COVID coverage for all dries up

 For the first time, the U.S. came close to providing health care for all during the coronavirus pandemic — but for just one condition, COVID-19.

Now, things are reverting to the way they were as federal money for COVID care of the uninsured dries up, creating a potential barrier to timely access.

But the virus is not contained, even if it’s better controlled. And safety-net hospitals and clinics are seeing sharply higher costs for salaries and other basic operating expenses. They fear they won’t be prepared if there’s another surge and no backstop.

“We haven’t turned anybody away yet,” said Dr. Mark Loafman, chair of family and community medicine at Cook County Health in Chicago. “But I think it’s just a matter of time ... People don’t get cancer treatment or blood pressure treatment every day in America because they can’t afford it.”

A $20 billion government COVID program covered testing, treatment and vaccine costs for uninsured people. But that’s been shut down. Special Medicaid COVID coverage for the uninsured in more than a dozen states also likely faces its last months.

At Parkland Health, the frontline hospital system for Dallas, Dr. Fred Cerise questions the logic of dialing back federal dollars at a time when health officials have rolled out a new “test-to-treat” strategy. People with COVID-19 can now get antiviral pills to take at home, hopefully avoiding hospitalization. Vice President Kamala Harris, who recently tested positive but is back working at the White House, is an example.

“Test-to-treat will be very difficult for uninsured individuals,” predicted Cerise, president and CEO of the system. “If it’s a change in strategy on the large scale, and it’s coming without funding, people are going to be reluctant to adopt that.”

Officials at the federal Department of Health and Human Services say the new antiviral drugs like Paxlovid have been paid for by taxpayers, and are supposed to be free of charge to patients, even uninsured ones.

But they acknowledge that some uninsured people can’t afford the medical consultation needed to get a prescription. “We hear from state and local partners that the lack of funding for the Uninsured Program is creating challenges for individuals to access medications,” said Dr. Meg Sullivan, chief medical officer for the HHS preparedness and response division.

The nation has not pinched pennies on the pandemic before.

“We’re well short of universal health coverage in the U.S., but for a time, we had universal coverage for COVID,” said Larry Levitt, a health policy expert with the nonpartisan Kaiser Family Foundation. “It was extraordinary.”

Recently an urgent White House request for $22.5 billion for COVID priorities failed to advance in Congress. Even a pared-back version is stuck. Part of the Biden administration’s request involves $1.5 billion to replenish the Uninsured Program, which paid for testing, treatment and vaccine-related bills for uninsured patients. The program has now stopped accepting claims due to lack of money.

That program, along with a less known Medicaid option for states, allowed thousands of uninsured people to get care without worrying about costs. Bipartisan support has given way as congressional Republicans raise questions about pandemic spending.

The Uninsured Program was run by the Health Resources and Services Administration, an HHS agency. Medical providers seeing uninsured people could submit their bills for reimbursement. Over the last two years, more than 50,000 hospitals, clinics, and medical practices received payments. Officials say they can turn the program back on if Congress releases more money.

The Medicaid coverage option began under the Trump administration as a way to help states pay for testing uninsured people. President Joe Biden’s coronavirus relief bill expanded it to treatment and vaccine costs as well. It’s like a limited insurance policy for COVID. The coverage can’t be used for other services, like a knee replacement. The federal government pays 100% of the cost.

Fifteen states, from deep blue California to bright red South Carolina, have taken advantage of the option, along with three U.S. territories. It will end once the federal coronavirus public health emergency is over, currently forecast for later this year.

New Hampshire Medicaid Director Henry Lipman said the coverage option allowed his state to sign up about 9,500 people for COVID care that includes the new antiviral drugs that can be taken at home.

“It’s really the safety net for people who don’t have any access to insurance,” said Lipman. “It’s a limited situation, but in the pandemic it’s a good back-up to have. It makes a lot of sense with such a communicable disease.”

With COVID cases now at relatively low levels, demand for testing, treatment and vaccination is down. But the urgency felt by hospitals and other medical service providers is driven by their own bottom lines.

In Missouri, Golden Valley Memorial Healthcare CEO Craig Thompson is worried to see federal funding evaporate just as operating costs are soaring. Staff have gotten raises, drug costs have risen by 20% and supply costs by 12%.

“We’ve now exited this pandemic ... into probably the highest inflationary environment that I’ve seen in my career,” Thompson said. The health system serves a largely rural area between Kansas City and Springfield.

In Kentucky, Family Health Centers of Louisville closed a testing service for uninsured people once federal funds dried up. The private company they were working with planned to charge $65 a test.

Things are manageable now because there’s little demand, said spokeswoman Melissa Mather, “but if we get hit with another omicron, it’s going to be very difficult.”

Floridian Debra McCoskey-Reisert is uninsured and lost her older brother to COVID-19 in the first wave two years ago. In one of their last conversations, he made her promise she wouldn’t catch the virus.

McCoskey-Reisert, who lives north of Tampa, has managed to avoid getting sick so far. But she’s overshadowed by fear of what could happen if she or her husband get infected.

“If either one of us get sick with COVID, we don’t have a way to pay for it,” she said. “It would likely bankrupt us if we can’t find some other help.”

Retrenchment on the uninsured mirrors some of the bigger problems of the U.S. health care system, said Chicago hospital physician Loafman.

“Quite frankly, we as a society take care of the uninsured for COVID because it’s affecting us,” he said. “You know, a gated community doesn’t keep a virus out ... that’s sort of the ugly truth of this, is that our altruism around this was really self-motivated.”

https://apnews.com/article/covid-business-health-chicago-congress-ab7e18b905e6e9974aacfafdd6d65122

Combining certain meds with ibuprofen can permanently injure kidneys

 Anyone who is taking a diuretic and a renin-angiotensin system (RSA) inhibitor for high blood pressure should be cautious about also taking ibuprofen, according to new research.

Diuretics and RSA inhibitors are commonly prescribed together for people with hypertension and are available under various pharmaceutical brand names. Painkillers such as ibuprofen are available over-the-counter in most pharmacies and stores in popular brands.

Researchers at the University of Waterloo used computer-simulated drug trials to model the interactions of the three drugs and the impact on the kidney. They found that in people with certain medical profiles, the combination can cause acute kidney injury, which in some cases can be permanent.

"It's not that everyone who happens to take this combination of drugs is going to have problems," said Anita Layton, professor of applied mathematics at Waterloo and Canada 150 Research Chair in mathematical biology and medicine. "But the research shows it's enough of a problem that you should exercise caution."

Computer-simulated drug trials can quickly produce results that would take much longer in human clinical trials. Layton and her team use mathematics and computer science to give medical practitioners a head start with issues like drug complications.

The research, in this case, can also speak directly to the many people who are taking drugs for hypertension and may reach for a painkiller with ibuprofen without giving it much thought.

"Diuretics are a family of drugs that make the body hold less water," Layton said. "Being dehydrated is a major factor in acute kidney injury, and then the RAS inhibitor and ibuprofen hit the kidney with this triple whammy. If you happen to be on these hypertension drugs and need a painkiller, consider acetaminophen instead."

Layton's new research paper, with co-authors Jessica Leete, Carolyn Wang, and Francisco J. López-Hernández, "Determining risk factors for triple whammy acute kidney injury," appears in the journal Mathematical Biosciences.

---

Story Source:

Materials provided by University of Waterloo. Note: Content may be edited for style and length.

---

Journal Reference:

1. Jessica Leete, Carolyn Wang, Francisco J. López-Hernández, Anita T. Layton. Determining risk factors for triple whammy acute kidney injury. Mathematical Biosciences, 2022; 347: 108809 DOI: 10.1016/j.mbs.2022.108809

https://www.sciencedaily.com/releases/2022/05/220505085618.htm

Screening before age 50 significantly reduces risk, incidence of colorectal cancer in women

 Screening for colorectal cancer (CRC) in women before the age of 50 can significantly reduce the risk of CRC compared to those who have no endoscopic screening or decide to initiate testing at age 50, according to a new study from Massachusetts General Hospital (MGH). These findings, published in JAMA Oncology, support recommendations from the American Cancer Society and the US Preventive Services Task Force over the past four years to commence screening at age 45 to address the steady increase in cases of younger-onset CRC.

"While there's been an alarming increase in the incidence of colorectal cancer in recent decades in younger individuals, screening has largely been focused on people over 50," says Andrew Chan, MD, MPH, a gastroenterologist and epidemiologist at MGH, and senior author of the study. "Our work provides first-of-its-kind data to show that initiating screening at a younger age can reduce an individual's risk of colorectal cancer and the population's overall incidence of cancer, thus demonstrating the substantial impact of earlier screening on both individual and population-wide scales."

Among all cancers, colorectal has the third highest incidence of death in both men and women in the U.S. Even as the overall number of CRC cases has declined, the incidence among people younger than 50 -- a group for whom routine screening was not recommended until only recently -- increased by 51 percent from 1974 to 2013, according to epidemiological data. To evaluate the association between CRC risk and endoscopies initiated at different ages, MGH conducted a comprehensive study that included 111,801 women from the Nurses' Health Study II, a large cohort of registered nurses residing in 14 states.

Researchers found a 50 to 60 percent lower risk of CRC among women who started endoscopy screening at age 45 compared to those who had not undergone screening at all. In addition, they learned that starting screening at ages 45 to 49 resulted in a significant reduction in the population's actual cases of CRC diagnosed through age 60, compared to a strategy in which women began screening at ages 50 to 54. While the study was focused on women, Chan suggests the same benefits likely accrue to men, though he adds further studies are needed.

The traditional CRC screening tool is the colonoscopy, where a physician uses a flexible tube with a camera to examine the colon and rectum. This invasive technique allows for removal of polyps that could over time become malignant, and for detection of early-stage cancers that can be treated more effectively. Options for screening have expanded more recently through stool-based tests that are non-invasive and may be more convenient for individuals.

Chan points to the substantial public health implications of his team's research. "Any trepidation that clinicians might have had about the effectiveness of CRC screening at a younger age will hopefully be allayed by these results," he says. "Our data show that we have an effective tool to address the epidemic of colorectal cancer among younger adults, and hopefully this will encourage physicians to have a conversation about screening with their younger patients which, in turn, will motivate them to follow through and get screened."

Chan is chief of the Clinical and Translational Epidemiological Unit at MGH, and director of Epidemiology, Mass General Cancer Center, and the Daniel K. Podolsky Professor of Medicine. Lead author Wenjie Ma, ScD is an instructor in Medicine, and co-senior author Mingyang Song, MD, is assistant professor of Medicine, both in the Clinical and Translational Epidemiology Unit at MGH.

The study was funded by the National Cancer Institute and National Institutes of Health.

---

Story Source:

Materials provided by Massachusetts General Hospital. Note: Content may be edited for style and length.

---

Journal Reference:

1. Wenjie Ma, Molin Wang, Kai Wang, Yin Cao, Ellen Hertzmark, Shuji Ogino, Kimmie Ng, Walter C. Willett, Edward L. Giovannucci, Mingyang Song, Andrew T. Chan. Age at Initiation of Lower Gastrointestinal Endoscopy and Colorectal Cancer Risk Among US Women. JAMA Oncology, 2022; DOI: 10.1001/jamaoncol.2022.0883

https://www.sciencedaily.com/releases/2022/05/220505143805.htm

Lucky Charms should be recalled after complaints of illness: Food pros

 Reports of sickness linked to Lucky Charms continue to widen as a federal investigation ramps up — and some food experts say manufacturer General Mills should consider a voluntary recall of the sugary breakfast cereal.

As of Thursday, the number of Lucky Charms complaints submitted to the FDA had climbed to 529 — more than double the 231 cases reported as of April 20. Meanwhile iwaspoisoned.com, a site that tracks food-borne illnesses, has tallied some 7,300 complaints as of May 5, up from 3,500 on April 20.

Lee-Ann Jaykus, a professor of food, bioprocessing, and nutrition sciences at North Carolina State University who has been studying the case, believes the outbreak may be linked to pandemic-related supply chain issues.

One possible culprit, according to Jaykus: an alternative additive such as the food dye used to make the colorful, charm-shaped marshmallows in the cereal — which might help explain why some people have reported having green-colored poop, she said.

Some food experts are calling on Lucky Charms manufacturer, General Mills, to voluntarily recall the cereal.

Getty Images

“My first guess is that it was an ingredient change, because many food companies experienced not being able to get an ingredient and having to source it from a new provider over the past couple of years,” Jaykus said.

Jaykus believes it is a chemical ingredient in the cereal, in part, because so many people reported becoming ill very quickly — a couple of hours in some cases. The onset of Salmonella, for example, can take six hours to several days. 

Bill Marler, an attorney and prominent expert on food-borne illnesses, agreed.

General Mills has said it does not believe the cereal is making people sick.

Boston Globe via Getty Images

“If it is the cereal that is making these, now 7,000, people ill, it seems more probable that it is a chemical or allergen as opposed to a bacteria or virus given the reported complaints and the length of reported illnesses,” Marler told the Post.

The FDA has not provided an update on its investigation and declined to comment. The agency has begun testing boxes of the cereal from consumers who reported an illness and it is investigating General Mills’ manufacturing facilities, according to its website. To date, no known pathogen has been identified.

“I cannot think of one incident or outbreak where there were hundreds or thousands of people sickened and you couldn’t figure out the cause,” Marler said.

With the lack of hard information, experts increasingly are recommending that General Mills initiate a recall.

“Although, there has been no scientific proven link, be it chemical or an allergen, between the several thousand illnesses and Lucky Charms,” Marler said, “my advice to General Mills is to recall the product and reset its trust with the consuming public until more is known.” 

“From a public health perspective the prudent thing to do would be to pull the product off the market,” Jaykus said.

Some experts believe the culprit could be a chemical ingredient.

Getty Images

Jaykus added that General Mills is “potentially looking at taking off a year’s worth” of cereal from the market, which has “enormous financial implications,” and is likely a reason the company has not issued a recall. 

“I can guarantee you that the lawyers on both sides [at General Mills and at the FDA] are getting involved in this,” Jaykus said, adding that the FDA has likely pressured General Mills to issue a recall.

The 58-year-old brand hasn’t previously been linked to a food-borne illness. Since April 1, when The Post first reported on the outbreak of vomiting, diarrhea among consumers nationwide, General Mills has insisted that it does not believe Lucky Charms are causing people to be sick.

In response, the company has bewildered some customers by handing out coupons for free cereal in response to their complaints to the company.

“We continue to cooperate with the FDA in investigating this matter. We have not found any evidence of consumer illness tied to our products,” General Mills spokesperson Andrea Williamson said in a statement.

Dry cereal is typically not a culprit in food borne illness outbreaks, but in 2018 Kellogg’s Honey Smacks cereal caused a multi-state outbreak of salmonella in which 135 people in 36 states were infected and 34 people were hospitalized, according to the Centers for Disease Control and Prevention.

Patrick Quade, founder of iwaspoisoned.com, says many of the Lucky Charms boxes that allegedly made consumers sick had an expiration date of January, February and March 2023. More than 400 consumers who submitted a complaint to the website included a photo of the box’s expiration date, Quade said.

https://nypost.com/2022/05/05/lucky-charms-should-be-recalled-after-complaints-of-illness-experts-say/

SCOTUS protesters plan to march on justices’ homes after public doxing over Roe v. Wade

 Militant pro-choice activists doxxed the six Supreme Court justices that are expected to dismiss Roe v. Wade — publishing their partial addresses online as part of a planned protest.

Heated protests outside the courthouse in Washington, DC continued Thursday, with 8-feet non-scalable fences erected late Wednesday ahead of the crowds, similar to the ones set up after the Jan. 6 Capitol riot.

The heightened security followed three days of tense protests that started just moments after the publication of a leaked draft opinion suggesting SCOTUS was poised to dismiss the landmark 1973 decision that legalized abortion nationwide.

At least one activist group is already planning a more direct attack — taking the protest direct to the homes of the six justices expected to dismiss the long-divisive federal right.

The group, “Ruth Sent Us,” has planned the protest for next Wednesday at what it called “the homes of the six extremist justices.”

It even included a map pinpointing homes — three in Virginia and three in Maryland — “where the six Christian fundamentalist Justices issue their shadow docket rulings from.”

It listed streets that are allegedly the homes of Samuel Alito, who authored the draft, as well as Clarence Thomas, Neil Gorsuch, Brett Kavanaugh, Amy Barrett and Chief Justice John Roberts.

“Our 6-3 extremist Supreme Court routinely issues rulings that hurt women, racial minorities, LGBTQ+ and immigrant rights. We must rise up to force accountability using a diversity of tactics,” the group said.

The group also has action planned for Mother’s Day on Sunday — telling followers to descend on Catholic churches in protest “that six extremist Catholics set out to overturn Roe.”

“Ruth Sent Us” promoted the so-called “Mother’s Day Strike” with a video of church-goers trying to kick out protesters who interrupted a service, chanting, “Without this basic right, women can’t be free — abortion on demand and without apology.”

The group’s moniker was inspired by late Justice Ruth Bader Ginsburg — seemingly ignoring the fact that she was a vocal critic of the landmark ruling.

While a staunch advocate for women’s access to abortion, Ginsburg criticized Roe v. Wade as too far-reaching and sweeping, making it too easy a target for anti-abortion campaigners.

Still, the “Ruth Sent Us” group said its inspiration was how “Ruth Bader Ginsburg spent her entire life moving the needle towards justice for all,” also highlighting Black Lives Matter.

“We intend to stop the corruption of our Supreme Court, and stop the spread of fascist laws,” the group said. “Instead of waiting for the extremist Court to strip our rights further, we must rise up now.”

Chief Justice Roberts on Tuesday confirmed that the leaked draft — published Monday night by Politico — was genuine, but stressed that “it does not represent a decision by the Court or the final position of any member on the issues in the case.”

The US Capitol Police confirmed to Fox 5 that the fence was part of multi-agency efforts to “prepare for any potential demonstrations in the area of the Supreme Court, including adding additional officers in the area.”

https://nypost.com/2022/05/05/supreme-court-surrounded-by-fence-after-roe-v-wade-protests/

Transcript: Valneva earnings call

 https://www.marketscreener.com/quote/stock/VALNEVA-SE-54466/news/Transcript-Valneva-SE-Q1-2022-Earnings-Call-May-05-2022-40287221/

US drug control strategy may have to work around Mexico

 Although the term fell out of favor a long time ago, people still like to talk about the “war on drugs.” Words matter, and when you declare “war” on something, as Americans are wont to do, there is an expectation that there will be a clear winner and loser.  

Last year marked 50 years since President Richard Nixon declared a war on drugs, and while it’s still not clear exactly what success looks like, it certainly doesn’t feel like we’re winning. In the last 12 months, over 106,800 Americans died from drug overdoses, the highest on record, and an astonishing 500 percent increase since 2001. And that is why the newly released National Drug Control Strategy is so important. 

The 2022 National Drug Control Strategy outlines the Biden administration’s plan to reduce illicit drug use and the associated harms and helps guide the efforts of 16 federal government agencies and departments involved in the overlapping facets of drug control: supply reduction, demand reduction, harm reduction and treatment. While much of the attention has been on the administration’s growing acceptance of harm reduction measures and the emphasis on treatment — two historically underutilized approaches to drug control — it also highlights the continued importance of supply reduction and the need to disrupt drug trafficking organizations and their illicit financial activities.   

The Biden administration is right to employ a whole of government approach to combat the drug crisis, and although the ink is barely dry on the new strategy, one of the key pillars of the new strategy — reducing the supply of illicit substances through international engagement — is already in serious jeopardy.   

Counterdrug cooperation between the United States and Mexico has been in shambles since U.S. authorities arrested former Mexican Secretary of Defense Salvador Cienfuegos in October 2020. The U.S. subsequently dismissed the charges against Cienfuegos, but the damage had been done. Following this incident, the Mexican government promptly issued a new national security law that crippled law enforcement cooperation with the U.S. and shuttered elite counterdrug units vetted by the U.S. Drug Enforcement Administration to help battle the Mexican drug cartels.   

Eighteen months later, tensions between the two countries are still running high, with Mexican President Andrés Manuel López Obrador doubling down on his policy of “hugs, not bullets” in confronting drug trafficking organizations like the Sinaloa Cartel and the Jalisco New Generation Cartel (CJNG), and regularly invoking Mexican sovereignty in his dealings with the United States. Barring a significant policy shift, relations between the two countries are likely to remain frosty, and the flow of illicit drugs to the U.S. is likely to continue unabated.   

The Biden administration should continue to engage with like-minded partners to combat drug production and trafficking around the world. However, without more robust support from source countries like Mexico — the primary supplier of illicit drugs to the U.S. — it must prioritize those elements of the National Drug Control Strategy it can actually control. Things like strengthening drug interdiction and law enforcement capabilities along the Southwest border, aggressively pursuing drug trafficking networks operating throughout the U.S., expanding evidence-based prevention strategies, supporting common sense harm reduction initiatives like increased funding for Naloxone and drug testing strips and ensuring greater access to quality drug treatment.  

Enhancing security cooperation with Mexico is a laudable goal, but it takes a willing partner. With hundreds of Americans dying each day, including an increasing number of teenagers and minorities, the U.S. cannot wait for bilateral relations to improve. The U.S. must focus its limited time, money, and resources on those drug control strategies most likely to get results — now. 

Jim Crotty is an associate vice president at The Cohen Group, a strategic advisory firm in Washington, D.C., and the former deputy chief of staff at the U.S. Drug Enforcement Administration.  The views stated in this article are his own. 

https://thehill.com/opinion/white-house/3478544-the-white-houses-new-drug-control-strategy-may-have-to-work-around-mexico/