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Tag: CDC

  • As HHS head, will RFK Jr. take on big insurers?

    As HHS head, will RFK Jr. take on big insurers?

    President-elect Donald Trump has nominated Robert F. Kennedy Jr. as the next head of the US Department of Health and Human Services, reports Sheryl Gay Stolberg and Susanne Craig for The New York Times. The choice is to be expected given RFK Jr.’s strong alliance with Trump. If the Senate confirms the nomination, as expected, what will it mean for the health of our nation?

    RFK Jr. is an anti-vaxxer, critical of our public health agencies, over which he will preside. It has been reported that he might try to end legal protection for pharmaceutical companies that release vaccines, likely deterring production of new vaccines. So, our public health is likely at serious risk.

    But, Kennedy also has promised to eliminate the corporate control of our federal food and health agencies, if confirmed. And, that is desperately needed.

    Kennedy correctly describes the Food and Drug Administration (FDA) as controlled by corporations. In his words, “The F.D.A. is just a sock puppet to the industries it is supposed to regulate.” The FDA gets “user fees” from pharmaceutical and medical device companies, which represent about half its budget. Not surprisingly, it behaves in ways that would make you question its independence.

    Pharmaceutical company stocks have fallen in value since Trump announced Kennedy as his pick for HHS Secretary. Big Pharma is likely right now trying to derail Kennedy’s nomination. But, it’s hard to imagine that the Republican Congress will oppose any of Trump’s cabinet nominees.

    It’s also clear that RFK Jr. will only have as much latitude to take on the big health care corporations as Trump allows him. What Trump will allow him to do remains an open question.

    Among some of RFK’s most extreme positions is a desire to prosecute The Lancet and the New England Journal of Medicine, two of the most respected medical journals in the country, under the federal anti-corruption statute. Kennedy claims that they publish “phony science.”

    Kennedy also has called for eliminating fluoride in public water supplies, a position counter to the science. The Centers for Disease Control and Prevention (CDC) calls water fluoridation one of the greatest public health achievements. It prevents tooth decay.

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  • This Fall, talk to your doctor about getting an RSV vaccine

    This Fall, talk to your doctor about getting an RSV vaccine

    It’s just about that time of year again, when flu season hits. This year, there’s a new vaccine, covered in full under Medicare Part D, which helps prevent coughs and shortness of breath resulting from an RSV respiratory infection. But, the New York Times reports that some pharmacies are charging people with Medicare more than $300 for the vaccine.

    RSV or respiratory syncytial virus kills as many as 10,000 people in the US every year and leads to as many as 160,000 hospitalizations. Two new FDA-approved vaccines have a very high likelihood of preventing hospitalizations and death from respiratory tract disease. But some commercial insurers are not covering it.

    According to the CDC, RSV is a common respiratory virus. Symptoms tend to be mild and cold-like, a runny nose, coughing, sneezing, fever or wheezing. But, sometimes people become short of breath or face lower oxygen levels. You can catch RSV from other people, usually through coughs or sneezes coming in contact with your nose or mouth or eyes. You can also catch it from touching a surface that has the virus on it.

    The CDC recommends that adults 60 years and older get a single dose of RSV vaccine, if your primary care doctor agrees. Older adults and people with weakened immune systems are at the highest risk of hospitalization from RSV. Older adults living in nursing homes or long-term care facilities are also at high risk. You can get the vaccine at the same time that you get your flu shot or other vaccines.

    Blue Cross, Blue Shield won’t cover the vaccine because it is not yet on the centers for Disease Control’s vaccine schedule for older adults.

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  • Coronavirus: Should you get the Pfizer booster vaccine?

    Coronavirus: Should you get the Pfizer booster vaccine?

    The FDA gave emergency approval to Pfizer’s “booster” vaccine for people over 65 who have been fully vaccinated against Covid-19 at least six months. And, soon after, the Centers for Disease Control and Prevention (CDC)  announced that it supports that decision as well as booster shots for people who have a serious medical condition or work in a high-risk settings.

    In short, about 60 million of the 100 million people who received the Pfizer vaccine and who are at high risk of getting a serious case of Covid-19 are eligible for the booster shot.  The booster is the same Pfizer vaccine as people originally received, just a third one, to boost people’s antibody levels and better protect them.

    Older adults and people with compromised health need vaccine protection. Covid-19 is the deadliest disease in American history, deadlier than the Spanish flu of 1918.

    Pfizer had wanted the booster to be available to all 100 million Americans who had received its vaccine. But, an expert FDA panel did not support Pfizer’s request, nor did the Centers for Disease Control and Prevention. Still, projections are that booster shots around the world will contribute $26 billion to its bottom line in 2022, PBS reports.

    Should you get a booster if you did not get the Pfizer vaccine? The FDA has not yet given approval for a booster to people who had the Moderna and Johnson & Johnson vaccines. For that reason, experts have not  recommended a Pfizer booster to people who received the Johnson & Johnson or Moderna vaccines.

    Some experts believe that people who are immunocompromised should get the third vaccine even if it is a different brand from the brand they initially received. But, one FDA representative says there is not enough evidence to know whether it would be as effective as getting a third injection of the same vaccine you originally received.

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  • Coronavirus: Why you should get a booster shot

    Coronavirus: Why you should get a booster shot

    If you were first in line to be vaccinated, it might be time to get a booster shot reports Sarah Jane Tribble for Kaiser Health News. Beginning next month, the Biden administration has announced that all adults will be able to get a booster shot. People over 65 or immunocompromised have very good reason to get a booster shot as soon as possible.

    We know that the Delta variant has been raging through the nation and infecting the unvaccinated, as well as small numbers of people who have been vaccinated. The good news is that those who are vaccinated appear to have far lower risk of getting severely ill, much less to need hospitalization. But, the Delta variant might mutate into another more dangerous form of the coronavirus, and we should be prepared and protected as best possible.

    We also know from new research that the Covid-19 vaccine wears off over time, with people losing the antibodies that protect them against the novel coronavirus. The rate at which it wears off appears to differ from one person to another. Pfizer’s research suggests that four to six months after the second shot, its vaccine’s efficacy drops from 96 percent to 84 percent.

    The Centers for Disease Control is currently saying that people need a booster shot eight months after their second dose of the Moderna or Pfizer vaccine. People who received the Johnson & Johnson vaccine can wait until November or later for their booster as these people did not begin getting vaccinated until March. As of yet, the administration does not have a booster plan for these individuals. But, Johnson & Johnson is testing the efficacy of a second shot now.

    What is a booster shot? A booster shot is the same as a third shot of the same vaccine you originally had.

    Who will get the booster shot first? Older adults, along with essential workers, will be at the front of the line for a booster shot, as they received their first two vaccine shots ahead of most other people.

    What are the benefits of the booster shot? It will provide you with more antibodies. As of now, we do not know the results of a trial evaluating the efficacy of a third dose.

    The CDC says that the mRNA vaccines offer neutralizing antibodies and cellular immunity. With two doses of the Moderna or Pfizer vaccines, people should have longer protection against becoming severely ill. The J & J vaccine uses a different technology, adenovirus vector. The data suggests that it provides the same benefits as the two Moderna or Pfizer shots.

    Is a booster safe? Some experts say it is safe. Others question whether it could lead to severe side effects. Some also think that younger people might be better off for now without the booster. People who get the booster could be more likely to develop inflammation of the heart, for example.

    Are you less likely to spread the virus with a booster shot? Booster shots provide you with more antibodies and a stronger immune response. As a result, the virus is less likely to replicate in your system. And, in turn, you are less likely to transmit the virus.

    Should your booster shot be from the same company as your initial vaccine? The CDC says it should be from the same company as your initial vaccine. Others believe that it could be beneficial to get your booster from a different company, but there is no good data on this.

    Is the booster shot free? Yes, it is free for everyone, including undocumented residents and people without insurance. You do not need to show ID.

    Will we need annual booster shots? It is possible we will need annual booster shots if the virus continues to mutate.

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  • Coronavirus: Plan for the vaccine!

    Coronavirus: Plan for the vaccine!

    Right now, there’s a a lot of talk about who will get the vaccine first. Health care workers, essential workers, poor people, older adults? Every state will likely roll out the vaccine differently. Here’s what you should consider:

    The first batch of vaccines that will be shipped out in the next several days will be small. The CDC is recommending that these vaccines go to health care workers and the frailest older adults at highest risk, living in nursing homes and other care facilities. Most states are expected to comply with that recommendation.

    After that, it’s possible that the next batch of vaccines will be large. If it is, states might not need to prioritize among health care workers, essential workers, poor people and older adults. There will be enough for everyone.

    Let’s hope that’s the case and plan for it. By some accounts, 70 percent of the population are essential workers. Not all of them are in contact with lots of people. But, 42 percent of Americans are essential workers who are on the front lines every day. So, it likely wouldn’t be possible to provide vaccines to all of them at once.

    If you or someone you love is over 65, consider making an appointment with your primary care doctor now for a vaccine in January. Worst case scenario, it is not yet available to you and you move the appointment back a couple of weeks. Best case scenario, you are set.

    Otherwise, it could be the case that the vaccine is available but that you can’t get an appointment for it. You don’t want to face that situation if you can avoid it.

    Keep in mind that the CDC will recommend who gets vaccine priority. But, governors in each state, along with state health officials, will have the ultimate say as to who gets vaccinated first in their states.

    Remember that you will need two doses of the vaccine to be protected!

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  • Coronavirus: Lack of timely data jeopardizes public health

    Coronavirus: Lack of timely data jeopardizes public health

    In a new report, Sins of Omission: How Government Failures to Track Covid-19 Data Have Led to More Than 1,700 Health Care Worker Deaths and Jeopardize Public Health, National Nurses United (NNU) underscores the need to reform our health care system. Federal and state governments do not have systems in place to protect  the health and well-being of Americans, much less our nation’s nurses and other health care workers.

    NNU reports that more than 1,700 health care workers have tested positive for COVID-19. Of those, at least 213 registered nurses have died unnecessarily. The federal government does not have the systems in place to keep health care workers safe in a pandemic. Hospitals and other health care companies are not reporting infection rates or deaths accurately or in real time. Workplaces have not been safe.

    Without reliable and timely information, there is no way to respond effectively to the novel coronavirus pandemic. We need to know where the virus is, we need the resources to protect people in those areas, and we need to know what is working to contain the spread of the virus. The NNU report explains that rather than tracking this data, federal and state governments are hiding it or ignoring it. They are also playing with available data to mislead the public.

    Federal and state governments are not requiring health care facilities to turn over mortality or infection rate data. Of course, these facilities have no interest in so doing. It could tarnish their images.

    Fewer than one in three states are providing infection data for health care workers. Without good data, there is no way to understand the breadth of the pandemic. There is no way to respond to it as warranted.

    The Centers for Medicare and Medicaid Services (CMS) has only required nursing homes to provide mortality and infection rate data for health care workers. That data is publicly available on its web site. Hospitals are not required to collect this data.

    The Trump administration has kept a lot of the COVID-19 data hidden at the department of Health and Human Services (HHS). It has traditionally been kept by the CDC, but the administration transferred it to HHS. The Trump administration is interfering in scientific work and failing to release accurate public health information. To be sure, it is not coming up with a strong national plan to keep the novel coronavirus from spreading.

    The CDC must be charged with tracking this data and given the resources and tools to do the job that is needed. Data should be independent and not played with for political or business reasons.

    Specifically, NNU calls for:

    • Daily reporting of data (as well as cumulative totals) on diagnostic testing and case counts at national, state, and county/local levels.
    • Daily reporting and cumulative totals of data on health care worker infections and deaths at an establishment level, such as the specific hospital or business.
    • Data on symptomatic cases must be reported at national, state, and county/local levels (influenza-like illness and Covid-like illness).
    • Daily reporting of data on hospitalizations and deaths must be reported at national, state, and county/local levels.
    • Hospital capacity data must be reported at national, state, and county/local levels; must be updated in real time; and must include total and available hospital beds by type (e.g., ICU, medical/surgical, telemetry, etc.), staffing, health care worker exposures and infections, and nosocomial (hospital-acquired) patient infections.
    • Data on the stock and supply chain of essential personal protective equipment (PPE) and other supplies must be reported at national, state, and county/local levels.

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  • Coronavirus: Medical testing corporations offer little and profit wildly

    Coronavirus: Medical testing corporations offer little and profit wildly

    As thousands of companies experience record losses and millions of Americans lose their jobs because of the coronavirus pandemic, the medical testing business–much like the health insurance business–is profiting wildly. Share prices for Quest Diagnostics and Laboratory Corporation of America, the two largest testing corporations in the US, are rising rapidly. Their profits come in tandem with nearly 5.5 million Americans who have fallen victim to the virus.

    Experts agree that testing is key to containing the novel coronavirus. But, it only works when people can afford it and testing labs can provide timely results. Even with insurance, a test can cost hundreds of dollars. In some cases, it can take more than a week or two to get results, and the results become meaningless.

    Most hospitals and insurance companies rely almost exclusively on Quest and the Laboratory Corporation of American for coronavirus testing. And, these labs are over capacity.Quest and Laboratory Corporation of America often cannot deliver quick test results for COVID-19. Testing does not deliver the benefits it should.

    States have found other testing labs that can deliver fast test results. And, fortunately, the CARES Act requires health insurers to pay the full cost of out-of-network testing. But, out-of-network labs can require people to pay upfront and then get reimbursement from their insurers. And, health insurers are unable to control the price.

    Meanwhile, Quest Diagnostics and the Laboratory Corporation of America are raking in money. Quest is projected to bring in $1 billion in 2020. The for-profit health care sector is flourishing. 

    Our for-profit health care system has birthed big lab corporations upon which most big insurers and hospitals rely exclusively for testing. These lab corporations can charge a lot for their COVID-19 services. And, they can take a long time to deliver results, knowing that, for the most part, they will not lose business to smaller labs that can deliver results quickly and at far lower cost.

    On top of that, test results lose their benefits because the US has no single electronic health database. Test results cannot be coordinated. The value of testing is not nearly as great as it should be.

    The highly fragmented for-profit US health care system is failing Americans. Small hospitals serving rural and low-income populations are closing, thousands of doctors are being laid off, and millions of Americans cannot get needed care.

    Public health is unprofitable. And, because profits drive our health care system, public health accounts for only about 2.5 percent of health care spending. We lack a national public health infrastructure that works. The government has cut spending on public health extensively in the last dozen years. We have 55,000 fewer public health workers. 

    There is no good reason that the  US has no coordinated means of monitoring the spread of the coronavirus in realtime.There’s no excuse for the fact that our testing system is so broken. It’s simply about our government’s and the for-profit health sector’s priorities. And, sadly, for Congress, supporting for-profit corporations continues to rank ahead of the public health and the well-being of Americans.

    Here’s more from Just Care:

  • Coronavirus: Who will get a vaccine and when?

    Coronavirus: Who will get a vaccine and when?

    With a few COVID-19 vaccines making their way through the clinical trial phase and seeing successful outcomes, it is more than likely that a vaccine will be approved by the end of this year or early next year. It will take time though to manufacture enough vaccines for the US population. The question becomes who will get a vaccine and when.

    As of now, experts assume that people will need at least two vaccine injections to be protected from the virus. By early 2021, it looks as if there might be enough vaccines for 50 million people, 100 million doses. If they are available, we don’t yet know the distribution plan.

    It makes sense that older adults would be at or near the top of the list to receive the vaccine since older adults are most likely to die if they catch the novel coronavirus. Essential workers are most at risk, and they should be at the very top of the list. Racial equity issues also should be factored into the decision of who gets the vaccine early on.

    Helen Branswell reports for Stat News that, as of now, there are three different entities charged with coming up with a plan for rolling out the vaccine: The National Academy of Medicine, which was asked by federal authorities to come up with a plan; the Advisory Committee on Immunization Practices (ACIP), a special panel charged with vaccine policy for the Centers for Disease Control and Prevention (CDC), which in situations like these normally comes up with the plan; and, Operation Warp Speed, the federal government’s fast-tracking program for the COVID-19 vaccine, which claims to have authority over how the vaccine is distributed.

    The hope is that these three entities can work collaboratively. Otherwise, it’s hard to imagine that they will all agree on a plan. And, if they do not, it’s unclear which agency will be the ultimate decider. This disorganization is another indicator of how desperately the US is in need of strong leadership.

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  • Coronavirus: Another reason to stay home, deadly mosquitoes

    Coronavirus: Another reason to stay home, deadly mosquitoes

    By now, we all recognize that we will not be able to contain the novel coronavirus effectively until we have a strong public health infrastructure. Kaiser Health News reports that without that strong public health infrastructure, we also might not be able able to protect ourselves against deadly mosquitoes.

    Sadly, our public health system is sorely lacking needed resources. It can’t meet the demand for assistance in keeping the novel coronavirus from spreading. And, local public health departments have few if any resources left this summer to help set mosquito traps or check out places where mosquitoes breed, such as irrigation ditches and plastic bins that hold standing water.

    In the last 12 years, 38,000 public health jobs have been cut in the US. Local public health departments do not have needed resources. They lack staff and they lack money.

    Around Columbus, Ohio, Washtenaw County, Michigan, Houston, Texas, and across Florida, the local health departments do not have enough staff to do standard testing of mosquitoes or chicken blood–since mosquitoes bite chickens–for deadly illnesses, like the West Nile virus. This is likely to be a serious problem. Outside the US, tens of thousands of people get sick from mosquito-borne illnesses every year.

    As of now, far fewer people in the US die each year from mosquito-borne illnesses than have died from COVID-19. Around 200 people in the US die from mosquito-borne illnesses each year. The relatively low number of deadly mosquito-related deaths each year could easily be much higher this year because public health departments are not containing the spread of mosquitoes, testing them for deadly illnesses and killing them before they are able to infect Americans.

    Mosquitoes kill more people than any other organism, including human beings. They are often such a deadly threat that the Centers for Disease Control and Prevention (CDC) published a policy brief underscoring the critical need for mosquito prevention and spraying even during the COVID-19 pandemic. Without preventive measures,  deadly mosquito populations could have far-reaching impact.

    Already, in the Florida keys, 14 people have contracted dengue, which can be dangerous. And, in Massachusetts, a mosquito carrying equine encephalitis was found. That mosquito kills one in three people it infects. And, mosquitoes carrying the West Nile virus have been found in 18 states. In nine states, so far, people have been infected by these dangerous mosquitoes. Symptoms include fever and body aches.

    We can only hope that the COVID-19 crisis does not lead to a deadly mosquito crisis. To date, Congress has not appropriated funds to help public health departments ensure mosquitos do not spread disease. Without these funds, necessary containment projects will not happen.

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  • Coronavirus: Face masks and face shields

    Coronavirus: Face masks and face shields

    You’ve likely already read a lot about the value of wearing a face mask when you are in public spaces. You’ve read less about face shields. Here’s what some experts are saying.

    You should always wear a face mask when you are around other people, both to protect yourself and to protect them. Though there are a range of opinions on the value of face masks, unlike gloves, there is no downside to wearing one. And, the upside is big.

    Some experts say that a face shield also will protect you and those around you, perhaps better than a mask. A face shield is a piece of curved plastic or Plexiglas that you wear over your eyes, nose and mouth.

    Why you should wear a face mask when you are in public spaces

    1. You don’t know who’s healthy and who’s sick. People who seem healthy–who feel healthy–could be carrying the novel coronavirus and spreading it. One in four people infected with the virus are asymptomatic.
    2. You might feel healthy and be carrying the virus. Your face mask protects others from catching the novel coronavirus from you.

    Even with a face mask, to protect yourself, you should limit your exposure to other people as much as possible, keep six feet from others when you are in public, and wash your hands regularly.

    How does a mask compare to a face shield in terms of protection?

    You don’t read a lot about face shields because there is not a lot of good data on their efficacy for the novel coronavirus. But, based on data on the protection a face shield offers for other viruses, some experts believe that a face shield could offer as good or better protection than a mask. It prevents you from spreading the virus. And, it arguably offers more protection from infection for you because it covers your eyes as well as your nose and mouth.

    According to Eli Perencevich, MD, a professor of internal medicine and epidemiology at the University of Iowa Carver College of Medicine,“face shields appear to significantly reduce the amount of inhalation exposure to influenza virus, another droplet-spread respiratory virus. In a simulation study, face shields were shown to reduce immediate viral exposure by 96 percent when worn by a simulated health care worker within 18 inches of a cough.”

    Pediatric infectious disease expert at the Cleveland Clinic, Frank Esper, MD, explains why a face shield could be preferable to a mask. “You don’t get to feel the breeze on your face, but you do get some fresh air, rather than trying to breathe through a cloth mask.” Moreover, face shields are easier to wear and you do not have to adjust them. They are also reusable and easy to clean.

    If you opt to wear a shield, Perencevich advises that “the shield should extend below the chin anteriorly, to the ears laterally, and there should be no exposed gap between the forehead and the shield’s headpiece.”

    And, Amesh Adalja, MD, a pandemic preparedness expert at Johns Hopkins Center for Health Security, says you don’t need to wear a mask if you wear a face shield. AARP quotes Adalja: “I don’t think you get much added benefit to wearing a mask if you’ve already got a face shield on, for the average person.” The odds of the viral particles floating upwards under your shield are a long shot for most of us, he adds: “Someone would have to stand underneath you and sneeze up into you. It would be an odd circumstance that would cause that.”

    However, while the face shield protects you, some believe that you will protect others better if you wear a mask. If you are carrying the virus and cough, the face shield will not catch the droplets as well as a mask.

    The CDC recommends wearing a mask in public settings and has little to say one way or the other about face shields.

    Why some people should wear a mask at home

    Many experts believe that the novel coronavirus can linger in the air. If they are correct and you live in a multi-family home, it is possible that the virus can travel through the vents in your apartment from another unit in your building. That’s how some people appear to have been infected with the virus.

    You should also wear a mask at home if someone in your home is sick. In that case, try to stay in a separate room and use a separate bathroom, if possible.

    What kind of mask do you need to wear?

    You don’t need a fancy mask. Simple masks help prevent the spread of the novel coronavirus. They keep contagious droplets from circulating in the air, blocking almost all of them. If you do not wear a mask, you exhale droplets that can remain in the air.

    Simple masks can also protect you from being infected. Much depends on how well your mask fits and what it is made of. A lot also depends upon whether you keep a six foot distance from others and wash your hands frequently.

    How do you put the mask on?

    Hold the mask by the ear loops when you put it on and take it off. Never touch the fabric piece of the mask with your hands. It filters the germs. If you touch it, you can spread the germs. Always wash your hands before putting your mask on and after taking it off.

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