New Technology a Sepsis Breakthrough?

 Sepsis is among the most feared conditions for healthcare providers. These blood infections strike with such rapid intensity that treating them demands a mix of both clinical skill and luck — recognizing symptoms early enough while choosing the right drug to tame the bacterial culprit before the germs have overwhelmed the body's immune system.

All too often, sepsis wins the race. According to the US Centers for Disease Control and Prevention, at least 1.7 million people in this country develop sepsis annually. About 350,000 die during hospitalization or are discharged to hospice.

But new research published in Proceedings of the National Academy of Sciences offers hope that clinicians may one day be able to detect and treat sepsis more quickly.

The researchers broke down whole blood and dried it by heating, resulting in a solid porous structure with the bacterial DNA trapped inside. They then used chemicals — primers and enzymes — to reach inside the porous structure and amplify the target DNA.

The team was able to detect four ​cause of bloodstream infections — the bacteria methicillin-resistant Staphylococcus aureus (MRSA), methicillin-susceptible Staphylococcus aureus (MSSA), gram-negative Escherichia coli, and the fungal species Candida albicans. They validated their method against clinical laboratory results that used blood cultures and DNA analyses to detect sepsis.

The technique took just 2.5 hours and required roughly 1 mL of blood, according to the researchers.

"This technique can have broad applications in detection of bacterial infection and presence of bacteria in large values of blood," Rashid Bashir, PhD, dean of the University of Illinois at Urbana-Champaign's Grainger College of Engineering, and a co-author of the study, told Medscape Medical News.

While infection control experts and sepsis prevention advocates said the new study offers no clues about how to treat sepsis once detected, they hope the innovation eventually could save lives.

A Rapid Killer

Sepsis occurs when the body overreacts to an infection. The severe response can lead to can to tissue damage, organ failure, and death.

Thomas Heymann, MBA, president and CEO of Sepsis Alliance, an advocacy group, said mortality can rise 8% for each hour treatment is delayed.

Infants born prematurely are particularly vulnerable. Bashir and his colleagues noted that 25% of all infants admitted to the neonatal intensive care unit are diagnosed with sepsis. Of those, as many as 35% may die from infection. Sepsis is the most expensive condition treated in US hospitals, accounting for $23.7 billion in costs annually, they added.

Despite high mortality rates and hospital costs, according to a Sepsis Alliance survey, only 66% of Americans are aware of the term sepsis. Only 19% can name the four primary signs of the condition: Altered body Temperature, an Infection, Mental decline, and feeling Extremely ill, or "TIME."

Getting the appropriate antibiotics to sepsis patients quickly can greatly improve chances of survival, but Bashir said the current method of confirming the diagnosis is too slow.

Blood Cultures Too Slow

Dr Cindy Hou

​Traditional blood cultures are among the most common methods of ​determining if a patient has a bloodstream infection. But the process takes about 24 hours for a culture to detect ​the category of bacteria and an additional day to determine exactly which bacteria is present, according to Cindy Hou, DO, infection control officer and medical director of research at Jefferson Health, Voorhees Township, New Jersey. At 72 hours, Hou said, a blood culture will finally be able to produce a "sensitivity" result, which tells doctors which antibiotics will be most effective against the pathogen.

By then, patients often are already past the point of saving. The bottom line, according to Bashir and his colleagues: Blood cultures are "too slow and cumbersome to allow for initial management of patients and thus contributes to high mortality."

Hou called the ability to identify the type of infection in just 2.5 hours an "amazing" feat.

"With sepsis, ​it is helpful to have rapid diagnostics where results come back quickly. Rapid is never rapid enough," she said. "These researchers are pushing the bar for what rapid means."

The new detection method is not yet available commercially. Bashir said he and his colleagues plan to scale their study and hope to find a way to bypass the long culture steps to identify target pathogens directly from a large volume of blood.

Hou said she believes a blood culture would still be necessary since clinicians would need sensitivity results to guide targeted treatment of infections.

"There is a lot more we need, but this paper is a call to arms for the field of rapid diagnostics to make rapid as fast as it really needs to be, ​but we still need to find solutions which are affordable," Hou said.

Even without a blood culture, Bashir's technology could improve care. Heymann said the technology could help convince clinicians worried about antibiotic resistance to prescribe treatment faster.

"We know we're overusing antibiotics and that's creating a new big problem" when it comes to sepsis treatment, he said. "Getting a diagnostic read earlier is a game changer."

Combined with a blood culture that can later confirm or help adjust the course of treatment, Hou said this new method of sepsis detection could improve care, especially in places where rapid diagnostics are not available and particularly if combined with physician education so they understand what treatment is best for various types of infection. 

Heymann agreed. Sepsis Alliance also operates the Sepsis Innovation Collaborative, a group that supports public-private innovation on sepsis care.

"We're losing someone every 90 seconds in the United States to sepsis," Heymann said. "There is a huge opportunity to do better and it's this kind of innovation that is really inspiring."

Hou is chief medical officer for Sepsis Alliance​, a medical advisor for the Sepsis Innovation Collaborative, an advisor for Janssen, and a key opinion leader for T2 ​Biosystems. Bashir and Heymann report no relevant financial relationships.

PNAS. Published online September 26, 2022. Abstract 

https://www.medscape.com/viewarticle/981967

Long-term Antidepressant Use Tied to an Increase in CVD, Mortality Risk

 Long-term antidepressant use is tied to an increased risk of adverse outcomes, including cardiovascular disease (CVD), cerebrovascular disease (CV), coronary heart disease (CHD), and all-cause mortality, new research suggests.

Investigators drew on 10-year data from the UK Biobank on over 220,000 adults and compared the risk of developing adverse health outcomes among those taking antidepressants with the risk among those who were not taking antidepressants.

After adjusting for preexisting risk factors, they found that 10-year antidepressant use was associated with a twofold higher risk of CHD, an almost twofold higher risk of CVD as well as CVD mortality, a higher risk of CV, and more than double the risk of all-cause mortality.

On the other hand, at 10 years, antidepressant use was associated with a 23% lower risk of developing hypertension and a 32% lower risk of diabetes.

The main culprits were mirtazapine, venlafaxine, duloxetine, and trazodone, although selective serotonin reuptake inhibitors (SSRIs) were also tied to increased risk.

"Our message for clinicians is that prescribing of antidepressions in the long- term may not be harm-free [and] we hope that this study will help doctors and patients have more informed conversations when they weigh up the potential risks and benefits of treatments for depression," study investigator Narinder Bansal, MD, honorary research fellow, Centre for Academic Health and Centre for Academic Primary Care, University of Bristol, United Kingdom, said in a news release.

"Regardless of whether the drugs are the underlying cause of these problems, our findings emphasize the importance of proactive cardiovascular monitoring and prevention in patients who have depression and are on antidepressants, given that both have been associated with higher risks," she added.

The study was published online September 13 in the British Journal of Psychiatry Open.

Monitoring of CVD Risk "Critical"

Antidepressants are among the most widely prescribed drugs; 70 million prescriptions were dispensed in 2018 alone, representing a doubling of prescriptions for these agents in a decade, the investigators note. "This striking rise in prescribing is attributed to long-term treatment rather than an increased incidence of depression."

Most trials that have assessed antidepressant efficacy have been "poorly suited to examining adverse outcomes." One reason for this is that many of the trials are short-term studies. Since depression is "strongly associated" with CVD risk factors, "careful assessment of the long-term cardiometabolic effects of antidepressant treatment is critical."

Moreover, information about "a wide range of prospectively measured confounders...is needed to provide robust estimates of the risks associated with long-term antidepressant use," the authors note.

The researchers examined the association between antidepressant use and four cardiometabolic morbidity outcomes ― diabetes, hypertension, CV, and CHD. In addition, they assessed two mortality outcomes ― CVD mortality and all-cause mortality. Participants were divided into cohorts on the basis of outcome of interest.

The dataset contains detailed information on socioeconomic status, demographics, anthropometric, behavioral, and biochemical risk factors, disability, and health status and is linked to datasets of primary care records and deaths.

The study included 222,121 participants whose data had been linked to primary care records during 2018 (median age of participants, 56–57 years). About half were women, and 96% were of White ethnicity.

Participants were excluded if they had been prescribed antidepressants ≤12 months before baseline, if they had previously been diagnosed for the outcome of interest, if they had been previously prescribed psychotropic drugs, if they used cardiometabolic drugs at baseline, or if they had undergone treatment with antidepressant polytherapy.

Potential confounders included age, gender, body mass index, waist/hip ratio, smoking and alcohol intake status, physical activity, parental history of outcome, biochemical and hematologic biomarkers, socioeconomic status, and long-term illness, disability, or infirmity.

Mechanism Unclear

By the end of the 5- and 10-year follow-up periods, an average of 8% and 6% of participants in each cohort, respectively, had been prescribed an antidepressant. SSRIs constituted the most commonly prescribed class (80% – 82%), and citalopram was the most commonly prescribed SSRI (46% – 47%). Mirtazapine was the most frequently prescribed non-SSRI antidepressant (44% – 46%).

At 5 years, any antidepressant use was associated with an increased risk for diabetes, CHD, and all-cause mortality, but the findings were attenuated after further adjustment for confounders. In fact, SSRIs were associated with a reduced risk of diabetes at 5 years (hazard ratio [HR], 0.64; 95% CI, 0.49 – 0.83).

At 10 years, SSRIs were associated with an increased risk of CV, CVD mortality, and all-cause mortality; non-SSRIs were associated with an increased risk of CHD, CVD, and all-cause mortality.

Antidepressant class	Risk (95% CI)
SSRIs	CV: 1.34 (1.02 – 1.77) CVD mortality: 1.87 (1.38 – 2.53) All-cause mortality: 1.73 (1.48 – 2.03)
Other antidepressants	CHD: 1.99 (1.31 – 3.01) CVD: 1.86 (1.10 – 3.15) All-cause mortality: 2.20 (1.71 – 2.84)

 

On the other hand, SSRIs were associated with a decrease in risk of diabetes and hypertension at 10 years (HR, 0.68; 95% CI, 0.53 – .87; and HR, 0.77; 95% CI, 0.66 – 0.89, respectively).

"While we have taken into account a wide range of pre-existing risk factors for cardiovascular disease, including those that are linked to depression such as excess weight, smoking, and low physical activity, it is difficult to fully control for the effects of depression in this kind of study, partly because there is considerable variability in the recording of depression severity in primary care," said Bansal.

"This is important because many people taking antidepressants such as mirtazapine, venlafaxine, duloxetine and trazodone may have a more severe depression. This makes it difficult to fully separate the effects of the depression from the effects of medication," she added.

Further research "is needed to assess whether the associations we have seen are genuinely due to the drugs; and, if so, why this might be," she added.

Strengths, Limitations

Commenting for Medscape Medical News, Roger McIntyre, MD, professor of psychiatry and pharmacology, University of Toronto, Canada, and head of the Mood Disorders Psychopharmacology Unit, discussed the strengths and weaknesses of the study.

The UK Biobank is a "well-described, well-phenotyped dataset of good quality," said McIntyre, chairperson and executive director of the Brain and Cognitive Discover Foundation, Toronto, who was not involved with the study. Another strength is the "impressive number of variables the database contains, which enabled the authors to go much deeper into the topics."

A "significant limitation" is the confounding that is inherent to the disorder itself — "people with depression have a much higher intrinsic risk of CVD, CV, and cardiovascular mortality," McIntyre noted.

The researchers did not adjust for trauma or childhood maltreatment, "which are the biggest risk factors for both depression and CVD; and drug and alcohol misuse were also not accounted for."

Additionally, "to determine whether something is an association or potentially causative, it must satisfy the Bradford-Hill criteria," said McIntyre. "Since we're moving more toward using these big databases and because we depend on them to give us long-term perspectives, we would want to see coherent, compelling Bradford-Hill criteria regarding causation. If you don't have any, that's fine, too, but then it's important to make clear that there is no clear causative line, just an association."

The research was funded by the National Institute of Health Research (NI) School for Primary Care Research and was supported by the NI Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. McIntyre has received research grant support from CI/GACD/National Natural Science Foundation of China (NSFC) and the Milken Institute; speaker/consultation fees from Lundbeck, Janssen, Alkermes,Neumora Therapeutics, Boehringer Ingelheim, Sage, Biogen, Mitsubishi Tanabe, Purdue, Pfizer, Otsuka, Takeda, Neurocrine, Sunovion, Bausch Health, Axsome, Novo Nordisk, Kris, Sanofi, Eisai, Intra-Cellular, NewBridge Pharmaceuticals,Viatris, AbbVie, and Atai Life Sciences. McIntyre is a CEO of Braxia Scientific Corp.

BJPsych Open. Published online September 13, 2022. Full text

https://www.medscape.com/viewarticle/981951

CMS' Financial Incentives Didn't Move the Dial on Home Dialysis

 Financial incentives to encourage home dialysis may be falling flat, according to a first-year analysis of Medicare's End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model.

Compared with controls, ESRD facilities and managing clinicians practicing within a hospital referral region randomized to receive financial incentives only increased the number of new patients with home dialysis in the first 90 days of treatment by a non-significant 0.12% (P=0.88), reported Yunan Ji, PhD, of Georgetown University in Washington, D.C., and colleagues.

Likewise, no secondary outcomes were significantly different between the groups, including the average percentage of weeks a patient received any home dialysis and number of dialysis sessions at home during the first 90 days.

"This raises questions about the efficacy of the financial incentives in the model and suggests that higher incentives may be necessary to affect behavioral change by dialysis clinicians and facilities," the group wrote in JAMA Health Forum.

Because prior financial incentives may have dissuaded physicians from encouraging home dialysis, CMS' ETC Model aimed at bolstering those rates -- along with kidney transplant waitlisting and living donor transplant rates -- in part through shifting Medicare payments from traditional fee-for-service payments to a value-based payment model.

Ji's group pointed out that while it's estimated that up to 85% of patients are likely suitable for home dialysis, only 12.6% of Medicare patients actually received home dialysis in 2019. Because home dialysis is not only cheaper, but also yields the same or better clinical outcomes, CMS announced a goal to have 80% of new ESRD patients receive home dialysis or a transplant by 2025.

This trial looked at outcomes from the first year (2021) of the ETC model, which is slated to stay in place through June 30, 2026. With the ETC model, the home dialysis payment adjustment (HDPA) increases the reimbursement rate for home dialysis for the first 3 years of the program. Additionally, performance payment adjustment (PPA) either increases or lowers the reimbursement rate for home and facility dialysis based on the rate of home dialysis and transplant, both of which are combined into a modality performance score.

"The HDPA increase in reimbursement rate for home dialysis was 3% in 2021, 2% in 2022, and 1% in 2023," the researchers explained. "The PPA adjustments were potentially much larger and depended on the facility's modality performance score. They could range from -5% to 4% in the first year and increase over time to -10% to 8% during the last year of the program."

However, an accompanying editorial led by Sri Lekha Tummalapalli, MD, MBA, MAS, of Weill Cornell Medicine in New York City, suggested that it may just be too early to see a difference, being that the study is only looking at the first year of this model.

Redesigning care to shift dialysis into the home "is complex and time-consuming, and many frontline nephrologists may still be unaware of the ETC model," they suggested, adding that "growing a home dialysis program requires investments in physical space and changes in staffing, training, and organizational culture."

On top of this, they also suggested that these ETC incentives may simply not be strong enough to make home dialysis profitable enough to elicit real change. Instead, barriers related to home dialysis must first be addressed in order to truly bolster uptake, they suggested, like improving funding for housing, utility improvements, caregiver support, and staff assistance programs.

The trial included data on 18,621 patients who newly initiated dialysis. These patients were managed within the 302 eligible hospital referral regions included in the trial -- 30% of which were randomized to receive these financial incentives.

Both the researchers and the editorialists said they remain eager to see how the subsequent years of the ETC model will play out.

Disclosures

The study was supported by the J-PAL North America Health Care Delivery Initiative.

Ji and co-authors reported relationships with J-PAL North America, the Massachusetts Institute of Technology, the White House National Economic Council from Stanford University, and the National Bureau of Economic Research.

Editorial author Tummalapalli reported relationships with Scanwell Health and Bayer AG. Other editorialists also reported disclosures.

Primary Source

JAMA Health Forum

Source Reference: Ji Y, et al "Financial incentives to facilities and clinicians treating patients with end-stage kidney disease and use of home dialysis" JAMA Health Forum 2022; DOI: 10.1001/jamahealthforum.2022.3503.

Secondary Source

JAMA Health Forum

Source Reference: Tummalapalli SL, et al "Early findings from Medicare's End-Stage Renal Disease Treatment Choices Model" JAMA Health Forum 2022; DOI: 10.1001/jamahealthforum.2022.3500.

https://www.medpagetoday.com/nephrology/esrd/101109

Rebranded Servier eyes €3bn in cancer drug sales by 2030

 Servier is already in the process of transforming itself into a much bigger player in cancer, and has just tripled its sales objectives for the category.

Fresh with a new brand identity, the France-headquartered pharma group has pledged to grow its oncology sales from its current objective of €1 billion in 2025 to €3 billion in 2030, continuing a diversification of its business from its traditional focus on cardiovascular diseases.

The strategy to build in cancer dates back to 2015, and has since gathered momentum with the purchase of the oncology businesses of Shire and Agios Pharma in 2018 and 2020, for $2.4 billion and $1.8 billion respectively, as well as smaller deals such as its takeover of Danish antibody specialist Symphogen.

The latter brought in acute myeloid leukaemia (AML) and cholangiocarcinoma therapy Tibsovo (ivosidenib), which was approved as a first-line therapy for AML last year in combination with Bristol-Myers Squibb’s chemotherapy Vidaza (azacitidine), dramatically expanding the eligible patient population for the drug.

It also allocates 50% of its internal R&D budget to cancer candidates, with a pipeline that now includes 39 projects, according to a business update posted today that includes the objective to become a “mid-size, focused, and innovative player in oncology, as well as in neuroscience and immuno-inflammation.”

It also sees continued growth in cardiovascular and venous diseases, as well as in generic medicines, and says its new visual identity (see above) reflects its “uniqueness” as an “independent group, governed by a foundation, committed to therapeutic progress to serve patient needs.”

Its updated plan predicts group sales of €6 billion in 2025 and operating profits of around €1.3 billion, rising to €8 billion and approximately €2.4 billion, respectively, five years later.

“Our group is founded on a vocation that inspires us and around strong values that drive us,” commented Servier’s president, Olivier Laureau.

“The initiated transformation and our ambition represent a new chapter in our history,” he added. “More than ever, with Servier 2030, we are focused on innovation and positive social impact thanks to an improved profitability and bold choices.”

https://pharmaphorum.com/news/rebranded-servier-eyes-e3bn-in-cancer-drug-sales-by-2030/

Lilly holds off on tirzepatide filing in obesity, waiting for second trial

 Eli Lilly has decided to wait for the readout of the second of its two phase 3 trials for tirzepatide in obesity, rather than filing on the strength of its first, positive study.

When Lilly reported strong results from SURMOUNT-1 earlier this year, the drugmaker suggested it may be able to file for approval of tirzepatide in obesity before the end of this year.

That won’t happen now, but Lilly says it will start a rolling application for the drug in obesity this year that will complete in the first quarter of next year after the readout of SURMOUNT-2.

On the plus side, the time that tirzepatide will stay under review at the FDA has just gotten shorter, as the FDA has granted the drug fast-track review that means it should make a decision within six months of the filing being completed.

The rolling submission suggests the drug should still be heading for a decision sometime in the latter half of next year – assuming, of course, the SURMOUNT-2 data expected in April 2023 is positive.

Lilly already has approval for the dual GLP-1/GIP agonist under the Mounjaro brand name as a diabetes therapy and is tipped to make rapid inroads in that market, with EvaluatePharma predicting sales could break the $1 billion barrier in 2024, and $3 billion two years later.

The drug is a bright spot in Lilly’s pipeline, and one which will step up an ongoing rivalry in diabetes with Novo Nordisk in the GLP-1 agonist category.

Novo Nordisk has been almost single-handedly rebuilding the market for obesity drugs in recent years, with its GLP-1 agonist drugs Wegovy (semaglutide) and Saxenda (liraglutide), and tirzepatide looks set to be the first major competitor to reach the market.

Earlier this year, Novo Nordisk said that once-weekly injection Wegovy was emerging from a challenging early rollout beset by production problems, and is now expected to lead an obesity franchise at the company that could reap $3.7 billion in 2025 sales.

Saxenda requires daily injections, so is expected to eventually become a secondary player in that effort as Wegovy gathers momentum. In the first half of the year, sales of the two obesity drugs grew 84% to around $920 million.

If anything could threaten Novo Nordisk’s ambitions in this area, it is likely to be tirzepatide. In SURMOUNT-1, patients taking a weekly injection of the drug saw an average 22.5% reduction in weight, with almost two-thirds of them achieving a 20% fall compared to just over 1% of the placebo group.

Novo Nordisk’s STEP trial programme for Wegovy revealed an average reduction in body weight of around 12%, suggesting greater potency for Lilly’s dual-acting drug – with the usual caveat about the perils of drawing comparisons between differently-designed studies.

Tirzepatide is hugely important for Lilly, as its once-weekly GLP-1 agonist for diabetes – Trulicity (dulaglutide) – will start losing patent protection in 2027 and is already feeling pressure from Novo Nordisk’s Ozempic, the diabetes brand of semaglutide.

https://pharmaphorum.com/news/lilly-holds-off-on-tirzepatide-filing-in-obesity-waiting-for-second-trial/

NYC subway service resumes after hazmat situation at 14th Street-Union Square

 One person was injured and multiple subway lines were temporarily suspended in Manhattan Friday during a hazmat incident involving pepper spray inside the 14th Street-Union Square station, MTA and FDNY officials said.

Service on the N‌‌, Q‌‌, R‌‌, W‌‌ and Nos. 4‌‌, 5‌‌, and 6‌ trains was suspended in much of Midtown and Lower Manhattan around 10:30 a.m., per NYC Transit. L‌ trains also were not running in Manhattan.

Service on all lines resumed about an hour later. Subway riders should expect residual delays, particularly on the D, F, and M lines, according to NYC Transit.

An NYPD spokesperson told PIX11 News a dispute on an R train led someone to spray a canister of pepper spray. An investigation was ongoing.

The FDNY received a call around 10:15 a.m. for a report of someone spraying peppery spray on the platform of the 14th Street-Union Square station. One person was taken to the hospital for treatment, per FDNY officials.

MTA spokesperson Michael Cortez said in an emailed statement that the incident appears to be isolated.

https://pix11.com/news/local-news/subway-lines-suspended-in-manhattan-amid-hazmat-situation-at-14th-street-union-square-officials/

‘State of emergency’: Adams says NYC migrant influx to cost city $1B

 New York City Mayor Eric Adams declared a state of emergency Friday over the influx of migrants into the Big Apple and estimated it will cost $1 billion to provide them with shelter space and social services.

Hizzoner made the announcements in a speech at City Hall in which he declared that the influx of migrants from south of the border had stretched the city’s social-safety net to its breaking point and pushed its shelter population to an all-time high.

“We are in a crisis situation,” Adams said. “This is a humanitarian crisis that started with violence and instability in South America, and it’s being accelerated by American political dynamics.

“This crisis is not of our own making, but one that will affect everyone in this city now and in the months ahead.”

City officials have struggled for weeks to find space for the incoming thousands, most of whom are Venezuelans seeking asylum from that country’s brutal dictatorship and economic collapse.

Adams rattled off statistics to bolster his dire warnings:

 – More than 61,000 people are now in city shelters, a near-record that officials say they will shortly exceed.

 – Officials are renting rooms in more than 40 hotels across the city to try and keep up with the influx.

 – Arriving families have enrolled 5,500 new students in New York City’s public schools, a jump from the previous tally of 3,200. 

The mayor said he would visit the tent city his administration is building on Randall’s Island to provide temporary housing for the arrivals.

Migrant families lined up outside of Living Word Christian Fellowship in Ozone Park, Queens to receive clothes.

Stephen Yang

Migrant families look through clothing donations in Queens.

Stephen Yang

Migrant families are staying in a hotel turned shelter in Queens while they await asylum hearings.

Stephen Yang

Officials hope the temporary facility will provide a much-needed buffer for the straining shelter system by providing 500 cots and referral services for incoming migrants before they are placed into the system.

“This is unsustainable,” Adams said of the situation. “New York City is doing all we can, but we are reaching the outer limit of our ability to help.”

The mayor called on Congress to pass legislation to shorten the mandatory waiting period for work papers for the migrants. The wait period is currently six months, a requirement that essentially forces the arrivals into the city’s shelter system and social-safety net for an extended period of time.

50 migrant students are currently enrolled in PS 33 in Chelsea, Manhattan.

Stephen Yang

He also called on Gov. Kathy Hochul to provide financial aid and staffing support and to free up state-controlled sites to provide housing. 

“We need help from the federal government, we need help from the state of New York,” he said. 

There’s little chance of Hizzoner getting his wish for reforms from Washington.

Adams said Friday that New York had rented rooms in more than 40 hotels across the city to provide emergency shelter space and that he would visit the tent city his administration is building on Randall’s Island to provide temporary housing for the arrivals.

https://nypost.com/2022/10/07/state-of-emergency-adams-says-nyc-migrant-influx-to-cost-1b/