for another three months.

US Department of Health and Human Services Secretary Xavier Becerra officially renewed the declaration, extending it through October 13, 2022.

The emergency declaration has been in place since January 2020, and the latest renewal comes as the Omicron offshoot BA.5, the most contagious variant yet, continues to stake its claim in the US. Daily case rates, though vastly undercounted, are the highest they’ve been in months, as are Covid-19 hospitalizations and deaths.

Data published this week by the US Centers for Disease Control and Prevention shows that more than half of the country’s population lives in a county with a “high Covid-19 Community Level,” where the health care system is at risk of becoming overburdened and universal indoor masking is recommended.

“The Public Health Emergency declaration continues to provide us with tools and authorities needed to respond to the highly transmissible COVID-19 subvariants that are currently circulating around the country,” a Biden administration official told CNN. “The PHE provides essential capabilities and flexibilities to hospitals to better care for patients, particularly if we were to see a significant increase in hospitalizations in the coming weeks.”

Indeed, ensemble forecasts from the CDC published this week do predict that hospitalizations in the US will rise over the next month. It’s the first time in weeks that the forecasts have predicted an increase in hospitalizations, instead of a stable outlook.

“Without the PHE in place, we would be limited in our ability to provide broad and equitable access to lifesaving treatments through our Test to Treat initiative, for example, which relies on flexibility for telehealth and operations,” the official said. “Not renewing the PHE would leave us with fewer tools to respond and mean more Americans would get severely ill and end up in the hospital.”

The public health emergency declaration allows many Americans to obtain free Covid-19 testing, therapeutic treatment and vaccines. Once it ends, people could face out-of-pocket costs depending on whether they are covered by Medicare, Medicaid or private insurance. But vaccinations would generally continue to be free for those covered by Medicare and private insurance, while state Medicaid programs would determine whether to continue covering vaccinations for their enrollees.

Also, Medicare has relaxed the rules governing telehealth so that many more beneficiaries can access such services during the declaration. Telehealth services are no longer limited just to those living in rural areas, and enrollees can conduct visits at home, rather than having to travel to a health care facility, and they receive a wider array of services via telehealth. These flexibilities will end for most beneficiaries after the emergency expires.

And states are not involuntarily disenrolling residents from Medicaid during the declaration, in exchange for receiving more generous federal matching funds. As many as 14 million people could lose Medicaid coverage after the emergency ends, according to separate projections by Kaiser and the Urban Institute.

Plus, many low-income families are receiving enhanced food stamp benefits thanks to the declaration, though some states have ended their own public health emergencies and stopped the beefed-up allotments.

A separate emergency declaration allows for the emergency use authorization of testing, treatments and vaccines. Its end date will be determined by the secretary of the US Department of Health and Human Services.

Its end date will be determined by HHS, and the agency has committed to provide at least 60-day notice before any change

Coronavirus In California Is Becoming Easier To Get, Much Harder To Avoid. Here’s Why

Coronavirus Today: Why things are getting worse - Los Angeles TimesSource: Los Angeles Times, by Luke Money

The number of coronavirus cases reported in California is on the brink of crossing 10 million, a milestone that probably undercounts the total significantly yet still carries an increasing sense of inevitability.

Since the hyper-transmissible Omicron variant stormed onto the scene in early December, the virus has wormed its way into seemingly every family and social circle. Residents who for years escaped infection were swept up in the resulting tidal wave of cases, though for many, the severity of illness has been lessened by vaccines, the availability of therapeutics and other factors.

A plethora of high-profile people who have recently tested positive — among them Vice President Kamala HarrisGov. Gavin Newsom and even Dr. Anthony Fauci — have also fueled the notion that catching the coronavirus is no longer a matter of if, but when.

“It’s going to get easier and easier to get and harder to escape infection. But that doesn’t mean we put ourselves in a sort of mind-set that, ‘You know, to hell with it. I’m just going to do anything I want to do anyway,’” Dr. Peter Chin-Hong, a UC San Francisco infectious-disease expert, said during an interview Friday.

It’s understandable that some might view the coronavirus as inescapable, especially amid massive numbers of new infections.

Nearly half of California’s officially reported cases — more than 4.9 million — have been tallied since Dec. 1, the day health officials confirmed Omicron’s presence in California, according to data compiled by The Times.

Officials note those figures are an undercount, and likely a significant one. According to data from the U.S. Centers for Disease Control and Prevention, the most recent seroprevalence estimate for California — the overall share of residents thought to have been infected with the coronavirus at some point — was 55.5% in February.

Still, that means there are likely millions of Californians who have never contracted the virus.

Among those are Chin-Hong, as well as Dr. Robert Wachter, chair of UC San Francisco’s Department of Medicine.

“The fact that I and a fair number of people who continue to be careful and are fully vaccinated and boosted remain COVID-free tells me that it’s possible we will continue to be that way, so I don’t buy the inevitability argument,” Wachter said in an interview Friday. “On the other hand, there are plenty of people who I know who have been just as careful as I have and have gotten it in the past few months, so I think there’s some randomness to this.”

Given the proliferation of ever-more-infectious Omicron subvariants, avoiding the coronavirus has become an increasingly tricky proposition.

“It is likely, as COVID-19 variants continue to evolve to be more transmissible and acquire the ability to evade the protection of antibodies against infection, which results in breakthrough infections in the vaccinated and in those with prior illness, it will be difficult for many to avoid being exposed to COVID-19 going forward,” said Dr. Robert Kim-Farley, an epidemiologist and infectious-disease expert with UCLA’s Fielding School of Public Health.

But infection isn’t inevitable, he added, and “everyone needs to be vigilant to avoid exposure and prevent severe disease,” especially during periods of high community transmission.

“Masking when in crowded indoor settings and being vaccinated and boosted are still the best protections. Also, if one becomes infected and symptomatic, medicines such as Paxlovid will significantly reduce the severity of the disease, especially for persons at higher risk,” he told The Times in an email.

Though there are indications that the latest coronavirus wave may be starting to level off in California, transmission remains elevated. Over the weeklong period ending Thursday, the state reported an average of 16,130 new cases per day — a decrease of almost 12% from two weeks ago, according to data compiled by The Times.

The new infections, however, have not created anywhere near the same level of strain on hospitals as the pandemic’s previous surges. But the number of coronavirus-positive patients is growing steadily.

As of Friday, 3,169 such individuals were hospitalized statewide — up 21% from two weeks ago. The number of patients being treated in intensive care units has likewise crept up, to 331, but that number remains among the lowest of the entire pandemic.

It’s true that not all patients are hospitalized for COVID-19 infections. The California Department of Public Health says about half are there “due to COVID-19 and not simply with COVID-19.” But officials say all coronavirus-positive individuals place demands on healthcare facilities.

“Even though half of these patients may not be hospitalized because they have COVID-19, they still influence hospital workload and burden due to special infection control precautions and placement,” the department told The Times in a statement last week.

But while this apparent script — less severe illness, even during a prolonged period of elevated transmission — is a promising development, officials and experts stress that it’s impossible to predict the future course of COVID-19.

One area of concern is the proliferation of two Omicron subvariants: BA.4 and BA.5. Those are not only highly transmissible, but have shown the ability to reinfect survivors of earlier Omicron strains.

In recent weeks, BA.4 and BA.5 have gradually made up a larger share of new coronavirus infections nationwide. Over the seven-day period ending June 18, the CDC estimated BA.5 accounted for 23.5% of new cases, and BA.4 made up 11.4%.

How the subvariants’ growing footprint will alter the pandemic’s path in California remains to be seen. However, the World Health Organization noted recently that “the rise in prevalence of BA.4 and BA.5 has coincided with a rise in cases” in several regions, and, in some countries, that increase “has also led to a surge in hospitalizations and ICU admissions.”

It is possible that increases in hospitalizations are simply the numerical byproduct of growing infections. As the WHO noted, current available evidence doesn’t indicate a change in disease severity associated with either BA.4 or BA.5.

“It’s still very early in our experience with BA.4 and BA.5, and so we are monitoring the literature closely to see if there is any data on that,” Dr. Paul Simon, chief science officer for the Los Angeles County Department of Public Health, said during a briefing Thursday. “And certainly, if we do see anything, even a slight increase in virulence for BA.4 and BA.5, that would raise a lot of concern for us and, I think, increase the stakes in terms of encouraging the various protective measures that the public can take.”

Another wrinkle is the recent decision by federal health officials to authorize children as young as 6 months to receive either the Pfizer-BioNTech or Moderna vaccine. While COVID-19 has not hit the youngest children as hard as other age groups, they’ve still been vulnerable to infection — and could potentially spread the virus to others more at risk of severe health issues.

“The fact that kids now under 5 are getting vaccinated, kids 5 and over can get a booster, there’s more Paxlovid going around, all of that might keep community viral load lower than it would have been,” Chin-Hong said.

But at this point, the coronavirus is still widely circulating. And each infection carries with it not just the chance of near-term health impacts, but the risk of developing “long COVID,” in which symptoms can linger for months.

That’s a possible outcome with which Wachter is all too familiar. His wife is still grappling with fatigue and some brain fog weeks after she was infected.

Some who develop long COVID, he said, will have prolonged symptoms that are “life-limiting in a way.” For others, those “will actually be disabling.” In either case, residents shouldn’t ignore the possibility.

Another symptom recently infected people should be wary of is guilt — a feeling that catching the coronavirus somehow indicates they made a bad decision and are now paying the price.

“It’s not a moral failure,” Chin-Hong said. “There are a lot of reasons why it’s so easy to get this particular infection, even when you’re taking a measured approach to life.”

After all, people still have to go to work, run errands and take care of their children or other relatives should they become ill. And many are now taking the opportunity to resume activities they either weren’t able to do or didn’t feel comfortable doing earlier in the pandemic.

“We’re humans. We’re social creatures. We were meant to get out and do things,” Wachter said. “All of us have to make choices about the level of risk that we’re willing to take. And that’s true when we get up and get out of bed in the morning; it’s true when we get on an airplane; it’s true when we get in the car.”

That’s not to say that precautions like masking in crowded indoor settings and getting vaccinated and boosted, when eligible, don’t still make sense. But Californians needn’t beat themselves up if they take those steps and still fall prey to the coronavirus.

“There are many people who are getting infected who are remaining super careful,” Wachter said. “That’s the thing now, even very cautious behavior is no guarantee you’re not going to get it. This damn thing is so incredibly infectious.”

TSA Stops Mask Enforcement After Federal Judge Voids Mandate

Biden Doubled Mask Fines for Travelers. What Does it Mean for Passengers? -  The New York TimesSource: The Washington Post, by Michael Laris and Justin George

Federal officials stopped enforcement of a federal mask mandate Monday in transportation settings after a federal judge struck down the requirement, raising public health concerns and prompting several airlines to announce that face coverings are optional on domestic flights.

 

U.S. District Judge Kathryn Kimball Mizelle of the Middle District of Florida said the mandate exceeds the statutory authority of the Centers for Disease Control and Prevention. Federal officials last week had extended the mask mandate for commercial flights and in other settings, including on buses, ferries and subways, until at least May 3.

 

The transportation mandate has been among the highest-profile mask requirements in the country, persisting after most school districts and other jurisdictions have allowed similar mandates to expire. Conflicts over masks have been particularly acute on airplanes, where some flight attendants have been physically attacked and verbally abused for enforcing mask rules.

The decision comes as coronavirus cases are again climbing in the Northeast as the BA.2 omicron subvariant, which is more contagious than its predecessor, becomes the predominant strain in the United States. Health officials say it’s not clear whether the rise is the start of a larger surge.

The CDC’s masking order has been enforced through directives issued by the Transportation Security Administration. A Biden administration official, who shared guidance with reporters on the condition of anonymity, said Monday evening that the court decision means the CDC’s order is “not in effect at this time. Therefore, the TSA will not enforce its Security Directives” requiring the face coverings.

Airlines began announcing they were dropping the requirement, with some caveats for international destinations. In a statement, United Airlines said that “effective immediately, masks are no longer required at United on domestic flights, select international flights (dependent upon the arrival country’s mask requirements) or at U.S. airports.”

In the Washington region, Metro announced late Monday that masks are optional on its rail and bus systems for customers and Metro employees.

In her decision Monday, Mizelle, who was appointed by President Donald Trump and clerked for Supreme Court Justice Clarence Thomas, said the CDC had relied on a 1944 law, the Public Health Service Act, to impose the mandate. But the government’s argument that it put the mask requirement in place for the purpose of “sanitation” falls short, Mizelle argued.

“Wearing a mask cleans nothing. At most, it traps virus droplets. But it neither ‘sanitizes’ the person wearing the mask nor ‘sanitizes’ the conveyance,” Mizelle wrote.

 

The case was brought on behalf of a legal group known as Health Freedom Defense Fund and airline passengers, including Ana Daza, who said she has anxiety aggravated by wearing a mask.

Mizelle found for the plaintiffs on three key issues, ruling that the CDC had exceeded its legal authority, that it had improperly avoided notice and comment procedures, and that its mandate was “arbitrary and capricious.” In her ruling, Mizelle argued that the mask mandate wrongly curtailed passengers’ freedom of movement.

“Anyone who refuses to comply with the condition of mask wearing is — in a sense — detained or partially quarantined by exclusion” from their means of transportation, she wrote.

 

Industry trade group Airlines for America said U.S. airlines “have been strong advocates for eliminating pandemic-era policies and are encouraged by the lifting of the federal transportation mask mandate.” The group said high U.S. immunity levels and widespread vaccine accessibility, plus hospital grade cabin-air filtration, should give travelers confidence.

The CDC said Monday it doesn’t comment on pending litigation.

In a legal filing last month defending the mandate, Justice Department lawyers said the plaintiffs in this case had relied on an “unduly narrow and grammatically incorrect” interpretation of the public health law. They noted that Congress had authorized health officials to make and enforce regulations “necessary to prevent the introduction, transmission, or spread of communicable diseases” from outside the country, or within it, using “sanitation” and “other measures.” They also noted that the Supreme Court, in a case last year, said those measures relate directly to preventing the interstate spread of disease “by identifying, isolating, and destroying the disease itself.”

 

Masking requirements have generally been made after considering emerging epidemiology on restricting the spread of the virus, and not on an “arbitrary or capricious” basis, Jeanne Marrazzo, director of the Division of Infectious Diseases at the University of Alabama at Birmingham, said in an email while quoting the words Mizelle used in her ruling.

“I believe the CDC was simply erring on the side of caution given the extraordinary mixing opportunities afforded by airports and mingling that occurs there,” she said. “On the plane, while it’s flying, as I have said before, air exchange is good, but we still don’t know HOW good it is with this much more contagious new variant.”

The Biden administration announced the mandate quickly after President Biden came into office, following the Trump administration’s resistance. Airline policies at the time had required that masks be worn.

 

“This is obviously a disappointing decision,” White House press secretary Jen Psaki said Monday, adding that the CDC and White House continue to recommend wearing masks in public transportation settings.

She said the Department of Homeland Security — which includes the TSA — was reviewing the decision. The Justice Department will “make any determinations about litigation,” Psaki said. A Justice Department spokeswoman said the agency is reviewing the decision and declined to comment further.

Sara Nelson, president of the Association of Flight Attendants-CWA, which represents nearly 50,000 flight attendants at 17 airlines, said many legal uncertainties remained on Monday. In a statement, she urged “calm and consistency in the airports and on planes.”

“The last thing we need for workers on the frontlines or passengers traveling today is confusion and chaos,” she said.

Nelson urged travelers to check with airlines for their masking requirements. She said clear communication would help flight attendants and other front-line workers avoid problems that could stem from the confusion over changing rules.

“In aviation operations, it is impossible to simply flip a switch from one minute to the next. It takes a minimum of 24-48 hours to implement new procedures and communicate this throughout the entire network,” she said.

A March poll by the health group KFF found Americans were roughly divided on whether the federal government should extend the mask requirement for airplanes, trains and other public transportation (48 percent) or let it expire (51 percent). More than 7 in 10 Democrats said it should be extended, while 76 percent of Republicans supported letting it expire.

Fliers on Monday had mixed reactions.

Stephanie Dexter, her husband, Brad, and their daughter, Eva, wore surgical masks and cone-shaped K95 masks as they walked out of Reagan National Airport on Monday afternoon. They had flown Eva from Omaha to D.C. for a spring vacation, where they planned to visit monuments and museums. The mask mandate did not weigh heavily on their minds.

“We were fine wearing them today,” said Stephanie Dexter. “I’m an asthmatic. I’m fine not getting sick.”

Phil Delin, 67, of Prince George’s County, Md., said he had heard “a sprinkle” about the judge’s ruling before he arrived at the airport with his golf clubs for a trip to Las Vegas.

“I still don’t understand a Florida judge reversing a federal mandate when the mandate is backed by as much science as it is,” he said. He had no second thoughts about wearing a mask aboard his Monday night flight.

Simon Rojas, 29, who had flown back into Reagan National from Las Vegas in shorts, stood outside while waiting for his ride as a chilly wind forced others waiting for a ride back into the terminal. He said he was pleased the judge ruled against the mandate, saying it made no sense to wear a mask on a plane when people are so close and are lifting masks to drink and eat.

“Just take them off,” Rojas, of Laurel, Md., said of mask regulations. “In the news, they’ve been saying the death rate is going down, right? Also, I think if you’re in such a closed space like a plane, that mask isn’t doing anything.”

The Biden administration has faced growing pressure to lift the mask requirement for air travel and public transit. Earlier this month, Republican leaders on the House and Senate transportation committees reiterated their call for Biden to “rescind or decline to extend the mask mandate.”

In late March, 21 mostly Republican-led states sued the government, seeking to immediately end the mask requirement.

Last month, executives from 10 airlines, including American, United and Delta, sent a letter to Biden urging him to end pandemic-related travel policies, including the mask mandate.

The ruling comes as airlines are seeing a surge in spring travel — one the industry anticipates will extend through the summer and beyond. Transportation Security Administration officials have reported an increase in the number of people screened at airport checkpoints, with many days routinely topping the 2 million mark, as they had before the pandemic.

Your Next COVID-19 Vaccine Will Be Different

Source: The Mercury News, by Lisa M. Krieger

After deploying four COVID-19 shots in a little more than two years, the nation is absorbing a troubling realization: That’s a pace that’s impossible to sustain.

This past week, experts began charting a path to a future that is less perfect – but more practical.

It means building a vaccine that targets more than one strain of the virus. It would reduce severe disease and death, but not prevent every infection. If the design is changed, all vaccines will be updated. Manufacturers will likely offer the same vaccine formulation to everyone, rather than a mélange of different products for different people on different schedules.

And the goal is to have it ready by next fall when the risk of illness is likely to soar. That’s a very tight deadline.

Faced with the triple threats of fading immunity, an evolving virus and holiday gatherings, “we have to be prepared, from a standpoint of national security, making sure that we can protect our population with a vaccine in hand,” Dr. Peter Marks told an expert advisory FDA committee on Wednesday.

What will that look like?

“If we settle down to one shot per year that combines COVID and flu, I think that will be sustainable,” said UC San Francisco infectious disease expert Dr. Peter Chin-Hong.

“Nobody will want to get a vaccine every six months,” he said. “So we have to change the strategy.”

The creation and distribution of COVID-19 vaccines will go down in history as one of medicine’s greatest achievements. Only one year after cases were first documented, a shot was available. Fifteen months later, an impressive total of four doses were available for many people: a two-dose primary series and two boosters.

But, with each announced dose, interest fades. While 77% of the eligible U.S. population has gotten one shot, that rate dips to 65% who have gotten two shots and only 50% who have gotten three shots. The fourth dose is just beginning to be rolled out.

Vaccine protection is fading, too. After every shot, our immunity follows the same disappointing downward trajectory. Vaccines that are 91% effective in preventing hospitalization during the first two months fall to 78% after four months – and, over time, keep declining.

This means that people who got their one shot back in early 2021 are increasingly vulnerable.

Funding also will fade. Today’s federal funding free-for-all strategy won’t continue indefinitely, predict experts. Costs will be shifted to private insurers. That puts pressure on efficiency and effectiveness.

Yet the virus is here to stay. And it will keep changing. The virus has mutated two to 10 times faster than the flu, depending on the strain, reported virologist Trevor Bedford of the Fred Hutchinson Cancer Research Center in Seattle. He said it will continue mutating a little or a lot – either is possible.

Initially, experts hoped that a three-dose regimen would offer long-term protection. That strategy works for measles, mumps, rubella, hepatitis B, HPV and other viruses.

But COVID is different because it changes more, said Chin-Hong. That creates special challenges for vaccination planning.

This means things must move fast. The FDA hopes to decide on the composition of a future vaccine in May or June. While some clinical trials of potential products are already underway, vaccine manufacturers need several months to produce enough doses of a reconfigured vaccine, according to Robert Johnson, director of an infectious disease division within the Department of Health and Human Services.

The panel agreed on these points:

• The promise of a new “bivalent” or “multivalent” vaccine.

There’s a diminishing return by repeatedly giving the same “monovalent” vaccine, which targets the original strain, especially as new variants emerge. It also seems unlikely that an omicron-specific booster is the best idea. The virus changes so frequently that it could quickly be out of date.

A better approach may be to design something that targets two or more strains of the virus, called a “bivalent” or “multivalent” vaccine. Such vaccines are already in the works at Moderna and Novovax.

“A multivalent vaccine is going to be important in hopefully prolonging the duration of protection,” said Dr. Mark Sawyer, professor of clinical pediatrics at UC San Diego.

• Therapeutics must play a growing role.

Rather than constantly adding vaccines, we should seek the help of antiviral drugs, monoclonal antibodies and other future therapies to treat infections to keep people out of hospitals.

With 80% protection against hospitalization in older and sicker adults, “I think we may have to accept that level of protection and then use other alternative ways to protect individuals with therapeutics and other measures,” said Amanda Cohn of the U.S. Centers for Disease Control and Prevention.

• Take a more unified approach to manufacturing.

Vaccine makers should target the same strains, using similar doses, panelists said. It will prove impossible to keep track of multiple vaccines with different compositions.

The CDC must take the lead in deciding when the vaccines are no longer effective against severe illness, said Dr. Paul Offit, professor of pediatrics at The Children’s Hospital of Philadelphia. “At some level, the companies kind of dictate the conversation here,” he said.

If a new vaccine is needed to respond to a scary variant, it won’t just be a booster. The whole two-dose “primary series” would be replaced.

Better data and new designs are needed.

Because we’re in a rush, we’re relying on what the data tells us about the immune response in blood. But we also need to get better at interpreting what these lab studies mean for protection out in the real world, said Dr. Hayley Ganz, professor of pediatrics at Stanford University Medical Center. Antibody counts are important, she said. But so are other parts of the immune system, as well as clinical outcomes.

Finally, we need to know what future products await us in the research pipeline, even if they are not yet FDA authorized.

“The current mRNA vaccines are great. They can be turned around quickly,” said infectious disease expert Dr. Ofer Levy of Boston Children’s Hospital. “But it may be that other platforms emerge that give broader protection. So as we move forward, we don’t want to bake in a system that excludes other types of vaccines.”

Wellness Plans & Smokers

Sixty-six percent of consumers in wellness programs say their program does not include a medical test for nicotine use, according to HealthMine study. Also, 66% of wellness programs don’t offer financial incentives to quit smoking. More than half of smokers lie on health forms, according to CDC data. The survey also reveals the following about employees in a wellness program:

  • 57% say their program does not offer a smoking cessation program.
  • 34% say their program does offer an incentive to quit smoking.
  • 48% say that colleagues who smoke should pay a penalty or premium.
  • 32% say they have smoked within the past two years, and 11% have participated in a smoking cessation program through their wellness plan.
  • 80% say they probably wouldn’t complete a smoking cessation program without a financial incentive.

Bill Would Prevent Over-Prescribing

A California bill would require doctors to check California’s prescription drug database before prescribing opiates. The Controlled Substance Utilization Review and Evaluation System (CURES) is the nation’s most advanced prescription drug monitoring program, but just 35% of California providers and dispensers use it. Carmen Balber, executive director of Consumer Watchdogs said, “California loses 4,500 people a year to preventable drug overdoses–more than any other state….The legislature can help…by requiring doctors to check the prescription database before recommending patients take the most dangerous and addictive drugs. It’s clear that making use of the database voluntary does not work.”

SB 482, by California state Senator Ricardo Lara, would require doctors to check California’s CURES database when prescribing Schedule II or III drugs like Oxycontin to a patient for the first time, and annually thereafter if the treatment continues. The Centers for Disease Control and Prevention issued new prescribing guidelines that recommend doctors use prescription drug databases every time they prescribe an opioid. Last month, president Obama proposed $1.2 billion in new federal funding to fight opioid abuse, including funds to expand the use of state prescription drug databases.

Twenty-two states mandate use of a state prescription database. States that track results have seen reduced doctor-shopping and lower opioid prescription rates. Also doctors say that the databases are useful to them in prescribing the right medications. The following states have seen improvements after mandating the use of a database:

  • New York saw a 75% drop in patients seeing multiple prescribers for the same drugs.
  • Kentucky found that opioid prescriptions to doctor-shopping individuals fell 54%. Also, overdose-related deaths declined for the first time in six years in 2013.
  • Tennessee saw a 36% drop in patients who were seeing multiple prescribers to get the same drugs. Tennessee prescribers say they are 41% less likely to prescribe controlled substances after checking the database, and 34% more likely to refer a patient for substance abuse treatment. Also, 86% of prescribers say the database is useful for decreasing doctor shopping.

Millions of Children Don’t Get Recommended Preventive Care

Millions of infants, children, and adolescents in the United States didn’t get key clinical preventive services, according to a report published by the Centers for Disease Control and Prevention (CDC). Clinical preventive services include medical or dental care that supports healthy development. The CDC report focuses on the following: prenatal breastfeeding counseling, newborn hearing screening and follow-up, developmental screening, lead screening, vision screening, hypertension screening, use of dental care and preventive dental services, human papillomavirus vaccination, tobacco use screening and cessation assistance, chlamydia screening, and reproductive health services. In 2007, 79% of parents with children aged 10 to 47 months said that their healthcare providers hadn’t asked them to complete a formal screen for developmental delays in the past year. In 2009, 56% of children and adolescents didn’t visit the dentist in the past year, and 86% didn’t get a dental sealant or a topical fluoride application. Forty-seven percent of girls 13 to 17 years had not received their recommended first dose of HPV vaccine in 2011. Thirty-one percent outpatient clinic visits from 11- to 21 year-olds during 2004 to 2010 had no documentation of tobacco use status; 80% of those who screened positive for tobacco use didn’t get any cessation assistance. Twenty-four percent of outpatient clinic visits for preventive care for three- to 17-year olds had no documentation of blood pressure  measurement.“The Affordable Care Act requires new health insurance plans to provide certain clinical preventive services at no additional cost with no copays or deductibles. Parents need to know that many clinical preventive services for their children, such as screening and vaccination, are available for free with many health plans,” said Lorraine Yeung, M.D., M.P.H., a medical epidemiologist with the CDC. For more information, visit www.cdc.gov/childpreventiveservices.

480 sickened, 33 dead in fungal meningitis outbreak

CDC officials reported Friday that the fungal meningitis outbreak associated with contaminated steroid shots has sickened 480 people and claimed another life, bringing the total number of deaths to 33. The most recent death was in Indiana. U.S. News & World Report/HealthDay News (11/16)

CDC: Smoking rate drops slightly from 2010 to 2011

The number of U.S. adult smokers fell only slightly, from 19.3% in 2010 to 19% in 2011, but heavy smoking has become less prevalent, declining more than 25% since 2005, CDC officials said. They added that state funding for antismoking programs failed to meet the agency’s recommendations. The findings appear in the Morbidity & Mortality Weekly Report. MedPage Today (free registration) (11/8)

West Nile cases hit highest mark since 2003

Through Tuesday, 5,054 cases have been reported in this year’s outbreak of the West Nile virus, the most for that period since 2003, CDC officials said on Wednesday. Ten states account for most of the cases, with Texas reporting more than any other state, and 228 deaths have been recorded. HealthDay News (11/7)

Last Updated 08/10/2022

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