North Carolinians are currently faced with choices and confusion about which personal protective measures they should take against COVID-19, as Gov. Roy Cooper released guidance encouraging schools to make masks optional starting March 7 and the state’s remaining counties with mask mandates ended them.
These changes follow a drop in cases across the state, as the Omicron surge appears to be on its way down, but they have left North Carolinians with questions: To mask or not to mask? Stock up on COVID tests? Is COVID over?
Experts are even unsure, as the pandemic enters yet another new phase.
North Carolina saw a sharp decrease in COVID cases following the surge of the highly transmissible Omicron variant across the world in December and January.
At the height of the Omicron surge, the North Carolina Department of Health and Human Services reported almost 45,000 COVID cases, dwarfing previous surges. That number is now down to fewer than 2,000 daily cases.
Some public health experts, such as Anthony Fauci, President Joe Biden’s top adviser on the pandemic predict an “uptick” of COVID cases as a result of the BA.2 subvariant of the Omicron variant, which is causing an increase of cases in Europe.
U.S. Surgeon General Vivek Murthy urged Americans to remain prepared for whatever COVID has in store, in an interview on “Fox News Sunday.”
“We’re in that mile 18 of a marathon,” Murthy said. “We can’t quit, because COVID’s not quitting.”
North Carolina DHHS Sec. Kody Kinsley said North Carolina tends to be six weeks behind COVID trends in Europe, during a press conference on March 17.
Though cases are rising in some European countries, in the past month, travel restrictions have started to ease throughout most European nations.
The United Kingdom, France, Greece, Romania and other nations have begun lifting requirements for entry such as passenger locator forms, COVID-19 entry restrictions, and proof of vaccination.
However, most countries in the European Union enforce policies regarding the use of facemasks while indoors or using public transit.
Loosen up?
While cases are low, John Wiesman, professor of the practice in the Department of Health Policy and Management at the UNC Gillings School of Global Public Health, said North Carolinians should enjoy this time.
“We are at a place where community transmission is much lower,” Wiesman said. “And we do have this pent-up demand to want to do things we haven’t been doing, whether it’s going to the movie theater, whether it’s doing some traveling, whether it’s seeing people in our family who we haven’t seen for a long time.”
That doesn’t mean COVID is over though, Wiesman said.
Thomas Holland, associate professor of Medicine at Duke University School of Medicine, hearkened back to the first COVID curveball, the Delta variant.
“Last summer when we had really low case counts,” Holland said, “and around June, July time, I felt pretty confident that we wouldn’t see another big surge until the winter — sort of traditional respiratory virus season, and that was wrong, right? Delta arrived around that time, and then we had a big surge even during the warm summer months.”
Even as North Carolinians enjoy this time, Wiesman said, they shouldn’t let their guard down.
“I think the keyword here is we just need to remain vigilant,” Wiesman said.
Remaining vigilant
Wiesman recommended consulting the Centers for Disease Control and Prevention (CDC) community-level transmission data to assess your risk. Wastewater data is also one way to detect COVID transmission early, Wiesman said. North Carolina Health News previously reported on how wastewater works as an early detection tool.
It’s not just up to individuals to remain vigilant, Wiesman said, but also governments.
“We need to make sure that our public health systems have the resources they need to track these variants and viruses,” Wiesman said.
A key part of that vigilance is for Congress to pass the supplemental pandemic funding that has been stalled in Washington. Biden asked Congress for $22.5 billion in his National COVID-19 Preparedness Plan, but so far that package has received pushback on both sides of the aisle.
Gov. Cooper, DHHS’s Kinsley and other North Carolina officials urged the importance of continued federal aid at a press conference on Thursday, North Carolina Health News previously reported.
“I am most concerned about our supply of testing in the private markets and the unique ability of the federal government to maintain those levels of supply by pushing and propping up that market,” Kinsley said Thursday. “So I hope we will see that funding come. We need it to stay prepared. It’s not the time to take a step back.”
Federal funding would help provide for some of the newer tools to fight against COVID, including the new antiviral medication Paxlovid, which has been shown to dramatically reduce the risk of hospitalization if taken early in a COVID infection and the long-acting antibody combination, Evusheld, which can be used for pre-exposure prevention against COVID. For months, supplies had been limited, but now doses of the drug are sitting on pharmacy shelves and in federal stockpiles.
There are things that individuals can do to prepare for whatever curveball COVID might throw next.
Taking action now
Wiesman encouraged taking this time to get vaccinated or boosted if you have not yet.
It’s also a good time to have some rapid tests at home. President Joe Biden announced earlier this month that people can order four more free rapid tests after rolling out the initial program in January. Insurers are now required to reimburse for the purchase of as many as eight rapid tests per month.
Especially as pollen season starts in North Carolina, using a rapid test can help determine if that runny nose is the result of the yellow stuff floating in the air or if you have a runny nose because you’ve caught COVID. Rapid tests are especially important if you want to spend time indoors or in close proximity to someone who is at risk of a bad outcome if they catch the virus.
You can also take action to help yourself and others by having a mask handy, Holland said.
“The places that I still wear a mask are the places where I don’t really know the vaccination status of the people around me,” Holland said. “Like going in the grocery store. Or in stores. I still mask up for that whether it’s required or not.”
Just because mask guidelines have loosened up for now does not mean that masks don’t work, Holland said. A well-fitting mask — such as an N95 or a KN 94 — helps to reduce transmission of the coronavirus.
In some cities in Europe, such as Madrid, Spain, the use of facemasks is mandatory for individuals both indoors and outdoors where distancing can not be maintained.
People wear masks when walking outside, on the subway, in classrooms, at work and sometimes even in cars. COVID testing sites are also widely available, and pharmacies carry take-home tests that cost the equivalent of about $6 to $8.
Though the vaccination rate has hit 85 percent in Spain, with 87 percent of people having at least one dose, lawmakers are still enforcing safety measures, and individuals are still taking precautions to ensure health and safety.
If cases start to pick up again in the U.S. like they are in Europe, Holland said it would make sense to mask up again and limit travel and interactions.
“We are still in an uncertain time,” Wiesman said. ”Just be aware of that.”
This article was updated to clarify that Gov. Cooper encouraged schools to lift their mask mandates.
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The first thing Barbara Fedders does when she meets clients with juvenile delinquency cases is read their police reports to them.
“I just read it to them because I do not think that they can read it,” said Fedders, director of the Youth Justice Clinic based out of the University of North Carolina at Chapel Hill School of Law. “Well over half of them really struggle.”
Throughout her career, Fedders has seen how reading disability and incarceration are intertwined. It doesn’t end in the juvenile justice system either — a study from 2000 of incarcerated people in Texas prisons found that approximately 80 percent of Texas prisoners were functionally illiterate.
Perpetually behind in their reading, these children experience frustration and embarrassment at being left behind. They act out, either out of frustration or because they’re trying to deflect people from finding out their secret. As they move from one grade to another, they fall further behind, falling through the cracks in the education system, and all too frequently ending up in the juvenile justice system. By the time they meet Fedders, they’ve spent years in school without learning anything because they can’t read, and they’re angry.
“If you fail school all the time, you internalize certain things about yourself that often show up in behaviors,” Fedders said. “And then there are also other kinds of things that are not reading disabilities, like ADHD, people who are on the autism spectrum, etc. That can manifest in behaviors and schools.”
It was impossible for Fedders to ignore the connection between delinquency cases and education. Despite the dropoff in juvenile delinquency referrals caused by the COVID-19 pandemic closing school doors for months, systemic problems still exist for children who can’t read.
Shining a light on reading disparities
Reading disabilities often go unchecked throughout North Carolina’s education system until it’s too late. Amanda Harrison knows how easy it is for a child with learning disabilities to fall through the cracks of the system — because her son almost did.
She advocated for her son, Jay, to get tested for dyslexia and get the help he needed, but the process was expensive and cumbersome. Now she advocates for other children who may not have the same resources as her son to get the help they need as well as a co-founder of Literacy Moms NC.
“I think COVID actually just shone a light on the disparities,” Harrison said. “And people became more aware of what was actually happening in the classroom. But it definitely was bad prior to COVID.
“Now that there’s more awareness around what is actually going on, it is shocking.”
Through Virginia Fogg’s work advocating for children with disabilities at Disability Rights North Carolina, it is not uncommon for her to get the school records of a 12- or 13-year-old who has a record of periodic suspensions from school only to find that child is reading on a kindergarten or first-grade level.
It no surprise to Fogg to learn that the child is acting out.
“If you can’t write by the time you get to middle school, all you want to do is not look different,” Fogg said. “All you want to do is not stick out. Whether you have a disability, you don’t have disability, that’s just human nature.”
North Carolina Health News analyzed 2020-2021 data from the North Carolina Department of Public Instruction (NC DPI) and found that more than 85 percent of students with learning disabilities across the state in grades four through eight failed their reading exams compared to about 50 percent of students without disabilities.
The reading disparities also run along racial lines. About 70 percent of Black students in grades four through eight across the state were found to be not proficient in their end -of-grade reading exams, compared to about 40 percent of white students.
Often, Fogg meets clients to go over their juvenile justice complaint and realizes they can barely read. Often, they have not even been identified as having a reading disability, she said.
Instead of getting the help they needed, they got a criminal complaint.
‘Drip, drip, drip of shame’
Not being able to read isn’t just embarrassing for children, it can be traumatic.
One study from the United Kingdom found that almost two-thirds of a sample of dyslexic adults suffered pos-traumatic stress disorder (PTSD) symptoms relating to school.
Ginny Sharpless, co-founder of Literacy Moms NC, is dyslexic herself. She couldn’t read until she was in sixth grade, and she still remembers how “terrible” school was for her.
Children who can’t read feel ashamed, Sharpless said. That shame and frustration is pervasive. Sharpless’ daughter is also dyslexic and struggled to read. When Sharpless’ daughter was just 5 years old, Sharpless found her daughter picking at her skin.
“I’m picking myself apart,” she said at the time. “I’m picking myself apart, so I’m not here anymore.”
Jennifer Delano-Gemzik, a former administrator and educator in eastern North Carolina and a state-certified trainer for Reading Research to Classroom Practice, said kids struggling in school as early as third grade have told her they plan to drop out.
“They think that they are dumb and that they can’t do it,” Delano-Gemzik said, “and so they already know and are planning to drop out.”
“It’s a constant drip, drip, drip of shame.”
School is so humiliating for children with reading disabilities, Sharpless said, that it’s no surprise to her that some children end up in the juvenile justice system.
In addition to being correlated with incarceration, research has found illiteracy impacts health outcomes as well, since patients who can’t read often have a hard time obtaining and understanding basic medical information.
Into the justice system
The connection between reading disabilities and the justice system is not limited to the United States either. Much of the literature on reading disabilities, such as dyslexia and incarceration, come from countries such as Sweden, the United Kingdom or Israel.
Even countries that have lower rates of mass incarceration than the U.S., such as Italy, see reading difficulties as a common theme among incarcerated children, said Michele Miravalle, a researcher at the Università degli Studi di Torino in Turin, Italy.
Miravalle has worked with students inside multiple Italian juvenile prisons as a prison observer for Associazione Antigone, a non-governmental organization that raises awareness about the Italian penal system. Many of the children he meets are 17 or 18 years old and didn’t even finish primary school, he said.
“They are just able to read or to write their name,” Miravalle said.
Back in North Carolina, Delano-Gemzik has worked with kids involved in the juvenile justice system starting as early as elementary school. They’re struggling, and the struggles that they have in school can translate also to their behavior outside of the building.
“They feel dumb,” Delano-Gemzik said. “They feel frustrated, and they’re using that behavior outside of school to win some type of power and self-definition.”
When their frustration and anger causes children to commit crimes, they wind up at Fedders’ desk.
She will read their police report to them and try to help them with their case while wishing it didn’t get to this point, wishing that society cared more about these children who were left behind before they became labeled as criminals, as “delinquent.”
The “When kids’ cries for help become crimes” series is part of a data fellowship with the USC Annenberg Center for Health Journalism. Help us cover health news across North Carolina through our partnership with Report For America. Contribute now to help fund reporting on gender health as well as prison health.
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The North Carolina attorney general’s office had “great concerns about how HCA was selected” as the purchaser of the Mission Health System, including that “the deck had been stacked in its favor from the beginning” by then-CEO Ronald A. Paulus and his advisor Philip D. Green, according to a 2018 internal document obtained by Asheville Watchdog.
“[W]ith no outside advice other than Phil Green,” whom the investigators wrote had an undisclosed “prior business relationship with HCA,” Mission Health’s board of directors decided not to issue requests for competitive bids or to hold an auction before agreeing to sell Asheville’s flagship hospital system to HCA Healthcare for $1.5 billion, according to the document, prepared in advance of a meeting between Department of Justice lawyers and HCA representatives on Oct. 30, 2018.
Instead, as Paulus “coached HCA behind the scenes on how to best present its case to the Mission Board,” the board invited only one other healthcare company — identified in other documents as Novant Health of Winston-Salem — to present a formal offer.
“In the end,” the document stated, “an outside observer could conclude that HCA rose to the top among a limited number of bidders because the deck had been stacked in its favor from the beginning by Dr. Paulus and Mr. Green.”
The attorney general’s office was so concerned about potential conflicts of interest by Paulus and Green that it requested the Mission board revote on the transaction, the attorney general’s deputy chief of staff, Laura Brewer, wrote to Asheville Watchdog this week. After considering the information, the Mission board voted again, unanimously, to approve it.
Paulus did not respond to Asheville Watchdog’s requests for comment. Green declined an interview request but noted that the attorney general, after an extensive review, did not object to the sale.
Only HCA, Novant, and Atrium Considered
The Oct. 30 document, written by Special Deputy Attorney General Jennifer T. Harrod, who led the North Carolina Department of Justice investigation, was among more than 6,000 records released Feb. 25 by the office of Attorney General Josh Stein in partial response to public records requests filed by Asheville Watchdog over the past two years.
The documents contain details not previously made public about the sale of the 133-year-old nonprofit hospital system, including that, other than HCA and Novant, Carolinas HealthCare System (now Atrium Health) was the only other healthcare company that the Mission board seriously considered. But Carolinas was rejected quickly and not even invited to make a presentation to the board, the records show.
The documents confirm and expand on Asheville Watchdog’s previous reporting on the role played by Paulus and Green. They show Green negotiated proposed term sheets — nonbinding proposals — for both a $1.5 billion sale of substantially all of Mission’s assets to HCA and for a $650 million joint venture with HCA that would have preserved some local control. HCA provided Paulus with a written affiliation proposal on Aug. 12, 2017, six weeks before the Mission board authorized Paulus to engage in calls and meetings with potential affiliation partners.
Overall, the newly released documents raise serious questions about the role of Paulus, Mission’s president and CEO; his longtime personal friend and advisor Green; and the 18-member Mission board of directors, which investigators said seems to have accepted HCA’s arguments about cost-savings and improved quality of care “uncritically.”
Paulus’s emails examined
Under state law, the attorney general has the right to review any transaction in which a nonprofit corporation sells substantially all of its assets. The investigation of the proposed Mission deal began in May 2018.
By October 2018, Harrod and other lawyers in the attorney general’s office had examined thousands of documents related to Mission’s decision to sell, including Paulus’s and Green’s email exchanges with HCA and other potential partners, and minutes of Mission board meetings.
On the afternoon of Oct. 30, 2018, Harrod, at least two other lawyers with the North Carolina Department of Justice, and four representatives of HCA met at the attorney general’s office in Raleigh. No one from Mission attended,the records show.
“We see that HCA’s purchase of Mission brings something new and dynamic to the region,” Harrod wrote in an opening statement. She said the Department of Justice investigators had met the previous week with the chairman and vice-chairman of Mission’s board, who talked “about how much HCA’s efficiency, commitment to patient care, and sophisticated data analytics impressed them.”
“At the same time,” she continued, “we have great concerns about how HCA was selected to be the entity that purchased Mission.”
“Here are the facts as we currently understand them,” Harrod wrote:
Paulus and Green “steered the process by which other bidders were identified. Mission decided, with no outside advice other than Phil Green, not to put out a request for bids or hold an auction.”
Green had “a prior business relationship with HCA” that “was never disclosed to the Mission board.”
When Mission’s board members visited HCA headquarters, “Dr. Paulus and Mr. Green both thought it was critically important for Mr. Green to attend that meeting to ensure its success.”
“Dr. Paulus coached HCA behind the scenes on how to best present its case to the Mission Board. On two occasions, he pointedly told HCA that Mission’s peers were and would favorably consider being acquired by HCA.”
Paulus discussed his continued role with potential buyers. One wanted him to be chief information officer. “Later, that partner was dropped from consideration on grounds that appear pretextual to us … Reading his email exchanges with HCA, an outside observer could conclude that he was working hard to demonstrate his value to HCA,” the memo states. (Just days after the Mission sale closed, Paulus announced he was joining HCA as a strategic advisor. Tax records show Paulus received more than $4 million for his final four months at Mission. The terms of his employment agreement with Mission and hisconsulting job with HCA remain unknown. A spokeswoman for HCA’s North Carolina Division said Paulus is no longer a strategic advisor to HCA.)
“Neither the board nor its advisors seems to have given any thought to the fact that certain transaction partners offered Dr. Paulus greater scope for advancement versus others or versus no transaction at all,” Harrod wrote.
“In our opinion, Dr. Paulus’s conduct violated the Mission conflict of interest policy, which requires an officer or board member with even a potential conflict to not merely recuse himself from voting on the matter, but also from advocating for an outcome. Dr. Paulus offered to recuse himself, but was advised that it was unnecessary. The rationale was that since all of the potential partners wanted Dr. Paulus to continue in some capacity, therefore he had no conflict of interest.”
“Just have to trust HCA”
Harrod had already expressed concerns to Mission that the terms outlined in the Letter of Intent (LOI) negotiated by Paulus and Green did not go far enough in protecting the public’s interests.
“Given Mission Health’s strong operating and financial position, we believe Mission should be well positioned to negotiate for strong terms to protect public health interests, as has been done in other similar transactions,” she wrote to Mission officials on Aug. 8, 2018.
Philip D. Green, Mission’s strategic advisor
Instead, on Aug. 30, 2018, HCA and Mission signed an official contract, called the asset purchase agreement (APA), on terms the attorney general’s office believed favored HCA.
“Dr. Paulus and Mr. Green were principal negotiators of the APA,” Harrod wrote in her memo in advance of the Oct. 30, 2018 meeting. “It appears to us comparing the terms of the LOI to the terms of the APA, HCA improved its position considerably.”
“One of the major inducements for Mission to enter the LOI with HCA was thepromise that hospitals and services would be maintained,” Harrod wrote. “We and others advised Mission prior to signing the APA, that such commitments needed to be specific and measurable in order to be enforceable.”
“The emails we have seen demonstrate that Dr. Paulus ultimately buckled in the face of resistance from HCA and decided that Mission would just have to trust HCA,” she wrote.
Harrod wrote, “Even now, the board believes that HCA has committed to maintaining the current level of services … even though the APA says no such thing.” For example, the agreement allowed HCA to eliminate some services and close facilities if they became “commercially unreasonable,” documents show.
Harrod also wrote that “Mission agreed to let HCA use its existing charity care policy, even though it appears to us that for most patients, they would be much better off under Mission’s policy.” Weeks earlier, lawyers for both HCA and Mission had written to Harrod that HCA’s charity care policies were “more generous in most respects” than Mission’s policies.
HCA’s $188 Million Settlement
In January 2017, six months before beginning discussions with Paulus and Green, HCA agreed to pay $188 million to settle litigation over its failure to abide by the terms of its purchase of nonprofit Health Midwest hospitals in the Kansas City area, a transaction similar to its later deal with Mission Health.
In a letter Sept. 10, 2018, Harrod asked Mission senior vice president Donald R. Esposito to “[d]etail the assurances Mission has received that HCA will honor its contractual obligations, in light of its failures to do so in connection with its acquisition of Health Midwest.”
In her document for the Oct. 30, 2018 meeting, Harrod stated: “Despite the experiences of the health care foundation in Missouri, Mission agreed to dispute resolution terms that overwhelmingly favor HCA.”
“These are examples, not an exclusive list,” Harrod concluded.
“The best possible deal”
The attorney general’s investigation intensified over the next two months and included ensuring that Mission’s board knew about Green’s prior business relationship with HCA.
“We requested that the board be fully informed of this relationship and then take another vote on the deal,” Brewer, the deputy chief of staff, told Asheville Watchdog this week. “We also ensured that Mr. Green would not receive any compensation dependent on closing of the transaction, including any ‘bonus’ or ‘success fee,’ and that neither he nor his company would otherwise benefit from the transaction.”
The Mission board held special sessions Dec. 13 and Dec. 20, 2018, and Jan. 8, 2019, to discuss final details of the pending deal, including the findings of Harrod’s investigation.
In the end, Mission Board chairman John R. Ball wrote, in a letter to Stein after the Jan. 8 meeting, that the board considered the attorney general’s concerns and “concluded that Mission’s management team and its outside advisors were committed at all times to securing for Mission the best possible transaction with potential merger partners, ultimately leading to the transaction with HCA.”
“No member of Mission’s management or its advisors took any action, or failed to take any action, that was detrimental to Mission’s interests,” Ball wrote.
The Mission board, Ball wrote, “believes it has been, and remains fully informed with respect to all these issues,” and was “steadfast” in its goal to close the sale to HCA. The board’s re-votewas once again unanimous.
Ball could not be reached for comment.
Letter of Non-Objection
In an August 2021 interview with Asheville Watchdog, Stein said state law limited his authority to halt the sale despite the information uncovered by his investigation. Because of the law’s restrictions, Stein said, he sought specific enforceable agreements, a number of concessions from HCA, and 15 additional conditions to be added to a revised asset purchase agreement.
NC Attorney General Josh Stein
Stein’s conditions included the hiring of an independent monitor to oversee HCA’s compliance with the agreement; enforceable commitments to maintain current levels of service at all six hospitals in the Mission system, not for the five years Paulus and Green negotiated in some cases, but for 10 years; and requiring HCA to adopt what he viewed as Mission’s more generous charity care obligations.
Stein also got HCA and Mission to agree that the attorney general could enforce the terms of the contract.
On Jan. 16, 2019, Mission and HCA agreed to the attorney general’s changes and signed an“amended and restated”asset purchase agreement. Harrod then informed them that the attorney general would not object to the sale.
Green: “Concerns were baseless”
Green declined to speak with Asheville Watchdog but emailed a statement. “The Attorney General, after reviewing thousands of pages of documents and conducting an inquiry into ensuring a fair process and the absence of any conflict of interest, concluded that any concerns were baseless and wrote a Non-Objection letter,” he wrote.
The letter of non-objection, written by Harrod, actually said the Attorney General’s investigation had identified “potential concerns.” But, it said, “Mission Health has represented to the Attorney General that … no one on Mission’s board and no one responsible for advising Mission’s board will receive any direct or indirect benefit as a result of the sale of the operating assets of the Mission Nonprofit Entities to HCA.”
Green is still listed as an independent advisor for large healthcare mergers and acquisitions and has a consulting company based in Arlington, Virginia. Paulus is still a principal of RAPMD Strategic Advisors, based in Asheville.
Update From Stein’s Office
Harrod, who led the investigation into the Mission-HCA sale, is no longer with the Attorney General’s office. She declined to comment for this story.
In a statement to Asheville Watchdog last week, Brewer, Stein’s deputy chief of staff, wrote, “Under North Carolina law (unlike in many other states), the Attorney General’s authority in these kinds of deals is quite limited” to ensuring a fair purchase price and “that the charitable mission of the non-profit is being carried forward.”
“North Carolina law does not give our Office the general authority to police health care transactions based on how they would impact patients, quality of care, rural access, and other issues,” Brewer wrote. “Even though the Attorney General’s legal authority over this type of transaction is quite limited, we succeeded in negotiating a number of significant improvements to the agreement.”
“Paying More and Getting Less Care”
HCA officially took control of the Mission system on Feb. 1, 2019.
Novant,the lone other bidder that Mission’s board rejected in favor of HCA’s $1.5 billion offer, went on to sign a $5 billion deal, including $2 billion in cash, to acquire a smaller and less profitable hospital in Wilmington.
The Attorney General’s office denied Asheville Watchdog’s request for a comparison of Novant’s and HCA’s offers for Mission, citing state statutes that exempt confidential business information from public records requests.
Ashton W. Miller, Novant’s manager of public relations, declined to comment.
In the statement she prepared for the Oct. 30, 2018 meeting with HCA representatives, Harrod wrote: “We understand that HCA plans to do further acquisitions in North Carolina. This may not be the last time we are across the table from each other.”
Last week, when Asheville Watchdog asked what lessons were learned from the Mission sale, Attorney General Stein responded:
“Too often, when one hospital swallows up another, patients end up paying more and getting worse care. North Carolinians need better safeguards to review transactions to put the patients’ interest first. I’m working with partners in the legislature now to determine how our laws can better protect patients in these health care transactions.”
Asheville Watchdog is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Peter H. Lewis is a former senior writer and editor at The New York Times. Email [email protected]. Sally Kestin is a Pulitzer Prize-winning investigative reporter. Email [email protected].
Asheville Watchdog gratefully acknowledges the assistance of the Duke University School of Law’s First Amendment Clinic, with special thanks to Danielle Siegel, Alexandria Murphy, Ben Rossi, and Dillon Farnetti.
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by Asheville Watchdog, North Carolina Health News March 20, 2022
<p>The North Carolina attorney general’s office had “great concerns about how HCA was selected” as the purchaser of the Mission Health System, including that “the deck had been stacked in its favor from the beginning” by then-CEO Ronald A. Paulus and his advisor Philip D. Green, according to a 2018 internal document obtained by <em>Asheville Watchdog</em>.</p>
<p>“[W]ith no outside advice other than Phil Green<strong>,”</strong> whom the investigators wrote had an undisclosed “prior business relationship with HCA,” Mission Health’s board of directors decided not to issue requests for competitive bids or to hold an auction before agreeing to sell Asheville’s flagship hospital system to HCA Healthcare for $1.5 billion, according to the document, prepared in advance of a meeting between Department of Justice lawyers and HCA representatives on Oct. 30, 2018.</p>
<p>Instead, as Paulus “coached HCA behind the scenes on how to best present its case to the Mission Board,” the board invited only one other healthcare company — identified in other documents as Novant Health of Winston-Salem — to present a formal offer. </p>
<p>“In the end,” <a href=”https://www.scribd.com/document/561957950/Attorney-General-Meeting-10-30-18″ target=”_blank” rel=”noreferrer noopener”>the document stated</a>, “an outside observer could conclude that HCA rose to the top among a limited number of bidders because the deck had been stacked in its favor from the beginning by Dr. Paulus and Mr. Green.”</p>
<p>The attorney general’s office was so concerned about potential conflicts of interest by Paulus and Green that it requested the Mission board revote on the transaction, the attorney general’s deputy chief of staff, Laura Brewer, wrote to <em>Asheville Watchdog</em> this week. After considering the information, the Mission board voted again, unanimously, to approve it.</p>
<p>Paulus did not respond to <em>Asheville Watchdog’s</em> requests for comment. Green declined an interview request but noted that the attorney general, after an extensive review, did not object to the sale. </p>
<h4 id=”h-only-hca-novant-and-atrium-considered”>Only HCA, Novant, and Atrium Considered</h4>
<p>The Oct. 30 document, written by Special Deputy Attorney General Jennifer T. Harrod, who led the North Carolina Department of Justice investigation, was among more than 6,000 records released Feb. 25 by the office of Attorney General Josh Stein in partial response to public records requests filed by <em>Asheville Watchdog</em> over the past two years. </p>
<p>The documents contain details not previously made public about the sale of the 133-year-old nonprofit hospital system, including that, other than HCA and Novant, <a href=”https://www.scribd.com/document/563194186/HCA-007144-Who-bid-against-HCA”>Carolinas HealthCare System</a> (now Atrium Health) was the only other healthcare company that the Mission board seriously considered. But Carolinas was rejected quickly and not even invited to make a presentation to the board, the records show.</p>
<p>The documents confirm and expand on <em>Asheville Watchdog’s</em><a href=”https://avlwatchdog.org/a-done-deal-how-mission-health-wooed-hca/”> previous reporting</a> on the role played by Paulus and Green. They show Green <a href=”https://www.scribd.com/document/480241477/Mission-Health-Fairness-Opinion-Presentation-to-NCDOJ-Redacted”>negotiated proposed term sheets</a> — nonbinding proposals — for both a $1.5 billion sale of substantially all of Mission’s assets to HCA and for a $650 million joint venture with HCA that would have preserved some local control. HCA provided Paulus with a written affiliation proposal on Aug. 12, 2017, six weeks before the Mission board authorized Paulus to engage in calls and meetings with potential affiliation partners.</p>
<p>Overall, the newly released documents raise serious questions about the role of Paulus, Mission’s president and CEO; his longtime personal friend and advisor Green; and the 18-member Mission board of directors, which investigators said seems to have accepted HCA’s arguments about cost-savings and improved quality of care “uncritically.” </p>
<h4 id=”h-paulus-s-emails-examined”>Paulus’s emails examined</h4>
<p>Under state law, the attorney general has the right to review any transaction in which a nonprofit corporation sells substantially all of its assets. The investigation of the proposed Mission deal began in May 2018. </p>
<p>By October 2018, Harrod and other lawyers in the attorney general’s office had examined thousands of documents related to Mission’s decision to sell, including Paulus’s and Green’s email exchanges with HCA and other potential partners, and minutes of Mission board meetings. </p>
<p>On the afternoon of Oct. 30, 2018, Harrod, at least two other lawyers with the North Carolina Department of Justice, and four representatives of HCA met at the attorney general’s office in Raleigh. No one from Mission attended<strong>,</strong> <a href=”https://www.scribd.com/document/564671203/HCA-009429-NC-DOJ-meeting-with-HCA-Healthcare-10-30-2018″>the records show</a>.</p>
<p>“We see that HCA’s purchase of Mission brings something new and dynamic to the region,” Harrod wrote in <a href=”https://www.scribd.com/document/561957950/Attorney-General-Meeting-10-30-18″>an opening statement</a>. She said the Department of Justice investigators had met the previous week with the chairman and vice-chairman of Mission’s board, who talked “about how much HCA’s efficiency, commitment to patient care, and sophisticated data analytics impressed them.” </p>
<p>“At the same time,” she continued, “we have great concerns about how HCA was selected to be the entity that purchased Mission.”</p>
<p>“Here are the facts as we currently understand them,” Harrod wrote:</p>
<ul>
<li>Paulus and Green “steered the process by which other bidders were identified. Mission decided, with no outside advice other than Phil Green, not to put out a request for bids or hold an auction.”</li>
<li>Green had “a prior business relationship with HCA” that “was never disclosed to the Mission board.”</li>
<li>When Mission’s board members visited HCA headquarters, “Dr. Paulus and Mr. Green both thought it was critically important for Mr. Green to attend that meeting to ensure its success.” </li>
<li>“Dr. Paulus coached HCA behind the scenes on how to best present its case to the Mission Board. On two occasions, he pointedly told HCA that Mission’s peers were and would favorably consider being acquired by HCA.”</li>
<li>Paulus discussed his continued role with potential buyers. One wanted him to be chief information officer. “Later, that partner was dropped from consideration on grounds that appear pretextual to us … Reading his email exchanges with HCA, an outside observer could conclude that he was working hard to demonstrate his value to HCA,” the memo states. (Just days after the Mission sale closed, Paulus announced he was joining HCA as a strategic advisor.<a href=”https://avlwatchdog.org/nonprofit-mission-made-lots-of-profits-especially-for-bosses/”> Tax records show</a> Paulus received <a href=”https://www.scribd.com/document/564647670/Dog-Mission-2018-IRS-990″>more than $4 million</a> for his final four months at Mission. The terms of his employment agreement with Mission and hisconsulting job with HCA remain unknown. A spokeswoman for HCA’s North Carolina Division said Paulus is no longer a strategic advisor to HCA.)</li>
<li> “Neither the board nor its advisors seems to have given any thought to the fact that certain transaction partners offered Dr. Paulus greater scope for advancement versus others or versus no transaction at all,” Harrod wrote. </li>
<li> “In our opinion, Dr. Paulus’s conduct violated the Mission conflict of interest policy, which requires an officer or board member with even a potential conflict to not merely recuse himself from voting on the matter, but also from advocating for an outcome. Dr. Paulus offered to recuse himself, but was advised that it was unnecessary. The rationale was that since all of the potential partners wanted Dr. Paulus to continue in some capacity, therefore he had no conflict of interest.” </li>
</ul>
<h4 id=”h-just-have-to-trust-hca”>“Just have to trust HCA”</h4>
<p>Harrod had already expressed concerns to Mission that the terms outlined in the Letter of Intent (LOI) negotiated by Paulus and Green did not go far enough in protecting the public’s interests. </p>
<p>“Given Mission Health’s strong operating and financial position, we believe Mission should be well positioned to negotiate for strong terms to protect public health interests, as has been done in other similar transactions,” she <a href=”https://www.scribd.com/document/563503255/HCA-001598″>wrote to Mission officials</a> on Aug. 8, 2018.</p>
<div class=”wp-block-image”>
<figure class=”alignleft”><img src=”https://lh6.googleusercontent.com/TrOkdVbUrI1OUjDzHNy3VyvYFRqOD_g_vcOoG89w5Pl-rppJIjATRQ7a5cYRa2pyEoiYnJxYyHN2qbK_XbmQc3Gmakzhe46TtSvS98FhvSuM5YdF-DppF6QbuRGGBejOrgh0MJV1″ alt=”” /><figcaption><strong>Philip D. Green, Mission’s strategic advisor</strong></figcaption></figure>
</div>
<p>Instead, on Aug. 30, 2018, HCA and Mission signed an official contract, called the asset purchase agreement (APA), on terms the attorney general’s office believed favored HCA. </p>
<p>“Dr. Paulus and Mr. Green were principal negotiators of the APA,” Harrod wrote in her memo in advance of the Oct. 30, 2018 meeting. “It appears to us comparing the terms of the LOI to the terms of the APA, HCA improved its position considerably.”</p>
<p>“One of the major inducements for Mission to enter the LOI with HCA was thepromise that hospitals and services would be maintained,” Harrod wrote. “We and others advised Mission prior to signing the APA, that such commitments needed to be specific and measurable in order to be enforceable.” </p>
<p>“The emails we have seen demonstrate that Dr. Paulus ultimately buckled in the face of resistance from HCA and decided that Mission would just have to trust HCA,” she wrote. </p>
<p>Harrod wrote, “Even now, the board believes that HCA has committed to maintaining the current level of services … even though the APA says no such thing.” For example, the agreement allowed HCA to eliminate some services and close facilities if they became <a href=”https://www.scribd.com/document/563277779/HCA-006986-Mission-HCA-Asset-Purchase-Agreement”>“commercially unreasonable,”</a> documents show.</p>
<p>Harrod also wrote that “Mission agreed to let HCA use its existing charity care policy, even though it appears to us that for most patients, they would be much better off under Mission’s policy.” Weeks earlier, lawyers for both HCA and Mission had written to Harrod that HCA’s charity care policies were “more generous in most respects” than Mission’s policies.</p>
<h4 id=”h-hca-s-188-million-settlement”>HCA’s $188 Million Settlement</h4>
<p>In January 2017, six months before beginning discussions with Paulus and Green, HCA agreed to pay $188 million to settle <a href=”https://caselaw.findlaw.com/mo-court-of-appeals/1765847.html”>litigation</a> over its failure to abide by the terms of its purchase of nonprofit Health Midwest hospitals in the Kansas City area, a transaction similar to its later deal with Mission Health. </p>
<p><a href=”https://www.scribd.com/document/563249268/HCA-008156-Inquiry-on-HCA-Health-Midwest-deal”>In a letter</a> Sept. 10, 2018, Harrod asked Mission senior vice president Donald R. Esposito to “[d]etail the assurances Mission has received that HCA will honor its contractual obligations, in light of its failures to do so in connection with its acquisition of Health Midwest.”</p>
<p>In her document for the Oct. 30, 2018 meeting, Harrod stated: “Despite the experiences of the health care foundation in Missouri, Mission agreed to dispute resolution terms that overwhelmingly favor HCA.” </p>
<p>“These are examples, not an exclusive list,” Harrod concluded.</p>
<h4 id=”h-the-best-possible-deal”>“The best possible deal” </h4>
<p>The attorney general’s investigation intensified over the next two months and included ensuring that Mission’s board knew about Green’s prior business relationship with HCA.</p>
<p>“We requested that the board be fully informed of this relationship and then take another vote on the deal,” Brewer, the deputy chief of staff, told <em>Asheville Watchdog</em> this week. “We also ensured that Mr. Green would not receive any compensation dependent on closing of the transaction, including any ‘bonus’ or ‘success fee,’ and that neither he nor his company would otherwise benefit from the transaction.” </p>
<p>The Mission board held special sessions Dec. 13 and Dec. 20, 2018, and Jan. 8, 2019, to discuss final details of the pending deal, including the findings of Harrod’s investigation. </p>
<p>In the end, Mission Board chairman John R. Ball wrote, in a <a href=”https://www.scribd.com/document/563183075/HCA-003176″>letter to Stein</a> after the Jan. 8 meeting, that the board considered the attorney general’s concerns and “concluded that Mission’s management team and its outside advisors were committed at all times to securing for Mission the best possible transaction with potential merger partners, ultimately leading to the transaction with HCA.”</p>
<p>“No member of Mission’s management or its advisors took any action, or failed to take any action, that was detrimental to Mission’s interests,” Ball wrote.</p>
<p>The Mission board, Ball wrote, “believes it has been, and remains fully informed with respect to all these issues,” and was “steadfast” in its goal to close the sale to HCA. The board’s re-votewas once again unanimous.</p>
<p>Ball could not be reached for comment.</p>
<h4 id=”h-letter-of-non-objection”>Letter of Non-Objection</h4>
<p>In an August 2021 interview with <em>Asheville Watchdog</em>, Stein said state law limited his authority to halt the sale despite the information uncovered by his investigation. Because of the law’s restrictions, Stein said, he sought specific enforceable agreements, <a href=”https://www.scribd.com/document/563629618/Comparison-of-Key-Terms-Before-and-After-Attorney-General”>a number of concessions</a> from HCA, and 15 additional conditions to be added to a revised asset purchase agreement. </p>
<div class=”wp-block-image”>
<figure class=”alignright is-resized”><img src=”https://avlwatchdog.org/wp-content/uploads/2021/11/IMG_6330-737×1024.jpeg” alt=”” class=”wp-image-17697″ width=”369″ height=”512″ /><figcaption>NC Attorney General Josh Stein</figcaption></figure>
</div>
<p>Stein’s conditions included the hiring of an independent monitor to oversee HCA’s compliance with the agreement; enforceable commitments to maintain current levels of service at all six hospitals in the Mission system, not for the five years Paulus and Green negotiated in some cases, but for 10 years; and requiring HCA to adopt what he viewed as Mission’s more generous charity care obligations. </p>
<p>Stein also got HCA and Mission to agree that the attorney general could enforce the terms of the contract.</p>
<p>On Jan. 16, 2019, Mission and HCA agreed to the attorney general’s changes and signed an<a href=”https://www.scribd.com/document/564608230/Amended-and-Restated-Mission-HCA-asset-purchase-agreement”>“amended and restated”</a>asset purchase agreement. Harrod then informed them that the attorney general would not object to the sale. </p>
<h4 id=”h-green-concerns-were-baseless”>Green: “Concerns were baseless”</h4>
<p>Green declined to speak with <em>Asheville Watchdog</em> but emailed a statement. “The Attorney General, after reviewing thousands of pages of documents and conducting an inquiry into ensuring a fair process and the absence of any conflict of interest, concluded that any concerns were baseless and wrote a Non-Objection letter,” he wrote.</p>
<p>The <a href=”https://www.scribd.com/document/563190320/HCA-003332-Letter-of-Non-Objection”>letter of non-objection</a>, written by Harrod, actually said the Attorney General’s investigation had identified “potential concerns.” But, it said, “Mission Health has represented to the Attorney General that … no one on Mission’s board and no one responsible for advising Mission’s board will receive any direct or indirect benefit as a result of the sale of the operating assets of the Mission Nonprofit Entities to HCA.”</p>
<p>Green is still listed as an independent advisor for large healthcare mergers and acquisitions and has<a href=”https://cis.scc.virginia.gov/EntitySearch/BusinessInformation?businessId=531549&source=FromEntityResult&isSeries{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}20={fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}20false”> a consulting company</a> based in Arlington, Virginia. Paulus is still a principal of RAPMD Strategic Advisors, based in Asheville.</p>
<h4 id=”h-update-from-stein-s-office”>Update From Stein’s Office</h4>
<p>Harrod, who led the investigation into the Mission-HCA sale, is no longer with the Attorney General’s office. She declined to comment for this story. </p>
<p>In a statement to <em>Asheville Watchdog</em> last week, Brewer, Stein’s deputy chief of staff, wrote<strong>,</strong> “Under North Carolina law (unlike in many other states), the Attorney General’s authority in these kinds of deals is quite limited” to ensuring a fair purchase price and “that the charitable mission of the non-profit is being carried forward.” </p>
<p>“North Carolina law does not give our Office the general authority to police health care transactions based on how they would impact patients, quality of care, rural access, and other issues,” Brewer wrote. “Even though the Attorney General’s legal authority over this type of transaction is quite limited, we succeeded in negotiating a number of significant improvements to the agreement.”</p>
<h4 id=”h-paying-more-and-getting-less-care”>“Paying More and Getting Less Care”</h4>
<p>HCA officially took control of the Mission system on Feb. 1, 2019.</p>
<p>Novant,the lone other bidder that Mission’s board rejected in favor of HCA’s $1.5 billion offer, went on to sign <a href=”https://avlwatchdog.org/mission-sale-good-for-wnc-or-just-hca/”>a $5 billion deal</a>, including $2 billion in cash, to acquire a smaller and less profitable hospital in Wilmington.</p>
<p>The Attorney General’s office denied <em>Asheville Watchdog</em>’s request for a comparison of Novant’s and HCA’s offers for Mission, citing state statutes that exempt confidential business information from public records requests.</p>
<p>Ashton W. Miller, Novant’s manager of public relations, declined to comment.</p>
<p>In the statement she prepared for the Oct. 30, 2018 meeting with HCA representatives, Harrod wrote: “We understand that HCA plans to do further acquisitions in North Carolina. This may not be the last time we are across the table from each other.”</p>
<p>Last week, when <em>Asheville Watchdog</em> asked what lessons were learned from the Mission sale, Attorney General Stein responded: </p>
<p>“Too often, when one hospital swallows up another, patients end up paying more and getting worse care. North Carolinians need better safeguards to review transactions to put the patients’ interest first. I’m working with partners in the legislature now to determine how our laws can better protect patients in these health care transactions.”</p>
<p><a href=”https://avlwatchdog.org/”><em>Asheville Watchdog</em></a><em> is a nonprofit news team producing stories that matter to Asheville and Buncombe County. Peter H. Lewis is a former senior writer and editor at The New York Times. Email </em><a href=”https://www.northcarolinahealthnews.org/2022/03/20/hca-deal-was-rigged-ag-office-concerned/mailto:plewis@avlwatchog.org”><em>plewis@avlwatchog.org</em></a><em>. Sally Kestin is a Pulitzer Prize-winning investigative reporter. Email </em><a href=”https://www.northcarolinahealthnews.org/2022/03/20/hca-deal-was-rigged-ag-office-concerned/mailto:skestin@avlwatchdog.org”><em>skestin@avlwatchdog.org</em></a><em>.</em></p>
<p><em>Asheville Watchdog gratefully acknowledges the assistance of the Duke University School of Law’s First Amendment Clinic, with special thanks to Danielle Siegel, Alexandria Murphy, Ben Rossi, and Dillon Farnetti. </em> </p>
This <a target=”_blank” href=”https://www.northcarolinahealthnews.org/2022/03/20/hca-deal-was-rigged-ag-office-concerned/”>article</a> first appeared on <a target=”_blank” href=”https://www.northcarolinahealthnews.org”>North Carolina Health News</a> and is republished here under a Creative Commons license.<img src=”https://i0.wp.com/www.northcarolinahealthnews.org/wp-content/uploads/2021/10/cropped-favicon02.jpg?fit=150{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}2C150&ssl=1″ style=”width:1em;height:1em;margin-left:10px;”><img id=”republication-tracker-tool-source” src=”https://www.northcarolinahealthnews.org/?republication-pixel=true&post=38271&ga=UA-28368570-1″ style=”width:1px;height:1px;”>
Today’s early morning highlights from the major news organizations.
KHN:
It Was Already Hard To Find Evusheld, A Covid Prevention Therapy. Now It’s Even Harder
As immunocompromised people across the country work to get Evusheld, a potentially lifesaving covid therapy, several hundred providers of the injections were removed from a federal dataset on Wednesday night, making the therapy even harder to locate. White House officials had announced March 15 that a planned purchase of more doses would have to be scaled back without new federal funding. (Recht, 3/17)
KHN:
Sharing Covid Vax Facts Inside ICE Detention, One Detainee At A Time
The sounds of wailing ambulances, car horns, and bustling traffic filtered into the high-rise home office of Dr. Daniel Turner-Lloveras in downtown Los Angeles as he settled into a brown leather couch to take a call. On the other end of the line, staring at a mint-green wall inside a plexiglass phone booth with little privacy, sat Pedro Figueroa, 33, a detainee at the U.S. Immigration and Customs Enforcement Mesa Verde detention facility in Bakersfield, California. “Is it mandatory to get the booster?” Figueroa asked in Spanish. “And why do I need it?” (de Marco, 3/18)
KHN:
KHN’s ‘What The Health?’: We May Be Done With Covid, But Covid’s Not Done With Us
Logistics expert Jeff Zients, who has headed the White House covid-19 response team since the start of the Biden administration, is stepping down and will be replaced by popular public health expert Dr. Ashish Jha, who will take a leave from his post as dean of the School of Public Health at Brown University. Meanwhile, White House officials are scrambling to figure out how to get the funding they need to continue their covid control efforts now that the president has signed the big spending bill for the remainder of the federal fiscal year. (3/17)
Biotechnology company Moderna on Thursday asked the Food and Drug Administration to allow adults 18 and older to receive a second booster shot of the company’s mRNA vaccine amid concerns that immune protection from the vaccines wanes over time. Moderna’s application is substantially broader than what Pfizer and its German partner, BioNTech, sought earlier in the week — FDA authorization for a second booster shot for adults 65 and older. (Shepherd, 3/17)
Moderna said its request for emergency use authorization is based partly on recently published data from the U.S. and Israel following the emergence of the omicron variant. The company did not specify what the U.S. and Israeli data showed, but Israel approved a fourth COVID vaccine shot for vulnerable people over the age of 18 in January 2022. Additionally, a study of more than 1 million Israelis over 60 showed that those who got a fourth dose of the Pfizer-BioNTech vaccine were half as likely to become infected and four-times less likely to fall severely ill than those who had only three shots. That study has not been peer-reviewed. (Tebor, 3/17)
Four-dose efficacy of mRNA vaccines against symptomatic Omicron COVID-19 infection is modest, according to a research letter yesterday in the New England Journal of Medicine that described a small study in Israel. Of 1,050 eligible Israeli healthcare workers, 154 received a fourth dose of Pfizer and 120 received a fourth dose of Moderna. The researchers selected two age-matched controls from the remaining eligible participants for each person vaccinated. (3/17)
With the nation yearning for a new normal after its long struggle with the coronavirus, U.S. Health Secretary Xavier Becerra warned Thursday that vaccines, tests and treatments will be “stuck on the ground” unless Congress provides the additional funds the White House has demanded. “We have reached a pivot point,” Becerra said in an interview with The Associated Press. “How well we pivot is on us.” (Alonso-Zaldivar, 3/18)
Speaker Nancy Pelosi (D-Calif.) on Thursday said she’s advised the Biden administration to seek tens of billions of dollars more in emergency COVID-19 relief, suggesting it will take more than $40 billion to meet the testing, vaccine and therapeutic needs of the U.S. and the larger global community. President Biden had initially asked Congress for $22.5 billion in new funding to fight the ongoing pandemic — a figure that was whittled down to $15.6 billion in the face of Republican opposition on Capitol Hill. (Lillis, 3/17)
After two top Biden administration health officials pleaded with Democrats on Thursday to approve more coronavirus aid funding, Speaker Nancy Pelosi apologized to them in front of her caucus for having to ask at all. Pelosi told Health and Human Services Secretary Xavier Becerra and top infectious disease adviser Anthony Fauci she was sorry they needed to come before House members from the president’s own party to call for $15 billion to continue the U.S. fight against Covid, domestically and abroad. (Ferris, Levine and Cancryn, 3/17)
President Biden’s chief medical adviser Anthony Fauci said in an interview aired on Thursday that officials need more than the $22.5 billion that the White House originally requested from Congress for the COVID-19 response. In an interview aired on “NBC Nightly News,” NBC’s Miguel Almaguer noted to Fauci that the billions of dollars requested by the White House was a “hefty price tag,” asking if all the money was needed. “I have to tell you, we need more than that,” Fauci answered. Biden’s chief medical adviser said that officials needed adequate funding in order to study possible future variants. (Vakil, 3/17)
The U.S. could soon see Covid-19 cases rise again and vulnerable people are likely to need a fourth vaccine dose, one of President Joe Biden’s top health advisers warned as the White House calls for more money to fight the pandemic. Anthony Fauci, the longtime head of the National Institute of Allergy and Infectious Diseases and a Biden adviser, said U.K. officials are already warning him of an increase there driven by the BA.2 sub-variant, easing restrictions and waning protection from vaccines, and that the U.S. tends to be a few weeks behind case curves in the U.K. “We have all three of those factors right now in this country,” Fauci said in an interview Thursday. “I would predict that we are going to see a bit of an increase, or at least a flattening out and plateauing of the diminution of cases. And the question is how do we deal with that.” (Wingrove, 3/17)
When it comes to discussing the White House’s pandemic response on TV, there’s nobody as qualified as Ashish Jha. Whether he’s on “Sesame Street” or Fox News, the Brown University public health school dean is a pitch-perfect pandemic adviser: clear, affable, and panic-averse. But the scope of his next job — steering the sprawling federal pandemic response — has some experts wondering whether someone with so little experience in government, policy, or logistics can rise to the task. (Facher and Garde, 3/18)
The ability to spread more easily from person to person appears to be the superpower that is driving an upstart sibling of the Omicron variant into wide circulation, a group of scientists has surmised. That conclusion about the virus known as “stealth Omicron” is explained in a brief report published this week by the New England Journal of Medicine. It’s based on the team’s finding that the virus, whose official name is BA.2, is only slightly better than the dominant BA.1 at evading the protective effects of COVID-19 vaccines. Both of the Omicron “subvariants” have a common core of genetic mutations. But each has a few that the other doesn’t. For instance, BA.2 lacks a mutation belonging to other versions of Omicron that makes it easy to differentiate them from the Delta variant. (Hence the “stealth” moniker.) (Healy, 3/17)
A flurry of high-profile coronavirus cases in the nation’s capital — including in people who have been around President Biden — has raised new questions about the trajectory of the two-year-old pandemic, even as the White House has signaled confidence in the country’s ability to resume normal activities. On Thursday, Mr. Biden canceled face-to-face meetings with Prime Minister Micheal Martin of Ireland after the prime minister received a positive result from a coronavirus test during a gala event on Wednesday night that both men attended. (Shear, 3/17)
U.S. communities with limited internet access had higher COVID-19 mortality rates during the first full year of the pandemic, according to researchers. In a study published earlier this month in the journal JAMA Network Open, University of Chicago authors wrote that for places with more limited access between 2.4 and six deaths per 100,000 people could be prevented, depending on whether they were rural, suburban or urban. “Adopting an asset-based approach, we believe this finding suggests that more awareness is needed about the essential asset of technological access to reliable information, remote work, schooling opportunities, resource purchasing and/or social community. Populations with limited internet access remain understudied and are often excluded in pandemic research,” they noted. (Musto, 3/17)
Because omicron has shown the ability to cause breakthrough infections despite vaccination status, this has led to fears that everyone will catch the virus at some point. However, it is important to clarify that the COVID vaccines continue to be highly effective in its primary purpose in preventing hospitalization and death. However, public health experts said it’s not inevitable Americans who have not gotten COVID yet eventually will, and that there are several reasons people have been able to avoid infection so far, including certain behaviors such as being serious about masking and social distancing, vaccination rates and maybe even genetics. (Kekatos, 3/18)
SARS-CoV-2 is transmitted from mother to baby before, during, and after childbirth about 1.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of the time, and vaginal births and breastfeeding do not raise the risk, finds a meta-analysis today in BMJ. … Of the 800 COVID-positive fetuses or babies with outcome data, 20 were stillbirths, 23 died during the first 28 days of life, and 8 were early pregnancy losses; 749 babies (93.6{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}) were alive at the end of follow-up. (3/17)
Waves of fatigue. The inability to smell milk that has gone bad. A racing heartbeat. These are just a few COVID-19 symptoms that can linger after an initial coronavirus infection. Though they may not always amount to the debilitating cases of long COVID-19 that can leave people bedridden or unable to perform daily functions, it’s very common to take weeks to fully recover — a condition I’ve been thinking of as “medium COVID.” I’ve been reporting on COVID-19 since the coronavirus pandemic started, and I thought I knew what an infection would be like for a young, otherwise healthy person like me. I knew there was a risk for long COVID-19, even with mild cases, but in my mind, there were two types of COVID-19: run-of-the-mill cases that didn’t last much longer than their isolation periods required, and long COVID-19, which was relatively rare. Instead, like so many Americans, I found myself caught somewhere in between. (Feldman, 3/17)
An appellate court on Thursday sided with Texas school districts in their dispute with state officials over mask mandates, which numerous school systems already have lifted as pandemic conditions have eased. The state’s the 3rd Court of Appeals affirmed a trial court’s orders that granted school districts temporary injunctive relief from the enforcement of an executive order from Gov. Greg Abbott prohibiting mask mandates. (Serrano, 3/17)
Local health officials handling the day-to-day response to the coronavirus crisis have faced hostility like never before, according to a new study of 1,499 episodes of harassment during the first year of the pandemic. Of 583 local health departments surveyed by Johns Hopkins University researchers, 57 percent reported episodes of staff being targeted with personal threats, doxing, vandalism and other forms of harassment from 2020 to 2021. (Rizzo, 3/17)
Covid-19 has added to caregiver fatigue according to health experts. Caregiver fatigue occurs when the caregiver of an individual feels physically and emotionally exhausted, often leading to a change in attitude, negative feelings toward the role and the care recipient and sometimes feelings of resentment, according to health experts. “We encourage families to try to plan ahead. It can be difficult to face an older loved one’s changing needs, but if you have plans in place for how your family/network will support the primary caregiver in both big and everyday ways you’ll be ahead of the curve,” Seniorly Vice President of Partnerships and gerontologist Marlena Del Hierro said in a statement to Fox News. (McGorry, 3/17)
For critical care nurse Emily Johnson, working long hours during the pandemic has meant delaying plans to get a master’s degree and missing time at home with three children under the age of 3, two of them foster kids. “My kids are growing up without me,” said Johnson, 33, who works in the burn center at University Medical Center in central Las Vegas. Despite plummeting COVID-19 cases and hospitalizations, Johnson and other UMC nurses say they aren’t getting a reprieve. After eliminating incentive pay for overtime last month, the hospital is now reimposing a requirement that nurses work mandatory overtime. (Hynes, 3/17)
Under pressure from short-staffed hospitals and burned-out nurses, lawmakers in several states recently passed bills designed to expand nursing schools. For more than two years, the COVID-19 pandemic has exposed both the importance of nurses and strain on the workforce. Hospitals, long-term care centers and even K-12 schools have been so short-staffed in recent months that they’ve had to cancel procedures, delay moving patients into inpatient beds or reduce other services. This legislative season, that sense of crisis has powered bipartisan efforts to increase nurse training and licensure. The proposals have split somewhat along party lines, with Republican lawmakers in red states emphasizing reduced education regulations and Democrats in blue states emphasizing funding increases. Still, leaders in both parties agree on the need to get more nurses educated and helping patients. (Quinton, 3/17)
Hospital systems are making the case to Congress that Medicare should continue covering hospital-at-home care after the public health emergency, arguing it could improve health outcomes, lower costs and alleviate capacity and staffing issues. More than 200 hospitals have received a waiver from the Centers for Medicare and Medicaid Services to participate in the program, but Medicare’s hospital-at-home coverage expires at the end of the public health emergency, which could come as soon as July. Some federal lawmakers are working to extend the waiver for at least two more years, but they’re unlikely to pass legislation before coverage lapses. Meanwhile, some health systems are trying out risk-based home hospital payment models with private payers. Some say they are seeking a more permanent solution via the Center for Medicare and Medicaid Innovation that could allow them to better tailor the program to their patient mix and organization. (Hellmann and Kacik, 3/17)
During the COVID-19 pandemic, many women have had to put their careers on hold to look after children who are remote learning, to care for elderly or ill loved ones or to relocate to be closer to family. They’ve left their positions temporarily or permanently as they juggle priorities. Since February 2020, more than 1 million fewer women are in the U.S. workforce, whereas men have regained all of the jobs they lost during the pandemic, according to a National Women’s Law Center analysis of Bureau of Labor Statistics data. In healthcare, where the workforce is 75{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} women, the sector was down 2.8{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of women’s jobs in November 2021 from January 2020, compared to 0.32{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} of men’s jobs, according to the Bureau of Labor Statistics. Yet, healthcare, like many other sectors, continues to have a high demand for workers. (Christ, 3/17)
Health and Human Services Secretary Xavier Becerra said Thursday that the department may readjust Medicare Part B premiums next month while it looks to work with Congress on other healthcare reforms in his second year on the job. As Becerra approaches his one-year anniversary in the position, he’s also fighting an uphill battle for more funding from Congress to keep COVID-19 relief and health coverage initiatives alive. HHS is interested in talking to Congress about Medicare Advantage overpayment issues and physician payment reform, Becerra told reporters Thursday. “We can’t let this go over the cliff. Not when we’re on the verge of turning the page,” he said. (Goldman, 3/17)
Stakeholders are advocating improvements in the New York State Department of Health’s data practices after an audit released Tuesday found that it understated the number of COVID-related nursing home deaths by at least 4,100 and did not make effective use of data to address nursing-home outbreaks. State Comptroller Thomas DiNapoli, whose office conducted the audit, said the Health Department should improve the quality of nursing homes’ self-reported data by collaborating more closely with the industry.“ Too often regulatory entities are just seen as being hostile to the industry,” DiNapoli said in an interview. (Kaufman, 3/17)
The federal government will reduce Medicare payments to 17 Cincinnati area hospitals with high rates of readmission or inpatient-developed infections and injuries in 2022. The penalties, which are a part of two separate pay-for-performance programs under the Affordable Care Act, include a 1{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} reduction of Medicare payments to hospitals with a high volume of in-house infections, or hospital-acquired injuries, and a separate reduction of up to 3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} for high readmission. Most penalties don’t reach the full 3{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} reduction, however. Five local hospitals – the University of Cincinnati Medical Center, TriHealth’s McCullough-Hyde Memorial Hospital, and St. Elizabeth Healthcare’s Edgewood, Florence, and Fort Thomas hospitals – were penalized for having high rates of complications classified under the Hospital-Acquired Condition Reduction program, according to data from the Centers for Medicare & Medicaid Services. (Sutherland, 3/17)
While health insurance coverage has broadly expanded across the country since implementation of the Affordable Care Act of 2010, many impoverished communities continue to lag behind, according to census data released Thursday. Overall, the nation’s uninsured population fell to 8.7 percent in 2020, from 15 percent in 2013. In Texas, however, American Community Survey results released Thursday show the uninsured rate was twice the national average — 17.3 percent, which was 3 percentage points more than the state with the next-highest uninsured rate, Oklahoma. (Macagnone, 3/17)
California lawmakers on Thursday voted to make abortions much cheaper for people on private health insurance plans, bringing California closer to becoming the fourth state in the country to ban insurance fees for the procedure. Thursday’s vote is part of lawmakers’ strategy to make reproductive care more accessible in preparation for a potential U.S. Supreme Court decision this summer that could overturn Roe v. Wade, the landmark 1973 case that banned states from outlawing abortions. … The Assembly approved a bill that would eliminate out-of-pocket costs for abortions on private health plans. While the bill would reduce the cost of abortions, it would also slightly increase monthly premiums for patients and their employers. (Beam, 3/17)
As other states move to limit or ban abortion, a Bay Area lawmaker proposed Thursday to establish a state fund to assist women traveling to California to obtain abortions. The legislation, SB1142, “sends a clear message to the rest of the nation,” said state Sen. Nancy Skinner, D-Berkeley. “We are fully committed to ensuring that California women and those who may seek refuge here have access to all reproductive services, including abortion.” (Egelko, 3/17)
A Washington state measure that prohibits legal action against people seeking an abortion and those who aid them was signed into law Thursday by the governor, in a move designed to rebut recent actions by conservative states. “We know this bill is necessary because this is a perilous time for the ability of people to have the freedom of choice that they have enjoyed for decades,” said Gov. Jay Inslee, a Democrat. (La Corte, 3/17)
Tennessee’s Senate Speaker Randy McNally on Thursday said he does not support legislation that would ban abortions and allow almost anyone to file civil lawsuits against violators and collect damages. Earlier this week, Tennessee became the latest GOP-led state to introduce legislation mimicking a law currently enacted in Texas law and its novel citizen-enforcement provision. (Kruesi, 3/17)
Biden administration officials held a closed-door meeting Thursday with several Florida LGBTQ students and their families about the state’s so-called Don’t Say Gay bill, the Education Department said. The legislation — officially named the Parental Rights in Education Act — would prohibit “classroom discussion about sexual orientation or gender identity” in Florida primary schools. Its passage in Florida’s House and Senate in recent weeks sparked national debate. (Lavietes, 3/17)
With fentanyl showing up in Harris County and the state at “an alarming rate,” authorities have launched a public awareness campaign on billboards and elsewhere to warn of the dangers of the synthetic opioid, often sold in counterfeit pills that can contain lethal doses. Representatives of government and public health agencies said at a press conference Thursday that the campaign aims to sound the alarm about the increasing illegal trade and the impact of fentanyl, along with the upward trend of the counterfeit pills. “One pill can kill” and “Fentanyl can kill: The first time could be your last time” are among some of the messages displayed on the billboards. They come as a record number of people are dying from overdoses in Texas, with the fentanyl driving what has been nationally recognized as an epidemic. (Tallet, 3/17)
San Francisco health officials issued a dire warning Thursday following what they said was a recent spike in fentanyl overdoses, specifically among people who ingested the powerful opioid when they thought they were using cocaine. Over the past two weeks, the city’s health department said it was alerted to three fatal fentanyl overdoses in San Francisco among people “who intended to use only cocaine but were unintentionally exposed to fentanyl.” The health department also reported nine similar, nonfatal overdoses in two groups of people. There were an estimated 474 deaths from fentanyl in 2021, the health department said. (Whiting, 3/17)
A mother who acknowledged using drugs before she gave birth to a stillborn child was sentenced to 11 years in prison by a Kings County judge in 2018 after pleading no contest to manslaughter to avoid a murder charge. Now another judge, with support from Attorney General Rob Bonta, has overturned the conviction and prison sentence, saying the crime she admitted committing is not recognized by law.“ There is no crime in California of manslaughter of a fetus,” Superior Court Judge Valerie Chrissakis said Wednesday. She ordered Adora Perez released from prison, where she has been held for nearly four years, and returned to Kings County Jail for a new hearing before her original judge on whether she should be tried for murder, which under state law can include the intentional or reckless killing of a fetus. But Bonta and women’s-rights advocates dispute that charge as well. (Egelko, 3/17)
The Kentucky House endorsed legalizing medical marijuana, passing a bill Thursday to strictly regulate the use of cannabis for a list of eligible medical conditions. The high-profile measure cleared the Republican-dominated House on a 59-34 vote after a long, sometimes-emotional debate. The years-long debate now shifts to the GOP-led state Senate on whether Kentucky should join the majority of states allowing medical marijuana. (Schreiner, 3/17)
Indiana’s new tax on vaping is being cut even before it takes effect despite protests from anti-smoking advocates. Gov. Eric Holcomb signed a bill this week that included provisions cutting the 25{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} tax that wholesalers were to be charged for closed-system vaping cartridges such as Juul devices to 15{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c}. State lawmakers approved the higher rate last year for Indiana’s first tax on electronic cigarettes to start in July 2022. (3/17)
For years, the Pennsylvania Department of Health allowed the state’s medical marijuana companies to sell hundreds of medicines that the agency now considers potentially unsafe. Something changed in November when regulators started a process that led last month to a massive recall and ban of 670 types of cannabis concentrates for vaping — $12 million worth — that they had previously approved for sale in Pennsylvania’s roughly 150 marijuana dispensaries. The move blindsided patients and an industry dominated by companies hyper-focused on broader legalization of marijuana. And regulators declined to explain the action beyond saying the medicines contained “added ingredients that have not been approved for inhalation” by the FDA. (Brubaker, 3/17)
The Montana State Prison will no longer be allowed to punish inmates with severe mental illnesses for behavior caused by their illnesses by putting them in solitary confinement or setting unreasonable behavioral expectations, under a settlement to a federal lawsuit announced this week. “This settlement represents huge gains for the humane treatment of inmates with severe mental illness,” Bernadette Franks-Ongoy, executive director of Disability Rights Montana, which filed the lawsuit against the Department of Corrections in 2015. (Hanson, 3/17)
The New Hampshire House on Thursday voted to repeal the state’s paid family medical leave program less than a year after it was signed into law, saying that it’s no longer needed because private insurance carriers have now filed similar plans in the state. The vote to repeal passed on a vote of 172-164 in the Republican-led House. (3/17)
Gov. Mike Dunleavy’s sweeping proposal to divide Alaska’s massive health department into two agencies via an executive order appears poised to go into effect this summer unless the Legislature makes a last-minute decision to meet in joint session by Saturday. State Senate leaders say there are no plans for a joint session, despite pressure from House leaders to “disapprove” the split — the only way the Legislature can take action. Dunleavy in January issued Executive Order 21, a 100-plus-page document that divides the unwieldy Alaska Department of Health and Social Services into a Department of Health and a Department of Family and Community Services. The administration contends the Alaska Constitution allows the governor to make such a sweeping reorganization rather than proposing a bill that’s subject to legislative review and amendments. (Hollander and Brooks, 3/17)
Three children in Wisconsin have died from influenza, the state health department announced Thursday. The news release reporting the first pediatric flu deaths this season did not say how old the children were or where in Wisconsin they lived. Flu seasons are typically tracked October through May in the United States. After an unusually mild 2020-21 season — which state health officials attribute to people staying at home because of the COVID-19 pandemic — flu numbers have bounced back in Wisconsin, but still are not as high as past years. (Heim, 3/17)
The first year of the COVID-19 pandemic saw more Americans drinking heavily or using illicit drugs — but apparently not smoking. U.S. cigarette smoking dropped to a new all-time low in 2020, with 1 in 8 adults saying they were current smokers, according to survey data released Thursday by the Centers for Disease Control and Prevention. Adult e-cigarette use also dropped, the CDC reported. (Stobbe, 3/17)
A new study from researchers at Brigham and Women’s Hospital in Boston links excessive daytime napping by older adults to a heightened risk of developing Alzheimer’s, the disease that causes severe cognitive decline. The study was published Thursday in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, the hospital said in a statement. “The vicious cycle we observed between daytime sleep and Alzheimer’s disease offers a basis for better understanding the role of sleep in the development and progression of Alzheimer’s disease in older adults,” Dr. Peng Li, a lead author of the study who works in the Medical Biodynamics Program at the Brigham’s Division of Sleep and Circadian Disorders, said in the statement. (Andersen and Fox, 3/17)
Nearly three dozen companies worldwide will soon start making generic versions of Pfizer’s coronavirus pill, the U.N.-backed Medicines Patent Pool that negotiated the deal said Thursday. The Medicines Patent Pool said in a statement that agreements signed with 35 companies should help make Pfizer’s antiviral nirmatrelvir, or Paxlovid, available to more than half of the world’s population. (3/17)
The World Health Organization has verified at least “43 attacks on health care” — including assaults on patients, health-care workers, facilities or infrastructure — since the beginning of the war in Ukraine, Tedros Adhanom Ghebreyesus, the agency’s director general, told reporters Wednesday. More than 300 health-care facilities are in combat zones or areas that Russia now controls, while 600 other facilities are within about six miles of the conflict line, he said. (Simon, Timsit and Jeong, 3/17)
A 68-year-old American man was killed in a Russian assault on the city of Chernihiv, a city northwest of Kyiv, the local authorities in the city reported on Thursday. The local police said the man, James Whitney Hill, was killed by heavy artillery attacks on unarmed civilians in the city. … Mr. Hill, who went by the name Jimmy or Jim to friends, and his partner, Ira, who is Ukrainian, had traveled to Chernihiv in December so that she could be treated for multiple sclerosis, friends of Mr. Hill told a local news broadcaster in Idaho this month. They had become trapped at a regional hospital there. (Specia and Schwirtz, 3/17)
The crisis in Ukraine has unleashed a network of online mental health experts, some refashioning routine virtual care in response to the war; others providing psychological first aid for refugees or support for local therapists who suddenly find themselves on the front line of an evolving mental health crisis. “We all — many, many professionals around the world — have mobilized to work with what’s going on there, with extensive psychological trauma,” said Galina Itskovich, a Brooklyn-based developmental psychotherapist who has been working with parents and professionals in Ukraine for several years. “We have a grass-roots movement here, getting connected very quickly.” (Sellers, 3/18)
As the fight intensified in northern Ethiopia in June last year, three aid workers from Doctors Without Borders jumped into their four-wheel drive and raced across the battle-scarred landscape, searching for casualties. Hours later they vanished. The aid workers stopped answering their satellite phone. A tracking device showed their vehicle making a sudden U-turn, then stopping. Colleagues frantically tried to locate them. (Marks and Walsh, 3/17)
This is part of the KHN Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
THURSDAY, March 17, 2022 (HealthDay News) — Premiums of postpartum melancholy between American mothers rose almost a few-fold for the duration of the COVID-19 pandemic, along with significant boosts in major despair and thoughts of self-hurt, according to a new study.
It included 670 new mothers who finished on-line screening in between February and July 2020. One-3rd screened constructive for postpartum melancholy and 20{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} experienced signs or symptoms of big depression.
Ahead of the pandemic, about 1 in 8 new mothers experienced postpartum melancholy and between 5{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} and 7{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} experienced big despair, in accordance to the U.S. Facilities for Condition Management and Avoidance.
“We also uncovered that almost 1 in 5 members who screened positive for postpartum despair noted getting ideas of harming them selves,” explained guide author Clayton Shuman, an assistant professor of nursing at the University of Michigan.
“This is very about supplied that prior to the pandemic, [a previous study] found the fee of suicidality among the prenatal and postpartum individuals is on the increase in the U.S.,” Shuman claimed in a university information launch.
New moms who fed their infants components have been 92{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} a lot more possible to screen positive for postpartum depression, and 73{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} additional possible to monitor for key despair than people who breastfed or bottle-fed with their have milk, the study observed.
Moms whose infants were being in neonatal intensive care units experienced a 74{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} greater hazard of postpartum melancholy, and mothers who have been anxious about contracting COVID-19 experienced a 71{fe463f59fb70c5c01486843be1d66c13e664ed3ae921464fa884afebcc0ffe6c} increased likelihood of screening favourable for postpartum melancholy, in accordance to the study.
Shuman reported the findings underscore the have to have to detect depression in new moms. But, he extra, screening is only a initially move.
“Therapy is pivotal to recovery,” Shuman reported. “Methods and schooling about postpartum melancholy will have to be far better disseminated and carried out. These sources ought to be shared with the standard community to cut down stigma, and shared with people who supply social and psychological assist to postpartum patients, these kinds of as partners and family customers.”
This study was part of a much larger just one termed COVID-19 MAMAS (Maternal Attachment, Temper, Means, and Aid) that spawned numerous papers about pregnancy and postpartum encounters throughout the pandemic.
Supply: College of Michigan, news release, March 14, 2022
As indoor mask mandates drop in some of North Carolina’s most populous counties and schools, other non-COVID viruses are likely to start cropping up.
We saw a similar trend in the summer of 2021. The U.S. saw a national spike in respiratory syncytial virus (RSV) as people got vaccinated and COVID restrictions loosened for a couple months before the onset of the Delta variant. RSV is a seasonal respiratory illness that usually spreads in the fall and winter, particularly among children who tend to have more severe cases of it.
Ibukun Christine Kalu, a pediatric infectious disease doctor at Duke. Photo courtesy of Duke Department of Pediatrics
Our patterns of behavior have been heavily altered by the pandemic and so have some trends in other common illnesses. Ibukun Kalu, a pediatric infectious disease doctor at Duke, said we typically expect to see a lot more RSV infections in January and February than what’s being reported this year. Instead, the virus peaked out of season.
COVID cases may be trending down at the moment, but other viruses and germs didn’t go away. We could start seeing more of the usual suspects — cold viruses and stomach bugs. Both have visited my house in recent weeks.
“As we mix a little bit more, we peel back masking, we travel a lot more, and we start to find ourselves in more crowded settings, I think we will see a different kind of spread of some of the other viruses that were a little bit lower in the last few years,” Kalu said.
As I’m writing this, my son’s preschool emailed warning parents that an intestinal virus is circulating through the school. Unfortunately, I’m too familiar with that one as it ran its course through my family last week. Though my house has been vomit-free for a few days, my 2-year-old is in the other room sleeping off yet another non-COVID virus that’s given him a runny nose and a 102 degree fever.
Why it’s worse for toddlers
Households with small children may be particularly susceptible to these non-COVID illnesses after two years of a pandemic.
“It does raise a lot of concern for this age group, particularly our lovely 2 to 3 year olds that really have not been exposed to non-COVID viruses for a multitude of reasons the last two years,” Kalu said. “We may see those kids get routine infections for the first time.”
It’s normal for small children to catch a lot of different viruses during their first few years of life, “priming” their naive immune systems to get stronger. A reasonable exposure to germs and bacteria are actually good for the immune system. But if you’re like me and you kept your toddler at home, skipping holiday gatherings and birthday parties until now, your little one’s immune system might have some catching up to do.
My son was born about six months before the pandemic, and he didn’t even have the sniffles for the first two years of his life. His immune system went untested. This winter when the Omicron variant spread rapidly, his preschool closed out of caution for days, sometimes weeks at a time. While I and every other parent of a small child were losing our sanity juggling work and these sporadic child care closures, my son stayed healthy.
Reporter Taylor Knopf’s son Theo takes the temperature of his stuffed elephant toy. Photo credit: Taylor Knopf
Since COVID cases started declining, my son’s preschool has been open and he has been congested, coughing, sneezing, vomiting or running fevers ever since. I’ve been checking in with his pediatrician, who says that this is all normal. I know his little immune system will be stronger for it, but it does feel like our household is experiencing a year’s worth of illnesses in a month’s time.
The good news, Kalu said, is that “the early immune system is extremely adaptable. It is so smart and learning from exposure and building defense systems. So it shouldn’t lead to any long-term negative outcomes for them. It just might mean a slightly rougher summer with some of these infections.”
So fellow parents of little ones, here’s your warning: stock up on children’s Tylenol, Gatorade, tissues and Imodium (for yourself, because one of you will get the stomach flu too). And always contact your child’s pediatrician with questions. Your child’s doctor can also test for RSV or influenza and get them extra support if needed as these illnesses can be worse for small kids, Kalu said.
As you or your child battle these other illnesses, you should also monitor for COVID-19 if you’re experiencing flu-like symptoms to prevent further spread.
“I think we should try and use tests as freely as possible, particularly for parents of toddlers who currently are not eligible for a vaccine,” Kalu advised. Rapid tests are very reliable when someone is showing symptoms. You can mail-order free government-funded rapid COVID tests to your home.
Don’t forget other vaccines
Spring usually means the tapering off of flu season. But this year could be different. If you haven’t gotten you or your child a flu shot yet, Kalu says it’s not too late to do so, especially if you’re planning gatherings and travel.
She said that public health experts typically expect to see a decline of flu and other respiratory viruses in March, but that they could linger a few extra months this year.
As statewide COVID cases have steadily declined, influenza-like illness increased slightly in early March, according to the state health department’s surveillance system. Nationally, there have been more cases of the flu and related hospitalizations in recent weeks, and flu vaccination rates are lower than previous flu seasons. While current flu cases are higher than last season, they are not higher than pre-pandemic levels.
Graph showing the percent of ED visits this season (red line) that are for influenza-like illness compared to previous seasons (grey lines). Recently, there’s been an uptick in the number of people reporting to North Carolina’s emergency departments complaining of flu-like illnesses. Data: NC DETECT; Graph courtesy: NC DHHS
“But the reassuring thing is we’ve handled these viruses for decades,” Kalu said. “We actually know what to do and perhaps we’ve learned a little bit more with a pandemic about how we can take better care of ourselves when we’re feeling ill to prevent spread.”
Parents should also make sure their children are up to date on their other vaccines, such as chickenpox or the MMR series which prevents measles, mumps and rubella.
The Centers for Disease Control and Prevention reported that vaccine ordering data show a 14 percent drop in 2020 and 2021 compared to 2019, and measles vaccine ordering is down by more than 20 percent.
Public health experts say it’s important to get all children up to date on their vaccines to prevent any outbreaks of illness. The CDC has resources for parents and physicians about how to catch up.
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