To the Bat Cave: In Search of COVID's Origins, Scientists Reignite Polarizing Debate on Wuhan 'Lab Leak'

KFF Health News, May 19, 2021

The lab leak hypothesis has picked up more adherents as time passes and scientists fail to detect a bat or other animal infected with a virus that has COVID's signature genetics.

This article was published on Wednesday, May 19, 2021 in Kaiser Health News.

By Arthur Allen

Once dismissed as a conspiracy theory, the idea that the COVID virus escaped from a Chinese lab is gaining high-profile attention. As it does, reputations of renowned scientists are at risk — and so is their personal safety.

At the center of the storm is Peter Daszak, whose EcoHealth Alliance has worked directly with Chinese coronavirus scientists for years. The scientist has been pilloried by Republicans and lost National Institutes of Health funding for his work. He gets floods of threats, including hate mail with suspicious powders. In a rare interview, he conceded that he can't disprove that the deadly COVID-19 virus resulted from a lab leak at the Wuhan Institute of Virology — though he doesn't believe it.

"It's a good conspiracy theory," Daszak told KHN. "Foreigners designing a virus in a mysterious lab, a nefarious activity, and then the cloak of secrecy around China."

But to attack scientists "is not only shooting the messenger," he said. "It's shooting the people with the conduit to where the next pandemic could happen."

Yet what if the messengers were not only bearing bad news but also accidentally unleashed a virus that went on to kill more than 3 million people?

The generally accepted scientific hypothesis holds that the COVID virus arose through natural mutations as it spread from bats to humans, possibly at one of China's numerous "wet markets," where caged animals are sold and slaughtered. An alternative explanation is that the virus somehow leaked from the Wuhan Institute, one of Daszak's scientific partners, possibly by way of an infected lab worker.

The lab leak hypothesis has picked up more adherents as time passes and scientists fail to detect a bat or other animal infected with a virus that has COVID's signature genetics. By contrast, within a few months of the start of the 2003 SARS pandemic, scientists found the culprit coronavirus in animals sold in Chinese markets. But samples from 80,000 animals to date have failed to turn up a virus pointing to the origins of SARS-CoV-2 — the virus that causes COVID. The virus's ancestors originated in bats in southern China, 600 miles from Wuhan. But COVID contains unusual mutations or sequences that made it ideal for infecting people, an issue explored in depth by journalist Nicholas Wade.

Scientists from the Wuhan Institute have collected thousands of coronavirus specimens from bats and registered them in databases closed to inspection. Could one of those viruses have escaped, perhaps after a "gain of function" experiment that rendered it more dangerous?

Daszak, who finds such theories specious, was the only American on a 10-member team that the World Health Organization sent to China this winter to investigate the origins of the virus. The group concluded its work without gaining access to databases at the Wuhan Institute, but dismissed the lab leak hypothesis as unlikely. WHO Director-General Tedros Adhanom Ghebreyesus, however, said the hypothesis "requires further investigation."

On Friday, 18 virus and immunology experts published a letter in the journal Science demanding a deeper dive. "Theories of accidental release from a lab and zoonotic spillover both remain viable," they said, adding that the Wuhan Institute should open its records. One of the signatories was a North Carolina virologist who has worked directly with the Wuhan Institute's top scientists.

That demand is "definitely not acceptable," responded Shi Zhengli, who directs the Center for Emerging Infectious Diseases at the Wuhan Institute. "Who can provide evidence that does not exist?" she told MIT Technology Review. Shi has said that thousands of attempts to hack its computer systems forced the institute to close its database.

Many leading virologists continue to believe that "zoonotic transmission" — from a bat or some other animal to a human — remains the most likely origin story. Yet the lack of evidence for that is troubling, 17 months after the emergence of COVID, said Stanley Perlman, a University of Iowa virologist who was not among the Science letter signatories.

The fact that no bat or other animal has been found infected with anything resembling the COVID virus, which suddenly swept through Wuhan at the end of 2019, "has put the lab leak hypothesis back on the table," although there is no evidence supporting that theory either, he said.

Alina Chan, a Broad Institute postdoctoral researcher who signed the Science letter, agrees that there is no "dispositive" evidence either way for COVID's emergence. But a network of amateur sleuths have put together evidence, she said, that the Wuhan Institute has COVID-like viruses in its collection that it has not deposited in global databases, as would be customary during a global pandemic. Chan and others are particularly curious about a bunch of SARS-like viruses that the institute collected from a cave in Yunnan province where guano miners suffered a deadly outbreak of respiratory disease in 2012.

"We don't have access to that data," Chan said. She and other scientists wonder why the COVID virus was so ideally suited to human-to-human transmission from the onset without signs of an intermediate host or circulation in the human population before the Wuhan outbreak.

In a paper posted to a virology forum last week, Robert Garry of Tulane University, who doubts the lab leak hypothesis, brought forth a new fragment of "spillover" evidence: The WHO report shows that some of the first 168 cases of COVID were linked to two or more animal markets in Wuhan, he said, with strains from different markets showing slight differences in their genetic sequence. "Maybe one animal was in a truck with a bunch of cages and then it spread it to another species and that's where the shift took place," Garry said.

Garry and other international scientists have worked with Shi and her lab for years. The evidence for Garry's supposition isn't airtight, he admitted, but it's more convincing than "contriving something where some of the world's leading virologists are covering up at the behest of the Chinese Communist Party," he said.

Shi has no greater defender in the United States than Daszak, whose EcoHealth Alliance was a wildlife protection organization when he joined it two decades ago. The group has since expanded its goals from protecting endangered animals to protecting humans endangered by the pathogens trafficked with those animals. The more than $50 million EcoHealth Alliance had received in U.S. funding since 2007 includes contracts and grants from two NIH institutes, the National Science Foundation and the U.S. Agency for International Development, as well as Pentagon funds to look for organisms that could be fashioned into bioterror weapons.

Daszak has co-authored at least 21 research papers on bat coronaviruses since 2005, finding hundreds of viruses capable of infecting people. He estimated that about 1 million people a year are infected with bat viruses — a number that's grown as humans encroach on bat habitats.

He recalled a 2019 visit to a cave filled with millions of bats. "Tourists were going in there in shorts, and we were in there in full PPE. They asked us, 'What are you doing?' and we told them, 'We're looking for viruses like SARS.'''

In April 2020, citing what he said was evidence of the virus's link to the Wuhan lab, President Donald Trump ordered the NIH to cancel a five-year, $3.7 million grant for EcoHealth Alliance's bat virus research. But about 70% of the group's annual $12 million budget continues to come from the U.S. government, Daszak said.

When the NIH grant was frozen, Daszak called the lab leak hypothesis "pure baloney," saying he was confident his Chinese scientific partners were not hiding anything. But he admits it is impossible to disprove.

"There are plenty of reasons to question China's openness and transparency on a whole range of issues including early reporting of the pandemic," he told KHN. "You can never definitively say that what China is telling us is correct."

Daszak said he thinks it more likely that China is covering up the role of the country's wildlife markets in COVID's origin. Farming of these animals employs 14 million people, and the government has closed and reopened the markets since SARS. Following the COVID outbreak, the Chinese authorities' investigation of Wuhan's animal markets, where the virus could have mutated after passage through different species, was incomplete, Daszak said.

"People don't realize how sensitive China is about this," he said. "It's plausible that they recognized there were cases coming out of a market and they shut it down."

A Controversy With Roots

The scientific conflict over the lab hypothesis is partly rooted in a debate over gain-of-function experiments, work that in theory could lead to the creation and release of more infectious or deadly organisms. In such experiments, scientists in a lab can, for example, test a virus's ability to mutate by exposing it to different cell types or to mice genetically engineered with human immune system traits.

At least six of the 18 signatories of the Science letter are part of the Cambridge Working Group, whose members worry about the release of pathogens from the growing number of virus labs around the world.

In 2012, Dr. Anthony Fauci, who leads NIH's National Institute of Allergy and Infectious Diseases, came out in support of a moratorium on such research, posing a hypothetical scenario involving a poorly trained scientist in a poorly regulated lab: "In an unlikely but conceivable turn of events, what if that scientist becomes infected with the virus, which leads to an outbreak and ultimately triggers a pandemic?" Fauci wrote.

In 2017, the federal government lifted its pause on such experiments but has since required some be approved by a federal board.

In his questioning of Fauci in the Senate last week, Sen. Rand Paul (R-Ky.) cited a 2015 paper written by Shi, Ralph Baric of the University of North Carolina and others in which they fused a SARS-like virus with a novel bat virus spike protein and found that it sickened research mice. The experiment provided evidence of the perils that lurked in Chinese bat caves, but the authors also raised the question of whether such studies were "too risky to pursue."

Critics have jumped on this paper as evidence that Shi was conducting "gain of function" experiments that could have created a superbug, but Shi denies it. The research cited in the paper was conducted in North Carolina.

Using a similar technique, in 2017, Baric's lab showed that remdesivir — currently the only licensed drug for treating COVID — could be useful in fighting coronavirus infections. Baric also helped test the Moderna COVID vaccine and a leading new drug candidate against COVID.

Research into COVID-like viruses is vital, Baric said. "A terrible truth," he said, "is that millions of coronaviruses exist in animal reservoirs, like bats, and unfortunately many appear poised for rapid transmission between species."

Baric told KHN he does not believe COVID resulted from gain-of-function research. But he signed the Science letter calling for a more thorough investigation of his Chinese colleagues' laboratory, he said in an email, because while he "personally believe[s] in the natural origin hypothesis," WHO should arrange for a rigorous, open investigation. It should review the biosafety level under which bat coronavirus research was conducted at the Wuhan Institute, obtaining detailed information on the training and safety procedures and efforts to monitor possible infections among lab personnel.

Fauci also told KHN, in an email, that "we at the NIH are very much in favor of a thorough investigation as to the origins of SARS-CoV-2."

Scaling the Wall of Secrecy

U.S.-China tensions will make it very difficult to conclude any such study, scientists on both sides of the issue suggest. With their anti-China rhetoric, Trump and his aides "could not have made it more difficult to get cooperation," said Dr. Gerald Keusch, associate director of the National Emerging Infectious Diseases Laboratory Institute at Boston University. If a disease had emerged from the U.S. and the Chinese blamed the Pentagon and demanded access to the data, "what would we say?" Keusch asked. "Would we throw out the red carpet, 'Come on over to Fort Detrick and the Rocky Mountain Lab?' We'd have done exactly what the Chinese did, which is say, 'Screw you!'"

Still, while China has shut off its laboratories to outside inquiry, that doesn't mean all investigative avenues are closed, Chan said. Many Chinese scientists were in contact with colleagues and journals outside the country as the pandemic emerged. Those communications may contain clues, Chan said, and someone should methodically interview the contacted individuals.

It's worth recalling that the only U.S. bioterror attack so far in the 21st century consisted of a U.S. bioterrorism researcher mailing anthrax spores to politicians and journalists. Hundreds of millions of dollars go into researching organisms around the world and there are risks of leaks, accidental or intentional, no matter how sophisticated the lab, Chan said.

But it would be unwise to limit support for global virus research, said Jonna Mazet, a University of California-Davis professor who led a USAID-funded program that trained scientists around the world to collect and research animal viruses. For her pains, she has received death threats and hacking attacks on her computers and home alarm system.

"If we don't do the work," she said, "we're just sitting ducks for the next one."

KHN correspondent Rachana Pradhan contributed to this report.

Arthur Allen: ArthurA@kff.org, @ArthurAllen202

Aiding Her Dying Husband, a Geriatrician Learns the Emotional and Physical Toll of Caregiving

KFF Health News, May 18, 2021

This has been a year like none other for Rebecca Elon, MD, who has dedicated her professional life to helping older adults.

This article was published on Tuesday, May 18, 2021 in Kaiser Health News.

By Judith Graham

The loss of a husband. The death of a sister. Taking in an elderly mother with dementia.

This has been a year like none other for Dr. Rebecca Elon, who has dedicated her professional life to helping older adults.

It's taught her what families go through when caring for someone with serious illness as nothing has before. "Reading about caregiving of this kind was one thing. Experiencing it was entirely different," she told me.

Were it not for the challenges she's faced during the coronavirus pandemic, Elon might not have learned firsthand how exhausting end-of-life care can be, physically and emotionally — something she understood only abstractly previously as a geriatrician.

And she might not have been struck by what she called the deepest lesson of this pandemic: that caregiving is a manifestation of love and that love means being present with someone even when suffering seems overwhelming.

All these experiences have been "a gift, in a way: They've truly changed me," said Elon, 66, a part-time associate professor at Johns Hopkins University School of Medicine and an adjunct associate professor at the University of Maryland School of Medicine.

Elon's uniquely rich perspective on the pandemic is informed by her multiple roles: family caregiver, geriatrician and policy expert specializing in long-term care. "I don't think we, as a nation, are going to make needed improvements [in long-term care] until we take responsibility for our aging mothers and fathers — and do so with love and respect," she told me.

Elon has been acutely aware of prejudice against older adults — and determined to overcome it — since she first expressed interest in geriatrics in the late 1970s. "Why in the world would you want to do that?" she recalled being asked by a department chair at Baylor College of Medicine, where she was a medical student. "What can you possibly do for those [old] people?"

Elon ignored the scorn and became the first geriatrics fellow at Baylor, in Houston, in 1984. She cherished the elderly aunts and uncles she had visited every year during her childhood and was eager to focus on this new specialty, which was just being established in the U.S. "She's an extraordinary advocate for elders and families," said Dr. Kris Kuhn, a retired geriatrician and longtime friend.

In 2007, Elon was named geriatrician of the year by the American Geriatrics Society.

Her life took an unexpected turn in 2013 when she started noticing personality changes and judgment lapses in her husband, Dr. William Henry Adler III, former chief of clinical immunology research at the National Institute on Aging, part of the federal National Institutes of Health. Proud and stubborn, he refused to seek medical attention for several years.

Eventually, however, Adler's decline accelerated and in 2017 a neurologist diagnosed frontotemporal dementia with motor neuron disease, an immobilizing condition. Two years later, Adler could barely swallow or speak and had lost the ability to climb down the stairs in their Severna Park, Maryland, house. "He became a prisoner in our upstairs bedroom," Elon said.

By then, Elon had cut back on work significantly and hired a home health aide to come in several days a week.

In January 2020, Elon enrolled Adler in hospice and began arranging to move him to a nearby assisted living center. Then, the pandemic hit. Hospice staffers stopped coming. The home health aide quit. The assisted living center went on lockdown. Not visiting Adler wasn't imaginable, so Elon kept him at home, remaining responsible for his care.

"I lost 20 pounds in four months," she told me. "It was incredibly demanding work, caring for him."

Meanwhile, another crisis was brewing. In Kankakee, Illinois, Elon's sister, Melissa Davis, was dying of esophageal cancer and no longer able to care for their mother, Betty Davis, 96. The two had lived together for more than a decade and Davis, who has dementia, required significant assistance.

Elon sprang into action. She and two other sisters moved their mother to an assisted living facility in Kankakee while Elon decided to relocate a few hours away, at a continuing care retirement community in Milwaukee, where she'd spent her childhood. "It was time to leave the East Coast behind and be closer to family," she said.

By the end of May, Elon and her husband were settled in a two-bedroom apartment in Milwaukee with a balcony looking out over Lake Michigan. The facility has a restaurant downstairs that delivered meals, a concierge service, a helpful hospice agency in the area and other amenities that relieved Elon's isolation.

"I finally had help," she told me. "It was like night and day."

Previously bedbound, Adler would transfer to a chair with the help of a lift (one couldn't be installed in their Maryland home) and look contentedly out the window at paragliders and boats sailing by.

"In medicine, we often look at people who are profoundly impaired and ask, 'What kind of quality of life is that?'" Elon said. "But even though Bill was so profoundly impaired, he still had a strong will to live and retained the capacity for joy and interaction." If she hadn't been by his side day and night, Elon said, she might not have appreciated this.

Meanwhile, her mother moved to an assisted living center outside Milwaukee to be nearer to Elon and other family members. But things didn't go well. The facility was on lockdown most of the time and staff members weren't especially attentive. Concerned about her mother's well-being, Elon took her out of the facility and brought her to her apartment in late December.

For two months, she tended to her husband's and mother's needs. In mid-February, Adler, then 81, took a sharp turn for the worse. Unable to speak, his face set in a grimace, he pounded the bed with his hands, breathing heavily. With hospice workers' help, Elon began administering morphine to ease his pain and agitation.

"I thought, 'Oh, my God, is this what we ask families to deal with?'" she said. Though she had been a hospice medical director, "that didn't prepare me for the emotional exhaustion and the ambivalence of giving morphine to my husband."

Elon's mother was distraught when Adler died 10 days later, asking repeatedly what had happened to him and weeping when she was told. At some point, Elon realized her mother was also grieving all the losses she had endured over the past year: the loss of her home and friends in Kankakee; the loss of Melissa, who'd died in May; and the loss of her independence.

That, too, was a revelation made possible by being with her every day. "The dogma with people with dementia is you just stop talking about death because they can't process it," Elon said. "But I think that if you repeat what's happened over and over and you put it in context and you give them time, they can grieve and start to recover."

"Mom is doing so much better with Rebecca," said Deborah Bliss, 69, Elon's older sister, who lives in Plano, Texas, and who believes there are benefits for her sister as well. "I think having [Mom] there after Bill died, having someone else to care for, has been a good distraction."

And so, for Elon, as for so many families across the country, a new chapter has begun, born out of harsh necessities. The days pass relatively calmly, as Elon works and she and her mother spend time together.

"Mom will look out at the lake and say, 'Oh, my goodness, these colors are so beautiful,'" Elon said. "When I cook, she'll tell me, 'It's so nice to have a meal with you.' When she goes to bed at night, she'll say, 'Oh, this bed feels so wonderful.' She's happy on a moment-to-moment basis. And I'm very thankful she's with me."

We're eager to hear from readers about questions you'd like answered, problems you've been having with your care and advice you need in dealing with the healthcare system. Visit khn.org/columnists to submit your requests or tips.

Judith Graham: khn.navigatingaging@gmail.com, @judith_graham

Doctors Now Must Provide Patients Their Health Data, Online and On Demand

KFF Health News, May 18, 2021

Advocates herald the rule as a long-awaited opportunity for patients to control their data and health.

This article was published on Tuesday, May 18, 2021 in Kaiser Health News.

By Sarah Kwon

Last summer, Anna Ramsey suffered a flare-up of juvenile dermatomyositis, a rare autoimmune condition, posing a terrifying prospect for the Los Angeles resident: She might have to undergo chemotherapy, further compromising her immune system during a pandemic.

After an agonizing three-day wait, the results of a blood test came back in her online patient portal — but she didn't understand them. As hours passed, Ramsey bit her nails and paced. The next day, she gave in and emailed her doctor, who responded with an explanation and a plan.

For Ramsey, now 24, instant access to her test results had been a mixed blessing. "If there's something I'm really nervous about," she said, "then I want interpretations and answers with the result. Even if it takes a few days longer."

On April 5, a federal rule went into effect that requires healthcare providers to give patients like Ramsey electronic access to their health information without delay upon request, at no cost. Many patients may now find their doctors' clinical notes, test results and other medical data posted to their electronic portal as soon as they are available.

Advocates herald the rule as a long-awaited opportunity for patients to control their data and health.

"This levels the playing field," said Jan Walker, co-founder of OpenNotes, a group that has pushed for providers to share notes with patients. "A decade ago, the medical record belonged to the physician."

But the rollout of the rule has hit bumps, as doctors learn that patients might see information before they do. Like Ramsey, some patients have felt distressed when seeing test results dropped into their portal without a physician's explanation. And doctors' groups say they are confused and concerned about whether the notes of adolescent patients who don't want their parents to see sensitive information can be exempt — or if they will have to breach their patients' trust.

Patients have long had a legal right to their medical records but often have had to pay fees, wait weeks or sift through reams of paper to see them.

The rule aims not only to remove these barriers, but also to enable patients to access their health records through smartphone apps, and prevent healthcare providers from withholding information from other providers and health IT companies when a patient wants it to be shared. Privacy rules under the Health Insurance Portability and Accountability Act, which limit sharing of personal health information outside a clinic, remain in place, although privacy advocates have warned that patients who choose to share their data with consumer apps will put their data at risk.

Studies have shown numerous benefits of note sharing. Patients who read their notes understand more about their health, better remember their treatment plan and are more likely to stick to their medication regimen. Non-white, older or less educated patients report even greater benefits than others.

For Sarah Ford, 34, of Pittsburgh, who has multiple sclerosis, reading her doctor's notes helps her make the most of each visit and feel informed.

"I don't like going into the office and feeling like I don't know what's going to happen," she said. If she wants to try a new medication or treatment, reading previous notes helps her prepare to discuss it with her doctor, she said.

The new rule will have less impact on Ford and the more than 50 million patients in the U.S. whose doctors had already made their notes available to patients before the rule kicked in. However, only about a third of patients with access to secure online health portals were using them.

While most doctors who have shared notes with patients think it's a good idea, the policy has drawbacks. One recent study found that half of doctors reported writing their notes less candidly after they were opened to patients.

Another study, published in February, found that 1 in 10 patients had ever felt offended or judged after reading a note. The study's lead author, Dr. Leonor Fernandez, of Beth Israel Deaconess Medical Center, said there is a "legacy of certain ways of expressing things in medicine that didn't really take into account how it reads when you're a patient."

"Maybe we can rethink some of these," she said, citing the phrase "patient admits to drinking two glasses of wine a day" as an example. "Why not just write 'two glasses of wine a day'?"

UC San Diego Health started phasing in open notes to patients in 2018 and removed a delay in the release of lab results last year. Overall, said Dr. Brian Clay, chief medical information officer, both have been uneventful. "Most patients are agnostic, some are super-jazzed, and a few are distressed or have lots of questions and are communicating with us a lot," he said.

There are exceptions to the requirement to release patient data, such as psychotherapy notes and notes that could harm a patient or someone else if released.

Dr. David Bell, president of the Society for Adolescent Health and Medicine, believes it's unclear exactly what qualifies as "substantial harm" to a patient — the standard that must be met for doctors to withhold an adolescent patient's notes from a parent. Clarity, he said, is especially important to protect teenagers living in states with less restrictive laws on parental access to medical records.

Most electronic medical records are not equipped to segregate sensitive pieces from other information that might be useful for a parent in managing their child's health, he added.

Some doctors say receiving devastating test results without counseling can traumatize patients. Dr. James Kenealy, an ear, nose and throat doctor in central Massachusetts, said a positive cancer biopsy result for one of his patients was automatically pushed to his portal over the weekend, blindsiding both. "You can give bad news, but if you have a plan and explain, they're much better off," he said.

Such incidents aren't affecting the majority of patients, but they're not rare, said Dr. Jack Resneck Jr., an American Medical Association board trustee. The AMA is advocating for "tweaks" to the rule, he said, like allowing brief delays in releasing results for a few of the highest-stakes tests, like those diagnosing cancer, and more clarity on whether the harm exception applies to adolescent patients who might face emotional distress if their doctor breached their trust by sharing sensitive information with their parents.

The Office of the National Coordinator for Health Information Technology, the federal agency overseeing the rule, responded in an email that it has heard these concerns, but has also heard from clinicians that patients value receiving this information in a timely fashion, and that patients can decide whether they want to look at results once they receive them or wait until they can review them with their doctor. It added that the rule does not require giving parents access to protected health information if they did not already have that right under HIPAA.

Patient advocate Cynthia Fisher believes there should be no exceptions to immediately releasing results, noting that many patients want and need test results as soon as possible, and that delays can lead to worse health outcomes. Instead of facing long wait times to discuss diagnoses with their doctors, she said, patients can now take their results elsewhere. "We can't assume the consumer is ignorant and unresourceful," she said.

In the meantime, hospitals and doctors are finding ways to adapt, and their tactics could have lasting implications for patient knowledge and physician workload. At Massachusetts General Hospital, a guide for patients on how to interpret medical terminology in radiology reports is being developed, said Dr. William Mehan, a neuroradiologist.

An internal survey run after radiology results became immediately available to patients found that some doctors were monitoring their inbox after hours in case results arrived. "Burnout has come up in this conversation," Mehan said.

Some electronic health records enable doctors to withhold test results at the time they are ordered, said Jodi Daniel, a partner at the law firm Crowell & Moring. Doctors who can do this could ask patients whether they want their results released immediately or if they want their doctor to communicate the result, assuming they meet certain criteria for exceptions under the rule, she said.

Chantal Worzala, a health technology policy consultant, said more is to come. "There will be a lot more conversation about the tools that individuals want and need in order to access and understand their health information," she said.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Healthcare Foundation.

Sarah Kwon: @skwonjournalist

Watch: Elisabeth Rosenthal on the COVID-19 'Infodemic' and the Media

KFF Health News, May 17, 2021

Journalists discussed the challenging environment for news and facts that grew out of the pandemic.

This article was published on Monday, May 17, 2021 in Kaiser Health News.

Jon Greenberg interviewed Elisabeth Rosenthal, editor-in-chief of KHN; Shefali Luthra, health and gender reporter at The 19th; and Derek Thompson, staff writer for The Atlantic, about COVID-19 misinformation during PolitiFact's United Facts of America: A Festival of Fact-Checking.

The journalists discussed the challenging environment for news and facts that grew out of the pandemic. One major issue was that Americans simply were not used to the idea that infectious diseases could cause mass disaster, Rosenthal said. That mentality, combined with misinformation spread by then-President Donald Trump, made it easy for lies about the virus to perpetuate. 

Homicides Surge in California Amid COVID Shutdowns of Schools, Youth Programs

KFF Health News, May 17, 2021

After more than a decade of fairly steady decreases, California's homicide rate surged in 2020.

This article was published on Monday, May 17, 2021 in Kaiser Health News.

By Phillip Reese

Amid a pandemic that left law enforcement agencies stretched thin and forced shutdowns that left young men with little to do, California registered a devastating surge in homicides in 2020 that hit especially hard in Black and Latino communities.

The number of homicide victims in California jumped 27% from 2019 to 2020, to about 2,300, marking the largest year-over-year increase in three decades, according to preliminary death certificate data from the California Department of Public Health.

There were 5.8 homicides per 100,000 residents in 2020, the highest rate in California since 2008.

Similar increases were seen nationwide. The number of homicides in a sampling of large cities grew 32% from 2019 to 2020, according to preliminary FBI data. The data encompasses over 200 cities with more than 100,000 people but does not include some big cities, like New York, Chicago and Philadelphia, that did not report.

The California death certificate data reveals striking disparities in who fell victim to homicide in 2020.

The number of homicides that took the lives of Black Californians rose 36% from 2019 to 2020, while homicides that took Hispanic lives rose 30%. By comparison, the number of white homicide victims rose 15% and the number of Asian victims rose 10%.

Most victims of homicide in 2020 were young, between 15 and 34 years old; the number of homicide victims in this age group rose from about 900 in 2019 to 1,175 in 2020, a 31% rise.

Firearms were the most common instrument of death, and the number of homicides involving guns rose 35% last year, the state data shows. Extending another long-standing trend: Males were five times as likely to be the victims of homicide as females. The number of male victims rose 30% in 2020, compared with a 14% rise in female victims.

The increase in deadly violence played out across large swaths of the state, urban and rural, and was keenly felt in the San Francisco Bay Area. Among California's 10 most populous counties, the sharpest increases were reported in Alameda County, where homicides rose 57%, followed by Fresno (44%), Sacramento (36%) and Los Angeles (32%). Only one of the 10 most populous counties — Contra Costa — saw a decline in homicides last year.

Law enforcement officials and criminologists said an increase in conflict among young adults, particularly those in street gangs, was a significant factor in the violence. They noted that schools and sports programs shut down as COVID-19 surged, as did large numbers of community and nonprofit programs that provide support, recreational outlets and intervention services for at-risk youth.

"They were bored," said Reynaldo Reaser, executive director of Reclaiming America's Communities Through Empowerment (R.A.C.E.), which offers sports leagues, gang mediation and youth development in impoverished neighborhoods of South Los Angeles. "And so, having nothing to do — no programs, no sports, no facilities open — the only thing they could focus on is each other."

Reaser runs a dynamic youth softball league that typically would draw more than 600 players and spectators during Sunday play, he said, many of them young gang members. But those games and other programs were curtailed during the COVID pandemic.

Terrell Williams, an 18-year-old who lives in the West Athens area of South Los Angeles, said he spent many nights doing "delinquent stuff" before Reaser's program changed his life. He said many of his peers felt cooped up and restless during the pandemic lockdowns, which contributed to an increase in violence.

"COVID tended to, I guess, make people not want to stay inside the house, and drove them outside more towards each other," he said.

Jorja Leap, a UCLA anthropologist and expert in gangs, violence and trauma, echoed that theme, saying the restrictions on youth intervention programs and other healthy activities played "a huge role" in the rise in violence.

"The sports after school — football, basketball, whatever it might be — all that is stopped," said Leap, a faculty member at UCLA's Luskin School of Public Affairs. "So, frankly, you got a lot of adolescent and young adult energies out there."

Leap said young adults were particularly vulnerable to the mental toll of the pandemic. "They finally get programs; they have people interested in them. And then, it's all of a sudden withdrawn," she said.

Pandemic-fueled anxiety and isolation corresponded with a huge increase in gun sales, which Leap said may also explain some of the increase in homicides. "I am worried about how easy it has been to get a gun during such a crisis time in America," she said.

"It's not 'Pick one factor,'" she added. "All of these factors reinforce each other."

David Robinson is the sheriff in Kings County, a largely rural county in Southern California that registered 15 homicides in 2020, up from four in 2019. He is also president of the California State Sheriffs' Association, giving him a wide lens on a difficult year.

Robinson agreed that an increase in gang activity and the "mental impact" of telling young adults they had to stay indoors likely contributed to the violence. But separately, he cited the toll the pandemic took on police agencies. Many officers fell ill with COVID, forcing their agencies to reduce patrols and other crime prevention efforts.

The mass protests that followed George Floyd's murder by a Minneapolis police officer last May also diverted resources, said Robinson. And the anger directed at police made it tougher for some officers to do their jobs.

"When there's this call to defund police, it has an impact on the mentality of the men and women doing the job," he said, adding that constant criticism can cause officers to "become more reactive than proactive."

Robinson echoed other law enforcement officers in noting that thousands of inmates were released early from state prisons and county jails during the pandemic to stem COVID outbreaks. He said he thinks research eventually will show a correlation with the surge in homicides.

Leap disagreed. "If you get two shoplifting charges, it's a felony," she said. "That's who they're releasing. They're not releasing people from death row."

With mass vaccinations taking place across the state and nation, more places are reopening and young adults have more options to engage in something positive. But Leap said it will take a broad effort to bolster jobs and education, along with short-term intervention aimed at those still hurting from the pandemic, to improve the social conditions that contributed to the increase in homicides.

"As much as we've never dealt with a global pandemic in modern times, we've never dealt with the aftermath of a global pandemic," she said.

Reaser, in Los Angeles, is nonetheless optimistic. After a year of shutdowns, his youth softball league is starting up again. Finally, instead of trying to work out conflicts over the phone or online, Reaser can get young adult rivals to talk, face to face, and bond in a positive way.

"I really think that a lot of programs will open up," he said. "A lot of violence will slow down."

Methodology

This story draws on data from three sources. The data from these sources matches closely, but not precisely. Cause of death and population figures for 1979 through 2018 come from the federal Centers for Disease Control and Prevention. Cause of death figures for 2019 and 2020 come primarily from the California Department of Public Health and are based on death certificates. The exception is 2019 data for eight largely rural counties with few homicides. CDPH did not publish specific 2019 homicide figures for those counties due to data privacy rules. For those counties, 2019 homicide data comes from the California Department of Justice. 

Phillip Reese is a data reporting specialist and an assistant professor of journalism at California State University-Sacramento.

This story was produced by KHN, which publishes California Healthline, an editorially independent service of the California Healthcare Foundation.

'Kicking You When You're Down': Many Cancer Patients Pay Dearly for Parking

KFF Health News, May 17, 2021

The costs of parking while in cancer treatment is finally drawing national scrutiny from oncology researchers and even some hospital administrators.

This article was published on Monday, May 17, 2021 in Kaiser Health News.

By Rebecca J. Ritzel

For cancer patients, the road from diagnosis to survivorship feels like a never-ending parade of medical appointments: surgeries, bloodwork, chemotherapy, radiation treatments, scans. The routine is time-consuming and costly. So, when hospitals charge patients double-digit parking fees, patients often leave the garage demoralized.

Iram Leon vividly remembers the first time he went for a follow-up MRI appointment at Dell Seton Medical Center in Austin, Texas, after he had been treated at another hospital for a brain tumor.

The medical news was good: His stage 2 tumor was stable. The financial news was not. When he sat down at the receptionist's desk to check out, Leon was confronted by a bold, red-lettered sign on the back of her computer that read: "WE DO NOT VALIDATE PARKING."

Below that all-caps statement was a list of parking rates, starting with $2 for a 30-minute visit and maxing out at $28 a day. Lose your ticket? Then you could pay $27 for an hour.

"To this day, I remember that sign," Leon, 40, said of the 2017 appointment, which he posted about on Facebook. "These patients were people who were coming in for various types of cancer treatment. These were people who were keenly aware of their own mortality, and yet the sign was screaming at them, 'We do not validate parking.'" (Hospital officials did not respond to requests for comment about their parking policy.)

JulieAnn Villa, who was diagnosed in March with her third bout of cancer, estimates she has spent "thousands of dollars" on parking fees during her years of treatment and follow-up care. She faces a transportation dilemma every time she commutes 6 miles to Chicago's Northwestern Memorial Hospital from her apartment. Should she take public transit? Call a pandemic surge-rate Uber? Ask a friend to drive her? Or pay $12 to $26 (with validation) to park in a garage where each floor is named after singers like Dolly Parton and Frank Sinatra?

She was hospitalized for multiple days in April after spending 23 hours alone in an overburdened ER, because she didn't want friends to pay to wait with her. "I almost drove myself, and I'm so glad I didn't," Villa said. "That would have been expensive."

Long a source of frustration for patients, the costs of parking while in cancer treatment is finally drawing national scrutiny from oncology researchers and even some hospital administrators.

"If you want to rile up patients or caregivers or family members, just bring up parking costs," said Dr. Fumiko Chino, a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York who studies the "financial toxicity" of cancer treatment, including costs not covered by insurance, such as parking fees.

Chino, who enrolled in medical school after her husband died of a rare neuroendocrine cancer in 2007, added, "For people who have to pay $15 to $18 every single time, which is what I remember paying, it really feels like the last straw, frankly — like kicking you when you're down."

Public transit is possible for some cancer patients in larger cities, but not for those too ill or immunocompromised. Others have accessibility issues. Many must travel to get care, making driving the best option.

Parking fees can have implications for more than just the patient. "Some patients say, 'This is the reason I didn't participate in a clinical trial, because I couldn't afford the parking,'" Chino said.

At a time when hospitals and drug companies are under increasing pressure to diversify clinical trial populations, testing only patients who can afford high parking fees is problematic, Chino said.

There are some pilot programs to improve access to drug trials, and some charities, such as the Leukemia & Lymphoma Society, offer travel grants, but accessibility remains a substantial barrier to cancer care, said Elizabeth Franklin, president of the nonprofit Cancer Support Community, which offers financial aid to patients and advocates in Washington, D.C., for "patient-centered" health policies.

"The true definition of a patient-centered healthcare system," Franklin said, is one that allows patients to choose the best means of transportation. "It's not making them go into debt because they've had to pay a ton of money for parking each time they go to the clinic or the hospital."

Chino and colleagues published a short study in July showing that some cancer patients pay $1,680 over the course of treatment.

According to readership statistics released in late March, the study was the most read and downloaded article in JAMA Oncology last year, and it continues to prompt a lively social media response. A thread on Reddit has logged more than 1,100 comments, including many from patients in other countries voicing surprise at U.S. parking policies.

The researchers calculated the cost to park at 63 National Cancer Institute-designated cancer centers while receiving the standard number of treatments for each of three types of cancers: node-positive breast cancer, head and neck cancers, and acute myeloid leukemia, or AML. They did not calculate costs for follow-up appointments, blood draws, routine scans and immune-boosting injections.

They found that, while 20 of the hospitals provided free parking for all cancer patients, the other 43 had widely varying fees.

"The range was $0 to $800 for breast cancer," Chino said. "That's huge, and it's not like the person who's paying $800 is necessarily getting any better treatment." The maximum charges for a standard course of therapy for head and neck cancer were $665 and for AML, $1,680.

Practices should change, Chino said, "to alleviate this strain for our patients."

Of the 63 hospitals, including those where parking is free for cancer patients, 54% offered free parking for chemotherapy and 68% for radiation treatment.

The top daily parking rate, according to the researchers, is $40 at New York's Mount Sinai Hospital. (A spokesperson for Mount Sinai declined to comment.) Chino's own institution, Memorial Sloan Kettering, is not far behind; parking at one of its main garages begins at $12 an hour and maxes out at $36 a day. A spokesperson for the hospital said some locations do offer free parking, and all patients can apply for aid to cover parking costs.

A few colleagues scoffed when Chino said she was researching parking charges, she said, but a growing number of mostly younger oncologists are concerned about indirect costs that contribute to the financial toxicity of cancer.

"It seems ethically incorrect to nickel-and-dime patients for parking charges," a trio of doctors wrote last year in an editorial published by the American Society of Clinical Oncologists. They acknowledge that most top cancer hospitals are in urban centers, where parking costs are often high and third-party agencies may operate the garages. "Nevertheless, in 2020, with our multibillion-dollar cancer center budgets, we as healthcare systems should do everything we can to help patients and caregivers," the editorial said.

City of Hope National Medical Center in Los Angeles is one of the 20 NCI-designated hospitals that do not charge patients for parking. Dr. Vijay Trisal, a surgical oncologist who serves as City of Hope's chief medical officer, takes pride in that distinction.

"Charging cancer patients for parking is like a knife in the back," he said. "We can't control copays, but we can control what patients pay for parking."

While Trisal would never want a patient to choose City of Hope for the free parking alone, he acknowledges the policy gives his hospital a competitive advantage.

"You would not believe how many patients have said to me, 'Thank you for not charging for parking,'" he said.

What Does Approval of the Pfizer Vaccine for Teens and Preteens Mean for My Child?

KFF Health News, May 15, 2021

Though kids have been less likely to develop severe illness, they still can pose a risk to vulnerable people around them because they may not even know they are carrying the virus.

This article was published on Friday, May 14, 2021 in Kaiser Health News. This story also ran on PolitiFact.

By Carmen Heredia Rodriguez

Q: The federal government approved the Pfizer vaccine for 12- to 15-year-olds. What does this mean for my child?

Extending the emergency use of the Pfizer-BioNTech vaccine to preteens and young adolescents adds nearly 17 million more Americans to the pool of those eligible to be immunized against covid-19, helping to build a vaccinated population closer to herd immunity. Moderna and Johnson & Johnson are also testing the efficacy of their vaccines in teens and children.

Although children appear to catch covid less often and develop milder symptoms than adults, they can develop a rare, severe inflammatory response or “long-haul covid” symptoms. It also remains to be seen what, if any, long-term effects these younger patients may experience from covid.

The share of covid cases in children and teens is increasing — nearly a quarter of the new weekly covid cases were found in this age group, as reported May 6 by the American Academy of Pediatrics and the Children’s Hospital Association.

And, though kids have been less likely to develop severe illness, they still can pose a risk to vulnerable people around them because they may not even know they are carrying the virus, as documented by the Centers for Disease Control and Prevention.

Dr. Margaret Stager, a pediatrician and the division director of adolescent medicine at MetroHealth Medical Center in Cleveland, said she has had to explain to her young patients that getting immunized would help their community curb the spread, cut the risk of variants and help society reopen.

“I talk about them doing their part,” Stager said. “That this is all part of them contributing to the greater good.”

The Fine Print

The CDC this week recommended use of the Pfizer vaccine for children ages 12 to 15 after the Food and Drug Administration extended its emergency use authorization to include these preteens and young adolescents. That means this age group now can receive the same shots in the same time frame — 21 days apart — as adults do.

In a reversal of its previous guidance, teens and adults do not need to wait 14 days before or after getting the covid shot to receive a vaccine for another condition. This could be a boon for health care providers who have child patients lagging on other, routine vaccines, which has been a persistent problem during the pandemic.

“It’s a tremendous opportunity to play catch-up,” said Stager.

CDC officials noted in the May 12 Advisory Committee on Immunization Practices’ recommendation that they do not have data specifically looking at potential side effects in patients immunized against covid and other illnesses at the same time. However, the agency made the decision given the strong safety data of the Pfizer-BioNTech shot and previous experience with other immunizations.

This question will become more important as covid vaccines are studied in younger children. Trials are planned to test the vaccine in children as young as 6 months old.

As in adults, the question of how long the immunity lasts in children remains unknown, said Dr. Rebecca Wurtz, an associate professor of infectious diseases at the University of Minnesota. However, she said, it’s likely that any waning immunity detected in adults will also be seen among the young.

“Whatever we learn in adults,” Wurtz said, “kids will be not far behind.”

Whether this approval will prompt schools to require vaccination against covid for K-12 students returning to the classroom this fall is a pending question, said Stager. It is unclear whether federal law allows state authorities to mandate a vaccine that has not yet been fully approved. That said, the government’s approval will also likely play into parents’ decisions about sending their children to summer camp.

What Did the Trial Find?

Pfizer tested the vaccine in 2,260 preteens and young adolescents living in the United States. Researchers followed participants for two months or more, the FDA said. Pfizer’s clinical protocol says the company will continue to follow participants for two years after the second dose.

Results show the vaccine is safe to use in this age group, causing side effects similar to those seen in young adult populations for whom it had already been cleared, according to the FDA in a press release. Those vaccinated also produced a strong immune response — the level of antibodies recorded in this age group was even stronger than what was seen in 16- to 25-year-olds.

The vaccinated group also had no covid cases when tested seven days after their second dose. Sixteen participants out of 978 who did not get the shot but were followed as part of the study as a control group tested positive for the virus. In short, the vaccine was 100% effective in preventing covid, according to the FDA.

Why So Few Kids?

One data point that may give parents pause is the trial’s number of participants. The relatively low number — especially when compared with the tens of thousands enrolled in adult trials — is a reflection of what the researchers were trying to accomplish, said Dr. Kawsar Talaat, an assistant professor of international health at Johns Hopkins University School of Public Health.

Gauging whether the shot was safe for children and if it generated a strong immune response did not require a large study group, she said. Statisticians can calculate how many people a trial needs to generate meaningful results without unnecessarily exposing people to dangerous pathogens like the coronavirus.

In addition, the findings pertaining to the younger age group built on what has already been learned in earlier studies.

“It’s just not practical to do 30,000-person trials over and over with the same vaccine,” Talaat said. Large trials are expensive, she added. Including minors also poses extra challenges, said Stager, such as getting parental consent.

Jerica Pitts, a Pfizer spokesperson, said in an email the company is using a “careful, stepwise approach” to including minors in clinical trials.

Stager said physiological similarities among 12- to 15-year-olds in response to vaccines have previously been documented. Studies related to a vaccine for the human papillomavirus have shown kids at this age generated similar, strong immune responses, too.

Administering the vaccine to preteens and young adolescents in large numbers may reveal additional effects that weren’t detected in the clinical trials, said A. Oveta Fuller, associate professor of microbiology and immunology at the University of Michigan Medical School.

That said, when weighing the threat of the virus versus the vaccine’s proven safety, she said, the choice is clear.

“The thing is the danger is really not so much the vaccines as it is what it protects against,” Fuller said, “and that’s covid disease.”

Latinos Are the Most Eager to Get Vaccinated, Survey Shows — But Face Obstacles

KFF Health News, May 14, 2021

One-third of unvaccinated Hispanics say they want the shots, compared with 17% of Blacks and 16% of whites.

This article was published on Thursday, May 13, 2021 in Kaiser Health News.

By Anna Almendrala

Hispanics who have yet to receive a COVID shot are about twice as likely as non-Hispanic whites or Blacks to say they'd like to get vaccinated as soon as possible, according to a survey released Thursday. The findings hint at fixable, though difficult, vaccine access problems for the population.

One-third of unvaccinated Hispanics say they want the shots, compared with 17% of Blacks and 16% of whites, according to the survey released Thursday by KFF. (KHN is an editorially independent program of KFF.)

The results reflect an opportunity for public health departments and local governments to reach out to Hispanics with information and vaccinating teams, said Liz Hamel, vice president and director of public opinion and survey research at KFF and director of the organization's monthly COVID vaccine surveys.

"There definitely is a large chunk of the Hispanic population that's eager to get it, but they just have either not been able to fit it into their schedule, or they have some concerns or questions or they haven't been able to access it," Hamel said.

According to the Centers for Disease Control and Prevention, only about 13% of people in the U.S. who have received at least one vaccine dose are Hispanics, though they make up about 17% of the overall population. (Only about half of the CDC's data includes the race or ethnicity of vaccinated individuals.)

Among unvaccinated Hispanics, 64% were worried about missing work because of vaccine side effects, and 52% were concerned about having to pay for the shots — although the shots are offered at no cost. These numbers are even higher for Hispanics who lacked lawful permanent resident status.

"It's hard for somebody who lives day-to-day to take off half a day to come to a clinic and try to get a vaccination," said Dr. José Pérez, chief medical officer of the South Central Family Health Center, a nonprofit health organization with clinic locations throughout South Los Angeles. "If they don't work that day, they don't earn a living and they don't eat."

Those facing immigration issues were more likely to be worried about being asked to show government-issued ID or a Social Security number, according to the KFF survey.

The Trump administration's anti-immigrant policies scared people away from seeking any public health services, for fear it could jeopardize their immigration status, Pérez said.

"For Americans who are used to having order in their life, and don't have to be fearful of this or that, this may seem a little bit foreign," he said. "But for the immigrant community in South L.A., these are factors that they deal with on an everyday basis."

Despite the survey's hopeful message, Pérez's organization has administered only a fraction of the doses it has on hand, although it has expanded vaccination sites and now offers a shot to anyone who walks into one of its clinics, Pérez said.

"All we can do is continue to push, educate and continue to put our name out there," he said. "Hopefully, we'll catch up."

The Biden administration recently announced tax credits for small businesses that give their workers paid time off to get the shot and recover in case of side effects. Providers are not allowed to charge people for the COVID vaccine, and must give out shots regardless of immigration status or health insurance coverage.

In California, where Hispanics make up nearly 40% of the population, 48% of COVID deaths and 63% of COVID infections, about 32% have received vaccinations. Cases and deaths are especially concentrated in dense, low-income neighborhoods that are majority Latino.

Community health clinics and organizations throughout the state are taking the case for vaccinations to sidewalks, supermarkets and anywhere else people gather, seeking to ensure people know how to sign up for a shot.

In the ZIP code around South Central Family Health Center's main site, only 16% of eligible residents had at least one shot as of May 7, according to the California Department of Public Health's vaccine tracker. Five months into the nation's vaccination campaign, as the CDC relaxes mask recommendations, the clinic is still pushing the importance of masks because of how few people have been vaccinated, Pérez said.

"Vaccine hesitancy" has become a catch-all excuse to explain low rates of vaccinations among minority populations, but the problem is complex, said Nancy Mejía, chief program officer of Latino Health Access in Santa Ana, California, a nonprofit that contracts with Orange County to bring COVID vaccine to Latinos.

Her group's community health workers, or promotoras, encounter people who face a wide variety of obstacles to get the shot, she said.

"We hear all of these questions about, 'Well, I don't have health insurance,' or 'Do I have to pay?' or 'I don't have email, how do I register?'" Mejía said. "When folks talk about hesitancy, we really have to ask what it is that we're talking about, and not continue to place blame on individuals who actually have really good questions."

Now that demand for vaccine appointments has plunged, Mejía and her group are focusing more on mobile vaccine events at condominium buildings, swap meets and parking lots where pedestrians and residents can simply walk up. The events are happening in the evenings after work or on the weekends to make the decision to get vaccinated as easy as possible.

"We're seeing other places that have been open the entire day and gotten only five people in," she said. "So, for us being open just a few hours in the evening, and getting over 100 people — that's a success story."

Carmelo Morales, a 35-year-old Los Angeles resident, used to count himself among the vaccine skeptical. After talking to friends and seeing posts on Instagram, he feared the shots might be a plot to make people sick. He didn't see the urgency of getting a shot.

But Morales, who works in a meatpacking plant, has been deeply affected by the cases and deaths he has seen among colleagues and their families over the past year. One day in late April, as he was walking home from work, he noticed healthcare workers at a church near his house packing up after a COVID vaccine event.

He asked if there were any leftover doses, and because his house was nearby, nurses waited for him to run home to get his ID so he could get his first shot.

"I just thought about it and was like, hey, it'd be better just to be maybe on the safer side."

Anna Almendrala: aalmendrala@kff.org, @annaalmendrala

Podcast: KHN's 'What the Health?': Drug Price Effort Hits a Snag

KFF Health News, May 14, 2021

Concerns raised by a group of moderate Democrats threaten to derail a bill being pushed by House Democratic leaders.

This podcast was published on Friday, May 14, 2021 in Kaiser Health News.

The high cost of prescription drugs is a top health issue for the public and politicians, but concerns raised by a group of moderate Democrats threaten to derail a bill being pushed by House Democratic leaders.

Meanwhile, the Food and Drug Administration has authorized the use of the Pfizer COVID-19 vaccine for everyone age 12 and up, and Pfizer is applying for full licensure of that vaccine. It is currently being distributed under emergency authorization. Full approval could open the door to vaccine requirements in some workplaces, schools or other gathering spots, which will likely touch off more controversy.

And the Biden administration reinstated an Obama-era policy barring discrimination in healthcare for LGBTQ individuals, even as more states pass anti-LGBTQ legislation.

This week's panelists are Julie Rovner of KHN, Joanne Kenen of Politico, Sarah Karlin-Smith of the Pink Sheet and Rachel Cohrs of Stat.

Among the takeaways from this week's podcast:

  • Opposition by a handful of conservative and moderate Democrats to House Speaker Nancy Pelosi's proposal to drive down prescription drug prices was a bit of a surprise since some of the members had voted for very similar legislation in the previous Congress. Back then, though, it was clear the bill had no chance of survival in a Republican-controlled Senate. Now the stakes are much higher because Democrats control Congress and the White House.
     
  • In addition to drugmakers' clout on Capitol Hill, some resistance to Pelosi's plan reflects the fact it was written by leadership behind closed doors and didn't go through the typical committee process, in which members of the House would have had a chance to debate and amend the legislation.
     
  • Another factor in the dispute is that several of the representatives who signed the letter to the speaker come from areas where drugmakers have large operations and argue that measures to lower prices could cost jobs.
     
  • The administration announced that more than 1 million people have signed up for health coverage on the Affordable Care Act's marketplaces during the special enrollment period established by the Biden administration. The enrollment boost is attributed to enhanced subsidies passed by Congress earlier this year and a strong messaging campaign about the need for insurance by the administration.
     
  • Democrats in the Senate are pushing forward the nomination of Chiquita Brooks-LaSure to head the Centers for Medicare & Medicaid Services, despite efforts by Sen. John Cornyn (R-Texas) to block her nomination as a protest against Biden administration policies that could cut Medicaid payments to Texas hospitals.
     
  • If Brooks-LaSure is confirmed, nominations for other key posts at HHS will likely quickly follow, such as the heads of Medicaid and the Health Resources & Services Administration. But there has been no movement on a new commissioner for the Food and Drug Administration.
     
  • The vaccine advisory committee for the Centers for Disease Control and Prevention is recommending that children 12 and older not only can safely get the Pfizer COVID-19 vaccine, but that it can be given with other vaccines. Health officials had previously recommended that vaccines be spaced apart. Pediatricians, however, are concerned about how many children missed other important vaccinations over the course of the pandemic.
     
  • Equipping pediatricians to give the vaccine to youngsters may prove vital in getting this age group protected. But the vaccine that has been approved requires the most stringent cold storage, so that may be a hurdle in getting it into doctors' offices. The administration is looking for ways to make it easier for pediatricians to deliver the shot.Bottom of Form

Plus, for extra credit, the panelists recommend their favorite health policy stories of the week they think you should read too:

Julie Rovner: HBO's "The Crime of the Century" by Alex Gibney

Joanne Kenen: Grist's "There's Federal Money Available to House the Homeless. No One's Taking It," by Adam Mahoney

Rachel Cohrs: Stat's "CDC's Slow, Cautious Messaging on COVID-19 Seems out of Step with the Moment, Public Health Experts Say," by Nicholas Florko

Sarah Karlin-Smith: KHN's "The Making of Reluctant Activists: A Police Shooting in a Hospital Forces One Family to Rethink American Justice," by Sarah Varney

To hear all our podcasts, click here.

And subscribe to What the Health? on iTunes, Stitcher, Google Play, Spotify, or Pocket Casts.

Listen: Pandemics, Patents and Profits

KFF Health News, May 14, 2021

The Atlantic's "Social Distance" podcast discusses the current patent controversy.

This podcast was published on Friday, May 14, 2021 in Kaiser Health News.

Julie Rovner, KHN's chief Washington correspondent, joins The Atlantic's "Social Distance" podcast, hosted by Dr. James Hamblin and Maeve Higgins, to talk about the current patent controversy and how the drug industry has protected itself over the years with vibrant campaigns about the needs for high profits to support drug development.

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